First of all, I want to thank the chairman of the Education and Labor Committee, Mr. Miller, for his leadership on this legislation. The hearing which was held at the Education and Labor Committee…
First of all, I want to thank the chairman of the Education and Labor Committee, Mr. Miller, for his leadership on this legislation.
The hearing which was held at the Education and Labor Committee was one of the most stunning, amazing, eye-opening events, I think, of this Congress. The bipartisanship which came together after that hearing to craft this legislation, again, I think is a testament to your leadership and the bipartisanship that you have created on that committee.
Mr. Speaker, back in 1998, The Hartford Courant won a Pulitzer Prize for a four-part investigation of seclusion and restraint all across the country. The name of the series was ``A Nationwide Pattern of Death,'' which I'd like to offer a copy of for the Record, and which, again, in chapter and verse, laid out the shocking, uneven application of this type of force against America's schoolchildren. In Connecticut, it actually resulted in action in terms of legislation which was put into place. Many of the minimum standards which are included in the legislation we're voting on today were incorporated into that measure. But, clearly, as a Nation, we have much more work to be done.
[From the Hartford Courant, Oct. 11, 1998]
A Nationwide Pattern of Death
(By Eric Weiss)
Roshelle Clayborne pleaded for her life.
Slammed face-down on the floor, Clayborne's arms were
yanked across her chest, her wrists gripped from behind by a
mental health aide.
I can't breathe, the 16-year-old gasped.
Her last words were ignored.
A syringe delivered 50 milligrams of Thorazine into her
body and, with eight staffers watching, Clayborne became,
suddenly, still. Blood trickled from the corner of her mouth
as she lost control of her bodily functions. Her limp body
was rolled into a blanket and dumped in an 8-by-10-foot room
used to seclude dangerous patients at the Laurel Ridge
Residential Treatment Center in San Antonio, Texas.
The door clicked behind her.
No one watched her die.
But Roshelle Clayborne is not alone. Across the country,
hundreds of patients have died after being restrained in
psychiatric and mental retardation facilities, many of them
in strikingly similar circumstances, a Courant investigation
has found.
Those who died were disproportionately young. They entered
our health care system as troubled children. They left in
coffins.
All of them died at the hands of those who are supposed to
protect, in places intended to give sanctuary.
If Roshelle Clayborne's death last summer was not an
isolated incident, neither were the recent deaths of
Connecticut's Andrew McClain or Robert Rollins.
A 50-state survey by The Courant, the first of its kind
ever conducted, has confirmed 142 deaths during or shortly
after restraint or seclusion in the past decade. The survey
focused on mental health and mental retardation facilities
and group homes nationwide.
But because many of these cases go unreported, the actual
number of deaths during or after restraint is many times
higher.
Between 50 and 150 such deaths occur every year across the
country, according to a statistical estimate commissioned by
The Courant and conducted by a research specialist at the
Harvard Center for Risk Analysis.
That's one to three deaths every week, 500 to 1,500 in the
past decade, the study shows.
``It's going on all around the country,'' said Dr. Jack
Zusman, a psychiatrist and author of a book on restraint
policy.
The nationwide trail of death leads from a 6-year-old boy
in California to a 45-year-old mother of four in Utah, from a
private treatment center in the deserts of Arizona to a
public psychiatric hospital in the pastures of Wisconsin.
In some cases, patients died in ways and for reasons that
defy common sense: a towel wrapped around the mouth of a 16-
year-old boy; a 15-year-old girl wrestled to the ground after
she wouldn't give up a family photograph.
Many of the actions would land a parent in jail, yet
staffers and facilities were rarely punished.
``I raised my child for 17 years and I never had to
restrain her, so I don't know what gave them the right to do
it,'' said Barbara Young, whose daughter Kelly died in the
Brisbane Child Treatment Center in New Jersey.
The pattern revealed by The Courant has gone either
unobserved or willfully ignored by regulators, by health
officials, by the legal system.
The federal government--which closely monitors the size of
eggs--does not collect data on how many patients are killed
by a procedure that is used every day in psychiatric and
mental retardation facilities across the country.
Neither do state regulators, academics or accreditation
agencies.
``Right now we don't have those numbers,'' said Ken August
of the California Department of Health Services, ``and we
don't have a way to get at them.''
The regulators don't ask, and the hospitals don't tell.
As more patients with mental disabilities are moved from
public institutions into smaller, mostly private facilities,
the need for stronger oversight and uniform standards is
greater than ever.
