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BILL NUMBER: SB 130 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY AUGUST 18, 2003
AMENDED IN ASSEMBLY JULY 15, 2003
AMENDED IN ASSEMBLY JUNE 30, 2003
AMENDED IN SENATE JUNE 3, 2003
AMENDED IN SENATE APRIL 29, 2003
AMENDED IN SENATE APRIL 10, 2003
INTRODUCED BY Senator Chesbro
FEBRUARY 5, 2003
An act to add Division 1.5 (commencing with Section 1180) to the
Health and Safety Code, relating to mental health.
LEGISLATIVE COUNSEL'S DIGEST
SB 130, as amended, Chesbro. Health and care facilities: use of
seclusion and behavioral restraints.
Existing law provides for the licensure and regulation of health
facilities, including various types of hospitals that provide mental
health treatment services, by the State Department of Health
Services.
Existing law, the California Community Care Facilities Act,
provides for the licensure and regulation of community care and
residential facilities by the State Department of Social Services.
Existing law authorizes these facilities to provide mental health
treatment services.
Under existing law, the State Department of Mental Health is
charged with the state administration of state hospitals for the
mentally disordered.
Under existing law, these facilities are authorized to provide
secure containment or use seclusion and restraints, as specified, on
patients.
This bill would require the California Health and Human Services
Agency, to provide leadership and coordination necessary
to reduce the use of seclusion and behavioral restraints in
facilities that are licensed, certified, or monitored by departments
that fall within its jurisdiction.
This bill would require the State Department of Mental
Health, the State Department of Developmental Services, and the
secretary , respectively, to develop technical assistance
and training programs to support the efforts of facilities to reduce
or eliminate the use of seclusion and behavioral restraints in
specified facilities, and to take steps to ensure
establish a system of data collection.
This bill would authorize specified facilities to use seclusion
and behavioral restraints for behavioral emergencies only when a
person's behavior presents an imminent danger of serious harm to the
person or others, would require an initial assessment of each person
upon admission for these purposes, and would prohibit specified
facilities from using specified types of seclusion and behavioral
restraints. This bill would also require these facilities to conduct
reviews, as specified, for each episode of the use of seclusion or
behavioral restraint, to conduct debriefings, as specified, and to
document the incident. This bill would also require these
certain facilities to report, as specified, each
death or serious injury occurring during, or related to, the use of
seclusion or behavioral restraints.
This bill would require the State Department of Health
Services, the State Department of Mental Health, the State Department
of Social Services, and the State Department of Developmental
Services to make annual reports to the Legislature on these
provisions.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. The Legislature finds and declares all of the
following:
(a) The use of seclusion and behavioral restraints is not
treatment, and their use does not alleviate human suffering or
positively change behavior. In addition, when used, they
are dangerous and dehumanizing.
(b) Inactivity, boredom, and confinement in noisy and crowded
wards are significant contributors to frustration, conflict, and
stress in facilities, and lead to the problem of the use of seclusion
and behavioral restraints.
(b) Good milieu programs, interesting activities, and attention to
every person's need for sufficient space all contribute to an
environment in which seclusion and behavioral restraints can be
minimized.
(c) An ongoing commitment to varied, active, and stimulating
choices of programming is important in addressing the problems of the
use of seclusion and behavioral restraints in facilities.
(d) The commitment of managers and staff of facilities is
essential to changing the culture of those facilities and reducing
the use of seclusion and behavioral restraints, and providing a safer
and more therapeutic environment for mental health patients ,
residents, and staff in California.
(e) In order to achieve the goal of a reduction in the use of
seclusion and behavioral restraints, California must utilize the best
practices developed in other states, and use the most efficient
modern resources to accomplish these goals, including computerized
data collection and analysis, public access to this information on
the Internet, strategies for organizational change, staff training in
risk assessment, crisis prevention and intervention,
patient debriefing models, and recovery-based treatment
models.
