Recently, CNN reported that since 1999, the number of opioid overdose deaths has quadrupled. Since the year 2000, more than a half million people have died from drug overdoses in America.  According to the Center for Disease Control and Prevention, an estimated 91 Americans die every day from opioid addiction and for every death, 30 more of users of opioid drugs are admitted to the emergency room. In the wake of these staggering statistics, the Trump administration announced a plan to aggressively fight opioid drug abuse.  The President’s pending budget reportedly proposes a $500 million increase to battle opioid misuse, prevention methods and drug treatment programs.

Research has shown that in California, approximately 2.3 million people 12 or older abuse or are dependent on alcohol and about 750,000 people abuse illegal drugs. Addiction to and abuse of methamphetamines and other stimulants is one of the most common reason for seeking treatment at rehab facilities, followed by marijuana, heroin, cocaine and opiates.  California has a large number of alcohol and drug treatment centers and facilities. In 2013, over 150,000 people from other states enrolled in California rehab facilities.

Negligence, Fraud and Abuse in Drug and Alcohol Rehab Centers:

Sadly, along with the upsurge in substance abuse is also an escalation in abuse inside of alcohol and substance abuse treatment centers.  In the past few years, government investigations have uncovered negligence, fraud and abuse.  A person seeking help at a rehabilitation center are extremely vulnerable both physically and mentally.  Suffering injury or abuse while in a treatment center can be traumatizing and may even lead or contribute to relapse. A recovery center must provide a trusted environment and has a duty to ensure the safety of it patients.  Unfortunately, they do not always maintain the proper standard of care.

Common injuries that arise in alcohol and drug rehab centers include:

Slip and Falls/Trip and Falls:  Easy to clean and maintain tile and linoleum floors are commonly found in these facilities.  Unfortunately, they tend to be slippery and when freshly clean and wet can make for a dangerous and hazardous condition resulting in injuries that may include broken bones and injury to the head, neck and back.

Infection and Disease:  Unsanitary facilities can be a hot bed for spreading infection.  Like many hospitals, rehab centers are susceptible to antibiotic resistant bacterial infections such as staph infection, MRSA and C-Diff.  Many times addicts, especially needle users carry diseases such as Hepatitis B Hepatitis C, HIV/AIDS, and other infectious diseases such as tuberculosis.  Facilities need to be cautious and vigilant not to inadvertently transfer these infectious diseases amongst their patients.

Assaults on Patients:  There are numerous incidents wherein patients get assaulted while in the rehab center.  Shockingly, there are too many instances where this physical abuse is conducted by staff.  These staff members are often physically strong and are hired to restrain unruly patients.  Many are not properly screened, trained and/or supervised.  They get “carried away” in their duties and use excessive force and invoke improper and harmful restraining and disciplinary measures resulting in serious injury. Likewise, some patients in the course of their treatment and recovery are combative and sometimes violent. This can result in fights breaking out between patients.  Some facilities are not properly staffed and/or their staff are not properly trained to properly handle such altercations and physical injuries arise.

Sexual Assault and Sexual Harassment:  Patients in early stages of treatment are often weak, fragile and vulnerable.  They may be susceptible to be taken advantage of by staff or fellow patients.  Staff members may take advantage of their position to manipulate and coerce patients into providing sexual favor. They take improper advantage and act inappropriately. There are even reported instances where staff members and fellow patients have forced themselves on a patient. Many times the victimized patient is made to feel guilty or responsible for the conduct. They remain silent and do not report the wrong. Such conduct should not be tolerated.

Improper Prescribing and Dispensing of Medication:   Prescription medication can only be prescribed by a state licensed medical doctor and only after a proper and thorough examination and evaluation has been performed of the patient.  Facilities must make sure that they have the needed medication on hand and be mindful of all of the patient’s health conditions and not just those relating to the addiction. So for example a patient suffers from copd or diabetes, the facility must make sure that they have the needed oxygen or insulin on hand at the facility and must be properly trained in its dispensing. The prescribed medication must be properly and carefully dispensed and the patient’s use of the medication must be closely followed.  There are strict guidelines as to the dosage, quantity and duration of the prescription.  Further care must be taken when medications are prescribed in combination. The wrongful or improper prescribing of medication can lead to injury, relapse and even death.

Improper Monitoring of Patients:  Patients need to be carefully monitored and assessed.  Such things as self-destructive tendencies or aggravated withdrawal symptoms must be quickly identified and treated.  Doctors, therapists, counselors and licensed clinicians must be actively involved in the course of their patient’s treatment and should not solely rely on the notes and assessments of nurses or unsupervised interns. Insurance coverage many times dictates the degree and duration of treatment and can result in early discharge of patients before they are ready to leave the facility.  This may lead to relapse, injury, overdose, or even suicide.

Improper Insurance Practices:  It is illegal in California to steer patients to certain facilities for referral fees or kickbacks.  It is illegal to upcode billing to maximize payment by the insurance company or falsify charts or diagnosis in order to secure insurance coverage and payment. Signatures cannot be falsified in medical charts or prescriptions. Courses of treatment cannot be mischaracterized or falsely created.  Interns must be properly supervised and most treatment and care must be administered by properly trained and licensed physicians and clinicians.  Insurance coverage benefits should not dictate length of stays or early discharge.  Patients should not be recycled through the system.

Bad Faith Conduct by the Insurance Company:  Addiction has been determined to be a disease by the American Medical Association.  Therefore, much of the prescribed care provided by rehab facilities is medically necessary and should be covered.  The Affordable Care Act (ACA) also has extended and mandated insurance coverage for alcohol and substance abuse treatment.  If you feel that your insurance company is either not providing you the coverage you feel you are entitled or is not properly paying a claim, you should consider have an attorney experienced in insurance matters review your policy and claim.

Drug and Alcohol Rehab Centers Have a Duty of Care to Uphold:

Alcohol and substance abuse treatment centers have a duty of care not to allow the above described conduct and behavior. They must be diligent to avoid and immediately remedy any foreseeable and preventable danger and harm.  When the rehab center fails to act with reasonable care and fails to upkeep required standards, they breach their duty and may be in breach of contract, negligent, fraudulent, guilty of committing negligent and intentional emotional distress, and required to pay monetary compensation for the harm and damages they caused. These monetary damages can include refunds of monies paid for admission to the facility, payment for future medical care as a result of the injuries, out of pocket expenses for needed medication, lost wages, emotional stress for the pain and suffering, and sometimes triple damage for the fraud or even the imposition of punitive damages.  There are even instances where injunctive relief is imposed and facilities are forced to either change their ways or be shut down.

Additionally, families of patients who have died as a result of the acts and omissions described in this article may have the right to bring a Wrongful Death action and seek monetary recovery for their losses which may include loss of income and future earnings that the deceased provided, loss of companionship, funeral expenses and other related damages.

Given the mandate on insurance companies to provide medical care, the infusion of governmental money, and the greater number of people who will be obtaining treatment from alcohol, drug and substance abuse facilities, the likelihood of the above described negligence, fraud and abuse is even more likely.  We need to be more vigilant in combating such wrongs.   If you or a loved one has been a victim of such wrongdoing or have witness or firsthand knowledge of fraud or abuse at a substance abuse treatment facility, please contact Southern California attorney Frederick Schwartz for a personal and confidential free consultation.  Most accepted cases are taken on a contingency basis wherein no fee is taken unless there is a monetary recovery.  Also, reporters of fraud and wrongdoing may act as a “whistleblower” and qualify for incentive awards from the court.