Community Grievance Decision Digest

RESTRAINT AND SECLUSION, RIGHT to be FREE FROM

THE LAW:

“...[patients] have a right to be free from physical restraint and isolation except for emergency situations or when isolation or restraint is a part of a treatment program.  Isolation or restraint may be used only when less restrictive measures are ineffective or not feasible and shall be used for the shortest time possible.  When a patient is placed in isolation or restraint, his or her status shall be reviewed once every 30 minutes.  Each facility shall have a written policy covering the use of restraint or isolation which ensures that the dignity of the individual is protected, that the safety of the individual is ensured and that there is regular, frequent monitoring by trained staff to care for bodily needs as may be required. 

Isolation or restraint may be used for emergency situations only when it is likely that the patient may physically harm himself or herself or others.  The treatment director shall specifically designate physicians who are authorized to order isolation or restraint, and shall specifically designate licensed psychologists who are authorized to order isolation.  If the treatment director is not a physician, the medical director shall make the designation... The authorization for emergency use of isolation or restraint shall be in writing, except that isolation or restraint may be authorized in emergencies for not more than one hour, after which time an appropriate order in writing shall be obtained from the physician or licensed psychologist designated by the director, in the case of isolation, or the physician so designated in the case of restraint.  Emergency isolation or restraint may not be continued for more than 24 hours without a new written order. 

Isolation may be used as part of a treatment program if it is part of a written treatment plan, and the rights specified in this subsection are provided to the patient.  The use of isolation as a part of a treatment plan shall be explained to the patient and to his or her guardian, if any, by the person who provides the treatment.   A treatment plan that incorporates isolation shall be evaluated at least once every 2 weeks. 

Patients who have a recent history of physical aggression may be restrained during transport to or from the facility.  Persons who are committed or transferred under s. 51.35(3) or 51.37 or under ch. 971 or 975, or who are detained or committed under ch. 980, and who, while under this status, are transferred to a hospital, as defined in s. 50.33(2), for medical care may be isolated for security reasons within locked facilities in the hospital.  Patients who are committed or transferred under s. 51.35(3) or 51.37 or under ch. 971 or 975, or who are detained or committed under ch. 980, may be restrained for security reasons during transport to or from the facility.

§ 51.61(1)(i)1, Wis. Stats. [Emphasis added.]

[NOTE:  Sec. 51.61(1)(i) allows use of "isolation" in only two circumstances--for emergencies or as part of a written treatment program.  For greater clarity, the term "seclusion" is used to refer to the emergency use of isolation and the term "time-out" for the use of isolation as part of a written approved treatment program.]

"‘Isolation’ means any process by which a person is physically or socially set apart by staff from others but does not include separation for the purpose of controlling contagious disease.”

HFS 94.02(26), Wis. Admin. Code [Emphasis added.]

"ISOLATION, SECLUSION AND PHYSICAL RESTRAINTS.  Any service provider using isolation, seclusion or physical restraints shall have written policies that meet the requirements of s. 51.61(1)(i), Stats., and this chapter.  Isolation, seclusion or physical restraint may only be used in an emergency, when part of a treatment program or as provided in s. 51.61(1)(i)2., Stats. For a community placement, the use of isolation, seclusion or physical restraint shall be specifically approved by the department on a case-by-case basis and by the county department if the county department has authorized the community placement.  In granting approval, a determination shall be made that use is necessary for continued community placement of the individual and that supports and safeguards necessary for the individual are in place."

HFS 94.10, Wis. Admin. Code [Emphasis added.]

“‘Emergency’ means that is likely that the patient may physically harm himself or herself or others.”

HFS 94.02(13), Wis. Admin. Code [Emphasis added.]

"1.Each inpatient shall have unscheduled access to a working flush toilet and sink, except when the patient is in seclusion or for security reasons or when medically contraindicated...

  3. Every patient in isolation or seclusion shall be provided an opportunity for access to a toilet at least every 30 minutes."

HFS 94.24(2)(i), Wis. Admin. Code [Emphasis added.]

DECISIONS

1. A patient at a county psychiatric hospital complained about a seclusion incident.  He raised issue about whether there was justification for the initial use of seclusion and whether he was released in a prompt and timely manner.  There was a discrepancy between a verbal report of one staff and the documentation form that was completed while he was in seclusion.  In the Level I grievance decision, the Client Rights Specialist (CRS) made a suggestion that staff more carefully document anything of concern that may be displayed while a patient is in seclusion. The improvements in documentation made by the hospital in response to his complaint were noted. The patient withdrew his complaint at Level III. (Level III decision in Case No. 00-SGE-13 on 8/2/00.)

2. A patient being emergency detained complained about being shackled by the sheriff officers during transport.  This is their standard practice.  The grievance process has no jurisdiction over the actions of law enforcement agencies. (Level III decision in Case No. 00-SGE-04 on 4/9/01.)

Last Updated: November 08, 2006