(f) Adequate numbers of staff are essential to reducing seclusion
and behavioral restraints in facilities; however, California faces a
human resource crisis in mental health care. According to the
California Mental Health Planning Council, vacancy rates for mental
health positions in California exceed 30 percent. The Employment
Development Department estimates that between 1998 and 2008, public
and private providers will need to fill 45,000 mental health
positions. To address this crisis, the Little Hoover Commission has
called for coordinated, integrated, and success-oriented strategies
such as hiring clients, recruitment efforts, training academies,
scholarships and loan forgiveness, workload analysis, and ensuring
training in core competencies. The Legislature finds that resolving
California's mental health workforce crisis is important to the goal
of reducing seclusion and behavioral restraints in California
facilities.
(g) It is the intent of the Legislature in enacting this act to
achieve a reduction in the use of seclusion and behavioral restraints
in facilities in California.
SEC. 2. Division 1.5 (commencing with Section 1180) is added to
the Health and Safety Code, to read:
DIVISION 1.5. USE OF SECLUSION AND BEHAVIORAL RESTRAINTS IN
FACILITIES
1180. (a) The California Health and Human Services Agency, in
accordance with their mission, shall provide the leadership and
coordination necessary to reduce the use of seclusion and behavioral
restraints in facilities that are licensed, certified, or monitored
by departments that fall within its jurisdiction.
(b) This division shall apply to all facilities that utilize
seclusion or behavioral restraints, including, but not limited to,
state hospitals, the psychiatric units of general acute care
hospitals, acute psychiatric hospitals, psychiatric health
facilities, crisis stabilization units, community treatment
facilities, group homes, skilled nursing facilities, intermediate
care facilties, community care facilities, and mental health
rehabilitation centers.
(c)
(b) The agency may make recommendations to the Legislature for
additional facilities or additional units or departments within
facilities that should be included within the requirements of this
division in the future, including, but not limited to, emergency
rooms.
(c) At the request of the secretary, the involved state
departments shall provide information about existing training
protocols and requirements for direct care staff who work in
facilities within their jurisdiction. All involved state departments
shall cooperate in implementing any training protocols established
pursuant to this division.
(d) It is the intent of the Legislature that the secretary pursue
federal and private funding to support the development of a training
protocol that can be incorporated into the existing training
activities for direct care staff conducted by the state, facilities,
and educational institutions to reduce the use of seclusion and
restraints.
(e) This section should be implemented as soon as it can
reasonably be achieved within existing resources. The agency and
involved departments may incrementally implement this section in
order to accomplish its goals within existing resources, or through
the use of federal or private funding or any subsequent appropriation
by the Legislature, or all of these.
1180.1. For purposes of this division, the following
definitions apply:
(1)
(a) "Behavioral restraint" means "mechanical restraint" or
"physical restraint" as defined in this section, used as an
intervention when a person presents an immediate danger to self or to
others. It does not include restraints used for medical purposes,
including, but not limited to, securing an intravenous needle or
immobilizing a person for a surgical procedure, or postural
restraints, or devices used to prevent injury or to improve a person'
s mobility and independent functioning rather than to restrict
movement.
(2)
(b) "Containment" means a brief physical restraint of a
person for the purpose of effectively gaining quick control of a
person who is aggressive or agitated or who is a danger to self or
others.
(3)
(c) "Mechanical restraint" means the use of a mechanical
device, material, or equipment attached or adjacent to the person's
body that he or she cannot easily remove and that restricts the
freedom of movement of all or part of a person's body or restricts
normal access to the person's body, and that is used as a behavioral
restraint.
(4)
(d) "Physical restraint" means the use of a manual hold to
restrict freedom of movement of all or part of a patient's
person's body, or to restrict normal access to
the patient's person's body, and that
is used as a behavioral restraint. "Physical restraint" is any
staff-to-patient staff-to-person
physical contact in which the patient person
unwillingly participates. "Physical restraint" does not
include briefly holding a person without undue force in order to calm
or comfort, or physical contact intended to gently assist a
person in performing tasks or to guide or assist a person from
one area to another.
(5)
(e) "Seclusion" means the involuntary confinement of a
person alone in a room or an area from which the resident
person is physically prevented from leaving.
"Seclusion" does not include a "timeout," as defined in
regulations relating to facilities operated by the State Department
of Developmental Services.
