Restraint death spurs advocates' questions

Sacramento Bee, Metro/Regional News
(http://www.sacbee.com/content/news)
By Christina Jewett -- Bee Staff Writer
Published 12:01 am PDT Friday, August 25, 2006

Mental health advocates on Thursday decried the asphyxia homicide of an Elk Grove woman in a Sacramento psychiatric hospital, saying it was the kind of death a 2003 state law was meant to prevent.

Ramona Knapp, 51, died Dec. 5, about 20 hours after she was pinned, prone against the floor, by a heavy medical worker for five minutes at Sierra Vista Hospital in south Sacramento, according to a Sacramento coroner's report released this week.

In this case, police do not suspect foul play. The state attorney general's office is expected to investigate the incident, officials said.

The death is a textbook example of patient restraint techniques the 2003 law outlawed, said Leslie Morrison, an investigating attorney with Protection and Advocacy, Inc. Morrison reviewed Knapp's autopsy report.

"I can't believe this is happening still," said Morrison, whose office monitors restraint deaths in California. She reviewed a similar homicide in San Diego County in 2003.

"Facilities and clinicians are continuing to put patients in a dangerous restraint position that's known to be deadly," Morrison said.

The law, written by state Sen. Wes Chesbro, D-Arcata, called for an end to the use of restraints in all but dire situations, and increased requirements for reporting restraint-related deaths and training about alternate techniques.

The use of "prone restraint," pinning people on their stomachs, has been a controversial issue nationwide. It is known to cause asphyxia leading to death, health care industry and legislative reports say.

Morrison wrote such a report in 2002, describing a scenario that mirrored Knapp's death. Knapp was obese and in a state of "excited delirium" when she died, according to the coroner's report.

"Prone containment should never be used for persons ... with obesity and those in an agitated, excited state," Morrison wrote in her 2002 report.

Legislators may revise the law in light of news of Knapp's death, said Peggy Collins, principal consultant to the state Senate's committee on developmental disabilities and mental health.

She said the committee will watch to see if techniques used to restrain Knapp were in line with the law. If they were allowed under the law, she said, it may need to be strengthened.

"It's a tragedy, there's no way around it," she said.

Tom Dresslar, spokesman for Attorney General Bill Lockyer, said the office takes cases of abuse in care facilities seriously, but on Thursday could not confirm if the office is looking at Knapp's death.

"If there's criminal abuse in care facilities, we're going to aggressively investigate and prosecute," Dresslar said.

The case does not reflect a record of problems at Sierra Vista Hospital, said Meghan Stanton, executive director of Consumer Self-Help, a non-profit organization that tracks patient complaints.

She said the number of complaints about Sierra Vista is in line with similar facilities.

"There isn't a standout issue where Sierra Vista isn't offering a certain standard of care," Stanton said.

However, Susan Gallagher, executive director of the Mental Health Association of Sacramento, said she gets a disproportionate number of complaints about Sierra Vista.

"We hear about overcrowding, long periods of time passing without people being checked on -- a lot of complaints from family members that staff doesn't listen to them," she said.

Sierra Vista is a 72-bed facility, at 8001 Bruceville Road, owned by Psychiatric Solutions Inc. of Tennessee.

The state Department of Health Services file for Sierra Vista Hospital details 10 complaints substantiated since 2004. They range from patient-on-patient assaults to an instance of a patient being held 30 hours past his 72-hour holding period.

Eight complaints in the same time period were determined not to reflect problems.

Federal authorities wrote a letter to the facility in 2001 threatening to cut Medicare funds due to "deficiencies" in the pharmacy and medical staff. But a follow-up letter shows that funds were not cut when the facility addressed problems.

Sierra Vista Hospital spokesman Mark Grip said he could not comment on the letters or specific cases.

Sacramento attorney Parker White has represented several plaintiffs who have sued and settled with Sierra Vista.

Parents sued after their 16-year-old daughter who was supposed to be monitored closely committed suicide.

Another family sued after their relative ran out of the facility into traffic and was killed.

The cases are likely anomalies, said White, who does not believe the facility is ill-run.

"You've got a mental health system with psychiatrists at top of group, down to minimum-wage people who are taking care of these patients," he said. "You're going to have problems in that world."

About the writer:

The Bee's Christina Jewett can be reached at (916) 321-1201 or cjewett@sacbee.com .

Go to: Sacbee ( http://www.sacbee.com/ ) / Back to story (http://www.sacbee.com/content/news/story/14307385p-15194011c.html)

This article is protected by copyright and should not be printed or distributed for anything except personal use.

The Sacramento Bee, 2100 Q St., P.O. Box 15779, Sacramento, CA 95852

Phone: (916) 321-1000