-Caveat Lector- ----Original Message Follows---- From: Martin Hirschfeld <[EMAIL PROTECTED]> To: undisclosed-recipients:; Subject: APA brags of congressional victories for psychiatric violence, profit Date: Mon, 6 Nov 2000 22:33:48 -0600 (CST) The following letter was released on 11 October 2000 by the APA to mark it's succesful gutting of H.R.4365 the "Abuse and Restraint Bill". Apologies if this has already been posted. The full version can be found at: http://www.psych.org ====================================================== APA PUBLIC POLICY ADVOCASY FEDERAL UPDATE: SECLUSION & RESTRAINT LEGISLATION PASSES October 11, 2000 TO: ALL APA MEMBERS FR: JAY B. CUTLER, DIRECTOR OF GOVERNMENT RELATIONS RE: SECLUSION & RESTRAINT LEGISLATIVE UPDATE Culminating a two-year battle, the House and Senate have cleared legislation that establishes new federal standards for the use of seclusion and restraint in hospital and non-hospital settings. The seclusion and restraint standards were sent to the President as part of H.R. 4365, an omnibus bill that reauthorizes the programs of the Substance Abuse and Mental Health Services Administration (SAMHSA), implements new child and maternal health programs, and enacts some features of the APA-supported Domenici-Kennedy Mental Health Early Intervention, Treatment, and Prevention Act (S. 2639). The seclusion and restraint provisions were modeled closely on legislation sponsored by Senator Chris Dodd (D-CT) that had previously passed the Senate twice, first as part of the SAMHSA reauthorization (S. 976) and later as an amendment to the Labor-HHS appropriations bill. ... ...HOUSE RESTRICTIONS DEFEATED: While APA would clearly prefer that Congress not legislate additional standards, advocacy groups and their allies were aggressively and relentlessly promoting clinically inappropriate and unacceptable restrictions on the medically-necessary use of seclusion and restraint via H.R. 4867, a stand-alone SAMHSA bill introduced by House Democrats. The House bill included much more stringent limits on use (e.g., a "must fail" requirement for use of lesser measures before restraint or seclusion is allowed; mandatory reporting of deaths and injuries to protection and advocacy systems; mandatory reporting of deaths occurring up to a week after discharge). APA coordinated an aggressive and ultimately successful lobbying strategy to kill the House bill with key support from AMA, AHA, NAPHS, and the Federation of American Hospitals. For institutions (e.g., public and private hospitals), the new requirements are effectively "Dodd lite" and APA and our coalition were able to win additional exceptions as noted for time outs and physical escorts. As a consequence, these standards will not create additional burdens or conflicts with current HCFA and pending JCAHO standards, and may actually offer an opportunity for some beneficial changes to the underlying HCFA rules. 1-HOUR RULE UNDER CONGRESSIONAL ATTACK: In related news, Representative Saxby Chambliss (R-GA), Chairman of the House Budget Committee Task Force on Health, has called on HCFA to suspend the so-called "1-hour rule" requiring Medicare/Medicaid hospitals to conduct a face-to-face assessment of patients by a physician or licensed independent practitioner within 1 hour of the initiation of restraints or seclusion. Representative Chambliss' request came in the wake of a finding by the Small Business Administration Office of Advocacy that HCFA did not consider the impact of the 1-hour rule on small hospitals. The SBA also found that HCFA had failed to consider less burdensome alternatives, putting HCFA in violation of the Regulatory Flexibility Act. In a letter to Representative Chambliss, the SBA commented that "In (HCFA's) zeal to published a good-intentioned regulation to protect patients' rights, some rather serious economic effects were overlooked. Some of the effects of the rule could have been alleviated -- while maintaining patients' rights -- through a more careful regulatory flexibility analysis." The SBA also noted that "the affected industry did not have a meaningful opportunity to comment prior to the effective date of the regulation. It is never advisable for agencies to make policy or regulatory decisions in a vacuum." The SBA concluded that "to the extent that HCFA did n! ot consider the impact of its regulation on small rural hospitals or less burdensome alternatives, the agency did not comply with the RFA (Regulatory Flexibility Act)." Representative Chambliss called on HCFA to suspend the 1-hour rule until the agency has completed the economic impact analysis required by Federal law. In late September, a U.S. District Court judge ordered HCFA to conduct the analysis, which it failed to do before implementing the 1999 seclusion and restraint rule. The Court, however, allowed the rule to stay in force pending the economic analysis. APA will continue to work with Congress and our allies to mitigate the impact of the 1999 rule. ### Any election in which only two individuals are allowed exposure is, by definition, a fraud. We are an occupied nation. http://www.mediachannel.org/views/oped/neo.shtml http://www.ddh.nl/nwd/2000/index-eng.html http://www.angelfire.com/mi/smilinks/thirdeye.html ### _________________________________________________________________________ Get Your Private, Free E-mail from MSN Hotmail at http://www.hotmail.com. Share information about yourself, create your own public profile at http://profiles.msn.com. <A HREF="http://www.ctrl.org/">www.ctrl.org</A> DECLARATION & DISCLAIMER ========== CTRL is a discussion & informational exchange list. 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