(6)
(f) "Secretary" means the Secretary of the California Health
and Human Services Agency.
(7)
(g) "Serious injury" means any significant impairment of the
physical condition as determined by qualified medical personnel, and
includes, but is not limited to, burns, lacerations, bone fractures,
substantial hematoma, or injuries to internal organs,
whether self-inflicted or inflicted by someone else.
(d) (1) The agencies or entities specified by the secretary, at
the request of the secretary, shall provide information to the
secretary regarding efforts undertaken to reduce the use of seclusion
and behavioral restraints, including, but not limited to, efforts to
pursue federal funding for this purpose.
(2) As funds become available, the secretary or his or her
designee shall develop technical assistance and training programs to
support the efforts of facilities to reduce or eliminate the use of
seclusion and behavioral restraints in those facilities that utilize
them. Technical assistance and training programs should be designed
with the input of clients and direct care staff and should be based
on best practices that lead to reduced use of seclusion and
behavioral restraints, including, but not limited to, the following:
(A) Assessment of underlying reasons for the escalated behavior.
(B) Avoidance and management of crisis situations.
(C) Treatment planning that identifies risk factors, positive
early intervention strategies, and strategies to minimize time spent
in seclusion or behavioral restraints.
(D) Conflict resolution, deescalation, and client-centered problem
solving strategies that diffuse and safely resolve emerging crisis
situations.
(E) Debriefing strategies that result in client and staff comfort
in identifying factors that lead to seclusion or behavioral restraint
and factors that would reduce likelihood of future seclusion or
behavioral restraint occurrences.
(3) The secretary shall pursue federal and private funding to
support the development of a training protocol that can be
incorporated into the existing training activities for direct care
staff conducted by the state, facilities, and educational
institutions to reduce the use of seclusion and restraints.
(e) organs.
1180.2. (a) This section shall apply to the state hospitals
operated by the State Department of Mental Health and facilities
operated by the State Department of Developmental Services that
utilize seclusion or behavioral restraints.
(b) The State Department of Mental Health and the State Department
of Developmental Services shall develop technical assistance and
training programs to support the efforts of facilities to reduce or
eliminate the use of seclusion and behavioral restraints in those
facilities described in subdivision (a).
(c) Technical assistance and training programs should be designed
with the input of stakeholders, including clients and direct care
staff, and should be based on best practices that lead to the
avoidance of seclusion and behavioral restraints, including, but not
limited to, all of the following:
(1) Conducting an intake assessment that is consistent with
facility policies and that includes issues specific to seclusion and
behavioral restraints as specified in Section 1180.4.
(2) Utilizing strategies to engage clients collaboratively in
assessment, avoidance, and management of crisis situations in order
to prevent incidents of seclusion and behavioral restraints.
(3) Recognizing and responding appropriately to underlying reasons
for escalating behavior.
(4) Utilizing conflict resolution, effective communication,
deescalation, and client-centered problemsolving strategies that
diffuse and safely resolve emerging crisis situations.
(5) Individual treatment planning that identifies risk factors,
positive early intervention strategies, and strategies to minimize
time spent in seclusion or behavioral restraints. Individual
treatment planning should include input from the person affected.
(6) While minimizing the duration of time spent in seclusion or
behavioral restraints, using strategies to mitigate the emotional and
physical discomfort and ensure the safety of the person involved in
seclusion or behavioral restraints, including input from the person
about what would alleviate his or her distress.
(7) Training in conducting an effective debriefing meeting as
specified in Section 1180.5, including the appropriate persons to
involve, the voluntary participation of the person who has been in
seclusion or behavioral restraints, and strategic interventions to
engage affected persons in the process. The training should include
strategies that result in maximum participation and comfort for the
involved parties to identify factors that lead to seclusion and
behavioral restraints and factors that would reduce the likelihood of
future incidents.
(d) (1) The State Department of Mental Health and the State
Department of Developmental Services shall take steps to establish a
system of mandatory, consistent, timely, and publicly accessible data
collection regarding the use of seclusion and behavioral restraints
in facilities described in this section. It is the intent of the
Legislature that data be compiled in a manner that allows for
standard statistical comparison.
