Tag Archives: Hartford Hospital’s Institute of Living

AUDIO Interview with Pamela Spiro Wagner: WNPR on Connecticut Hospitals’ Use of Restraints and Seclusion

(***SEE PAMELA’S COMMENTS AT BOTTOM OF PAGE…)

Connecticut Hospitals Responding to Psychiatric Restraint Numbers

“They don’t want you to get out. They pull [restraints] as tight as possible to the sides of the bed.”
Pamela Spiro Wagner

Pamela Spiro Wagner’s apartment is full of art she’s made while in psychiatric care. One piece dominates the room. It looks like a painting at first. It shows a threadbare seclusion room and a restraining bed.

“That’s made of Vogue magazines. If you look at it, you’ll see there’s a little label of Prada leather on the leather restraints, which was done on purpose,” Wagner said. She made it while alone in a hospital seclusion room. The magazines were the only art supplies she had.

Wagner has schizophrenia. She’s been in and out of Connecticut hospitals for decades, and she knows what it’s like to be restrained. “They use leather, or rubber, or plastic, or whatever restraints that they wrap around your wrists, usually tight because they don’t want you to get out. They pull them as tight as possible to the sides of the bed,” she said.

Wagner was put in four-point restraints. That means each limb is bolted to the bed, and she said she’s stayed there for nearly a day at a time. “I would just scream from the base of my lungs,” she said, “like the screams that if you had any heart, your heart would break if you heard me scream.”

“Restraint is Pretty Traumatic”

Patricia Rehmer, Commissioner of the Connecticut Department of Mental Health and Addiction Services, said the department has cut down on restraint since receiving a federal grant in 2008. “We know,” she said. “The literature is clear; the clients are clear. Seclusion and restraint is usually a pretty traumatic event. If we had our way, there would be no seclusion and restraint. We’d love to get to zero, but that’s not always possible.”

Credit WebKazoo / Connecticut Health I-Team

The Department of Mental Health and Addiction Services oversees state hospitals in Bridgeport, New Haven, Hartford, and Middletown. Rehmer said that because patients stay longer at state hospitals, doctors and nurses have more time to work with them on ways to avoid restraint. “Frankly, there are differences between our hospitals, our hospital beds, and general hospital beds, for example,” she said.

Read C-HIT Report: State Restrains Psychiatric Patients at High Rate

Restraining or secluding patients used to be commonplace in psychiatric facilities, but ten years after a series of deaths nationwide, there’s been a push to lessen the time patients spend restrained. Federal data released earlier this month showed that Connecticut’s rates of restraint are still high compared to most of the country – more than double the national average. The state ranks eleventh nationwide, and third for use of restraints among the elderly.

Connecticut Institutions Adapt

Bridgeport Hospital topped the list statewide. The hospital has a large geriatric unit, and the numbers were high for elderly patients.

“We realized about a year and a half ago that we were really having a problem,” said Ryan O’Connell, Bridgeport Hospital’s vice president of performance and risk management. He pointed out that the numbers only go up to the middle of 2013, and said that the hospital started changing its practices since then. “It was much more common for us to go to some type of restraint,” he said.

O’Connell said the image of the barren room and four leather straps is all wrong at Bridgeport. They’re mostly trying to keep patients with dementia from wandering off and into danger. “I think it’s really important,” he said, “that nobody thinks that we were tying people down [by their] hands and feet.”

Bridgeport is moving toward something called comfort rooms, with colorful wallpaper, toys, games, or comfortable furniture. They’re becoming common alternatives in a lot of institutions, like Connecticut Valley Hospital in Middletown — a state hospital that cut back on using restraints by about 88 percent in the past decade.

In 2002, a patient died after being restrained at CVH. The hospital conducted investigations after the death, but Director Charles Dike said they’d already decided to make a change before it happened. “Our target is to make sure we use it as sparingly as possible, only when it is absolutely necessary, and that we discontinue it as quickly as possible,” he said.

