Report: Kaiser violated state law by restraining psychiatric patient 108 times in two months 

October 28th, 2015

California Department of Public Health cites state’s largest HMO for excessive and unwarranted use of restraints

Investigation of Kaiser’s inpatient psychiatric services follows two damning reports on HMO’s outpatient mental health services

EMERYVILLE — Acting on a tip from a whistleblower, state regulators have cited Kaiser Permanente for violating state laws that prohibit excessive use of restraints on patients.  In a report uncovered by NUHW last week, the California Department of Public Health (CDPH) cited Kaiser for breaking the law by restraining a single psychiatric patient, without justification, 108 times during a two-month period at Kaiser’s largest California hospital, Los Angeles Medical Center.

The report on Kaiser’s inpatient psychiatric services follows two damning reports and a $4 million fine levied against Kaiser’s outpatient psychiatric services by the state’s Department of Managed Health Care, which cited Kaiser for illegally delaying patients’ access to mental health care, falsifying records to conceal those delays, and providing patients with false or misleading information about the services available to them.

The CDPH citation, filed August 26, 2015, shows that Kaiser restrained a 29-year-old male patient at its Los Angeles Medical Center with walking and bed restraints, separately and in combination, 108 times between June 23 and August 24, 2014. The CDPH’s investigation, concluded in June 2015, found Kaiser in violation of state laws that call for the least restrictive restraints possible, require the use of restraints to be based on the patient’s actual as opposed to potential behavior, prohibit the use of standing orders for use of restraints, and require the use of restraints to be discontinued at the earliest possible time and for a duration not to to exceed four consecutive hours for adult patients.

In many of the 108 instances cited by the CDPH, Kaiser set standing orders that left the patient in restraints for hours at a time. In 35 of the 108 instances, Kaiser never removed the walking restraints — a four-point restraint of the wrists and ankles that allows for limited ambulatory movement — and often used them in combination with bed restraints, creating an eight-point restraint in which the patient lay supine with his wrists and ankles locked to the bed.

The CDPH found that Kaiser not only overused restraints but used them for anticipatory reasons rather than in response to aggressive behavior exhibited by the patient. During the month of July 2014, nearly half of the restraint orders reviewed by the CDPH (28 of 65) showed that they were placed “based on [the patient’s] history or in anticipation of aggressive behavior,” with “no documentation of what the patient did that initiated the use of physical restraints or the continuation of restraint orders.”

The CDPH citation can be found here: https://nuhw.org/wp-content/uploads/2015/10/CDPH-DeficiencyStmtKaiserLAMC_InptPsych08-18-15.pdf

The use of seclusion and restraints for psychiatric patients has been a growing concern. In 2008, the federal Centers for Medicare and Medicaid Services amended its regulations, stating all patients have the right to be free from restraint or seclusion, of any form, imposed as a means of coercion, discipline, convenience, or retaliation by staff. Advocacy groups such as the American Psychiatric Nurses Association and National Alliance on Mental Illness have called for the reduction and ultimate elimination of seclusion and restraints due to the grave risks they pose to patients.

The National Union of Healthcare Workers is a democratic, worker-led union representing 11,000 workers throughout California. NUHW.org.