Guidelines changed at detox center for 'suicidal gestures,' 'physical behavior'

DULUTH, Minn. -- The locks have been taken off two secured rooms in the Duluth Detoxification Center in the wake of an incident last year when a client was stripped of clothing and left naked in one of the rooms.

"We've removed the locks on those close observation rooms so they can no longer be locked," said Gary Olson, executive director of the Center for Alcohol and Drug Treatment, whose services include the detox center on 1402 E. Superior St.

The center provides 24 beds for "medically managed detoxification from drugs and alcohol," according to the CADT's website.

The state Department of Human Services fined the center $3,000 last month for that incident and another regarding a scuffle that occurred when personnel tried to take a client's cellphone.

Olson said he met with the CADT's board last week before finalizing updates in what is called the center's "protective procedures policy."

In addition to removing the locks from the two rooms, Olson cited the following updates:

-- Clients who "present with suicidal gestures" are sent to the hospital.

-- Police will be called when clients display "physical behavioral problems" that staff are unable to "de-escalate verbally."

Neither is really new, Olson said; it's more a matter of clarifying existing policies. In the case of suicidal threats or behavior, it's about removing the "discretionary aspect."

"So if we make an error it's going to be on the side of making sure people are seen at the hospital."

The detox center isn't licensed to determine whether a suicide threat is legitimate, Olson said.

"Somebody in (the hospital) setting has to make that decision. They can be returned to us, but they have to make that call, not us."

Calling police about uncontrollable behavior is nothing new either, Olson said. The difference is that with the locked seclusion rooms no longer available, the bar for calling the police is lower.

"That's an ongoing discussion with law enforcement, and they're not 100 percent happy with it," he said. "But they understand the situation."

Ron Tinsley, Duluth police spokesman, said he wouldn't comment on another agency's policies.

"If we receive a 911 call we're going to respond," Tinsley said.

Dr. Kristi Estabrook, a psychiatrist who evaluates patients in the emergency department at Essentia Health-St. Mary's Medical Center, said in an email that it's not clear to her if the change in policies has meant more patients in the ER.

"In general, we have a high volume of patients who cannot utilize detox due to being acutely suicidal," Estabrook wrote. "This is a difficult population to get appropriate care for because many psychiatric hospitals want someone to be sober before they will agree to even review for a need for psychiatric admission, so they are detoxing in the ED or the medical hospitals."

But Dr. Christopher Delp, an emergency room physician at St. Luke's, said the policy on suicide threats was, in effect, giving detox clients a "get out of jail free card."

"If you get put into detox by the police on a 72-hour hold and you don't like it there, all you have to do is say I'm suicidal and you get out of there," Delp said. "And they know that."

He's noticed a "big uptick" in patients coming to the ER from the detox center in the past couple of weeks, Delp said.

He has never succeeded in sending a patient back to detox, Delp added.

"Even though it's my clinical judgment that they're not suicidal, they have to be cleared by a psychiatrist," he said. And by then, it's too late to return them to detox.

"What's happening for us now is we are becoming the holding tank for detox patients," Delp said. "Once they sober up they say they're no longer suicidal and they get discharged from the ER."

He thinks the "dogmatic approach" the detox center is taking is bad, Delp said.

"There has to be some room for a judgment to be made," he said. "They know when people are gaming them. If you tie their hands ... that is taking the judgment away of good people who have worked there for a long period of time."

The client who was left naked in one of the locked rooms had wrapped clothing around the neck, prompting staff to remove the clothing, according to the DHS report.

Those reports never indicate the client's gender.

Stripping a person of clothing was never an acceptable procedure, Olson said.

"The people who come to detox, all of them are considered to be vulnerable adults," he said. "We need to think about treating (them) like we would treat our children. You wouldn't take your children's clothing away."

In the case of the scuffle over the cellphone, it was appropriate for staff to take the device, Olson said. But a physical hold was used that wasn't spelled out in the center's policy. That's what drew the state's notice.

Another state-approved hold has been added to the detox center's policy, he said.

No personnel were fired because of the incidents, said Olson, who attributed them to inadequate training.

"Whose fault is that?" he asked. "Well, I think that's on me and my chief operating officer. The decision was based on what they believed at the time. ... We didn't terminate anybody. They're great people; they do a great job. It's very difficult work. I think sometimes we get a little complacent about that."