CVH started using comfort rooms years ago. Dike said that instead of putting a patient in restraints, they try to encourage a patient to spend a little time alone doing something relaxing. He said, “If somebody says to me, when I’m not doing so well, I like to go into my room and play music, and that helps me calm down…” He said that nurses will remember, and bring it up if the patient starts to lose control.

Dike doesn’t expect to stop using restraints. He said there will always be outliers — patients who come straight from emergency rooms and prisons.

Ellen Blair is the nurse director at Hartford’s Institute of Living, which is part of the Hartford Hospital system. Figures for 2013 show Hartford Hospital restrains patients at a little over the state average, but she said they’ve cut back since then thanks to new training programs and more comfort rooms.

Blair said that when a patient does go into restraints, they’re looked after. “I personally go and make sure I know that patient,” she said. “We all talk about it at least every couple of hours, because we don’t want to keep it going any longer than we have to.” She said patients aren’t left alone, and that restraint is only used as a last resort when patients are dangerous to themselves or others.

“Every day,” Blair said, “we come here thinking, okay, we’re going to have a good day. We’re going to prevent people from getting agitated and having to go to that level.” Restraint, however, remains a last resort these hospitals said they don’t plan to take off the table entirely.

PSYCHIATRIC ADVANCED DIRECTIVE -2014 – Words to Caregivers (Short and Simple)

I am uploading my new PAD, IN ORDER TO AVOID INJURIES SUCH AS THESE, brought on in Jan 2013 at Hartford Hospital’s Institute of Living. and photographed the very day I was released.

Now I have a torn left rotator cuff..anything to do with this, I wonder? from IOL 4 point restraints
Left shoulder,,,
Left shoulder,,, caused by brutality  or four point restraints at IOL
Bruises from locked leather retraint cuffs on for many hours, immobilizing me
Bruises on bare ankle from long term use of 4-point  leather restraint cuffs, locked so tightly i could not move. — from IOL 2013

Although I brought the PAD both to the Institute of Living in Jan 2013 and to Yale in Aug 2013, I don’t know what happened that it was abrogated so deeply and so widely. At Yale, they forced medication on me, holding me down three times daily at times, resulting in such psychic regression that as you have all read, I routinely stripped naked, defecated on the floor and smeared feces all over the wall. That I was at one and the same time attempting to communicate with these people, by WRITING WORDS IN MY SHIT, was utterly disregarded by all at the time. But I assure you that if I was regressed and psychotic in doing such things, I was nevertheless still verbal! I am also virtually certain that had they not grabbed me, pinned me to the floor and held me down for three painful injections in the buttocks of a drug that Soviet dissidents have long called pure torture (Haldol in the 60s/70s was the subject of many a televised congressional hearing, and discussed in just such terms…) my response would have been very very diffferent indeed. 

 

That said, they did what they claimed they had to do, and when I left, I left feeling absolutely convinced that my life was and had been mortally threatened, that I could NEVER return, that I would literally be murdered if ever I dared.   Nothing more need be said about such sadistic places as the Institute of Living at Hartford Hospital. Even in the Patient Care Guide and Journal, they are at pains to make it clear that any loud or out of control behavior will be dealt with swiftly and severely, with seclusion, restraints, and even charges pressed by the local authorities! (NO attempts to soothe the traumatized patient or act on what CMS has urged be the best practices of trauma-informed and patient-centered-care at the IOL. No, at Hartford Hospital, it is all about NO SWEARING and staying quiet, non-disruptive. The “Or else” threat behind it all is not even implied but openly stated in their rules and obligations section. Why ANYONE would want to set themselves up for treatment in such a place is beyond me…They have even edited out any attempts at kindness from the old handbook that I was given just a year ago.   Yale at least attempted to live up to a policy of Trauma-informed  and Patient-centered care. When they said No Restraints policy, I believe they meant it, at least in terms of NO MECHANICAL leather and shackles restraints.

