P.R. Laws tit. 24, § 6159h
(a) Seclusion shall only be employed as a therapeutic measure to keep the minor from inflicting harm upon him or herself or others or from damaging property. Its use shall be circumscribed to hospital institutions, live-in treatment institutions for minors, and centers that have emergency acute care wards. Before secluding a minor, his/her physical condition shall be taken into account. Under no circumstance shall seclusion be used as punishment, as a disciplinary measure, or for the convenience of the personnel of the hospital institutional provider of mental healthcare services.
(b) Seclusion shall only be employed when there is a written order issued by a child and adolescent psychiatrist, or in default thereof, a general psychiatrist who, after consulting with the former and having personally examined the minor, is clinically convinced that the employment of seclusion is the indicated alternative. The examination shall include an evaluation of the physical condition and the mental state of the minor.
(c) The seclusion order shall be entered in the clinical record, which shall include the grounds for such issue, and the minor’s closest family member or his/her guardian shall be notified of the employment of seclusion measures as soon as practicable. A seclusion order shall be valid for eight (8) hours as of its issue. Each seclusion order shall require that the child and adolescent psychiatrist, or in default thereof, that a general psychiatrist, after consulting with the former, issue a new order after having conducted a direct evaluation of the minor. The psychiatrist who orders seclusion shall immediately give written notice to the medical director and the inter- or multidisciplinary team of the grounds for the employment thereof, in order for its justification and results to be evaluated.
(d) It is further provided that the initial seclusion period shall last one (1) hour for minors who are ten (10) years of age or older. No seclusion order shall be issued for minors under ten (10) years of age. If additional seclusion periods are necessary, the child and adolescent psychiatrist shall issue a new order. Upon expiration of said period, the minor shall be reevaluated by the child and adolescent psychiatrist and if he/she deems that the minor poses a danger to him/herself or others or to property, a second seclusion period may be instituted, which shall not exceed one (1) hour.
(e) The child and adolescent psychiatrist, or in default thereof, a general psychiatrist, after consulting with the former, who orders seclusion, shall immediately designate a registered nurse trained and certified in this modality to personally and constantly observe the minor, and enter his/her observations in the clinical record every fifteen (15) minutes. The person so designated shall keep communication and direct visual contact with the secluded minor, without infringing upon the minor’s right to privacy. Such observations shall be legible, detailed, clear and precise, and drafted so as to describe the minor’s behavior.
(f) Seclusion rooms shall be properly prepared, pursuant to federal and Commonwealth protocols in effect, in order to keep the minor from harm.
(g) The medical director shall review all seclusion orders on a daily basis and investigate the reasons the psychiatrist had to issue such orders. With the purpose of assuring the professional accountability of team members and safeguarding the civil rights of the minor, the medical director and the inter- or multidisciplinary mental healthcare team shall formally review all seclusion cases as soon as practicable.
(h) The institution shall establish in writing a protocol for the employment of seclusion pursuant to the provisions set forth in this section. All mental healthcare professionals qualified to order and observe a minor in seclusion shall complete a training course in the use and application of this therapeutic modality. The provisions of this section shall be subject to the regulations that the Administration shall promulgate for these purposes, and to the licensing requirements for institutional providers of mental healthcare services.
History —Oct. 2, 2000, No. 408, § 8.09; Aug. 6, 2008, No. 183, § 43.