§ 33.04 Restraint of patients.

(a) As used in this section, "restraint" means the use of an apparatus
on a patient which prevents the free movement of both arms or both legs
or which totally immobilizes such patient, and which the patient is
unable to remove easily.

(b) Restraint shall be employed only when necessary to prevent a
patient from seriously injuring himself or others. It may be applied
only if less restrictive techniques have been clinically determined to
be inappropriate or insufficient to avoid such injury. It may not be
employed as punishment, for the convenience of staff, or as a substitute
for treatment programs.

(c) The "camisole" and the "full or partial restraining sheet", or
such other less restrictive restraints authorized by the commissioner,
shall be the only permissible forms of restraint.

(d) Restraint shall be effected only by written order of a physician
after a personal examination of the patient except in an emergency
situation, as provided by subdivision (e) of this section. The order
shall set forth the facts justifying the restraint and shall specify the
nature of the restraint and any conditions for maintaining the
restraint. The order shall also set forth the time of expiration of the
authorization, with such order to apply for a period of no more than
four hours, provided, however, that any such order imposing restraint
after nine o'clock p.m. may extend until nine o'clock a.m. of the next
day. A full record of restraint, including all signed orders of
physicians, shall be kept in the patient's file and shall be subject to
inspection by authorized persons.

(e) If an emergency situation exists in which the patient is engaging
in activity that presents an immediate danger to himself or others and a
physician is not immediately available, restraint may be effected only
to the extent necessary to prevent the patient from injuring himself or
others at the direction of the senior member of the staff who is
present. The senior staff member shall cause a physician to be
immediately summoned and shall record the time of the call and the
person contacted. Pending the arrival of a physician, the patient shall
be kept under constant supervision. If a physician does not arrive
within thirty minutes of being summoned, the senior staff member shall
record any such delay in the patient's clinical record and also place
into the patient's clinical record a written description of the facts
justifying the emergency restraint which shall specify the nature of the
restraint and any conditions for maintaining the restraint until the
arrival of a physician, the reasons why less restrictive forms of
restraint were not used, and a description of the steps taken to assure
that the patient's needs, comfort and safety were properly cared for.
Such physician shall place in the clinical record an explanation for any
such delay.

(f) During the time that a patient is in restraint, he shall be
monitored to see that his physical needs, comfort, and safety are
properly cared for. An assessment of the patient's condition shall be
made at least once every thirty minutes or at more frequent intervals as
directed by a physician. The assessment shall be recorded and placed in
the patient's file. A patient in restraint shall be released from
restraint at least every two hours, except when asleep. If at any time a
patient upon being released from restraint makes no overt gestures that
would threaten serious harm or injury to himself or others, restraint
shall not be reimposed and a physician shall be immediately notified.
Restraint shall not be reimposed in such situation unless in the
physician's professional judgment release would be harmful to the
patient or others.

(g) A record of all restraints shall be kept by the director of the
facility.

(h) Nothing in this section shall prevent the use of mechanical
supports necessary to keep an infirm or disabled patient in a safe or
comfortable position or to provide stability necessary for therapeutic
measures such as immobilization of fractures, administration of
intravenous or other medically necessary procedures.