 

And I believe that had Robert Ostroff MD, NOT been in charge of my care during the week or two that Robert Milstein MD was away, some of the brutality might not have occurred at Yale and I might be writing less devastated things about the Washington Square 2 unit, a place I had once so hopefully described as a “soft, gentle place to land in a psychiatric crisis.” But as much as because of my outrageous and disruptive behavior in response to their trauma as because of their repetitive violence and cruelty, I can never return there…a sad thing I suppose, since there is literally no safe place in Connecticut for me.* *more on this later or in another post.  What I have posted here is an update in order to Keep me OUT of the hospital as much as to direct my care if I am put inside, It is not the whole thing, only the first two or three pages, I would be happy to upload the whole thing so you can see how I did it, if anyone indicates interest. Let me know. So far it was always the first three pages that got people’s attention.   ______________________________________________________

Pamela Wagner’s

PSYCHIATRIC ADVANCE DIRECTIVE 2014

 

FOR WHEN I AM HOSPITALIZED OR INFORMATION TO HELP TO AVOID IT

 

Miss Wagner has experienced multiple episodes of severe psychological and physical trauma, including date rape, the suicide of two friends, and domestic abuse by caregivers. She should NOT be subjected to restraints, involuntary seclusion, or forced medication. The use of these inevitably leads to re-traumatizing and injury, regression and severe worsening of her psychiatric symptoms.

 

HOW TO INTERVENE IN A CRISIS:

  • DE-ESCALATION IS ESSENTIAL  
  • DO NOT TOUCH ME OR GRAB ME.
  • DO NOT LAUGH AT ME.
  • I WILL CALM DOWN IF YOU REMEMBER THAT:

 

  1. I AM SCARED AND PARANOID. I ONLY FIGHT IF I FEEL UNDER ATTACK.  DO NOT USE A SHOW OF FORCE, AS THIS WILL FRIGHTEN ME MORE.

 

  1. DON’T ISSUE ULTIMATUMS…That will push us all into a corner and serve nothing
  1.  AN UNRUFFLED PERSON SHOULD ASK ME TO TAKE A DEEP BREATH, and try other verbal calming techniques. I am always grateful for people remaining calm when I am upset.

 

  1.  NEVER LEAVE ME ALONE IN A BARREN (seclusion) ROOM.

 

  1. A WEIGHTED OR WARMED-UP BLANKET SOOTHES ME. SOMETHING ICY TO EAT CAN ALSO HELP.

 

  1. PLEASE LISTEN TO WHAT I HAVE TO SAY.  Medication may not be needed if you hear what the problem is.

 

  1.  IF NECESSARY, YOU MAY PERSUADE ME TO TAKE ORAL MEDICATION, if you negotiate this with dignity and kindness. Keep speaking to me calmly and explain your reasoning.

 

*I cannot reiterate enough that if you utilize 4-point restraints or seclusion, it is virtually guaranteed that you will see regression, increased hostility and aggressiveness as a result. Please don’t do something everyone will regret.

 

 

ADDITIONAL STATEMENT TO CAREGIVERS (PLEASE READ)

It is important that you understand that I do not have a personality disorder (you can confirm this with Dr Angela C——, or any of my longtime outpatient providers and friends and family members). If my behavior/emotions seem out of control, it is because I am out of control – temporarily.

I have had tertiary CNS Lyme disease, which I was informed after multiple positive PCR and Western Blots during treatment was likely incurable. During my initial illness, my brain developed MRI lesions which may predispose me to temporary emotional and behavioral abnormalities but these are NOT my norm. Anyone who knows me well would tell you that, if you ask them.

I am not always able to communicate my fear but because I feel so threatened and unable to communicate clearly about it (lest there be consequences to me) I may become very angry at the hospital situation. I am not an angry person, but I do have trauma issues, as many people do.

Please be aware that I am sometimes mute, in frustration and overwhelmed by circumstances. You can provide me with a pad and pen to facilitate communication, but berating me into speaking will no purpose and may only precipitate anger.

Ascertain from me whether the information you have at hand is correct. Too many records and hospital charts have been drawn up on faulty information from earlier charts or information gleaned from others but not from me, and the consequences to my treatment have been devastating.

I would prefer NOT to take any medications and will resist them. I want to experience my LIFE AND MY FEELINGS. If you insist on meds, the ones that work best are _______.

I will not take any drug that induces weight gain. If you force it, know that I will fight you, tooth and nail.