Who will be responsible for accidents if physical restraints on mental health patients are banned?

In the wake of the death of a patient at a mental hospital, a series of bills have been proposed to restrict the physical restrictions of people with a mental health condition.

However, the medical community expressed concerns that the ban would increase incidents. Reflecting such concerns, the Korean Medical Association (KMA) plans to submit an opinion to the National Assembly opposing the proposed law.

Currently, two bills in the National Assembly aim to amend the “Mental Health Promotion and Mental Patients’ Welfare Service Support Act” to limit the physical restrictions on patients in psychiatric hospitals.

One amendment, introduced by Rep. Seo Mi-hwa of the opposition Democratic Party of Korea (DPK) on Monday, requires psychiatric hospitals to notify mentally ill patients of the reasons for isolating and stifling them and the conditions for their release. Even if physical restraints are necessary, other methods must be applied first. It also stipulates that specific methods other than physical restraint are to be determined by a Ministry of Health and Welfare decree. Violators will be punished by imprisonment for up to one year or a fine of up to 10 million won ($7,460). There is also a provision to report the situation of isolation and stifling to relevant officials.

The other amendment introduced by Rep. Kim Ye-ji of the ruling People Power Party on Aug. 27 bans all physical restraints in psychiatric hospitals.

The KMA opposed both amendments. In its regular briefing on Wednesday, the association pointed out that both amendments are out of touch with medical reality and could pose additional risks.

“Physical restraint is one of the medical practices used to help stabilize and recover mentally ill patients at risk of harming themselves and others due to various mental illnesses and to protect mental healthcare workers, other patients, and other people,” the association said. “Healthcare providers should use it appropriately when necessary for the treatment of mentally ill patients.”

If isolation and compulsion are prohibited or restricted unconditionally, it may put the mentally ill person or mental healthcare workers at risk due to various accidents, and the responsibility for such accidents may be borne by the mentally ill person or their guardian, it said.

The KMA cited a recent case in which a patient admitted to a psychiatric hospital to treat alcoholic dementia was diagnosed as a person with quadriplegia after falling out of bed after the restriction was eased.

“To limit seclusion and restraint, regulations should be put in place to exempt or limit the liability of mental healthcare providers or their duty of care for accidents that occur as a result,” the association added.

It also opposed mandatory reporting and notification of seclusion and compulsion, saying that would “impede the smooth practice of medical practice due to increased administrative burdens” and that “physical restraints are often implemented first in very urgent situations.”

“Taking away the choice of medical practice from doctors and indefinitely expanding the scope of liability of medical institutions and workers will further encourage the shunning of essential medical care,” the association said. “These are inappropriate laws without considering the situation in the medical field.”