Seclusion, restraints and screams marked man’s final hours at psychiatric unit

September 22, 2010

Cliff Detty – family photo

By LARA COOPER, a Noozhawk reporter

(Note: This is part two in a three part series. Part one highlights how the father of a mentally ill man fought for his son. Noozhawk followed the ordeal of Rich Detty, a Santa Maria man whose son, Cliff, died while under restraints at a Santa Barbara County psychiatric health facility in April.)

After hours of screaming, Cliff Detty wasn’t breathing. His chest lay still beneath the restraint that held it down. His limbs, also strapped down, stopped thrashing. Under the clinical lights of the room in which he was placed for observation, the 46-year-old Santa Maria man was alone when he slipped away.

It’s unclear how much time passed before nurses noticed he wasn’t breathing, and the CPR they began wasn’t enough to ward off death. The voice that had been screaming out for release from the straps was now quiet. Paramedics arrived, but after a time, the chest compressions stopped. Now, only silence.

The events of that night in late April, revealed through the medical reports left behind, didn’t take place in a jail or a prison but in a local psychiatric unit run by Santa Barbara County’s Department of Alcohol, Drug and Mental Health Services. Detty, diagnosed with paranoid schizophrenia, had been transported to the county’s Psychiatric Health Facility in Santa Barbara from the emergency room of Marian Medical Center in Santa Maria.

When Detty arrived in Santa Barbara on the evening of April 28, 2010, PHF staff noted that he was aggressive, to say the least. Almost immediately, staff made the decision that he needed to be restrained. Putting patients in restraints is a risky practice, even when everything is done correctly, and the procedure can cause injuries to staff, as well as injuries, or worse, to the patient.

And something else may have set Detty on the path to his early death that night: He had a high level of methamphetamines in his system, a situation that is known to greatly increase the risk of sudden death while under restraint.

The fact that Detty was placed in restraints is not surprising. That’s because the 16-bed Santa Barbara unit to which he was taken keeps patients in restraints almost three times as long as other similarly sized California facilities that submitted quarterly reports to the state Office of Patient Rights, according to OPR data. While large mental institutions throughout California, and the nation, are choosing to phase out the practice for safety reasons, Santa Barbara’s facility has continued to use the procedure.

ADMHS officials have refused to comment on Detty’s specific case, so what happened to him that night has been taken directly from the medical documentation logged at the time at the Psychiatric Health Facility. The reports reviewed by Noozhawk reveal a grim picture of what unfolded that night, with Detty becoming more agitated the longer he was kept in restraints.

Before the night was through, the reports appear to indicate that Detty, who was 6 feet tall and 187 pounds, had been confined in restraints continuously for nearly 11 hours. Although officials won’t confirm this, none of Detty’s documentation notes that he had been released from restraint. Upon arriving at the PHF unit, “patient was agitated, screaming at staff during transfer from gurney to bed, aggressive and combative,” one report reads.

The seclusion restraint form, filled out at 9:45 p.m., stated that the “patient is very aggressive and combative upon arrival to the unit, unable to follow directions, yelling and screaming at the staff, threatening staff ‘Leave me alone, you f****, I’ll kick your asses.’”

Criteria for release was listed as “able to calm down and follow directions, no threatening remarks, no yelling or screaming.” The form says Detty was “instructed to calm down, and listen,” given several doses of anti-psychotic medications, and placed in an observation room, where a microphone and camera were kept on so staff could observe him.

But several discrepancies in the report raise questions. The report stating that seclusion and restraint had been initiated was only signed by a nurse on duty, and not a medical doctor, who should have signed the order within 24 hours, as required by the California Code of Regulations.

Detty continued yelling, urinated on himself, had his linens changed and a diaper placed on him, and was “uncooperative” to care, the report states. Lead nurse Reyn Bugay lamented in her notes that Marian Medical Center ER staff should have administered more drugs prior to transferring Detty to Santa Barbara.

Detty continued screaming, pulling at his restraints and saying “I want to go back to my place,” the report states. Another report for seclusion and restraint was filled out at 10:30 p.m., and reported that Detty would wake up agitated, between periods of sleep. At this point, he was naked and held by a five-point restraint, the maximum secured restraint with straps across each of his limbs and midsection. A PHF worker wrote that Detty didn’t appear able to understand the criteria of his release from the restraints, much less be able to discuss it.

“Agree with Seclusion and Restraint until able to vow compliance or maintain behavior,” the caretaker wrote.

Another discrepancy pops up at that time. At 10:30 p.m., a group of nurses, lead by Bugay, had a debriefing session. Under the state Health and Safety Code, debriefing should occur after the patient has been released from restraint, in order to evaluate how to avoid a similar incident in the future. The system was designed to create a feedback loop between patients and caregivers.

But these nurses held the debriefing while Detty was still in restraints, and not responding well. Patient participation is voluntarily, but it’s apparently highly unusual that nurses indicated Detty had chosen not to participate in the session.