``Patients increasingly are not in hospitals but in
contract facilities where no one has the vaguest idea of what
is going on,'' said Dr. E. Fuller Torrey, a nationally
prominent psychiatrist, author and critic of the mental
health care system.
Because nobody is tracking these tragedies, many restraint-
related deaths go unreported not only to the government, but
sometimes to the families themselves.
``There is always some reticence on reporting problems
because of the litigious nature of society,'' acknowledged
Dr. Donald M. Nielsen, a senior vice president of the
American Hospital Association. ``I think the question is not
one of reporting, but making sure there are systems in place
to prevent these deaths.''
Typically, though, hospitals dismiss restraint-related
deaths as unfortunate flukes, not as a systemic issue. After
all, they say, these patients are troubled, ill and sometimes
violent.
The facility where Roshelle Clayborne died insists her
death had nothing to do with the restraint. Officials there
say it was a heart condition that killed the 16-year-old on
Aug. 18, 1997.
Bexar County Medical Examiner Vincent DiMaio ruled that
Clayborne died of natural causes, saying that restraint use
was a separate ``clinical issue.''
But that, too, is typical in restraint cases. Medical
examiners rarely connect the circumstances of the restraint
to the physical cause of death, making these cases impossible
to track through death certificates.
The explanations don't wash with Clayborne's grandmother.
``I'll picture her lying on that floor until the day I
die,'' Charlene Miles said. ``Roshelle had her share of
problems, but good God, no one deserves to die like that.''
With nobody tracking, nobody telling, nobody watching, the
same deadly errors are allowed to occur again and again.
Of the 142 restraint-related deaths confirmed by The
Courant's investigation:
Twenty-three people died after being restrained in face-
down floor holds.
Another 20 died after they were tied up in leather wrist
and ankle cuffs or vests, and ignored for hours.
Causes of death could be confirmed in 125 cases. Of those
patients, 33 percent died of asphyxia, another 26 percent
died of cardiac-related causes.
Ages could be confirmed in 114 cases. More than 26 percent
of those were children--nearly twice the proportion they
constitute in mental health institutions.
Many of the victims were so mentally or physically impaired
they could not fend for themselves. Others had to be
restrained after they erupted violently, without warning and
for little reason.
Caring for these patients is a difficult and dangerous job,
even for the best-trained workers. Staffers can suddenly find
themselves the target of a thrown chair, a punch, a bite from
an HIV-positive patient.
Yet the great tragedy is that many of the deaths could have
been prevented by setting
standards that are neither costly nor difficult: better
training in restraint use; constant or frequent monitoring of
patients in restraints; the banning of dangerous techniques
such as face-down floor holds; CPR training for all direct-
care workers.
``When you look at the statistics and realize there's a
pattern, you need to start finding out why,'' said Dr. Rod
Munoz, president of the American Psychiatric Association,
when told of The Courant's findings. ``We have to take
action.''
Mental health providers, who treat more than 9 million
patients a year at an annual cost of more than $30 billion,
judge themselves by the humanity of their care. So the misuse
of restraints--and the contributing factors, such as poor
training and staffing--offers a disturbing window into the
overall quality of the nation's mental health system.
For their part, health care officials say restraints are
used less frequently and more compassionately than ever
before.
``When it comes to restraints, the public has a picture of
medieval things, chains and dungeons,'' said Dr. Kenneth
Marcus, psychiatrist in chief at Connecticut Valley Hospital
in Middletown. ``But it really isn't. Restraints are used to
physically stabilize patients, to prevent them from being
assaultive or hurting themselves.''
But in case after case reviewed by The Courant, court and
medical documents show that restraints are still used far too
often and for all the wrong reasons: for discipline, for
punishment, for the convenience of staff.
``As a nation we get all up in arms reading about human
rights issues on the other side of the world, but there are
some basic human rights issues that need attention right here
at our back door,'' said Jean Allen, the adoptive mother of
Tristan Sovern, a North Carolina teen who died after aides
wrapped a towel and bed sheet around his head.
Others have a simple explanation for the lack of attention
paid to deaths in mental health facilities.
``These are the most devalued, disenfranchised people that
you can imagine,'' said Ron Honberg, director of legal
affairs for the National Alliance of the Mentally Ill. ``They
are so out of sight, so out of mind, so devoid of rights,
really. Who cares about them anyway?''
