St. Elizabeths, the District’s only public psychiatric hospital, has ramped up its use of restraint and seclusion on patients in recent years, according to a report on the Southeast facility, released Monday by Disability Rights DC.

The 28-page report by DRDC, a federally-designated advocacy organization, outlines that St. Elizabeth’s “steadily increased its use of restraint and seclusion,” despite D.C. laws that generally prohibit such tactics. The findings of DRDC’s review were first reported by the Washington Post.

D.C. law maintains that restraint and seclusion should only be used in a select number of situations, primarily in emergencies when it’s “necessary to prevent serious injury” and “less restrictive interventions have been considered and determined to be ineffective.” The law also says restraint or seclusion should be used “in the least restrictive manner possible” and “ended at the earliest possible time.”

The hospital’s own policies require that staff use these methods as a last resort and only if a patient poses an “imminent threat,” per the report.

Even with these policies in place, the hospital staff administered 782 restraints and 291 seclusion during 2018 — much higher than in 2012, when the staff restrained patients just five times and secluded them 30 times, according to the report. Between January and April 2019, staff performed restraints 252 times and seclusion 66 times. The hospital stopped publicly reporting its restraint and seclusion numbers in May of 2019.

In the first six months of 2020, the hospital recorded 149 restraints and 55 seclusions, based on DRDC’s own review of the hospital’s unusual incident reports.

“On multiple occasions, St. Elizabeths staff disregarded the legal and policy requirements of using restraint and seclusion that were promulgated to prevent widespread use and abuse,” the report reads.

St. Elizabeths has faced scrutiny this year for its handling of the coronavirus pandemic, and four patients sued the hospital in April saying staff weren’t doing enough to protect them from the virus. A total of 14 patients and one staff member have died from the virus, D.C. Health data show.

St. Elizabeths CEO Mark Chastang said in a statement emailed to DCist that the facility is committed to the highest standards of care and that the hospital’s aim is “for every patient to get the best and most appropriate treatment to recover and thrive to their fullest potential with family and friends back in the community.”

Asked whether the hospital can confirm or deny the claims made in the report, a spokesperson for D.C.’s Department of Behavioral Health sent a statement that the hospital uses “alternative interventions including de-escalation techniques to maintain a safe, supportive environment for patients and staff.”

“As a last resource in extreme circumstances, restraint and seclusion may be used to prevent an aggressive patient from harming themselves, other patients, or staff,” the spokesperson said. “The time patients spend in restraint or seclusion consistently is below the national average for psychiatric hospitals.”

Yet, DRDC detailed a number of concerning incidents based on its review of surveillance video and DBH’s reports over the past few years, including repeated use of restraint on a patient with “a history of trauma and sexual abuse.”

In its review of eight incidents involving the patient, the organization found that the staff restrained the patient even in cases where she didn’t resist. Footage from February showed “a disturbing scene where seven staff, five of whom were men, converged on her while she was quietly sitting on a mat in the seclusion room” before a male nurse slid her pants and underwear down to inject her in the buttocks, the report says.

According to the report, the hospital’s policy is supposed to prevent patients with a trauma history from being secluded or restrained.

“Widely used, abusive restraints and seclusions are far from respectful or dignified treatment,” the report concludes. “These extreme measures have no therapeutic value, cause suffering, may trigger severe pain from past trauma, and frequently result in emotional and physical harm, and even death.”