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Pursuant to the Protection and Advocacy for Mentally Ill Individuals Act (PAIMI Act), 42 U.S.C. § 290ii-1(a), certain specified facilities are required to report to the protection and advocacy agency in the state in which the facility is located:

each death that occurs at each such facility while a patient is restrained or in seclusion, or each death occurring within 24 hours after the patient has been removed from restraints and seclusion, or where it is reasonable to assume that a patient’s death is a result of such seclusion or restraint.

In New Hampshire, the Disabilities Rights Center is the protection and advocacy agency to which this report must be made.

The facilities required to report as defined by the PAIMI Act “include, but not limited to, hospitals, nursing homes, community facilities for individuals with mental illness, board and care homes, homeless shelters, and jails and prisons.” 42 U.S.C. § 10802(3). Federal Regulations expands this definition to include “any public or private residential setting that provides overnight care accompanied by treatment services. Facilities include, but are not limited to the following: general and psychiatric hospitals, nursing homes, board and care homes, community housing, juvenile detention facilities, homeless shelters, and jails and prisons, including all general areas as well as special mental health or forensic units.” 42 C.F.R. § 51.2.

As specified above, the reporting requirement is triggered when the death occurs in the context of restraint or seclusion. 42 U.S.C. §§ 290ii(d)(1)(a)(b)(2) defines these terms as follows.

The term “restraints” means—
(A) any physical restraint that is a mechanical or personal restriction that immobilizes or reduces the ability of an individual to move his or her arms, legs, or head freely, not including devices, such as orthopedically prescribed devices, surgical dressings or bandages, protective helmets, or any other methods that involves the physical holding of a resident for the purpose of conducting routine physical examinations or tests or to protect the resident from falling out of bed or to permit the resident to participate in activities without the risk of physical harm to the resident (such term does not include a physical escort); and

(B) a drug or medication that is used as a restraint to control behavior or restrict the resident’s freedom of movement that is not a standard treatment for the resident’s medical or psychiatric condition.

The term “seclusion” means a behavior control technique involving locked isolation. Such term does not include a time out.

The law further requires that “notification …include the name of the resident and …be provided not later than 7 days after the date of the death of the individual involved.” 42 U.S.C. § 290ii-1(a).

This reporting obligation went into effect October 17, 2000.

Additionally, pursuant to 42 C.F.R. § 483.374(b) psychiatric residential treatment facilities that provide inpatient psychiatric services to individuals under 21 for which the facility receives Medicaid reimbursement as a Medicaid provider must report “serious occurrences” to “both the State Medicaid agency and, unless prohibited by State law, the State-designated Protection and Advocacy system.” “Serious occurrences that must be reported include a resident’s death, a serious injury to a resident as defined in § 483.352 of this part, and a resident’s suicide attempt.” 42 C.F.R. § 483.374(b). “Staff must report any serious occurrence involving a resident...by no later than close of business the next business day after a serious occurrence. The report must include the name of the resident involved in the serious occurrence, a description of the occurrence, and the name, street address, and telephone number of the facility” 42 C.F.R. §§ 483.374(b)(1). 42 C.F.R. 483.352 defines “serious injury” as “any significant impairment of the resident as determined by qualified medical personnel. This includes, but is not limited to, burns, lacerations, bone fractures, substantial hematoma, and injuries to internal organs, whether self-inflicted or inflicted by someone else.”

These reporting requirements went into effect in May 2001.