N.Y. Mental Hygiene Law § 33.04: Restraint of patients

§ 33.04 Restraint of patients.

(a) As used in this section, "restraint" means the use of an apparatus

on a patient which prevents the free movement of both arms or both legs

or which totally immobilizes such patient, and which the patient is

unable to remove easily.

(b) Restraint shall be employed only when necessary to prevent a

patient from seriously injuring himself or others. It may be applied

only if less restrictive techniques have been clinically determined to

be inappropriate or insufficient to avoid such injury. It may not be

employed as punishment, for the convenience of staff, or as a substitute

for treatment programs.

(c) The "camisole" and the "full or partial restraining sheet", or

such other less restrictive restraints authorized by the commissioner,

shall be the only permissible forms of restraint.

(d) Restraint shall be effected only by written order of a physician

after a personal examination of the patient except in an emergency

situation, as provided by subdivision (e) of this section. The order

shall set forth the facts justifying the restraint and shall specify the

nature of the restraint and any conditions for maintaining the

restraint. The order shall also set forth the time of expiration of the

authorization, with such order to apply for a period of no more than

four hours, provided, however, that any such order imposing restraint

after nine o'clock p.m. may extend until nine o'clock a.m. of the next

day. A full record of restraint, including all signed orders of

physicians, shall be kept in the patient's file and shall be subject to

inspection by authorized persons.

(e) If an emergency situation exists in which the patient is engaging

in activity that presents an immediate danger to himself or others and a

physician is not immediately available, restraint may be effected only

to the extent necessary to prevent the patient from injuring himself or

others at the direction of the senior member of the staff who is

present. The senior staff member shall cause a physician to be

immediately summoned and shall record the time of the call and the

person contacted. Pending the arrival of a physician, the patient shall

be kept under constant supervision. If a physician does not arrive

within thirty minutes of being summoned, the senior staff member shall

record any such delay in the patient's clinical record and also place

into the patient's clinical record a written description of the facts

justifying the emergency restraint which shall specify the nature of the

restraint and any conditions for maintaining the restraint until the

arrival of a physician, the reasons why less restrictive forms of

restraint were not used, and a description of the steps taken to assure

that the patient's needs, comfort and safety were properly cared for.

Such physician shall place in the clinical record an explanation for any

such delay.

(f) During the time that a patient is in restraint, he shall be

monitored to see that his physical needs, comfort, and safety are

properly cared for. An assessment of the patient's condition shall be

made at least once every thirty minutes or at more frequent intervals as

directed by a physician. The assessment shall be recorded and placed in

the patient's file. A patient in restraint shall be released from

restraint at least every two hours, except when asleep. If at any time a

patient upon being released from restraint makes no overt gestures that

would threaten serious harm or injury to himself or others, restraint

shall not be reimposed and a physician shall be immediately notified.

Restraint shall not be reimposed in such situation unless in the

physician's professional judgment release would be harmful to the

patient or others.

(g) A record of all restraints shall be kept by the director of the

facility.

(h) Nothing in this section shall prevent the use of mechanical

supports necessary to keep an infirm or disabled patient in a safe or

comfortable position or to provide stability necessary for therapeutic

measures such as immobilization of fractures, administration of

intravenous or other medically necessary procedures.