(2) The State Department of Mental Health and the State Department
of Developmental Services shall develop a mechanism for making this
information publicly available on the Internet.
(3) Data collected pursuant to this section shall include all of
the following:
(A) The number of deaths that occur while persons are in seclusion
or behavioral restraints, or where it is reasonable to assume that a
death was proximately related to the use of seclusion or behavioral
restraints.
(B) The number of serious injuries sustained by persons while in
seclusion or subject to behavioral restraints.
(C) The number of serious injuries sustained by staff that occur
during the use of seclusion or behavioral restraints.
(D) The number of incidents of seclusion.
(E) The number of incidents of use of behavioral restraints.
(F) The duration of time spent per incident in seclusion.
(G) The duration of time spent per incident subject to behavioral
restraints.
(H) The use of involuntary emergency medication that is used to
control behavior.
(e) A facility described in subdivision (a) shall report each
death or serious injury of a person occurring during, or related to,
the use of seclusion or behavioral restraints. This report shall be
made to the agency designated in subdivision (h) of Section 4900 of
the Welfare and Institutions Code no later than the close of the
business day following the death or injury. The report shall include
the encrypted identifier of the person involved, and the name,
street address, and telephone number of the facility.
1180.3. (a) This section shall apply to all facilities that
utilize seclusion or behavioral restraints except state mental
hospitals and developmental centers. Facilities to which this
section applies include, but are not limited to, the psychiatric
units of general acute care hospitals, acute psychiatric hospitals,
psychiatric health facilities, crisis stabilization units, community
treatment facilities, group homes, skilled nursing facilities,
intermediate care facilities, community care facilities, and mental
health rehabilitation centers.
(b) (1) As funds become available, the secretary or his or her
designee shall develop technical assistance and training programs to
support the efforts of facilities to reduce or eliminate the use of
seclusion and behavioral restraints in those facilities that utilize
them.
(2) Technical assistance and training programs should be designed
with the input of stakeholders, including clients and direct care
staff, and should be based on best practices that lead to the
avoidance of seclusion and behavioral restraints, including, but not
limited to, all of the following:
(A) Conducting an intake assessment that is consistent with
facility policies and that includes issues specific to seclusion and
behavioral restraints as specified in Section 1180.4.
(B) Utilizing strategies to engage clients collaboratively in
assessment, avoidance, and management of crisis situations in order
to prevent incidents of seclusion and behavioral restraints.
(C) Recognizing and responding appropriately to underlying reasons
for escalating behavior.
(D) Utilizing conflict resolution, effective communication,
deescalation, and client-centered problemsolving strategies that
diffuse and safely resolve emerging crisis situations.
(E) Individual treatment planning that identifies risk factors,
positive early intervention strategies, and strategies to minimize
time spent in seclusion or behavioral restraints. Individual
treatment planning should include input from the person affected.
(F) While minimizing the duration of time spent in seclusion or
behavioral restraints, using strategies to mitigate the emotional and
physical discomfort and ensure the safety of the person involved in
seclusion or behavioral restraints, including input from the person
about what would alleviate his or her distress.
(G) Training in conducting an effective debriefing meeting as
specified in Section 1180.5, including the appropriate persons to
involve, the voluntary participation of the person who has been in
seclusion or behavioral restraints, and strategic interventions to
engage affected persons in the process. The training should include
strategies that result in maximum participation and comfort for the
involved parties to identify factors that lead to seclusion and
behavioral restraints and factors that would reduce the likelihood of
future incidents.
(c) (1) Within existing resources, the secretary or his or
her designee shall take steps to ensure
establish a system of mandatory, consistent, timely, and
publicly accessible data collection regarding the use of seclusion
and behavioral restraints in all facilities described in subdivision
(b) (a) that utilize seclusion and
behavioral restraints. In determining a system of data collection,
the secretary should utilize existing efforts, and direct new or
ongoing efforts, of associated state departments to revise or improve
their data collection systems. The secretary should
consider shall make recommendations for a
mechanism to ensure compliance by facilities, including, but not
limited to, penalties for failure to report in a timely manner. It
is the intent of the Legislature that data be compiled in a manner
that allows for standard statistical comparison and be maintained for
each facility subject to reporting requirements for the use of
seclusion and behavioral restraints.
