Volume 5, Number 4

Risk Management Regulatory Concerns: The Evolving Legal Framework for Chemical Restraints

Debra A. Pinals, MD, and Paul S. Appelbaum, MD

Dr. Pinals is Associate Professor of Psychiatry, Law and Psychiatry Program, Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA.

Dr. Appelbaum is A.F. Zeleznik Professor and Chair, Department of Psychiatry, and Director, Law and Psychiatry Program, University of Massachusetts Medical School, Worcester, MA.

Editor's Note

Chemical restraint is defined as any drug administered orally or parenterally to restrict a patient's movement and that is not standard treatment for the condition and already part of their established regimen. Only physicians or duly licensed professionals may initiate restraint. The orders cannot be written as standing orders or on a prn basis; a new order must be written each time a restraint is implemented.

In 2000, Congress passed legislation governing the use of seclusion and restraint. Their requirements were very similar to those of the HCFA, with several added restrictions on the use of chemical restraints in nonmedical facilities for children and youth as well as in juvenile medical or psychiatric facilities.

As always, it is imperative to document all details, including an explanation of the specific behavior warranting restraint, alternative less restrictive measure that were considered, and information re-garding observations made while the patient was being monitored.

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