Key:

USC – United States Code

CFR – Code of Federal Regulations

H&S – Code California Health and Safety Code

Laws prohibiting chemical restraint:

  • 22 CCR §72527 (a)(23)
  • H&S Code 1180.4(k)
  • 42 CFR §483.13(a)
  • 42 USC §§ 1395i-3(c)(1)(A)(ii) & 1396r(c)(1)(A)(ii)
  • 22 CCR §72319
  • Note: The excerpt of the following regulation contains pertinent provisions on the right to be free from chemical restraint but excludes other parts of the regulation.

    California Code of Regulations, Title 22, Section 72527 (a)(23)

    Patients’ Rights.

    (a) Patients have the rights enumerated in this section and the facility shall ensure that these rights are not violated. The facility shall establish and implement written policies and procedures which include these rights and shall make a copy of these policies available to the patient and to any representative of the patient. The policies shall be accessible to the public upon request.

    Patients shall have the right:

    (23) To be free from psychotherapeutic drugs and physical restraints used for the purpose of patient discipline or staff convenience and to be free from psychotherapeutic drugs used as a chemical restraint as defined in Section 72018, except in an emergency which threatens to bring immediate injury to the patient or others. If a chemical restraint is administered during an emergency, such medication shall be only that which is required to treat the emergency condition and shall be provided in ways that are least restrictive of the personal liberty of the patient and used only for a specified and limited period of time.

    California Code of Regulations, Title 22, Section 72018

    Chemical Restraint.

    Chemical restraint means a drug used to control behavior and used in a manner not required to treat the patient’s medical symptoms.

    Note: The excerpt of the following law contains pertinent provisions on the right of residents to be free from chemical restraints but excludes other parts of the law.

    California Health and Safety Code Section 1180.4(k)

    (k) A person in a facility described in subdivision (a) of Section1180.2 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 person’s freedom of movement, if that drug is not a standard treatment for the person’s medical or psychiatric condition.

    Note: The excerpt of the following law contains pertinent provisions on the right of residents to be free from chemical restraints but excludes other parts of the law.

    United States Code, Title 42, Section 1395i-3(c)(1)(A)(ii)

    Requirements relating to residents’ rights

    (1) General rights

    (A) Specified rights

    A skilled nursing facility must protect and promote the rights of each resident, including each of the following rights:

    (ii) Free from restraints

    The right to be free from physical or mental abuse, corporal punishment, involuntary seclusion, and any physical or chemical restraints imposed for purposes of discipline or convenience and not required to treat the resident’s medical symptoms. Restraints may only be imposed–

    (I) to ensure the physical safety of the resident or other residents, and

    (II) only upon the written order of a physician that specifies the duration and circumstances under which the restraints are to be used (except in emergency circumstances specified by the Secretary until such an order could reasonably be obtained).

    Note: The excerpt of the following law contains pertinent provisions on the right of residents to be free from chemical restraints but excludes other parts of the law.

    United States Code, Title 42, Section 1396r(c)(1)(A)(ii)

    Requirements relating to residents’ rights

    (1) General rights

    (A) Specified rights

    A nursing facility must protect and promote the rights of each resident, including each of the following rights:

    (ii) Free from restraints

    The right to be free from physical or mental abuse, corporal punishment, involuntary seclusion, and any physical or chemical restraints imposed for purposes of discipline or convenience and not required to treat the resident’s medical symptoms. Restraints may only be imposed–

    (I) to ensure the physical safety of the resident or other residents, and

    (II) only upon the written order of a physician that specifies the duration and circumstances under which the restraints are to be used (except in emergency circumstances specified by the Secretary until such an order could reasonably be obtained).

    Code of Federal Regulations, Title 42, Section 483.13

    Resident behavior and facility practices.

    (a) Restraints. The resident has the right to be free from any physical or chemical restraints imposed for purposes of discipline or convenience, and not required to treat the resident’s medical symptoms.

    (b) Abuse. The resident has the right to be free from verbal, sexual, physical, and mental abuse, corporal punishment, and involuntary seclusion.

    (c) Staff treatment of residents. The facility must develop and implement written policies and procedures that prohibit mistreatment, neglect, and abuse of residents and misappropriation of resident property.

    (1) The facility must–

    (i) Not use verbal, mental, sexual, or physical abuse, corporal punishment, or involuntary seclusion;

    (ii) Not employ individuals who have been–

    (A) Found guilty of abusing, neglecting, or mistreating residents by a court of law; or

    (B) Have had a finding entered into the State nurse aide registry concerning abuse, neglect, mistreatment of residents or misappropriation of their property; and

    (iii) Report any knowledge it has of actions by a court of law against an employee, which would indicate unfitness for service as a nurse aide or other facility staff to the State nurse aide registry or licensing authorities.

