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Seclusion, Restraints and Screams Marked Man’s Final Hours at Psychiatric Unit

Reports chronicling Cliff Detty's treatment raise questions, discrepancies. Second in a series

Cliff Detty, shown in an undated family photo, died while in restraints at Santa Barbara County’s Psychiatric Health Facility on April 29, 2010. The Sheriff’s Department has not yet released a cause of death. Click here for a Noozhawk slide show.
Cliff Detty, shown in an undated family photo, died while in restraints at Santa Barbara County’s Psychiatric Health Facility on April 29, 2010. The Sheriff’s Department has not yet released a cause of death. Click here for a Noozhawk slide show.  (Detty family photo)

By Lara Cooper, Noozhawk Staff Writer |

[Noozhawk’s note: Noozhawk is following the ordeal of Rich Detty, a Santa Maria man whose son, Cliff, died while under restraints at a Santa Barbara County psychiatric health facility in April. Second in a series.]

After hours of screaming, Cliff Detty wasn’t breathing. His chest lay still beneath the restraint that held it down. His limbs, also strapped down, stopped thrashing. Under the clinical lights of the room in which he was placed for observation, the 46-year-old Santa Maria man was alone when he slipped away.

It’s unclear how much time passed before nurses noticed he wasn’t breathing, and the CPR they began wasn’t enough to ward off death. The voice that had been screaming out for release from the straps was now quiet. Paramedics arrived, but after a time, the chest compressions stopped. Now, only silence.

The events of that night in late April, revealed through the medical reports left behind, didn’t take place in a jail or a prison but in a local psychiatric unit run by Santa Barbara County’s Department of Alcohol, Drug and Mental Health Services. Detty, diagnosed with paranoid schizophrenia, had been transported to the county’s Psychiatric Health Facility in Santa Barbara from the emergency room of Marian Medical Center in Santa Maria.

When Detty arrived in Santa Barbara on the evening of April 28, 2010, PHF staff noted that he was aggressive, to say the least. Almost immediately, staff made the decision that he needed to be restrained. Putting patients in restraints is a risky practice, even when everything is done correctly, and the procedure can cause injuries to staff, as well as injuries, or worse, to the patient.

And something else may have set Detty on the path to his early death that night: He had a high level of methamphetamines in his system, a situation that is known to greatly increase the risk of sudden death while under restraint.

The fact that Detty was placed in restraints is not surprising. That’s because the 16-bed Santa Barbara unit to which he was taken keeps patients in restraints almost three times as long as other similarly sized California facilities that submitted quarterly reports to the state Office of Patient Rights, according to OPR data. While large mental institutions throughout California, and the nation, are choosing to phase out the practice for safety reasons, Santa Barbara’s facility has continued to use the procedure.

ADMHS officials have refused to comment on Detty’s specific case, so what happened to him that night has been taken directly from the medical documentation logged at the time at the Psychiatric Health Facility. The reports reviewed by Noozhawk reveal a grim picture of what unfolded that night, with Detty becoming more agitated the longer he was kept in restraints.

Before the night was through, the reports appear to indicate that Detty, who was 6 feet tall and 187 pounds, had been confined in restraints continuously for nearly 11 hours. Although officials won’t confirm this, none of Detty’s documentation notes that he had been released from restraint. Upon arriving at the PHF unit, “patient was agitated, screaming at staff during transfer from gurney to bed, aggressive and combative,” one report reads.

The seclusion restraint form, filled out at 9:45 p.m., stated that the “patient is very aggressive and combative upon arrival to the unit, unable to follow directions, yelling and screaming at the staff, threatening staff ‘Leave me alone, you f****, I’ll kick your asses.’”

Criteria for release was listed as “able to calm down and follow directions, no threatening remarks, no yelling or screaming.” The form says Detty was “instructed to calm down, and listen,” given several doses of anti-psychotic medications, and placed in an observation room, where a microphone and camera were kept on so staff could observe him.

But several discrepancies in the report raise questions. The report stating that seclusion and restraint had been initiated was only signed by a nurse on duty, and not a medical doctor, who should have signed the order within 24 hours, as required by the California Code of Regulations.

Detty continued yelling, urinated on himself, had his linens changed and a diaper placed on him, and was “uncooperative” to care, the report states. Lead nurse Reyn Bugay lamented in her notes that Marian Medical Center ER staff should have administered more drugs prior to transferring Detty to Santa Barbara.

