Attachment C

Procedures for Four and Five Point Restraints

OP-050108

A. The following procedures will be followed in the application of four/five point restraints.

1. The camera operator will videotape the disruptive behavior of the inmate prior to the cell entry and throughout the entire process. Care will be taken to protect the safety of the camera operator
2. Under normal circumstances, all security-related applications of four/five point restraints will be approved in advance by the warden/designee, and health services staff will review the inmate's medical record for any medical condition that may affect the use of four/five point restraints
3. When the use of four/five point restraints is necessary for medical or psychological reasons, their use will be approved in advance by the facility head and the deputy director/private prison administrator, staff physician, or duty nurse, who will review the inmate's record for any medical condition that may affect the use of four/five point restraints.
4. Use of four/five point restraints will be used only when an inmate is destroying state property, to prevent self-injury or injury to others, or for medical or psychological reasons
5. Placement of an inmate in four/five point restraints will be accomplished by use of force team, as specified in facility policy.
6. At least one of the following listed personnel will be present for the application four/five point restraints, unless a life-threatening situation necessitates immediate action. If the situation is life-threatening, the shift supervisor will determine the need for immediate action prior to the arrival of at least one of the following personnel:

a. Warden

b. Deputy Warden

c. Chief of Security

d. Duty Officer

B. Applications of four/five point restraints will include the following progressive steps

1. A "Use of Force Checklist" will be completed by the shift supervisor in charge prior to forced cell entry. Medical staff will complete a "Medical Checklist" prior to restraining an inmate patient
2. The shift supervisor will give the inmate a direct order to submit to handcuffs, prior to any cell entry by the use of force team.
3. The inmate will be removed from the cell and searched while the cell is prepared for the application of four/five point restraints.
4. The inmate, stripped to underwear, or jumpsuit, will be placed on the bunk mattress in a supine (face up) position. Should bedsores or other injuries to the inmate's backside prevent placing the inmate in a face up position, the inmate may be restrained face down, upon approval from the supervising physician. Leather or nylon restraints will be used to secure the inmate, unless such restraints are clearly inadequate to restrain the inmate

C. After restraints are applied, medical staff will examine the inmate to ascertain if restraints are too tight.

Medical staff will also examine the inmate to check for injuries incurred during the restraining application. Medical staff will review the inmate's medical record immediately after the initial assessment is complete, to identify any pre-existing medical condition that might affect the use of such restraints. Such medical conditions will be logged on the individual Restrictive Housing Unit (SHU) custody log or the unit activity log and will be documented in the medical/clinical record.

1. All cell entry officers will be examined by medical staff for entries
2. The Restrained inmate will be checked every fifteen minutes, to include a circulation check, by the SHU officer/medical staff, who will immediately report any medical problems to the health services staff.
   1. The unit manager, duty officer, or shift supervisor will check on the restrained inmate at least once per shift
   2. If an inmate is placed in a stripped cell, unit staff will check the inmate at a minimum of every fifteen minutes. These checks will be documented in the medical log
3. If a inmate is place in ambulatory restraints, security office will perform a safety check on the inmate at a minimum of every fifteen minuets and a medical; circulatory check every two hours. These checks will be documented in the medical log.

D. The inmate will not be le left on four/five point restraints more than 72 hours.

A determination will be made at 24 hours to determine whether additional restraint is necessary. Any period of restraint in excess of 24 hours will require review and determination by the Warden and the Correctional Health Services Administrator that the inmates behavior dictates further restraint. If further restraint is necessary, the inmates status must be reviewed again at 48 hours and an additional determination made at that time by the Warden and Correctional Health Services Administrator or highest ranking medical officer on duty. All continued use of restraint must be documented in the SHU custody log or unit activity log.

The warder will review the inmate every 24 hours, to determine that the inmate is receiving proper treatment and if the need exists for continued use of restraints.

E. All relevant information concerning the restrained inmate will be entered in the individual SHU custody log of the unit's activity log.

Every event, both verbal and physical, will be considered relevant and entered in the logs. Each log entry will contain the date, time, details of the event or visit from an official, and initials of the reporting officer

F. The restrained inmate will receive three meals per day, in conjunction with the master sack lunch menu (or master menu items, if they are finger-type foods).

No forks, knives or spoons will be authorized, and plates and cups will be made of paper or Styrofoam. Water will be offered with every meal and every two hours. All meals will issued will logged in the individual SHU or unit activity log.

G. The restrained inmate will be given the opportunity to use the restroom or bedpan at a minimum of every four hours.

All restroom use will be logged in the individual SHU or unit activity log.

H. Use of Force Report

1. If the restrained inmate resists feeding, water, restroom use, or any other activity, it will logged in the individual SHU or unit activity log.
2. If the restrained inmate resists feeding, water, restroom use, or any other activity, and force is used, it will logged in the individual SHU or unit activity log.

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