Failure to Ensure Resident Rights: Use of Restraints Without Medical Necessity
Penalty
Summary
The facility failed to ensure that two residents admitted under the custody of the United States Marshals Service were able to exercise their rights as residents, specifically their right to be free from physical restraints not required to treat medical symptoms. Both residents were admitted while shackled at the wrists, ankles, and abdomen, and were under constant armed guard supervision. The use of these restraints was not based on medical necessity or physician orders, but rather on law enforcement requirements, as indicated in the residents' care plans and confirmed by facility staff and law enforcement personnel. Record reviews showed that both residents had significant medical diagnoses, including cerebral infarction, epilepsy, chronic pulmonary disease, and heart failure. Despite these conditions, there was no documentation of medical justification for the use of restraints, nor were there any consents or physician orders for their application. Nursing staff monitored the residents' skin integrity under the restraints but did not participate in decisions regarding the use or removal of the restraints, deferring instead to the directives of the U.S. Marshals Service. Interviews with facility staff, law enforcement, and the residents themselves confirmed that the restraints were applied and maintained by the Marshals Service, with the facility accepting the residents under these conditions. The facility's own restraint management policy emphasizes a restraint-free environment and the use of restraints only when ordered to treat medical symptoms, which was not the case for these residents. The residents remained restrained at all times, with only temporary removal of a handcuff during meals upon approval from the Marshals.