When a loved one enters a rehab center, we hope that the only outcomes are positive. While seeking treatment is a critical first step on the journey to sobriety, it is not without certain risks. One of the most critical periods of stay in a rehab facility comes at the outset when the patient has discontinued substance use and experiences withdrawal. Rehab centers must ensure that patients are not exposed to any unnecessary risks, including the especially sensitive period of withdrawal.
Dangers of Withdrawal
The Substance Abuse Abuse and Mental Health Services Administration (SAMHSA) categorizes withdrawal into two types: acute withdrawal and protracted withdrawal. Acute withdrawal is defined as the initial symptoms arising from suddenly discontinuing the use of a substance. The length of the acute withdrawal period will depend on the substance(s) from which a patient has discontinued use. These periods can range from 5-7 days (alcohol) to 1-4 weeks (benzodiazepines).
The symptoms that a patient might experience during a period of acute withdrawal will, much like the time period, vary depending on the substances previously used. Examples of the most common substances include the following.
Alcohol: hyperactivity, anxiety, tremors, sweating, nausea, increased heart rate and blood pressure, fever, hallucinations, delirium tremens
Opioids: irritability, anxiety, fatigue, insomnia, muscle aches, runny nose nausea, vomiting, diarrhea, fever, chills, sweating
Benzodiazepines: blurry vision, headache, body ache, restlessness, sweating, nausea, diarrhea, disorientation, dizziness, dry mouth, fever, chills, decreased muscular control, shortness of breath, hallucinations
Symptoms that last beyond the initial period, or that reappear after this period, are then labeled as protracted withdrawal (or post-acute withdrawal, chronic withdrawal, or extended withdrawal). The symptoms of protracted withdrawal are mainly psychological and can often be a major factor in the incidence of relapse.
In addition to the common symptoms of withdrawal, more serious complications can occur, especially if the patient has used multiple substances.
Withdrawal Management Care Standards
Due to the severe health risks posed by withdrawal, protocols have been established for health care providers and organizations. The World Health Organization (WHO), in the publication Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings, sets forth guidelines for the standard of care for withdrawal management (the medical and psychological care of patients who are experiencing withdrawal symptoms as a result of ceasing or reducing use of their drug of dependency). These guidelines include the following.
- Keeping patients who are going through the withdrawal process away from patients who have completed the withdrawal process.
- Providing access to health care workers 24 hours per day. Such health care workers should include a doctor who is on call and able to attend to address any possible complications as well as nurses to monitor patients, dispensing medications, and providing information about withdrawal.
- Maintaining a quiet and calm atmosphere for the withdrawal experience (allow the patient to sleep, relax, and engage in moderate activity such as walking).
- Providing information about the withdrawal process in order to alleviate anxiety.
- Refraining from forcing the patient to engage in vigorous physical exercise as well as therapy or counseling during withdrawal.
Opioid Withdrawal Care Standards
In the same publication, the WHO devotes attention to patients who are experiencing withdrawal from opioids. It specifically notes that some patients who should not complete opioid withdrawal. The WHO recommends that opioid-dependent pregnant women not undergo opioid withdrawal as this can cause miscarriage or premature delivery. The recommended treatment approach is methadone maintenance treatment. Additionally, the WHO advises that patients commencing methadone maintenance treatment do not need to undergo withdrawal before commencing treatment. Additionally, it sets forth monitoring guidelines. Patients should be monitored three to four times per day to check for complications.
Liability of Rehab Centers in the United States
Rehab centers in the US are not required to follow the WHO standards articulated above. However, they are required to follow standards set by the state in which they are located and any other governing bodies from which the organization obtains accreditation. These standards include specific protocols for patients going through withdrawal.
If a patient is injured or experiences serious complications or illness during this period, the rehab center may be liable. These centers are required to have adequate policies in place. If employees follow these standards and a patient experiences an injury, the rehab facility may be liable to a failure to set forth adequate standards. Additionally, a rehab center may have adequate policies in place, but an employee may not follow the policies, resulting in harm to a patient. In such a case, the organization itself may still be liable under the theory of vicarious liability.
Vicarious liability is a legal doctrine under which an employer may be liable for the actions of employees. This typically applies to an employee's actions (or the failure to act) when the employee is performing duties that fall within the scope of his or her employment.
Lawsuits Against Rehab Centers
A civil lawsuit against a rehab center for withdrawal-related injury or illness seeks to compensate a victim and/or their loved ones. In such a lawsuit, it may be possible to recover damages for the costs you've incurred, as well as expenses that you may incur in the future. Such damages can include things like ambulance transport, hospitalization, surgery, physical therapy/rehabilitation services, mental health counseling, and more.
Personal Injury Attorneys Gilman & Bedigian
The team at Gilman & Bedigian aggressively advocate on behalf of victims and their families. If you or a loved one experienced an injury or illness in a rehab facility, contact our legal team. We can sit down, discuss your case, and advise you on the best path towards healing and recovery.