Detty continued screaming, pulling at his restraints and saying “I want to go back to my place,” the report states. Another report for seclusion and restraint was filled out at 10:30 p.m., and reported that Detty would wake up agitated, between periods of sleep. At this point, he was naked and held by a five-point restraint, the maximum secured restraint with straps across each of his limbs and midsection. A PHF worker wrote that Detty didn’t appear able to understand the criteria of his release from the restraints, much less be able to discuss it.

“Agree with Seclusion and Restraint until able to vow compliance or maintain behavior,” the caretaker wrote.

Another discrepancy pops up at that time. At 10:30 p.m., a group of nurses, lead by Bugay, had a debriefing session. Under the state Health and Safety Code, debriefing should occur after the patient has been released from restraint, in order to evaluate how to avoid a similar incident in the future. The system was designed to create a feedback loop between patients and caregivers.

But these nurses held the debriefing while Detty was still in restraints, and not responding well. Patient participation is voluntarily, but it’s apparently highly unusual that nurses indicated Detty had chosen not to participate in the session.

Meanwhile, Detty’s agitation grew. Another page, also filled out at 10:30 p.m., describes all the strategies staff used to try to calm him down. Eight boxes are checked, including “active listening” and “offer medication.” But from the reports, it appears that release from the restraints was never considered, in spite of increasing panic from the patient. State law requires that staff check every 15 minutes to ensure the restraints have been applied correctly, and that they remain in their line of sight for observation in the meantime. One report describes each check: Detty’s screaming and “pulling at restraints” is mentioned 13 times.

It’s unclear how much time had elapsed when attendants noticed that Detty was no longer yelling, around 1:15 a.m. on April 29. “Patient noted to have no respiration,” and then a quick succession of events records Detty’s last moments alive:

“911 called, CPR started, paramedics arrived, patient expired.”

Four months later, Detty’s father, Rich, doesn’t have many answers about what happened that night. Although a toxicology report has been issued detailing what was in Detty’s blood when he died, the Sheriff’s Department still hasn’t issued a cause of death in the case. The Coroner’s Office is part of the Sheriff’s Department.

When Rich Detty was finally able to read the PHF medical reports, he was disturbed.

“It bothered me a lot that all he did was scream and yell and just wanted to be free,” he told Noozhawk. “I hope when people die they go out in dignity and class, and on their own terms ... but that was pretty miserable.”

Related Stories

» Click here for the first story in Noozhawk’s series on the Cliff Detty case: While Son Struggled with Mental Illness, Father Fought His Own Battle

» Click here for the third story in Noozhawk’s series: Seclusion and Restraint Practice Poses Risks, Prompts Questions

» Click here for a related commentary: Brian Stettin: Laura’s Law Might Have Saved Cliff Detty

» Click here for a Noozhawk slide show.

» Click here for mental health care resources that are available 24 hours a day.

Noozhawk staff writer Lara Cooper can be reached at .(JavaScript must be enabled to view this email address).

» on 08.31.10 @ 01:50 PM

To say this is heart-breaking would be an understatement! It’s  saddening and yet somewhat infuriating to have to hear about stories like this, were there could have been proper intervention.  As  it is, services,venues and resources are in the few to nonexistent, when there are no outlets to treat mentally ill people they tend to usually end up in the prison system,  and it’s there that they usually get treated. This is unacceptable! And with the likes of many cases, it is usually observed that police personel aren’t adequately equipped  with the knowledge to manage such mentally ill persons, especially those with paranoid schizophrenia. Coming from a family with a history of having schizophrenia and myself being diagnosed with bipolar disorder, these issuses strike a chord with me to an extent that cannot be expressed accuratly through the medium of writing. Furthermore  the incompetance of the staff at the psychiatric unit to follow proper procedures bewilders my cognitive abilites to formulate a possible reason for their inate lack of responsibility and tactless and rather foolish behaviour. It is an alarming realization that tells me we’re along way from where we need to be, and that we must do all that we can to reform mental health services. We must strive to adhere to the initial  perspective and not falter. I also am agianst measure S for the fact that it’s well intentioned on one end but falls short on the other, a wounded proposition that only adresses part of the problem but isn’t the solution to. A new jail in north county isn’t needed, but a reformation, a reassessment  of the way things are operated at jails and the prison system are, you wouldn’t build a house on a bad foundation now would you? This is exactly what this measure does. As for the treatment of mental health patients, that too must be addressed on larger basis.     

