State facility improperly handcuffed retarded residents

The staff at the state's facility for retarded adults in Cambridge routinely put residents in metal handcuffs and other improper restraints to punish them and to control their behavior, according to state investigators.

Handcuffs and ankle restraints were widely used for minor behavior problems, not only for safety reasons as is required by law, investigators found. The abuse of restraints, which occurred over a two-year period, was detailed in a report made public today by the state's Ombudsman for Mental Health and Developmental Disabilities.
Officials from the Department of Human Services (DHS), which operates the facility, admitted that such practices were routine until they were stopped last spring. Officials said they ended the excessive use of restraints after the Minnesota Department of Health cited the facility for 15 rule violations in February.

"We don't deny it," said Loren Colman, assistant commissioner at DHS. "We responded with the plan of correction."

Roberta Opheim, the state's mental-health ombudsman, said she took the unusual step of publicly chastising the facility to reduce the chances of such abuses from occurring again.

"We cannot go back to the days of the past and the practices of the past," Opheim said. "I think it's important to speak out on behalf of some of the most vulnerable citizens of Minnesota."

The report detailed cases in which residents were put in restraints for touching a pizza box, spitting and going outside without a coat. One resident's arm was broken, and several remained terrified and anxious about the facility after their release, the report said.

The staff said restraints were the only way to manage the often-difficult residents who are temporarily committed to the 48 bed facility by the courts.

The Cambridge facility, the Minnesota Extended Treatment Program (METO), is a short-term residential treatment program for adults who are mentally retarded. It is designed to be an emergency safety-net facility for Minnesotans who sometimes need temporary crisis care, or who are sent there instead of jail.

Experts say that the staff could have used behavioral techniques to control patients, instead of resorting to force.

When family members and guardians complained or demanded that restraints not be used, the staff threatened retaliation by limiting visiting times and withholding information, the report said.

"I pleaded with them not to use metal handcuffs, I told them it was demeaning and humiliating," said Lorie Jensen, of Little Canada, whose 19-year-old son was at the Cambridge facility in 2006 and 2007. She said he was put in restraints for spitting and biting his hand. "The sad thing is he didn't know what he did was wrong."

Jensen's complaint about her son's treatment sparked the investigation. When Opheim questioned the staff about the use of restraints, "they believed the practice was an acceptable treatment modality," she said. But state law allows use of restraints only if the resident is threatening harm, she said.

"There were several incidents when the person was released from a restraint that he/she would immediately touch the staff person and be placed back into restraints," the ombudsman's report says.

A real conundrum

The staff members "are not bad people," said Rick Amado, a behavioral psychologist and a former clinical director at the facility. "They can become frustrated, they cannot allow one resident to hurt another." Amado, who left the facility before the problems arose, said it's likely that the staff did not have the appropriate training or resources to handle the residents. "They are pushed to the point where the only way they can assure the safety of others is to restrain them. It's a real conundrum."

Opheim noted that budget cuts in recent years have sharply reduced the amount of resources for staff training at the Extended Treatment Program.

"They treat some challenging individuals, but they had failed to try and develop a graduated system of moving eventually to restraints," said Darcy Miner, director of compliance monitoring for the Health Department. She noted that the facility is now in full compliance.

Steve Larson, director of Arc of Minnesota, an advocacy group for the mentally retarded, said that in the long term the Extended Treatment Program needs more oversight to prevent such practices from recurring.

Opheim said that's why she made the report public. "If we don't speak out on these practices, they grow elsewhere," she said.