Meanwhile, Detty’s agitation grew. Another page, also filled out at 10:30 p.m., describes all the strategies staff used to try to calm him down. Eight boxes are checked, including “active listening” and “offer medication.” But from the reports, it appears that release from the restraints was never considered, in spite of increasing panic from the patient. State law requires that staff check every 15 minutes to ensure the restraints have been applied correctly, and that they remain in their line of sight for observation in the meantime. One report describes each check: Detty’s screaming and “pulling at restraints” is mentioned 13 times.

It’s unclear how much time had elapsed when attendants noticed that Detty was no longer yelling, around 1:15 a.m. on April 29. “Patient noted to have no respiration,” and then a quick succession of events records Detty’s last moments alive:

“911 called, CPR started, paramedics arrived, patient expired.”

Four months later, Detty’s father, Rich, doesn’t have many answers about what happened that night. Although a toxicology report has been issued detailing what was in Detty’s blood when he died, the Sheriff’s Department still hasn’t issued a cause of death in the case. The Coroner’s Office is part of the Sheriff’s Department.

When Rich Detty was finally able to read the PHF medical reports, he was disturbed.

“It bothered me a lot that all he did was scream and yell and just wanted to be free,” he told Noozhawk. “I hope when people die they go out in dignity and class, and on their own terms … but that was pretty miserable.”

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I’m saddened to hear about this whole situation because I was at one point in my life dealing with the same issues with a (now former) spouse that suffered from bipolar. When we first married, she really worked hard on keeping up with her meds and blood tests. As time went along, it became apparent that she didn’t like the side effects of the meds of which there were many and in the end I ended a 5 year marriage. In that period I’ve endured the massive swings of emotions and health problems where she would lay in bed and just want to die to where she was so excited about everything, you could almost see her heart jump out of her chest.

For Mr. Detty’s Father, the system really doesn’t work for a solution, only a continuation. Despite being the husband that paid for her medical care and took her to her doctor appointments, I was shut out of her meetings because i caught her in a lie to lower her dose of medication. Despite being the one who was her partner, I was dropped in being one who could help her condition. In the end, I pulled the plug on our relationship both financially and emotionally and moved on. In retrospect 11 years later, I’m still disgusted at the system on how it handles mental illness.

I guess you didn’t read my first sentence or maybe it wasn’t clear enough. The comment was from the Noozhawk article that appeared on Noozhawk 3 weeks ago.

Sorry keithb, You’re right and I missed it. I just went over to Noozhawk and dropped a copy/paste on Irishhenman, which is where my post should have been directed. ;)

“Additionally, our mental health facilities are full of criminal offenders avoid jail,”

Took care of that didn’t we, you are not briefed on what a patient has done to get where he is.

Conditions for release, “able to calm down and follow directions, no threatening remarks, no yelling or screaming.” The form says Detty was “instructed to calm down, and listen,” given several doses of anti-psychotic medications, and placed in an observation room, where a microphone and camera were kept on so staff could observe him.” to death.

So under your conditions he was not a criminal, don’t try to spin out of this.

“instructed to calm down, and listen,” given several doses of anti-psychotic medications,”

Several doses of Haldol or Thorazine both can cause death when inter-mixed with street drugs these are professionals who work there?,,,,,, I am merely speculating on the drugs given, check the record,,,,, Just maybe given that he was drugs, they shouldn’t of given him more, maybe the burnt out workers should of calmed him down by holding his hand instead of taking it away from him. Tied down in the sun on an ant hill, honestly a lot of you know me, I speak the truth Clifford was no threat and about 1/4 the U.S. population is currently on meth, or something else,over half if you count prescription narcotics, when a person goes to mental health or is taken there, they feel safe, like the situation is out of their hands as it is, some act out as Clifford did. I guess the staff just wasn’t up to the task of protecting their patients from harm from there own, one to many injected doses.

Should of just untied him, an if that didn’t work tie him back up again, instead of the last fatal shot. Major screw up!

You’re so right about administering too many drugs. Mr father developed dementia while he was in the hospital and was taken to a hospital psych ward, supposedly to be stabilized. He was there for 6 weeks and they were trying all sorts of medications. Haldol was one of the drugs that made him worse, he literally wouldn’t sleep for days when they would give it to him, likewise Ativan and all drugs of that class did the same thing to him. We finally went in and just took him home and got some 24/7 male caregivers because he was so violent we couldn’t trust that we would be able to handle him. We also stopped all the drugs. He was an angel within 24 hours and had another good 2 years before he relapsed. I’m serious, within 24 hours we didn’t need the care givers and he was forgetful but happy, pleasant and conversational. He even resumed driving. All we had to do was get him out of that locked ward and off all the drugs they had been giving him.

