Shackles Case Prompts Policy Change

Shackles case prompts policy change
Published: Thursday, November 15, 2007
By Nancy Remsen
Burlington Free Press Staff Writer

An investigation into the use of shackles, deputies and a police cruiser to move a 7-year-old boy with mental illness between two hospitals led this week to a change in transport policy at Rutland Regional Medical Center.

Jill Jesso-White, spokeswoman for the medical center said that from now on, Rutland psychiatric patients -- adults and children -- who are being involuntarily committed to another hospital will travel in an ambulance under the least restrictive circumstances possible.

A deputy sheriff might accompany emergency medical personnel and the patient, Jesso-White said. "We don't plan on it being in shackles."

The change in policy comes after Vermont Protection and Advocacy Inc. criticized the hospital for placing a child in a cruiser wearing metal handcuffs for the 75-mile trip to The Retreat in Brattleboro without medical personnel. The incident occurred a year ago.

The child's grandmother and guardian, who persuaded law enforcement to let her ride along, complained to Vermont Protection and Advocacy, an organization charged with investigating allegations of abuse and neglect of people with disabilities. The organization issued its report to the public Wednesday but had already provided it to officials at Rutland Regional Medical Center.

"We took the matter very seriously," Jesso-White said. "We took it as an opportunity to review our practices."

In its report, Vermont Protection and Advocacy detailed how the boy, who has a history of mental illness that includes bipolar disorder and attention deficit and hyperactivity disorder, ended up in the emergency department of Rutland Regional Medical Center on two consecutive days after being disruptive at school. The second time, a Rutland police officer brought him to the hospital after he ran out of the school building, found a pipe and swung it at staff chasing him.
His grandmother agreed reluctantly to send him to The Retreat in Brattleboro for evaluation, never realizing he would travel in shackles.

Vermont Protection and Advocacy questioned whether the child needed a secure form of transportation for the trip because hospital records showed he was quiet for several hours before the departure.

More significantly, said A.J Rubin, VP&A's supervising attorney, it was illegal for the child to be sent in shackles with police but without medical personnel.

Lawmakers and mental health advocates began raising concerns four years ago about the mode of transportation being used to move acutely ill psychiatric patients. In 2004 the Legislature passed a law that directed "all reasonable and appropriate efforts" be made to use the least restrictive means possible. In 2006, the Legislature strengthened the law, saying, "It is the policy of the state of Vermont that mechanical restraints are not routinely used."

Still, a significant number of psychiatric patients -- including children -- have continued to be moved between hospitals in restraints in police cruisers because the patients are deemed dangers to themselves or others. The Vermont Protection and Advocacy investigation cited state data showing that half the 60 children sent to The Retreat in Brattleboro between September 2005 and January 2006 traveled in cruisers.

Only Southwestern Vermont Medical Center in Bennington has made it a practice to use ambulances rather than cruisers to move psychiatric patients.

In June, the HowardCenter and Washington County Mental Health Services expanded the options for patients in northwestern and central Vermont when they announced they would buy vans. The two agencies have trained staff who accompany patients in the vans or in ambulances. The new vans are equipped with comfortable seats, a selection of music and videos to reduce patients' stress.

Rep. Anne Donahue, R-Northfield, helped write the legislation that put restrictions on patient transportation. She became aware of the case involving the 7-year-old boy only Wednesday.

"After the Legislature speaking so clearly, how could anyone with a 7-year-old even think of doing it?" she asked. The law was strengthened in 2006, she said, because of the outrage that a 10-year-old autistic boy had been transported in shackles.

Contact Nancy Remsen at 651-4888 or nremsenb@bfp.burlingtonfreepress.com