State mental hospital misused restraints on patients

South Dakota's state-run mental hospital in Yankton violated patients' rights by misusing restraints to control potentially unruly subjects, a federal inspection found.

Employees at the Human Services Center excessively used restraints and failed to document the reasons for placing them on patients, according to the Centers for Medicare and Medicaid Services, which began an unannounced inspection of the facility in late February.

Patients were strapped to plank-like boards instead of being placed in restraint beds, inspectors said. Mesh bags called spit hoods, placed over patients' heads, were overused, as were leg and wrist restraints. One patient was kept in ambulatory restraints for almost six days before being discharged, the inspection found.

"These deficiencies resulted in safety risks, violations of the patients’ right to be free from undue restraint and failure to ensure privacy for patients,” inspectors wrote in a 43-page report.

The misuse of restraints was among dozens of problems flagged in the CMS report, delivered amid growing violence at the hospital. An Argus Leader Media investigation found a rise in attacks on employees, who said safety concerns are fueling high turnover and low morale.

A spokeswoman for the Department of Social Services, which oversees the Human Services Center, said the state has addressed the problems.

"We submitted a Plan of Correction that was approved by CMS and have made the necessary changes," spokeswoman Tia Kafka wrote in an email.

Mental health professionals, including a former administrator of the Human Services Center, said they were stunned by the inspection claims.

Dr. David Bean, former head of the state hospital, said he doesn't understand why patients would be strapped to transport boards.

“In my 50 years of practicing psychiatry, that is something I’ve never heard of, never seen, or have never used,” Bean said.

Phyllis Arends, executive director of the National Alliance on Mental Illness in Sioux Falls, said it’s upsetting to imagine some of the state's most vulnerable patients being treated in the way described in the report.

“That is horrible, horrifying,” Arends said.

Arends said she doesn’t blame employees for the problems. She said it's likely a lack of training and resources that fostered the improper use restraints.

“They didn’t know what else to do, so that’s what they did,” Arends said.

John Swenson, a former mental health technician at the hospital, said employees weren't aware that the use of transport boards or safety hoods was wrong. That's what they were trained to do, he said, and the practices were emphasized in annual reviews.

“Staff just doesn’t do it on their own,” Swenson said.

CMS visited the state hospital Wednesday for a follow-up inspection. Federal officials declined to comment this week on what inspectors found and whether the previous problems were resolved. The federal investigation comes as the hospital grapples with security and turnover issues.

Department of Social Services Secretary Lynne Valenti said safety for staff and patients remains a top priority. Restraints are only used to protect staff and patients from serious injury, she said, and changes have been made to reduce the potential risk.

“We welcome the opportunity to improve in these areas,” Valenti said. “Our plan to improve in this area and implementation were just approved this week during an on-site visit by (CMS).”

An Argus Leader Media investigation found workers have left the state hospital at a rate of about one every three days since July 2008. The hospital's employees have logged more than 1,000 injuries attributed to combative patients since the start of the decade.

Follow Mark Walker on Twitter @argusmwalker.