For Immediate Attention 

Todd Spitzer Remarks that Mental Health Patients 
are Research Material More here

From the Desk of Kathi Ann Stringer
Corona, CA 92882
Kathi's Mental Health Review - www.toddlertime.com/restraints 

September 2, 2003

Senator Wesley Chesbro
State Capital
Room 5100
Sacramento, CA 95814

Voice 916-445-3375
Fax 916-323-6958

Reference: Notice of Painful Use of Restraints 

PASS SB 130 and REVISE  [Click here for SB-130]

Dear Elected Official

SB 130 As It Stands Now.
Section – 1180.3 (h) “A facility described in subdivision (a) of Section 1180.2 or subdivision (a) of Section 1180.3 shall keep under constant, face-to-face human observation a person who is in seclusion and in any type of behavioral restraint at the same time. Observation by means of video camera may be utilized only in facilities that are already permitted to use video monitoring under federal regulations specific to that facility.”

Please DELETE in SB 130:
“Observation by means of video camera may be utilized only in facilities that are already permitted to use video monitoring under federal regulations specific to that facility.”

To help exemplify this point, please read what happened to me while in restraints of February this year.  

Start

A chronic and exceptionally painful application of five-point-restraints was used against me on February 19^th.   The event took place at the Oasis Treatment Center.  There was an examination of the hospital’s policy concerning restraints and discovered that the only requirement as to body arrangement was the ‘prone position.’ 

I have researched several of the available California regulations for public viewing and was disappointed that I could not find any explicit instructions concerning placement of the body extremities during the use of restraint to prevent chronic and acute pain.  Please, something needs to be done.

This material was not developed and researched ‘to get someone into trouble’ but to serve, as a testament to the severe lack of insight to control what appeared to be punitive retaliatory conduct toward me from staff.  I am dismayed that my cries and screams went unanswered for over forty minutes. (Please see attached letter, “2/19/03 PAINFUL USE OF RESTRAINTS”) This strikes me as a substantial lack of human compassion in a business that requires knowledge of trauma and skillful use of treatment modalities.

I am concerned that I when I was screaming in distress staff did not seem interested in providing relief.  I would also venture that this incident is not isolated to me but widespread.  It is not unreasonable to reach this conjecture since often the Mental Health Workers (MHW) are hired without training.  Once hired, the MHW ‘training’ amounts to a casual ‘walk through’ of policy.  In addition, in-service training has only a limited effect that is directly linked to staff turnover, fading memories and lack of coaching. 

Another concern is that staff has the attitude of ‘staying on the same page and not dropping the ball’ which has positive and negative components.  The negative component is the distorted assumption that a patient is ‘splitting staff’ when crying out for intervention.  It is reasonable to conclude that staff in lower positions is not going to risk job loss and confront middle management that may create a rift and unpleasant consequences…i.e. job loss, hours cutback, pass over for promotions and etc.  Note the following example:

A Mental Health Worker reports non-compliance directly to the Director of Nursing. The Director of Nursing reprimands the charge nurse.  The charge nurse may be vindictive and set into motion a distorted smear campaign to destroy the Mental Health Worker.  The example is noted within the team to stave off further non-compliance reporting. 

These problems are not unique to Oasis Treatment Center.  They are intrinsic within the current mental health system due to inadequate training and accountability flow errors.  The passage of Bill SB 130 would be very, very helpful.

I have outlined below the problems surrounding this event.

Problem(s):

Please see attached letter, “2/19/03 PAINFUL USE OF RESTRAINTS” for reference.

1.      Restraints were applied to cause chronic pain.

2.      Staff appeared satisfied I was having problems, as if the tables were turned. I did not feel safe.  I felt punished.  There was no feeling of safety in chronic pain.

3.      The Charge Nurse (Norma) did not investigate the situation for assessment with her RN training but instead relied on a Mental Health Worker (Matt) to make that assessment for her.

4.      The secondary arm restraints (longer ones) were cinched up tight as possible.  There were no holes exposed on one side of the buckle.

Corrective Action Requested:

PASSAGE OF Bill SB 130 with REVISION

Please DELETE in SB 130:
“Observation by means of video camera may be utilized only in facilities that are already permitted to use video monitoring under federal regulations specific to that facility.”

In addition please read:

Panic Attack – First Time in Restraints (Included)

You have my complete support to help resolve this problem within the mental health system.  I thank you for respecting the language SB 130.  The Bill’s language has respect, empathy and desire to help with a warm personal regard imbued throughout.  Your diligence and resolve to protect patients that are unable to protect themselves by supporting Bill SB 130 is imperative.  

Thank you for honoring me as an individual with the support of SB 130 and deletion of 1180.3 (h). “Observation by means of video camera may be utilized only in facilities that are already permitted to use video monitoring under federal regulations specific to that facility.”