This was one of the comments on the original article:

Mr. Detty’s story is tragic but not unfamiliar. Working with these kinds of patients daily I continue to be disheartened by the tone of comments comming from people who do not work with these patient’s regularly, and the assumption that the staff are poorly trained or don’t care about the people they treat. In California in particular the public is quick to judge, but when it comes time to put money into mental health they balk. More concerning is the lack of interest and caring by California politicians and leaders. If the plight of the mentally ill was truely important to both these groups, it would be evident in funding, rersources, facilities, public education, and politicians who advocate for the mentally ill. This is not the case. Like a police officer who is making a critical and immediate decision with an armed, threatening, and uncooperative person where others are in harms way, psychiatric nursing staff regularly encounter patients whose dangerous acts can cause immediate and serious injury to others or themselves. Intoxicated mentally ill persons who are violent pose a significant and immedicate risk of serious injury to the staff and other patients. Some times restraint is the only option (should always be the last option) to protect those patients from harm to themselves or others. The issue was most likely not whether or not restraint were neccessary, it may not be one of policy or procedure either, rather it is most likely an issue of monitoring the patient after he was in restraints! I cannot emphasize enough, after being in this field over 30 years for 5 different facilities, and being a commited advocate for patient safety first, those who believe that restraint is never neccessary have not worked with violent and aggressive menatlly ill or intoxicated patients. Additionally, our mental health facilities are full of criminal offenders avoid jail. Those who would quickly determine that staff don’t care for the violent and aggressive mentally ill they are treating, have no idea of the committment and character of the people who work with the mentally ill. You don’t stay in this field with the exposure to danger, staffing issues, decreasing resources, negative public perception, numerous responsibilities, and minimal gratification, unless you love this work, and care deeply for the people who have been entrusted to your care!!!

Sorry keithb but I don’t buy your weak excuses. This man was held in restraints for 11 straight hours. Strapped down to a table. You all knew that he was suffering from psychosis in the form of paranoid schizophrenia and somehow these “power freak medical professionals” developed a criteria that required Mr. Detty to be calm, polite, and lets just say rational. First you know damn well that it can take days or even weeks to identify the proper medication to treat individual psychosis and you also know that even when you administer the correct medication that it takes day’s or even weeks before the patient shows marked improvement.

When the staff saw that they were exacerbating the problem why not try a straight jacket? It would have been less confining. How about a padded cell, don’t you have those? They didn’t help Mr. Detty because they didn’t like his attitude and he was going to do things their way or suffer. Just how long were they going to leave him those restraints while he lay there stark ass naked, defecating and urinating all over himself while he screamed and struggled? Don’t even try to tell me how much they cared because I would say they shouldn’t be allowed to work with any psychotic patients, not ever. I find the individuals that were on staff that night to be incompetent, willful and sadistic.

If you had done this in the State of Rhode Island, you would all be in jail for man slaughter. The type of restraints that were applied to Mr. Detty are illegal there. Somebody should be charged with man slaughter regardless of whether it was legal or not in this state. I mean it, someone needs to GO TO PRISON for this.

and another thing…..I don’t care if he was on Meth, the man had been diagnosed with schizophrenia years earlier, he was not capable of being responsible for himself.

Cindy Amen! You know me and this guy were friends, you would of liked him, he has hundreds of friends unaware of his death, you are right somebody needs to go to prison and I know innocent until proven guilty but, this hospital took the law into their own hands, one flew over the coo coos nest. And that one or two or three, is sweating heavily right now because they know they could be strapped down for what they did, let’s see the toxicological report, but I am leaning toward your conclusion.

Oh cry me a river Keith. You and many of the rest of the public employees are a bunch of overpaid thankless idiots that suck our tax dollars. We have had men die in custody in the local jail because of being restrained while on meth. Don’t you think it would be prudent that when someone is brought in that they would be tested for meth before putting them in restraints if they had any of the tell tail symptoms? Why are you so called professionals not trained for that? If you really cared like you say you do, this would be common practice to avoid needless deaths. Friggin hypocrite.

So if they got more money they wouldn’t of tied him up?

I just found out I went on a surfing trip to Hawaii in 1989 with the victim, my whole hearten apologizes to the family and friends, this was Clifford, pismo beach surfer who was not violent,

I will testify under oath that even under the influence of the most powerful drugs this man was not dangerous in anyway, I am anonymous, but when the time comes, I have a provable story to prove it, my sympathy to you, a great wrong has been committed, I surfed, fished and went on a plane with this man, he has never even been in a fight! These hacks just up ended killed him and I will help you prove it! Contact Calcoast I hereby give my permission for them to give to you my email and telephone, this is a tragedy that cannot be let go. Again I am and many others are truly sorry for your loss at the hands of people, we pay, this is a personal matter now!

When Detty arrived in Santa Barbara on the evening of April 28, 2010, PHF staff noted that he was aggressive, then they gave him a butt load of more drugs tied him down and watched his death, morbid!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Maybe he was screaming because he was going to die! Wake up, this a patient, who have been dangerous, these day’s a great white shark, who would be harder to restrain, has more rights, I for one hate tweekers, but don’t make it my life’s work to kill them. This kind of thing happens because of the hand off from police to mental health and by the way your son passed away,,,,, er please don’t sue the crap out of us, that is if you can find a scummy lawyer to take your case, you raised him it’s your fault he’s a drug addict. That’s what you will would get from LEO, I for one think your son was a victim and

twenty million is a good figuer to start with.