- The Washington Times - Wednesday, December 24, 2008

STAUNTON, Va. | Mental patients in psychiatric hospitals across the country are being locked up alone for years, despite laws aimed at preventing the practice, because medical workers say they’re too dangerous to handle any other way.

Health officials call them outliers - rare, unpredictably violent people who don’t respond to medication or other treatment. Advocates call them victims of a system that has lost patience and creativity in caring for those who are most difficult to treat.

Loopholes in federal and state laws and impotent oversight allow hospitals to lock some patients away for the safety of staff and other patients. Some cases involving seclusion and restraints have resulted in costly lawsuits, yet they are so rare that many advocates had no idea there were similar situations in other states until the Associated Press inquired.

Nobody tracks such cases. However, through interviews and records from advocacy groups and state and federal agencies, the AP found at least a dozen patients who were held in seclusion for months or years at a time.

In Virginia, one man was locked in a three-room suite for 15 years and another patient was held in a similar setup for five years. Connecticut and Florida have paid millions over allegations that they tethered patients to furniture for years.

Federal law requires that seclusion or restraints - including drugs - be used on patients covered by Medicare or Medicaid only in emergencies to protect others. Such measures can be used for more than 24 hours only if a physician deems it necessary, and only if a doctor updates the assessment daily.

Moreover, the U.S. Supreme Court has ruled it unconstitutional to restrain or isolate patients for extended periods.

The laws and court rulings don’t cap the consecutive days a patient can be isolated or restrained, though, so hospitals can hold a patient indefinitely by simply signing off on it every 24 hours.

The Supreme Court also has ruled that hospitals must treat people who are involuntarily committed. So Dr. Stuart Grassian, a psychiatrist who has studied the effects of solitary confinement on prisoners, and others question whether outliers are being held legally.

“Once a person is locked up, the state has to provide them with adequate and appropriate treatment, otherwise they lose any authority and any legitimacy to keeping the people locked up against their will,” he said.

Advocates insist that with training and staffing, hospitals can eliminate the need for seclusion and restraints in nearly all cases.

A spokesman for the Justice Department’s Civil Rights Division, which investigates complaints concerning institutionalized individuals, would not comment on the use of seclusion and restraint. Since 2006, the Justice Department has reached settlements with California, Vermont and the District.

At Western State Hospital in Staunton, the state stepped in after staff placed Cesar Chumil in a three-room “limited containment suite” in 1993, where he has remained since. Mr. Chumil averaged 300 assaults against staff and another 100 against patients over seven years before he was placed in the suite, according to records from a hearing obtained by the AP.

Hospital officials say the 58-year-old has more freedom than before, when records show he spent thousands of hours in a small seclusion cell or restrained to a bed or chair.

Last summer, a state oversight panel determined that the hospital should move Mr. Chumil out of seclusion. The hospital moved all other patients off his ward this month and unlocked the door to his suite so he could go out into an activity room when he wanted.

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