(f) The secretary shall develop a mechanism for making this
information publicly available on the Internet as soon as possible.
(g) Data collected pursuant to subdivision (e) shall include all
of the following:
(1) The number of deaths that occur while a person is in
(2) The secretary shall develop a mechanism for making this
information, as it becomes available, publicly available on the
Internet. This paragraph shall be implemented as soon as it
reasonably can be achieved within existing resources.
(3) The departments shall cooperate and share resources to develop
uniform reporting for all facilities, by establishing new or
amending existing reporting requirements for facilities described in
subdivision (a). As additional facilities are required to report
information regarding the utilization of seclusion and behavioral
restraints, the information shall be made publicly available pursuant
to this subdivision.
(4) Data collected pursuant to this subdivision shall include all
of the following:
(A) The number of deaths that occur while persons are in
seclusion or behavioral restraints, or where it is reasonable to
assume that the a death was proximately
related to the use of seclusion or behavioral restraints.
(2)
(B) The number of serious injuries sustained by persons
while in seclusion or subject to behavioral restraints.
(3)
(C) The number of serious injuries sustained by staff that
occur during the use of seclusion or behavioral restraints.
(4)
(D) The number of incidents of seclusion.
(5)
(E) The number of incidents of use of behavioral restraints.
(6)
(F) The duration of time spent per incident in seclusion.
(7)
(G) The duration of time spent per incident subject to
behavioral restraints.
(8) The use of involuntary emergency medication.
(h) Within existing resources, the secretary shall make
recommendations for additional facilities or additional units or
departments within facilities that should be included within the
requirements of this section, including, but not limited to,
emergency rooms.
(i)
(H) The use of involuntary emergency medication to control
behavior.
(5) Within existing resources, the secretary or his or her
designee shall make recommendations to the Legislature on how to
best assess the impact of serious staff injuries sustained
during the use of seclusion or behavioral restraints, on staffing
costs and on workers' compensation claims and costs.
(j)
(6) Within existing resources, the secretary or his or her
designee shall work with the state departments that have
responsibility for oversight of seclusion and behavioral restraints
to review and eliminate redundancies and outdated requirements in the
reporting of data on seclusion and behavioral restraints.
1180.1. A facility described in subdivision (b) of Section 1180
(d) This section should be implemented as soon as it can
reasonably be achieved within existing resources. The agency and
involved departments may incrementally implement this section in
order to accomplish its goals within existing resources, or through
the use of federal or private funding or any subsequent appropriation
by the Legislature, or all of these.
1180.4. (a) A facility described in subdivision (a) of Section
1180.2 or subdivision (a) of Section 1180.3 shall conduct an
initial assessment of each person upon admission to the facility, or
as soon thereafter as possible. This assessment shall include input
from the person and from someone whom he or she desires to be
present, such as a family member, significant other, or
authorized representative designated by the person, if he or
she desires, and if the desired third party can be present
at the time of admission. This assessment shall also include ,
based on the information available at the time of initial
assessment, all of the following:
(a)
(1) A person's advance directive regarding deescalation or
the use of seclusion or behavioral restraints.
(b)
(2) Identification of early warning signs, triggers, and
precipitants that cause a person to escalate, and identification of
the earliest precipitant of aggression for persons with a known or
suspected history of aggressiveness, or persons who are currently
aggressive.
(c)
(3) Techniques, methods, or tools that would help the person
control his or her behavior.
(d)
(4) Preexisting medical conditions or any physical
disabilities or limitations that would place the person at greater
risk during restraint or seclusion.
(e)
(5) Any trauma history, including any history of sexual or
physical abuse that the affected person feels is relevant.
1180.2. A facility described in subdivision (b) of Section 1180
(b) A facility described in subdivision (a) of Section 1180.2 or
subdivision (a) of Section 1180.3 may use seclusion or
behavioral restraints for behavioral emergencies only when a person's
behavior presents an imminent danger of serious harm to self or
others.
