Ongoing use of patient restraints holds criticized

JASON STEIN

State officials haven't done enough to end the use of dangerous patient restraints like the one that suffocated a 7-year-old girl at a private Rice Lake clinic two years ago — leaving open the possibility of a similar tragedy, an advocacy group says.

The new report by the patients group Disability Rights Wisconsin maintains that a lack of state oversight contributed to the death of Angellika Arndt at the partly state-funded day treatment program in May 2006.

After an escalating series of events that allegedly began with Arndt gurgling her milk with a straw, three staff members ended up holding the 67-pound girl face down on the floor while a male staff member lay across her back for more than an hour, unwittingly crushing the breath out of her chest, the report found.

"The system failed her," Disability Rights managing attorney Kristin Kerschensteiner said of Arndt. "I just don't think there has been a timely and sufficient response to that."

In a statement, Department of Health Services Secretary Karen Timberlake, whose agency oversaw the now closed private clinic, said state officials are responding correctly to the "very tragic incident."

"After Angellika Arndt died, the Department of Health Services took very strong actions against the facility, which ultimately closed its doors after we rejected several plans to correct deficiencies," Timberlake said.

Northwest Guidance and Counseling Clinic pleaded no contest to one felony count of negligence in the case, receiving a fine of $100,000.

A staffer, Brad Ridout, pleaded no contest to a misdemeanor negligence count and received 60 days in jail and one year of probation. In spite of the closing of the Rice Lake clinic later in 2006, 11 Northwest locations have remained in operation and still receive state and federal funding, the report found.

In a statement, Denison Tucker, a Northwest representative, said that "Angie's death is our darkest moment. "Over the past 2½ years, we have taken responsibility, we have worked closely with the Department of Health Services, and we have made changes within our programs. We will never forget this tragedy," said Tucker, who declined further comment.

In the 23 days Arndt was a patient at the Rice Lake clinic, she was restrained at least nine times and spent at least 14 hours in prone restraint, according to the Disability Rights report, which drew on Arndt's school and treatment records, the autopsy, and official investigations and court records.

The findings raised the question of whether the holds on Arndt were being used as a form of punishment and inappropriate therapy, said Kerschensteiner, who argued restraints should only be used as a last resort to keep patients from hurting themselves or others.

The report noted that the health department had taken other steps to protect children, including issuing interim guidelines in September 2006 for using seclusion and restraints in day treatment centers.

The health department acted even more quickly in June 2006 to restrict Northwest's use of restraints. But the report found the department has not banned "the use of all restraints that restrict breathing" and other dangerous holds in the facilities it regulates, in spite of a November 2007 request for it to do so by Disability Rights and four other groups representing patients and their families.

The agency should do so and also issue guidelines that clarify that clinics should use more positive forms of treatment with patients instead of secluding or restraining them, Disability Rights said.

Health department spokeswoman Stephanie Smiley said the report's finding regarding rules on restraints that cut off breathing was "inaccurate," saying existing rules already ban the use of such holds.

The department is also promoting more positive treatment methods, inluding holding three training programs since January with some 450 providers attending, Smiley said.

"The department decided not to issue a blanket moratorium on the use of seclusion and restraints without providing a training and technical assistance plan," Timberlake said. "The department will continue to work with our partners to issue additional guidance on the dangers of the use of seclusion and restraint."