Red flags raised at METO

Ombudsman finds handcuffs being used to restrain clients far too often.

A treatment program in Cambridge for those with developmental disabilities has relied far too long on using handcuffs to restrain clients.
So says the Minnesota Office of Ombudsman.
In a report released last week, the Ombudsman detailed how handcuffs were used at Minnesota Extended Treatment Options (METO) to restrain one client 299 times in 2006 and 230 times in 2007. Others were restrained for varying lengths of time.
Since bringing the issues before METO management and the Minnesota Department of Human Services (DHS), changes have been made to how frequently handcuffs and leg hobbles are used.
"We have already taken corrective action to come into compliance with the Ombudsman’s recommendations and the standards of the Office of Health Facilities Complaints and the Department of Human Services Licensing Division," said a DHS spokesperson.
DHS has hired four national experts to review METO and recommend program changes. The report is expected in the next few weeks.
HOW DID WE GET HERE?
America has moved away from confining those with developmental disabilities, pointed out Ombudsman Roberta Opheim in her report. "For over 40 years, it has been the policy of this nation that persons with developmental disabilities have the right to receive treatment in the least restrictive setting. They have the right to achieve the highest attainable integrated life possible."
The report asks, "How did we get to this point in 2008?"
While METO, formed after the Cambridge State Hospital was closed in 1999, began with high goals, it has slid into negative practices, according to the Ombudsman.
COMPLAINTS MADE
The Ombudsman first became concerned about METO in April 2007. A caller raised concerns about METO's use of metal handcuffs and leg hobbles to restrain a particular individual on a regular basis. The caller felt that as guardian his/her wish that this type of treatment not be used should be followed. After being contacted by the Ombudsman's office, METO staff agreed to the guardian's wishes, and the case was closed.
In September, the Ombudsman's office again received complaints about metal handcuffs and leg hobbles being used at METO. Based on the new information from two people, the Ombudsman decided to review several other files chosen at random.
This investigation revealed that the standard practice at METO was to place clients in restraints after they misbehaved for two minutes.
A full-scale investigation was launched.
Of the 40 records reviewed in October, 65% of clients had been restrained. Of those 74% had been restrained over 10 times.
Clients were routinely being restrained in a prone, face-down position and placed in metal handcuffs and leg hobbles.
Some were being restrained for such "aggressive behavior" as touching a pizza box, spitting and talking about running away.
METO policy specifically stated that a person should not be restrained for more than 50 minutes, yet this was being done. To be taken out of restraints, a client needed to be calm for 15 minutes, yet many became agitated while in restraints and thus stretched out the length of time restrained.
Following site visits in January, the Minnesota Department of Health citied METO for 15 rule violations.
NO CHANGE
When Ombudsman staff returned to check on progress in March, they were disappointed in the lack of changes made.
One person in the SLF unit had been restrained 23 times from Feb. 10 to March 17, 2008. Another person had been restrained in February, and slept through most of March.
Changes had been made to how often restraints were used in the ICF unit. This is the unit eligible to receive federal funds, and the federal program does not allow for such restrictive restraints. "There is no indication that the change was because of any acceptance that this practice is a problem or that they intend to change their practice in the other six units," said the Ombudsman report.
ISSUES
The Ombudsman condemns the accepted belief among staff that clients will not get better unless the restraints are used.
She pointed out that improper use of restraints can constitute abuse under Minnesota's Vulnerable Adult Act.
The report recommends that the Department of Human Services begin a comprehensive review of the policies and procedures at METO.
The Ombudsman also pushed that all staff receive training in positive behavioral programming, rights of clients, and documentation.
Additionally, the Ombudsman took issue with the length of time some patients have been at METO, and recommended that staff begin planning for the discharge of anyone who has been there past two years.
"The system as a whole fell complacent in their roles to protect these vulnerable Minnesotans," said the Ombudsman.
"These citizens deserve better and the taxpayers of Minnesota deserve more effective use of their resources."

What is METO?
• A short-term program for those with developmental disabilities.
• Residents have some of the most challenging behaviors, and may have been involved in the criminal justice system or lost their less restrictive community placement
• Licensed for 48 beds
• Established after the Cambridge State Hospital was closed

The problem:
• Handcuffs and leg hobbles were being used on clients too often
• They should only be used when there is imminent risk to the client or others
• One client was restrained 299 times in 2006 and 230 times in 2007. Reasons included touching the pizza box or a staff member.
• Others were restrained for various behavioral problems that ranged from hitting oneself to tipping over a chair.

In their words:
"What the Ombudsman found was a program that was established with a good foundation and lofty goals, but had slid into a pattern of practice that used restraints as a routine treatment modality in too many cases."