Mental Health; Mental Hospitals; Requiring Residents to Participate in Fire Drills

Subject:

Mental Health; Mental Hospitals; Requiring Residents to Participate in Fire Drills

Requested By:

Sarah T. Morrow, M.D., M.P.H. Secretary Department of Human Resources

Questions:

1. In a fire-drill situation at a State mental hospital is the staff authorized to physically remove a non-consenting patient from his ward?

2. In such a situation would it make any difference if the patient were on voluntary or involuntary status?

3. If the answer to question (1) is yes, what degree of force should be utilized in removing the patient?

Conclusions:

1. Yes.

2. No.

3. Only a reasonable degree of force under existing circumstances should be utilized in removing the patient.

It appears that the Life-Safety Code and accreditation standards vital to the operation and funding of State mental hospitals require that internal disaster, fire and evacuation drills shall be held at least quarterly for each work shift of program personnel in each separate patient-occupied building. These questions are prompted by the refusal, on occasion, of some patients to get out of bed and leave the ward during such a drill.

The patients involved include some who are involuntarily committed to the hospital by court order, others who are voluntarily admitted upon their own request, and juveniles or other incompetents who are voluntarily admitted with court ordered approval. In all of these situations, the State occupies the positions of parens patriae regarding these residents; as a result, the State is responsible for the patient’s safety, health and welfare. Certainly the evacuation of all residents, including those reluctant to participate would be necessary in order to truly evaluate the adequacy of evacuation procedures. Thus, the ability to require participation in the basic drills described is a fundamental necessity in order to enable the fulfillment of the State’s responsibilities — for the short range purpose of immediate protection of the residents involved as well as for the long range purpose of insuring the continued operation of the hospitals in order to care for present and future mentally ill persons. No distinction should be made on this score as to the right to refuse to participate by the voluntarily admitted patient or those patients present pursuant to a court order. In other words, the remedy available to a purely voluntary competent patient, should he so desire, would be a request for discharge within the time limitations levied by G.S. 122-56.3, not absolution from compliance with reasonable requirements of the hospital.

In order to secure evacuation, reasonable force may be utilized. As an addendum, though, it would seem that the employees securing compliance should be persons trained in the handling of mentally ill patients who have performed similar functions in insuring compliance with other reasonable hospital directives. On a cautionary note, it should be recognized that any foreseeable injury to the patients which is caused by undue force could well leave the hospital, the State and the individual employee vulnerable to litigation seeking damages.

Rufus L. Edmisten Attorney General

William F. O’Connell Special Deputy Attorney General