This regulation governs the use of medical restraints by mental health (MH) providers in the District of Columbia when administering emergency medical or surgical treatment to an uncooperative consumer. It requires a licensed physician's written opinion that treatment is necessary to prevent serious injury or death, mandates documentation of all attempts to use less restrictive means, and restricts restraints to the minimum duration necessary for the procedure. Special consent requirements apply when the consumer is a minor or has a legal guardian, and routine medical procedures may not use restraints without informed written consent.
View official source512 MEDICAL RESTRAINTS 512.1 Medical restraints may be used to administer medical or surgical treatment to an uncooperative consumer, if: (a) In the written opinion of a physician licensed to practice medicine in the District, medical or surgical treatment is necessary to prevent the immediate serious injury or death of the consumer; and (b) The procedures set forth in §§ 506.3, 506.9, 506.10 and §§508.1, and 508.2, governing the use of restraints, are followed. 512.2 The MH provider shall document in the consumer's clinical record that all attempts to gain the consumer's cooperation through less restrictive means have failed, or that making such attempts would delay the necessary emergency treatment and further jeopardize the consumer's life and safety. 512.3 The documentation in the consumer's clinical record shall also describe the circumstances that give rise to the medical emergency, as well as the reasons why restraints are deemed necessary to administer the needed treatment. 512.4 In the event the consumer is a minor or an adult with a legal guardian, the parent or guardian's consent shall be obtained if possible. If the parent or guardian is not available, the MH provider shall document all attempts to gain the parent's or guardian's consent, or that making such attempts would delay the necessary emergency treatment and further jeopardize the consumer's life and safety. 512.5 The least restrictive and most comfortable restraints available shall be used as necessary to accomplish the emergency medical or surgical procedure. The restraints may only be applied for the duration of the procedure and then shall be removed. 512.6 The use of restraints to perform routine medical procedures, such as phlebotomy, urine screen, or x-ray is prohibited, unless informed consent to the restraint is obtained from the consumer or the consumer's surrogate healthcare decision- maker pursuant to 22-A DCMR, Chapter 1. The consent shall be in writing and placed into the consumer's clinical record for each procedure. SOURCE: Emergency and Proposed Rulemaking published at 51 DCR 8691 (September 3, 2004)[EXPIRED]; as amended by Emergency and Proposed Rulemaking published at 51 DCR 11863 (December 31, 2004)[EXPIRED]; as amended by Emergency and Proposed Rulemaking published at 52 DCR 5957 (June 24, 2005)[EXPIRED]; as amended by Final Rulemaking published at 52 DCR 7229 (August 5, 2005). District of Columbia Municipal Regulations Mental Health 22-A DCMR § 512