Few seemed to care much about Roshelle Clayborne at Laurel
Ridge, where she was known as a ``hell raiser.''
But Clayborne had made one close friendship--with her
roommate, Lisa Allen. Allen remembers showing Clayborne how
to throw a football during afternoon recess on that summer
afternoon in 1997.
``She just couldn't seem to get it right and she was
getting more and more frustrated. But I told her it was OK,
we'd try again tomorrow,'' said Allen, who has since rejoined
her family in Indiana.
Within three hours, Clayborne was dead.
She had attacked staff members with pencils. And staffers
had a routine for hell raisers.
``This is the way we do it with Roshelle,'' a worker later
told state regulators. ``Boom, boom, boom: [medications] and
restraints and seclusion.''
After she was restrained, Roshelle Clayborne lay in her own
waste and vomit for five minutes before anyone noticed she
hadn't moved. Three staffers tried in vain to find a pulse.
Two went looking for a ventilation mask and oxygen bag,
emergency equipment they never found.
During all this time, no one started CPR.
``It wouldn't have worked anyway,'' Vanessa Lewis, the
licensed vocational nurse on duty, later declared to state
regulators.
By the time a registered nurse arrived and began CPR, it
was too late. Clayborne never revived.
In their final report on Clayborne's death, Texas state
regulators cited Laurel Ridge for five serious violations and
found staff failed to protect her health and safety during
the restraint. They recommended Laurel Ridge be closed.
Instead, the state placed Laurel Ridge on a one-year
probation in February and the center remains open for
business. In a prepared statement, Laurel Ridge said it has
complied with the state's concerns--and it pointed out the
difficulty in treating someone with Clayborne's background.
``Roshelle Clayborne, a ward of the state, had a very
troubled and extensive psychiatric history, which is why
Laurel Ridge was chosen to treat her,'' the statement said.
``Roshelle's death was a tragic event and we empathize with
the family.''
With no criminal prosecution and little regulatory action,
the Clayborne family is now suing in civil court. The Austin
chapter of the NAACP and the private watchdog group Citizens
Human Rights Commission of Texas are asking for a federal
civil rights investigation into the death of Clayborne.
Medications and restraint and seclusion.
Clayborne's friend, Lisa Allen, knew the routine well, too.
For six years, Allen, now 18, lived in mental health
facilities in Indiana and Texas, where her explosive
personality would often boil over and land her in trouble.
By her own estimate, Allen was restrained ``thousands'' of
times and she bears the scars to prove it: a mark on her knee
from a rug burn when she was restrained on a carpet; the loss
of part of a birthmark on her forehead when she was slammed
against a concrete wall.
Exactly two weeks after Roshelle Clayborne's death, Lisa
Allen found herself in the same position as her friend.
The same aide had pinned her arms across her chest.
Thorazine was pumped into her system. She was deposited in
the seclusion room.
``It felt like my lungs were being squished together,''
Allen said.
But Lisa Allen was one of the lucky ones.
She survived.
The fact of the matter is that today, 19 States have no laws or regulations related to the use of seclusion or restraints in school. Seven States place some restrictions on restraint, but do not regulate seclusions. That's within the 31 that was referred to by Mr. Kline. Seventeen States require that selected staff receive training before being permitted to restrain children. The rest do not. Thirteen States require schools to obtain consent prior to foreseeable or nonemergency physical restraints, while 19 require parents to be notified afterwards. Only two States require annual reporting on the use of restraints. Eight States specifically prohibit the use of prone restraints or restraints that impede a child's ability to breathe.
I would argue, Mr. Speaker, that as a government, as a Nation that provides massive amounts of education dollars across the country, we would never countenance racial discrimination or gender discrimination by any institutions that receive those funds.
I don't think it's too much to say that we should not allow these types of practices which, in some instances, result in, as the chairman said, actual deaths and traumatic lifelong injuries, to be countenanced by the American taxpayer. This measure establishes minimum standards. It establishes transparency. It gives us as a country the opportunity to allow States to take leadership in terms of implementing their own rules and regulations. But it says as a Nation we are not going to tolerate this type of behavior, of which schools themselves are mandated reporters. If it was happening in a child's home, and as a teacher became aware of it, they would be required by law to report it to child protection agencies as a result of Federal law. We can do at least as much for the school environment which children go to every day in this country.
I urge a strong, powerful bipartisan vote in support of this legislation so that we can raise our children to a new level as they go to school every day.