6(B)(vii). Klatovy Hospital Psychiatric Department
At the time of MDAC’s visit, Klatovy Hospital Psychiatric Department had nine cage beds. “We have some internal regulation but not in detail. We have no information about how long, in what situation, etc.” said the director openly, noting that since cage beds had been banned in social care institutions, some former social care institution residents had been transferred to his hospital where cage beds were still allowed.
When MDAC asked the director about informed consent, he laughed: “No, confused patients are not able to give consent, they are not logical because they are delusional.” Staff said that there were usually four people in cage beds at any one time in the hospital, often two patients placed in them each day. They pointed out on that on the day of the MDAC’s visit only one cage bed was in use. However, the monitoring team witnessed several cage beds occupied, albeit with the sides open and unlocked. Upon clarification, it transpired that “placement in a cage bed” in this institution meant only cases where the netting is up and the cage is locked.
A doctor told MDAC that the only person in a locked cage bed at the time of the monitoring team’s visit would be discharged the next day because the family wanted to take care of him at home. It was not clear to the monitoring team why a person who was deemed so “agitated”/”aggressive”/”ill” to require a cage bed would be discharged the very next day to someone’s home, which presumably did not have a cage bed.
Seemingly contradicting the director, a psychiatrist told the monitoring team that a doctor must prescribe every the use of cage beds, and (in common with other forms of restraint) was required to record in the patient’s medical records the type of restraint, when it was initiated, the period of time used, the reason for its use and the frequency of observation. The doctor informed the team that the hospital informed the court by post once a week about the use of restraints. The director said that there was a “brief” internal registry, but the monitoring team was not shown any evidence of this.
An isolation room contained two cage beds stood side by side length-ways. The bed frames had been attached to the wall in order to prevent the inhabitant from toppling from the bed to the floor, which had reportedly happened in the past. Across from each bed was a commode chair-toilet-pan. MDAC was permitted to take photographs. Staff told the monitoring team that the beds were old and strong and cannot be broken easily, and that they were used for isolating ”problematic” patients.
Both cage beds had old leather straps with a belt buckle attached to them. Staff explained that the straps were permanently attached to the beds for cases when there “may not be enough time” to attach them. Staff said that a patient had once “escaped” from the cage bed by lifting up the mattress and the underlying boards. He had been “caught” in the corridor. A nurse told MDAC that it was easy for a patient to damage the netting, and it was observed that the nets had been visibly repaired in several places. It was clear that leather belts were used to restrain people damaging the netting.
In this hospital, patients could be simultaneously placed in a seclusion room, put into a cage bed, strapped down by leather belts, and sedated with neuroleptics. This amounts to quadruple means of restraint applied simultaneously to the same patient.
When a patient was in a cage bed, the nurse checked on them at intervals of up to an hour, staff said. The patient was not given food, and only a drink if they requested. Patients could be taken to the toilet, but given that the cage beds are used mostly for elderly patients who wear nappies, staff did not feel that this was necessary. Staff said that sometimes a patient was locked into a cage bed at 8pm and released at 6am. Alternatively if a patient was found wandering around at 1am, staff said they would be placed in a cage bed. Patients were chemically restrained before being placed in cage beds, and “aggressive patients” were always chemically restrained without being put in a cage bed, with straps being used if patients were “really aggressive”.
MDAC monitors went into another room containing four cage beds, each of which was open and occupied by an elderly person. A male doctor walked over to an elderly woman in one of the cage beds. He pulled up the netting on the side of the cage bed as an unrequested demonstration of how the cage bed can be closed. As he did this, the woman became visibly frightened and repeatedly said, “please don’t do that”. He stopped, letting go of the netting.
According to the director, the hospital had plans to upgrade its facilities. Under the new structure the same number of cage beds would exist, but in a different configuration of rooms. The hospital planned to “upgrade” the cage beds: some new cage beds would apparently be sourced from a nearby social care institution (where cage beds were previously banned). The director stated that others would come from a neurology ward where they were replacing their beds.