Central State Hospital policy states prone restraints are prohibited

Published: Apr. 6, 2023 at 5:58 PM EDT|Updated: Apr. 6, 2023 at 6:17 PM EDT
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DINWIDDIE, Va. (WWBT) - Central State Hospital Policies and Procedures provides more insight into how medical personnel should appropriately restrain patients.

NBC12 obtained the Behavioral Health and Developmental Services documents through the Freedom of Information Act.

The manual reads: “Prone means face down, as opposed to supine, which means on one’s back. The use of prone restraint is expressly prohibited by hospital policy.”

The manual says medical personnel should not lay patients face down.

It also says there’s a clear link between prone restraint and sudden death.

“It can make it more difficult for someone to breathe because you’re putting weight on the chest and diaphragm,” Prone Restraint Expert Seth Stoughton said.

Stoughton was the prosecution’s use-of-force expert in the Derek Chauvin trial for the murder of George Floyd.

He has studied police tactics and testified in cases across America for the last decade.

Stoughton says police are trained not to use prone restraint.

“Almost universally, officers are trained to avoid prone restraint,” Stoughton said. “The prone position is really an important one in police training, particularly in apprehension control training. When someone is on their stomach, it’s much easier for officers to put them in handcuffs. And it’s very hard for that individual to fight back or resist effectively. So, officers will often use that prone position as a mechanism to get someone under control, to secure them in handcuffs.”

Stoughton says the central issue was police and hospital workers keeping 28-year-old Irvo Otieno face down and handcuffed with weight on his back for an extended period of time.

He says prone restraint contributes to positional asphyxia.

“It can make it more difficult for someone to breathe because you’re putting weight on the chest and diaphragm, especially when someone is agitated, like after a fight or when certain conditions may exist, like the individual may have used cocaine or may be intoxicated from alcohol, or they have already they have pre-existing restrictions on their breathing like they have COVID, or they’ve been pepper sprayed, or they have a spit mask on or something like that.”

The hospital’s manual states medical personnel should consider the patient’s history and physical condition and treat the patient with the care and respect one would wish for themselves or their family members.

It also states what its medical personnel should do if someone violates its restraint policy.

“In the event that during an emergency behavior management episode, if a client is found to be in a face down or prone position, the involved staff is to immediately turn the involved client to his/her back,” the policy states.

Investigators say surveillance video shows a handcuffed and shackled 28-year-old Irvo Otieno was pushed face-down on the hospital floor, where he would suffocate for minutes.

Video shows he was surrounded by Henrico Sheriff’s deputies and Central State hospital workers.

Those ten people are now charged with second-degree murder in his death.

The manual says when a patient is restrained, that person is under hospital staff observation constantly to ensure the patient’s physical safety and competence.

Staff is also supposed to immediately notify a nurse if there is a change in a patient’s consciousness, physical status or if they have any concerns about the individual.

Within 24 hours after the restraint or seclusion, the manual states hospital staff involved are supposed to hold a debriefing and document the case in an electronic health record.

The manual also states patients are supposed to receive medical screening and medical assessment by a certified practitioner prior to admission.

NBC12 has not confirmed if that happened with Otieno.

This past month, a spokesperson from Central State Hospital released a statement stating that the hospital and the Behavioral Health and Developmental Services are fully cooperating with Virginia State Police’s investigation into Otieno’s death.