Addendum to Interim Report on Restraint Deaths in Psychiatric Institutions, p. 1
IS THERE A MONETARY INCENTIVE BEHIND THE USE OF RESTRAINTS?
Kenneth Clark, M.D., a Harvard College graduate and psychiatrist, stated that patients were placed in restraints because this then justified their placement in a Psychiatric Intensive Care Unit, which gives a higher rate of reimbursement.
Regarding reimbursement rates for patients placed in restraints know that if they say a patient is uncontrollable the patient is then transferred to the Psychiatric Intensive Care Unit (PICU). The daily rate is higher, so there is a rate increase when the patient is in restraints as the patient obviously needs more intensive care. I know there were instances where the patient was aggravated or provoked to justify the use of restraints and this placement.
The staff at the hospital where I worked referred to the practice as Mayhem Therapy. I don't have exact figures but I do know that it cost more than a thousand dollars a day for a patient for this. This estimate is probably on the low side.1
One psychiatric facility lists their rates for various programs and services. Intensive Care for both adults and adolescent patients costs more than standard services:
Inpatient Hospitalization Programs
*Adult Standard $550.00 per day
*Adolescent Standard $575.00 per day
*Intensive Care (Adult & Adolescent) $650.00 per day.2
Psychiatric Intensive Care Units do include the use of restraints and seclusion in their treatment of patients as noted in the information in the promotional materials of one psychiatric hospital that provides this service.3
Psychiatric hospitals are not the only facilities that get a higher reimbursement rate for patients who are labeled as being more agitated and/or a problem. In an excerpt from an interview with a former residential treatment facility employee from Texas, the claims of Dr. Clark were echoed:
You keep up the incident reports because the insurance company wants to know the progress. You have a Catch-22 in that the insurance wont keep the client there if there isn't some progress, so you have to show some progress, and then if you have a lot of agitation, then you can say that because he has become more difficult, his care has gone from $5,000 to $9,000 per month. That was done.4
A news article that ran in the Charlotte Observer April 5, 1999, discussed the fact that state officials were once again questioning the effectiveness of treatment at an upstate psychiatric facility where they had twice previously removed children after incidents of little care, given drugs they did not need and, in one instance, the sexual assault of a 14-year-old. How much does all of this cost the state?
The state pays $252 per day to the facility for each child covered by Medicaid. From July 1 to March 1, the state paid a total of $642,424, compared with $216,493 during the previous 12 months, according to the state Department of Health and Human Services.5
In March of this year, 9-year-old Timithy Thomas became the latest child to die of asphyxiation after being physically restrained. The facility where Timithy Thomas was placed charges $172.00 per child per day which comes to over $5,100 per month.6
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