1180.3. (a) A facility described in subdivision (b) of Section
1180
(c) A facility described in subdivision (a) of Section 1180.2 or
subdivision (a) Section 1180.3 may not use either of the
following:
(1) A physical restraint or containment technique that obstructs a
person's respiratory airway or impairs the person's breathing or
respiratory capacity, including techniques in which a staff member
places pressure on a person's back or places his or her body weight
against the person's torso or back.
(2) A pillow, blanket, or other item covering the person's face as
part of a physical or mechanical restraint or containment process.
(b) A facility described in subdivision (b) of Section 1180 may
(d) A facility described in subdivision (a) of Section 1180.2 or
subdivision (a) Section 1180.3 may not use physical or
mechanical restraint or containment on a person who has a known
medical or physical condition, and where there is reason to believe
that the use would endanger the person's life or exacerbate
the patient's medical condition.
(c) A facility described in subdivision (b) of Section 1180 may
not use prone mechanical restraint on a patient at risk for
positional asphyxiation as a result of one of the following risk
factors that are known to
the provider:
(1) Obesity.
(2) Pregnancy.
(3) Agitated delirium or excited delirium syndromes.
(4) Cocaine, methamphetamine, or alcohol intoxication.
(5) Exposure to pepper spray.
(6) Preexisting heart disease, including, but not limited to, an
enlarged heart and other cardiovascular disorders.
(7) Respiratory conditions, including emphysema, bronchitis, or
asthma.
(d) A facility described in subdivision (b) of Section 1180 shall
avoid the deliberate use of prone containment techniques whenever
possible, utilizing the best practices in early intervention
techniques such as deescalation. If prone containment techniques are
used in an emergency situation, a staff member shall observe the
patient for any signs of physical duress throughout the use of prone
containment. Whenever possible, the staff member monitoring the
patient shall not be involved in restraining the patient.
(e) A facility described in subdivision (b) of Section 1180 may
not place a patient in a facedown position with hands held or
restrained behind the patient's back.
(f) A facility described in subdivision (b) of Section 1180 may
not use physical restraint or containment as an extended procedure.
(g) A facility described in subdivision (b) of Section 1180 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.
(h) A facility described in subdivision (b) of Section 1180 shall
afford to patients who are restrained the least restrictive
alternative and the maximum freedom of movement, while ensuring the
physical safety of the patient and others, and must use the least
number of restraint points.
(i) A person in a facility described in subdivision (b) of Section
1180 life or seriously exacerbate the person's
medical condition.
(d) (1) A facility described in subdivision (a) of Section 1180.2
or subdivision (a) of Section 1180.3 may not use prone mechanical
restraint on a person at risk for positional asphyxiation as a result
of one of the following risk factors that are known to the provider:
(A) Obesity.
(B) Pregnancy.
(C) Agitated delirium or excited delirium syndromes.
(D) Cocaine, methamphetamine, or alcohol intoxication.
(E) Exposure to pepper spray.
(F) Preexisting heart disease, including, but not limited to, an
enlarged heart and other cardiovascular disorders.
(G) Respiratory conditions, including emphysema, bronchitis, or
asthma.
(2) Paragraph (1) shall not apply when written authorization has
been provided by a physician, made to accommodate a person's stated
preference for the prone position or because the physician judges
other clinical risks to take precedence. The written authorization
may not be a standing order, and shall be evaluated on a case-by-case
basis by the physician.
(e) A facility described in subdivision (a) of Section 1180.2 or
subdivision (a) of Section 1180.3 shall avoid the deliberate use of
prone containment techniques whenever possible, utilizing the best
practices in early intervention techniques, such as deescalation. If
prone containment techniques are used in an emergency situation, a
staff member shall observe the person for any signs of physical
duress throughout the use of prone containment. Whenever possible,
the staff member monitoring the person shall not be involved in
restraining the person.
(f) A facility described in subdivision (a) of Section 1180.2 or
subdivision (a) of Section 1180.3 may not place a person in a
facedown position with hands held or restrained behind the person's
back.
