Bill would extend Minnesota's prone restraint law until late 2013

Sue Abderholden heads Minnesota's office of the National Alliance on Mental Illness.
MPR Photo/Marisa Helms

A state House committee discussed legislation Thursday that would allow schools to keep using a controversial physical restraint to subdue or calm students with severe mental health disabilities. The legislation was laid over.

The method is called "prone restraint" and involves holding a student face down on the floor.

Several states have specifically banned prone restraint, citing incidents of children being injured and even dying because they couldn't breathe while being restrained.

Minnesota has gone to great strides to ensure prone is used safely and sparingly, said Sue Abderholden, the executive director of Minnesota's office of the National Alliance on Mental Illness.

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"This is nothing that anyone likes... and I think that's really important," she said. "No one's promoting their use, but I think there are situations that school personnel will tell you they get into where a child really is imminently going to hurt themselves or others - and they need to do something to protect everyone. And sometimes, prone restraints is what they use."

When prone restraint is used, the child is laid on his or her stomach and face down or to one side. The arms and legs are held down to limit the child's movement. A person is not sitting or lying on a child -- that would likely be illegal in Minnesota because state law bans the use of any restraint that limits a child's ability to breathe.

Prone restraint has always been legal in Minnesota, but there were very few laws regulating its use until last August. That's when a law that Abderholden helped write took effect. The law put new requirements on schools for when they could use prone restraint. It also, for the first time, required the state to keep track of how many times it's used.

"It's infinitely better because each district has to have a plan; they had to have training; they have to report it to families, which they didn't have to do before; and they have to report prone restraint to the state department of education, which we also had no data before," she said. "So we have no idea, frankly, if it's going down or up because we had no data before."

Abderholden said she suspects there were incidents in the past where officials were using prone restraint as a punishment for things like acting out in class or throwing things. But the new law only allows prone to be used in emergencies when there's imminent danger of someone being hurt or property being damaged. And with all the training that's now required before you can put someone into a prone hold, supporters say that distinction will be clear.

The law isn't just a prone restraint law -- it addresses all forms of physical holding as well as when it's okay to put children into seclusion. The section about prone restraint is only effective for one year -- from August 2011 to August of this year. That's why lawmakers are having their committee hearing today -- to discuss whether to let that section about prone restraint remain for an additional year. If they don't, the interpretation is that prone restraint would then be illegal in Minnesota.

Dan Stewart, a lawyer for the Minnesota Disability Law Center, said he isn't convinced prone restraint can ever be done in a way that's considered totally safe. The Disability Law Center is a group that provides free legal assistance to people with disabilities.

"Even when things are going well, in terms of the procedure itself, there's an unacceptable risk associated with prone restraint," he said.

The fact that more than a dozen states ban prone restraint means facilities in those states have been forced to figure out alternatives, Stewart said, and Minnesota should study what's worked well in other states.

Even though Minnesota has only kept track of incidents since August, the numbers already prove that prone restraint is overused, he said. The numbers show prone restraint was used 592 times in five months. A large percentage of those incidents, however, occurred multiple times to a very small number of students.

"We have lots of uses," Stewart said. "We have repeated use on the same student. We have racial disproportionality. I'm not sure we need more data to make any other type of judgment."

Supporters would point out it's impossible to tell if that 592 really is a big or small number. Remember, there was no data collection before last August, so it's impossible to compare that number to anything. That's why supporters say another year is necessary -- give schools more time to gather data and let officials really study how they're using prone restraint.

Abderholden said that even though she wants to keep prone restraint legal now, it's only because she feels a well-implemented law might eventually have the effect of reducing the use of prone.

"We want to get to zero, but we want it to be a planned effort, which means we need more than six months or a law of implement to get there," she said.