Very sincerely yours,

Written on 2/19/03 PAINFUL USE OF RESTRAINTS

Added about restraints – Restraints applied incorrectly.  Both arms were restrained adjacent and outward from my body with my elbows bent over each edge of the mattress in a downward position.  After two hours staff released left (L) foot and right (R) hand.  However right (R) foot and left (L) arm was not released and were not rotated for range of motion.  The pain mounted in left (L) shoulder.  I used my right (R) hand to support my left (L) arm to lessen the pain and now my right (R) arm tired also.  The pain went down my neck into my left (L) shoulder. 

Approximately three hours later I screamed for relief and did not receive full range of motion in all extremities at the two-hour mark.  Staff said RN did not leave instructions to rotate and staff refused.  I was screaming for relief.  Staff (x2) seemed satisfied that I was in pain and closed the door.  I kept screaming the regulations for S&R mandated by the State until staff finally opened the door and said they were aware of that law.  Staff restrained my right (R) wrist that was tired from holding up my left (L) arm and restrained my left (L) foot – and released my left (L) hand and right (R) foot.  Staff left the room.  Because one arm had been supporting the other arm, no relief was provided.  The pain continued.  I kept shifting positions on the bed seeking relief.  I tried several positions over a twenty-minute period.  I screamed for relief again.  I screamed that, “If I don’t get relief, I’ll report this to patients’ rights.”  Gilbert held his hand and flat parallel from the floor.  He held his hand high so I could see it though the window.  Then he wavered his hand and made a facial expression stating, “Oh, I’m really scared,” mocking me, taughting me, so it appeared. 

It was no use.  I concentrated and tried to offset the pain in my neck and shoulder but it was impossible.  I screamed again for relief.  Matt opened the door and stated, “You got yourself into this, you wouldn’t stop, now deal with it!”  Matt closed the door.  I couldn’t take it anymore.  I started screaming profanities and began to panic with fear that no one would help me.  I began to have vivid memories of the first time I was in restraints and had went into a full panic attack.  I began crying with the screams.  Matt raised his voice. I could hear him though the door stating, “Calm down because if you don’t stop screaming you will be left in there longer.”  I was panicking.  My heart was pounding.  I felt there would be no end to this pain.  Matt opened the door again and said I was in restraints for only 3 hours and 20 minutes and it was required that I stay in them for a full 4 hours.  I said, “Lupe said if I contracted I would be released.”  Matt indicated that was false and Lupe only said that to calm and relax me, and I had another 40 minutes to go.  I screamed, “So Lupe lied to me then?”  Matt stated, “I don’t know because I wasn’t in the room when she said it.”  His answer confused me and the thought of 40 minutes more in these restraints terrified me.  Would I be able to hang in there that long?  Could I continue to bear the pain?  At least now I had a timeframe to work with so the panic lessened some.  Matt shut the door.  I kept screaming.  He opened the door and said that Norma the charge nurse was aware of the situation and now it was up to her.  He shut the door.  I kept repositioning myself – the pain continued in the lower shoulder area.  Both arms were tired taking turns holding the weight.  It was a dance of pain.  Forty minutes later Norma entered the room and released me.  I glanced at the clock and it was exactly 4:00 PM, so she was apparently aware of my dilemma and timed her entry to the full extent of the painful restraint.  Time: 12:00 noon till 4:00 PM.

Panic Attack – First Time in Restraints.

Written by Kathi Stringer

I whirled around. Nothing but a flash of bright white lights hazed among a mixture solid gloss walls. Hands, they were everywhere. Grabbing limbs tossing me flat on my stomach, pressing me tight against the mattress. I couldn't move and was confused as to what was happening. My legs were tugged downward toward the end of the cot. Leather was flopped around my wrists and tighten in their vertical slots into a metal lock. A hot rush of blood alerted my senses purging the synaptic responses and throwing them into a different dimension. This is hell, I thought I'm on my way to hell. So this is what a violent death this like, my heart must be failing as the eyes wanted to roll back into the skull.

Their voices murmured to one another as they vacated chamber. One stayed behind. She was kind.

"Something's happening to me!" I screamed. "Stop! Don't leave me like this! My heart is thumping so hard; I think I'm dying!"

"Panic" she said. "You are having a panic attack." She positioned herself between the bed and the wall directly above me. "You're in 5-point, 5-point restraint," she said softly trying to offer comfort. It was only a vestige but yet I thought if she should leave I would die alone as my blood still grew hotter. My extremities were narrowly restricted without consideration. "Try to calm down," she soothed. She began to move toward the exit.

"God, please don't leave me like this. I'll die. My body is reacting and I can't make it stop! Maybe if you stay a few more moments I'll be able to breath again." She left anyway. I felt faint from the trauma. If I wasn't crazy before I was surly being driven there at this instant. The room seemed to slowly spin through a jelly moat. Thick. My brain began to collapse, imploding in opposition to every neurotransmitter actively tying to escape its doom.

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