Table 1

Cases Reflecting Patients' Minimum Constitutional Rights

Case	Relevant Findings
Youngberg v. Romeo, 457 U.S. 307 (1982)²¹	Involuntarily committed patients have a substantive right to safe conditions of confinement, freedom from bodily restraints, and some training to protect their liberty interests. What constitutes adequate training is best decided on a case-by-case basis and is best determined by the judgment of a qualified professional. Liberty interest is not absolute, but must be balanced by the need for institutions to protect residents from the danger of violence. “Persons who have been involuntarily committed are entitled to more considerate treatment and conditions of confinement than criminals whose conditions of confinement are designed to punish” (Ref. 21, pp 321-2).
Washington v. Harper, 494 U.S. 210 (1990)²²	The use of R&S does not constitute a valid alternative to meaningful psychiatric treatment, even in a prison setting involving an inmate who does not want to receive antipsychotic medication. The ruling cited an amicus curiae brief filed by the American Psychiatric Association: “Physical restraints are effective only in the short term, and can have serious physical side effects when used on a resisting inmate, as well as leaving the staff at risk of injury while putting the restraints on or tending to the inmate who is in them … [R]espondent has failed to demonstrate that physical restraints or seclusion are acceptable substitutes for antipsychotic drugs, in terms of either their medical effectiveness or their toll on limited prison resources” (Ref. 22, pp 226-7).
Wyatt v. Stickney²³	Involuntarily committed patients have a constitutional right to treatment that would cure or improve their mental conditions. The ruling called for adequate (increased) staffing levels and individualized treatment plans.
Davis v. Rennie, 264 F.3d 86 (1st Cir. 2001), cert. denied, Rennie v. Davis, 535 U.S. 1053 (2002)²⁴	Staff at a mental health facility can be held to a higher standard than is applicable in correctional settings. “…[T]here is precedent for subjecting the conduct of a mental health worker to a more exacting standard than that of a prison guard controlling a riot” (Ref. 24, p 99). Not every incident of forceful restraint amounts to a violation of the patient's Fourteenth Amendment rights, but force should be used sparingly. “… [F]orce [should] be used as sparingly as possible” (Ref. 24, p 111).
Campbell v. Sikes, 169 F.3d 1353 (11th Cir. 1999)²⁵	In a prison setting, evidence of staff members' good faith in applying R&S included compliance with prison procedures for restraints, extensive documentation, and monitoring when restraints were used, including the use of videotaped monitoring. A five-factor test was used in determining whether use of force was excessive.
People v. Harvey, 528 N.E.2d 1053 (Ill. App. Ct. 1988)²⁶	A counselor was found guilty of involuntary manslaughter for the death of a teenaged boy who was forcibly restrained to punish him for nonviolent disobedience. The boy aspirated his vomit during the restraint. The court noted that the boy was not assaultive until the staff tried to restrain him. Punitive or custodial use of R&S may be acceptable in correctional or criminal settings, but punitive use in treatment settings violates the patient's constitutional rights.
Threlkeld v. White Castle Systems, Inc., 127 F. Supp. 2d 986 (N.D. Ill. 2001)²⁷	A woman, forcibly injected with lorazepam by the physician-defendant in an emergency room, could “make a prima facie case for negligence based on a violation of the [Illinois] Mental Health Code” and also stated a claim for battery because her consent was not obtained for the injection. The patient had been brought to the ER by police officers and was locked in an observation room and restrained. She was upset and crying, but the physician who ordered the shot testified that he did not think that she was a threat to herself or others. He ordered a nurse to give the patient the shot to “calm her down” so that he could talk to her, but he never obtained consent.