All share a basic design: a mesh bag that slips over the head, often with an additional layer of cloth covering the mouth to block spit, secured by a strap around the neck.
Once in place, a patient or detainee who spits spits only on himself.
But in the hidden, largely unaccountable world of psychiatric facilities, these may be one of the most deadly and least regulated devices used to restrain, control or punish recalcitrant patients.
“There’s no regulation, there’s no research, there’s no evidence to support their use.”
A recent investigation by The Seattle Times found that, in the past decade, spit hoods were involved in the deaths of at least five patients.
Despite that, the devices are commonly used in medical settings in at least 29 states, with 15 employing them in state-operated psychiatric facilities.
It’s not that the potential dangers of spit hoods aren’t well known. Tranzport Products, the maker of one of the most widely used models, the Tranzport Hood, includes right on its label: “Warning: Improper use of Tranzport Hood can cause injury or death. Improper use may cause asphyxiation, suffocation or drowning in one’s own fluids.”
So the hoods can and do kill people, but psychiatric facilities just don’t give a spit.
Risks multiply when spit hoods are used alongside other restraints—or the patient’s spit, mucus, vomit or blood saturates the cloth covering their mouth, blocking airflow.
Unable to breathe, they simply die—a fact that often goes unnoticed amid the chaos of restraining them… until it’s too late.
Such deaths are usually described as “accidental.”
“One death is too many,” said Florida State University criminology professor George Kirkham. “We can say more people die from shootings or beatings, but the families of these folks are devastated just the same.”
In 2015, Erik Haak, 33, died at the Winnebago Mental Health Institute in Wisconsin after eight staff pinned him to the floor on his stomach. They then placed a spit hood over his head, causing his face to turn blue. His death was ruled “mechanical asphyxiation.”
Haak’s death wasn’t an isolated incident:
- 2017 (Tennessee) — Austin Hunter Turner, 23, died after being hooded by police and transported to a hospital by paramedics. He had been tased and tied facedown on a gurney, with blood spilling from his mouth beneath the hood.
- 2020 (California) — Joseph Jimenez, 29, died after a spit hood was fastened over his head while he was handcuffed to a gurney.
- 2022 (Texas) — LaDamonyon “DeeDee” Hall, 47, a transgender woman, was covered with a spit mask while being transported to Baylor University Medical Center. She yelled, “I’m dying,” and struggled against the handcuffs and straps securing her to a gurney. She was later declared dead at the hospital, her death ruled an accident.
- 2022 (Florida) — In Hernando County, Tim Peters, 49, died after being pepper sprayed and having two spit hoods placed over his head.
- 2024 (Colorado) — Paramedics tied Jesus Lopez Barcenas, 36, facedown to a gurney, injected him with a sedative and placed a spit hood over his head. He became unresponsive and died shortly thereafter.
Such deaths often occur while patients are being transported to hospitals or psychiatric facilities—when spit hoods are applied by paramedics in the backs of ambulances, far from public view.
Dr. Tobias Wasser, former chief medical officer at a maximum-security psychiatric hospital in Connecticut, said, “There’s no regulation, there’s no research, there’s no evidence to support their use. It’s insulting and dehumanizing, and I would never support [it].”
Most disturbing is the fact that, unlike other restraint systems, no government agency regulates the use of spit hoods. The US Food and Drug Administration and the US Department of Health and Human Services do not classify spit hoods as medical devices, a designation that would subject them to safety regulations. The Centers for Medicare & Medicaid Services, which enforces national healthcare safety standards, doesn’t require training for their use. And spit hoods aren’t even mentioned in the American Psychiatric Association’s guidance document on seclusion and restraint (the association claims it has no “formal position on spit hoods as a form of restraint”).
The Joint Commission, a leading hospital accrediting body, says it is “up to the organization to determine the appropriate use of spit guards or hoods in accordance with MIFU [manufacturer’s instructions for use], use of the product or device, organizational policy and any applicable law or regulation.”
In other words, just like the government agencies, they duck responsibility.
As a result, spit hoods aren’t subject to oversight and their deadly consequences often go undocumented. Statistics on deaths are typically inaccurate, because their effects are camouflaged when used in combination with other restraints.
Policies concerning use of the devices vary wildly, with many police departments and hospitals providing none at all on their proper use.
A Marshall Project review of 100 police departments in 25 states found that only 10 restrict the use of spit hoods to cases where patients or arrestees are actually spitting.
Too often, spit hoods are used not to protect staff, but as a form of punishment. In 2018, in a Kansas hospital, a 13-year-old girl was repeatedly restrained with a spit hood over five days. One nurse, disturbingly, commented: “On day two, I was going to take the restraints off, but she was being so mouthy.”
A patient at Western State Hospital in Washington pleaded, “I’m not spitting! I’m not spitting!” The nurse’s reply? “I don’t believe you,” before yanking the spit hood over her head.
“The tragedy here is that we continue to be scared of people with severe mental illnesses, and so we can keep them on the margins,” Christopher Frueh, a professor of psychology at the University of Hawaii, said.
“They’re not a group of people with money or resources. There’s no powerful lobbying groups. There’s no powerful financial incentives for any particular group to take care of them.”
This is why healthcare regulatory agencies must act immediately, issuing strict, enforceable rules for the use of these dangerous devices. Psychiatric facilities, hospitals and police departments that insist on using spit hoods must train staff properly and enforce protocols to safeguard patients and their basic human rights.
But first and above all, they need to do something far more fundamental: care.
