questions and answers
The emergency in the hospital: when is a patient restrained?
Paramedics bring a man to the new Central Emergency Room Altona (ZNA) in the Asklepios Clinic Altona. photo
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If a patient is raging, he can be bedridden. At least that’s how it is in psychiatry. And otherwise? One thing is clear: Fixation is the last resort.
It happens more often in psychiatric wards: If patients endanger themselves or others, they can be fixed to the bed with belts. But this also happens in other clinics. This had terrible consequences in a Pforzheim hospital: a patient who was fixed to the bed died on Tuesday evening after a fire in the emergency room. Investigators are investigating the circumstances. In general, a patient may only be tied to the bed under certain conditions.
Are there binding rules for restraints in hospitals?
To the knowledge of the Baden-Württemberg Hospital Association (BWKG), there is no universal checklist. “It’s a medical decision,” said a spokeswoman. And only a last and short-term measure in cases of self-harm or harm to others. The law on help and protective measures in the case of mental illnesses (Mental Health Aid Act – PsychKHG) provides guidance.
When can a person be arrested?
The legal background is complicated because each federal state has its own law. In Baden-Württemberg, according to the PsychKHG, “special security measures” are permissible under strict conditions. According to Section 25, this applies “if and as long as there is a current, significant risk to safety in the recognized facility, in particular in the event of significant self-endangerment, the endangerment of important legal interests of third parties or if the accommodated person wants to leave the facility without permission, and this risk not with less can be countered by intrusive means”.
What are the hurdles?
The freedom of the person protected by the Basic Law (Articles 2 and 104) is a valuable asset. According to a judgment of the Federal Constitutional Court in 2018, restraint for a longer period of time may only be made after a judicial decision. According to the PsychKHG, a shorter security measure can be ordered by a doctor for a limited period of time. It must be revoked immediately if the requirements for its order no longer apply. The highest German judges also demanded that a restrained patient be continuously monitored by nursing or therapeutic staff.
What security measures are there?
In addition to detention and isolation in a specially secured room, the PsychKHG expressly mentions restraint. There are different levels: on the legs, arms and stomach – sometimes also around the chest and forehead. With a seven-point fixation, the patient cannot even move his head.
How often do fixations occur?
The hospital society for general clinics does not have any figures on this. As far as the psychiatric institutions in the state are concerned, the Federal Constitutional Court assumed 17,600 cases at the hearing on the restraint of psychiatric patients in 2018 in Baden-Württemberg alone.
A few deaths after restraints became known nationwide: In 2019, for example, a 34-year-old student from Cameroon died of heart failure after security service employees forcibly restrained him. The death of Oury Jalloh, who died in 2005 in a fire in his cell in Dessau (Saxony-Anhalt) after fleeing Sierra Leone, his hands and feet tied, caused a stir. Jalloh was drunk and on drugs. It is still unclear whether he set fire to the mattress himself.
What is the status after the Pforzheim fire?
It is still unclear how the fire started, what the man died of and why he was not taken to safety. The circumstances of the fixation are also examined. “It takes a certain amount of time until everything is cleared up,” said the prosecutor.
The Karlsruhe human rights lawyer David Schneider-Addae-Mensah assumes a homicide by omission. He has filed a criminal complaint against unknown persons on suspicion of murder. There is an urgent suspicion that the patient died as a result of the fire because he was unable to escape. During a fixation, a “seat watch” is mandatory. “Apparently there was no such thing, or she left the dead man alone,” said the lawyer. With his ad, he primarily wants to put pressure on the fact that it is also clear for general clinics and old people’s and nursing homes that someone always has to be careful when restraining people.