(g) A facility described in subdivision (a) of Section 1180.2 or
subdivision (a) of Section 1180.3 may not use physical restraint or
containment as an extended procedure.
(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.
(i) A facility described in subdivision (a) of Section 1180.2 or
subdivision (a) of Section 1180.3 shall afford to persons who are
restrained the least restrictive alternative and the maximum freedom
of movement, while ensuring the physical safety of the person and
others, and shall use the least number of restraint points.
(j) A person in a facility described in subdivision (a) of Section
1180.2 and subdivision (a) of Section 1180.3 has the right to
be free from the use of seclusion and behavioral restraints of any
form imposed as a means of coercion, discipline, convenience, or
retaliation by staff. This right includes, but is not limited to,
the right to be free from the use of a drug used in order to control
behavior or to restrict the patient's person'
s freedom of movement, if that drug is not a standard treatment
for the patient's person's medical or
psychiatric condition.
1180.4. (a) A facility described in subdivision (b) of Section
1180 shall conduct a clinical, administrative, and quality review for
each episode of the use of seclusion or behavioral restraints.
(b) A facility described in subdivision (b) of Section 1180 shall,
within 24 hours after the use of seclusion or behavioral restraints,
conduct a debriefing regarding the incident with the person, and, if
the person requests it, the person's family member, domestic
partner, significant other or authorized representative, the staff
members involved in the incident, and a representative of the senior
or management staff of the facility, to discuss how to avoid
1180.5. (a) A facility described in subdivision (a) of Section
1180.2 or subdivision (a) of Section 1180.3 shall conduct a clinical
and quality review for each episode of the use of seclusion or
behavioral restraints.
(b) A facility described in subdivision (a) of Section 1180.2 or
subdivision (a) of Section 1180.3 shall, as quickly as possible but
no later than 24 hours after the use of seclusion or behavioral
restraints, conduct a debriefing regarding the incident with the
person, and, if the person requests it, the person's family member,
domestic partner, significant other, or authorized representative, if
the desired third party can be present at the time of the debriefing
at no cost to the facility, as well as the staff members involved in
the incident, if reasonably available, and a supervisor, to discuss
how to avoid a similar incident in the future. The person's
participation in the debriefing shall be voluntary. The purposes of
the debriefing shall be to do all of the following:
(1) Assist the patient person to
identify the precipitant of the incident, and suggest methods of more
safely and constructively responding to the incident.
(2) Assist the staff to understand the precipitants to the
incident, and develop alternative methods of helping the person avoid
or cope with those incidents.
(3) Help treatment team staff devise treatment interventions to
address the root cause of the incident and its consequences, and to
modify the treatment plan.
(4) Provide an opportunity for both persons and staff to assess
the appropriateness and efficacy of staff response during the
emergency, and attend to the person's feelings.
(5)
(4) Help assess whether the intervention was necessary and
whether it was implemented in a manner consistent with staff training
and hospital policies.
(c) The facility shall, in the debriefing, provide both the
patient person and staff the
opportunity to discuss the circumstances resulting in the use of
seclusion or behavioral restraints, and strategies to be used by the
staff, the person, or others that could prevent the future use of
seclusion or behavioral restraints.
(d) The facility staff shall document in the patient's
person's record that the debriefing session took
place and any changes to the person's treatment plan that resulted
from the debriefing.
1180.5. A facility described in subdivision (b) of Section 1180
shall report each death or serious injury occurring during, or
related to, the use of seclusion or behavioral restraints. This
report shall be made to the agency designated in subdivision (h) of
Section 4900 of the Welfare and Institutions Code no later than the
close of the business day following the death or injury. The report
shall include the name of the person involved, and the name, street
address, and telephone number of the facility.
1180.6. The State Department of Health Services, the State
Department of Mental Health, the State Department of Social Services,
and the State Department of Developmental Services shall annually
provide information to the Legislature, during Senate and Assembly
budget committee hearings, about the progress made in implementing
this division. This information shall include the progress of
implementation and barriers to achieving full implementation.
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