Allegation
Failure to utilize an approved restraint technique and failure to safely manage a pediatric behavioral health patient resulting in a fractured arm.
Case Details
A minor behavioral health patient was admitted to an inpatient psychiatric facility due to aggression, self-injurious behaviors, impulsivity, and threats of harm toward self and others. During the hospitalization, the patient demonstrated frequent behavioral disturbances requiring redirection by staff.
During a morning medication pass, the patient became disruptive, refused direction, and began kicking and striking a behavioral health technician who was attempting to escort him back to the nursing station. In response, the staff member attempted to physically restrain the patient by grasping the patient’s arm above the elbow and guiding him toward the nursing station. Following the encounter, the patient complained of significant arm pain and reported being injured during the restraint. Initial nursing assessment revealed no obvious deformity or swelling, although the patient expressed an inability to move the extremity due to pain. Ice and pain medication were provided and the patient continued to be monitored.
During a subsequent assessment later that day, staff noted significant swelling of the upper arm and persistent pain with movement. The attending physician was notified, and diagnostic imaging was ordered. Imaging subsequently revealed an acute fracture of the humerus. The patient was referred for urgent orthopedic evaluation and was examined the same day. Treatment included immobilization with a removable cast and sling, and activity restrictions were implemented. The patient’s guardian was notified regarding both the injury and treatment plan.
An internal investigation was conducted following the incident. Video surveillance showed the patient striking and kicking staff before being escorted toward the nursing station while held by the arm. The footage did not clearly depict the exact mechanics of the injury but did confirm that the patient was visibly holding the injured arm shortly after the encounter. Review of the incident revealed that the staff member reported attempting to use a restraint technique commonly referred to as a basket hold; however, the technique employed was not one of the approved restraint methods authorized by facility policy.
Additional review demonstrated that the staff member had no prior disciplinary history and had previously completed de-escalation and restraint training. Following the event, the employee received corrective action and was required to complete retraining before returning to direct patient care responsibilities. Child protective services were notified and investigated. Law enforcement was not involved.
Allegations and Defense
The plaintiff alleged that facility staff failed to utilize an approved restraint technique and unnecessarily exposed the patient to a foreseeable risk of injury during behavioral management. It was further alleged that the injury occurred as a direct result of improper physical intervention.
The defense maintained that staff were attempting to manage an actively aggressive patient who was striking and kicking personnel. The facility emphasized that the employee had no prior disciplinary actions, had received training, and was attempting to control a rapidly evolving behavioral situation.
Resolution
The case was resolved through settlement. Factors influencing resolution included the documented fracture, evidence that a restraint technique may have been used that was not approved by facility policy and that the precise mechanism of injury could not be conclusively determined from the available surveillance footage.
Risk Reduction Strategies
Use Approved Restraint Techniques: Train staff to apply only the restraint techniques they have been taught and are approved to use during patient care.
Follow Facility Restraint Policy: Enforce staff compliance with facility requirements for restraint authorization, monitoring, reporting, and post-restraint review.
Use Restraint Only When Necessary: Attempt verbal de-escalation, environmental changes, and other less restrictive interventions first. Initiate physical restraint only when there is an imminent risk of harm.
Validate Staff Competency: Provide routine refresher training and competency checks on crisis intervention, approved restraint techniques, and safe patient handling.
Reassess Promptly After Physical Intervention: Examine the patient immediately after any use of force and continue reassessments when pain, swelling, limited movement, or other injury concerns are reported.