    (2) The facility must ensure that all alleged violations involving mistreatment, neglect, or abuse, including injuries of unknown source, and misappropriation of resident property are reported immediately to the administrator of the facility and to other officials in accordance with State law through established procedures (including to the State survey and certification agency).

    (3) The facility must have evidence that all alleged violations are thoroughly investigated, and must prevent further potential abuse while the investigation is in progress.

    (4) The results of all investigations must be reported to the administrator or his designated representative and to other officials in accordance with State law (including to the State survey and certification agency) within 5 working days of the incident, and if the alleged violation is verified appropriate corrective action must be taken.

    California Code of Regulations, Title 22, Section 72319

    Nursing Service – Restraints and Postural Supports.

    (a) Written policies and procedures concerning the use of restraints and postural supports shall be followed.

    (b) Restraints shall only be used with a written order of a licensed healthcare practitioner acting within the scope of his or her professional licensure. The order must specify the duration and circumstances under which the restraints are to be used. Orders must be specific to individual patients. In accordance with Section 72317, there shall be no standing orders and in accordance with Section 72319(i)(2)(A), there shall be no P.R.N. orders for physical restraints.

    (c) The only acceptable forms of physical restraints shall be cloth vests, soft ties, soft cloth mittens, seat belts and trays with spring release devices. Soft ties means soft cloth which does not cause abrasion and which does not restrict blood circulation.

    (d) Restraints of any type shall not be used as punishment, as a substitute for more effective medical and nursing care, or for the convenience of staff.

    (e) No restraints with locking devices shall be used or available for use in a skilled nursing facility.

    (f) Seclusion, which is defined as the placement of a patient alone in a room, shall not be employed.

    (g) Restraints shall be used in such a way as not to cause physical injury to the patient and to insure the least possible discomfort to the patient.

    (h) Physical restraints shall be applied in such a manner that they can be speedily removed in case of fire or other emergency.

    (i) The requirements for the use of physical restraints are:

    (1) Treatment restraints may be used for the protection of the patient during treatment and diagnostic procedures such as, but not limited to, intravenous therapy or catheterization procedures. Treatment restraints shall be applied for no longer than the time required to complete the treatment.

    (2) Physical restraints for behavior control shall only be used on the signed order of a physician, or unless the provisions of section 1180.4(e) of the Health and Safety Code apply to the patient, a psychologist, or other person lawfully authorized to prescribe care, except in an emergency which threatens to bring immediate injury to the patient or others. In such an emergency an order may be received by telephone, and shall be signed within 5 days. Full documentation of the episode leading to the use of the physical restraint, the type of the physical restraint used, the length of effectiveness of the restraint time and the name of the individual applying such measures shall be entered in the patient’s health record.

    (A) Physical restraints for behavioral control shall only be used with a written order designed to lead to a less restrictive way of managing, and ultimately to the elimination of, the behavior for which the restraint is applied. There shall be no PRN orders for behavioral restraints.

    (B) Each patient care plan which includes the use of physical restraint for behavior control shall specify the behavior to be eliminated, the method to be used and the time limit for the use of the method.

    (C) Patients shall be restrained only in an area that is under supervision of staff and shall be afforded protection from other patients who may be in the area.

    (j) When drugs are used to restrain or control behavior or to treat a disordered thought process, the following shall apply:

    (1) The specific behavior or manifestation of disordered thought process to be treated with the drug is identified in the patient’s health record.

    (2) The plan of care for each patient specifies data to be collected for use in evaluating the effectiveness of the drugs and the occurrence of adverse reactions.

    (3) The data collected shall be made available to the prescriber in a consolidated manner at least monthly.

    (4) PRN orders for such drugs shall be subject to the requirements of this section.

    (k) “Postural support” means a method other than orthopedic braces used to assist patients to achieve proper body position and balance. Postural supports may only include soft ties, seat belts, spring release trays or cloth vests and shall only be used to improve a patient’s mobility and independent functioning, to prevent the patient from falling out of a bed or chair, or for positioning, rather than to restrict movement. These methods shall not be considered restraints.

    (1) The use of postural support and the method of application shall be specified in the patient’s care plan and approved in writing by the physician, psychologist, or other person lawfully authorized to provide care.

    (2) Postural supports shall be applied:

    (A) Under the supervision of a licensed nurse.

    (B) In accordance with principles of good body alignment and with concern for circulation and allowance for change of position.

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