In 2009 Federal Agencies were asked in a Freedom of Information Act Request to produce their statistics on the number of restraint and seclusion fatalities annually for the past decade. The Federal Agencies that were asked to produce these statistics were:
- SAMHSA
- TJC
- CMS
- NASMHPD and
- FDA
In response to the FOIA, the requester was told that none of the foregoing Federal agencies had statistics on restraint or seclusion.
Here is a copy of the FOIA request:
To Whom It May Concern:
In 1999 the GAO issued a report regarding the use of restraint and seclusion in Mental Health. Part of the recommendations of the report was for HCFA (now CMS) to work with the FDA and SAMHSA to establish databases necessary to collect data on the use of restraint and seclusion at healthcare facilities receiving federal funding and working with state protection and advocacy centers to ensure accurate reporting of sentinel events including deaths.
Our finding has been that when the desire to eliminate or reduce restraint beyond a certain point exceeds the actual realities of the institution and population served, we are seeing the following results including increases
in the use of mechanical and chemical restraint, increase in worker and patient injuries, longer holding times, increased worker compensation and time off claims an increase in the use of law enforcement and an increase in assaults.
Please advise whether CMS or any other HHS or other government agency i.e. SAMHSA or FDA has actual data on the following:
1. number of physical restraints conducted annually- either cumulative for all federally supported healthcare facilities or by facility type;
2. number of chemical restraints conducted annually- either cumulative for all federally supported healthcare facilities or by facility type;
3. number of mechanical restraints conducted annually- either cumulative for all federally supported healthcare facilities or by facility type;
4. number of sentinel events preferably with a separate category for restraints (physical, mechanical & chemical – each separately delineated) that have had catastrophic or terminal outcomes;
5. worker compensation claims or injury statistics for workers annually for assault/batteries or other patient/staff physical altercations including fatal or catastrophic incidents including those resulting in short or long term disability – either cumulative for all federally supported healthcare facilities or by facility type.
Federal Government’s Response
- SAMHSA – no such data
- CMS – no such data
- FDA – no such data
- NASMHPD – no such data
- TJC – no response.
Question: Exactly how can SAMHSA, FDA, NASMHPD or CMS evaluate the use of restraint and seclusion if they do not now and have not ever collect the requisite data.
Wouldn’t a policy based on nothing be by definition arbitrary and capricious not to mention disingenuous and outright fraudulent.
Imagine the public outcry if a private company attested to numbers and outcomes it had no back-up data for.