» on 08.31.10 @ 02:46 PM

drug and wildly abusive person comes in…we use as much drugs and abuse as it takes to show him whose boss.  I couldn’t imagine being bounced from the emergency.  Of course it’s always very clear how abusive the patient is or how much illegal drugs someones been doing.  WHAT WE ALWAYS GET IS “DON’T KNOW” WHEN IT’S THE STAFF IN QUESTIONS.  Funny huh?

» on 08.31.10 @ 10:30 PM

No sympathy for someone who does drugs.

» on 09.01.10 @ 06:44 PM

Psychiatry is a harmful and dangerous practice which is disabling and debilitating the lives of many people through so -called anti-psychotic drugs and E.C.T. There is a need for people in America to waken up to this fundamentally flawed practice and the harm it is causing and work for human rights for people labeled ‘mentally ill’

» on 09.01.10 @ 07:40 PM

Sad story but blaming government is not the answer.  Our city, county, state and federal government are bankrupt already and won’t be able to provide a solution.  Families are going to have to be responsible for their own care and lots of people are going to slip through the cracks…

» on 09.03.10 @ 01:51 PM

+ methamphetamine
+ aggression
+ proximity to other human beings =

early death

  Do you factor the Psychiatric Health Facility staff as contributors to the above equation?

Was it possible to have a good outcome with this patient?

» on 09.09.10 @ 09:27 PM

Mr. Detty’s story is tragic but not unfamiliar. Working with these kinds of patients daily I continue to be disheartened by the tone of comments comming from people who do not work with these patient’s regularly, and the assumption that the staff are poorly trained or don’t care about the people they treat. In California in particular the public is quick to judge, but when it comes time to put money into mental health they balk. More concerning is the lack of interest and caring by California politicians and leaders. If the plight of the mentally ill was truely important to both these groups, it would be evident in funding, rersources, facilities, public education, and politicians who advocate for the mentally ill. This is not the case. Like a police officer who is making a critical and immediate decision with an armed, threatening, and uncooperative person where others are in harms way, psychiatric nursing staff regularly encounter patients whose dangerous acts can cause immediate and serious injury to others or themselves. Intoxicated mentally ill persons who are violent pose a significant and immedicate risk of serious injury to the staff and other patients. Some times restraint is the only option (should always be the last option) to protect those patients from harm to themselves or others. The issue was most likely not whether or not restraint were neccessary, it may not be one of policy or procedure either, rather it is most likely an issue of monitoring the patient after he was in restraints! I cannot emphasize enough, after being in this field over 30 years for 5 different facilities, and being a commited advocate for patient safety first, those who believe that restraint is never neccessary have not worked with violent and aggressive menatlly ill or intoxicated patients. Additionally, our mental health facilities are full of criminal offenders avoid jail. Those who would quickly determine that staff don’t care for the violent and aggressive mentally ill they are treating, have no idea of the committment and character of the people who work with the mentally ill. You don’t stay in this field with the exposure to danger, staffing issues, decreasing resources, negative public perception, numerous responsibilities, and minimal gratification, unless you love this work, and care deeply for the people who have been entrusted to your care!!!

» on 09.23.10 @ 02:16 AM

Sorry Irishhensman but I don’t buy your weak excuses. This man was held in restraints for 11 straight hours. Strapped down to a table. You all knew that he was suffering from psychosis in the form of paranoid schizophrenia and somehow these “power freak medical professionals” developed a criteria that required Mr. Detty to be calm, polite, and lets just say rational. First you know damn well that it can take days or even weeks to identify the proper medication to treat individual psychosis and you also know that even when you administer the correct medication that it takes day’s or even weeks before the patient shows marked improvement.
When the staff saw that they were exacerbating the problem why not try a straight jacket? It would have been less confining. How about a padded cell, don’t you have those? They didn’t help Mr. Detty because they didn’t like his attitude and he was going to do things their way or suffer. Just how long were they going to leave him those restraints while he lay there stark ass naked, defecating and urinating all over himself while he screamed and struggled? Don’t even try to tell me how much they cared because I would say they shouldn’t be allowed to work with any psychotic patients, not ever. I find the individuals that were on staff that night to be incompetent, willful and sadistic.
If you had done this in the State of Rhode Island, you would all be in jail for man slaughter. The type of restraints that were applied to Mr. Detty are illegal there. Somebody should be charged with man slaughter regardless of whether it was legal or not in this state. I mean it, someone needs to GO TO PRISON for this.
and another thing…..I don’t care if he was on Meth, the man had been diagnosed with schizophrenia years earlier, he was not capable of being responsible for himself.

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