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Williams' medical records, released at the behest of her family, say she arrived at the institution in the back of a squad car shortly after midnight, agitated and refusing to take medications. She was deemed combative and is reported to have attempted to assault a staff member.

About 5:45 a.m., four people carried Williams into a room where she was strapped to a table and injected with a powerful tranquilizer and other medications. When the drugs failed to calm her, the records show she was forcibly medicated again.

About 8:40 a.m., Williams' medical records say she was still in restraints when a staff member checked on her and found she was no longer breathing and had no pulse. She was rushed by ambulance to Wayne Memorial Hospital, where she was declared dead.

Calvin Williams got the news of her daughter's death by telephone.

"The doctor called and said, 'We lost her,' " she said. "That's all he'd say. 'We lost her.' "

Rules for restraints

Physically restraining patients can endanger them and staff members. Those who work at mental hospitals are instructed to use nonconfrontational methods to calm patients and to use force only as a last resort.

When physical intervention becomes necessary, hospital staffers are trained to use holds designed to limit patients' ability to move while not injuring them. If a patient continues to resist, sedatives may be administered with the approval of a doctor, and the patient will be carried by staff members holding the arms, legs and head into a special "restraint" room.

There, the patient is strapped to a steel bed with wide leather bands on the person's arms and legs. Regulations require that the patient must be released "at the earliest possible time."

Though specific procedures for restraining patients in state hospitals vary by institution, Cherry Hospital's policy is that no patient should be strapped down for more than 30 minutes. The restrained patient must be under constant observation by at least one staff member.

On the confidential forms used to report mental-hospital deaths to the state Division of Health Service Regulation, staffers are required to indicate when a patient died after being physically restrained or locked away in a seclusion room. At least five have died after being placed in restraints since 2003.

In Williams' case, however, no such report was made by Cherry Hospital, a violation of state and federal laws. Investigators learned of her death from an anonymous tip.

State investigators responded by making an unannounced visit to Cherry. They interviewed staff members about Williams' death and read the written records.

They found the accounts incomplete and, in some cases, contradictory.

Key point left out

Williams' medical records, as written by the staff at Cherry, didn't tell the full story of how she died. Not included was the key detail that she managed to get out of her restraints -- despite the requirement for constant supervision.

When she walked out of the restraint room on her own about 7:30 a.m., a staff member called for "male help," according to the federal investigative report. Health- care technicians, the least-trained and lowest-paid members of the hospital's medical staff, often are charged with tackling patients and restraining them.

About 15 people are estimated to have responded to the emergency page. They held Williams face-down on the floor for about 10 minutes until she stopped resisting and went "limp," according to the investigative report.

She was carried back into the restraint room, where her gown was changed because she had urinated on herself. She was then put back in the leather straps without the approval of a doctor, a violation of procedures.

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