January 9, 2003
The Honorable Thomas A. Scully
Administrator
Centers for Medicare and Medicaid Services
Department of Health and Human Services
200 Independence Avenue, SW
Washington, DC 20201
Dear Administrator Scully:
The December 23, 2002 edition of the American Medical News reported that
the Centers of Medicare and Medicaid Services (CMS) was considering abolishing
the rule requiring face-to-face physician evaluation of hospital patients
within one hour of the initiation of seclusion or restraint procedures.
A copy of the article is attached. We are very alarmed to hear that CMS
is considering eliminating this important protection for individuals in
hospitals and other mental health facilities.
Both seclusion and restraint procedures have a high potential for significant
adverse effects. In fact, it was primarily as a result of a 1998 Hartford
Courant series of stories that described a decade of 142 deaths caused
by restraint and seclusion usage in mental health facilities throughout
the country, and a 1999 General Accounting Office study title
"Improper Restraint or Seclusion Use Places People at Risk",
that CMS (then the Health Care Financing Administration) issued the rules
on seclusion and restraint as part of the current Medicare and Medicaid
Hospital Conditions of Participation. These rules, including the one-hour
rule mentioned in the
American Medical News article, were based on best available clinical data
and State regulatory experiences that reduced the likelihood of harm caused
by the use of seclusion and restraint.
We encouraged the Health Care Financing Administration to establish these
rules and applauded their implementation as a positive step in protecting
a vulnerable population. We oppose any efforts to weaken this patient
protection and would urge you not to do so without clear evidence showing
the change would not diminish protection against harm or death for individuals
subject to seclusion and restraint procedures.
Please advise us as to the course of action you plan to take with respect
to these important protections for patients in mental health facilities.
If, in fact, CMS plans to abolish any of the current seclusion and restraint
procedure rules, we request that you apprise us of which requirements
will be changed, your assessment of the potential effect of such changes
on patient care, as well as the timetable for the implementation of such
changes.
We know that protecting the health and safety of Medicare and Medicaid
beneficiaries is one of the top priorities for CMS. Weakening limitations
on the use of seclusion and restraint certainly does not appear to be
consistent with that goal. We look forward to your timely response.
Sincerely,
Rep. Pete Stark
Rep. John D. Dingell
Rep. Ted Strickland
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