The California Behavioral Health Information Notice (BHIN) 21-001 document provides an important breakdown of the types of services and staffing licensed drug rehab facilities must provide.

The requirements are broken down into four types of facilities and the type of care they should administer in order to get licensed and maintain a license.

The BHIN 21-001 document has a few important sections that may help families take action after losing a loved one at a negligent facility. They include the standards for how often patients should be checked on and benchmarks for how many staff members should be on duty.

The Level of Care Designations Used by the DHCS

The California Department of Health Care Services (DHCS) licenses drug treatment facilities. Licensing requirements depend on the type of services the facility will provide and the type of Substance Use Disorder (SUD) patients it intends to treat.

The BHIN guidelines detail the DHCS requirements laid out in California’s Health & Safety Code HSC 11834.015, the American Society of Addiction Medicine (ASAM) criteria, and other legislation.

For licensing, the DHCS uses Level of Care (LOC) designations. They boil down to four types of facilities with different types of focus.

DHCS LOC 3.1: Clinically Managed Low-Intensity Residential Services. 24-hour care with trained and credentialed personnel. This is the lowest level of licensing, usually geared towards getting patients ready for outpatient therapy.

DHCS LOC 3.3: Clinically Managed Population-Specific High-Intensity Residential Services. 24-hour care with trained and credentialed personnel. Also a less intensive program, focused on patients with cognitive or other functioning impairments. This is for patients who struggle with physical or emotional conditions that affect their ability to handle everyday tasks and responsibilities.

DHSC LOC 3.5: Clinically Managed High-Intensity Residential Services. 24-hour care with trained and credentialed personnel. Treatment is specialized to help SUD patients with co-occurring mental health disorders. This complicated condition, also known as dual-diagnosis, refers to patients who deal with SUD and one or more mental health disorders at the same time.

DHSC LOC 3.2 WM: Clinically Managed Residential Withdrawal Management (WM). 24-hour care with trained and credentialed personnel. This type of facility is equipped with doctors, nurses, and staff ready to treat patients who may arrive already in withdrawal or face withdrawal complications as soon as they start practicing abstinence inside what’s supposed to be a “drug-free” facility.

Homes That Aren’t Licensed by the DHCS

Some care providers offer services below these standards and aren’t required to get licensed. Sober Living Homes provide a place to live for recovering SUD patients and peer support. They generally do not provide medical monitoring or professional counseling.

In most cases, a recovery residence wouldn’t require licensing. However, these facilities can still be financially liable to families if a resident is allowed to die.

Drug Treatment Centers BHIN 30-Minute Checks

The BHIN guidelines also cover the important issue of monitoring in a drug treatment facility. The careful surveillance of vulnerable patients who could seek drugs, seek to harm themselves and others, or even try elopement (running away) is key to any recovery.

These heartbreaking outcomes can often be prevented when bed checks (or Q30 checks) and face-to-face check-ins are made. They are often promised by facilities but then can be forgotten or skipped, leading to a dangerous situation for patients.

The BHIN document demands this level of surveillance at a California facility:

“Personnel trained in providing detoxification services perform close observation and face-to-face physical checks at least every 30 minutes and monitor vital signs at least once every 6 hours during the first 72 hours following admission. Documentation of observations and checks must be recorded in the resident’s file and signed by the trained personnel.”

This 30-minute check rule applies to all patients in an LOC 3.2 facility going through detox and the dangers of withdrawal. Drug treatment center owners are liable to provide this care and may even promise it on their websites.

They become fully liable when these and other examples of neglect come to light:

• How long a loved one sat unattended after attempting self-harm, experiencing serious withdrawal symptoms, or overdosing.
• How long it took staff members to call for an ambulance.
• How long it took staff members to administer NARCAN after an overdose.
• The monitoring and care that took place after an overdose was treated. This can include the failure to place a patient in the recovery position so they can’t choke on their vomit. It can involve administering rescue breathing for patients who suddenly have breathing issues while in withdrawal or recovery from overdose.

See: How Bed Checks logs can be falsified.

DHCS Staffing Requirements at Drug Treatment Clinics

These guarantees of proper monitoring can’t be fulfilled if there aren’t enough staff members on duty. It takes eyes on patients and face-to-face check-ins to prevent tragic outcomes.

The text in the BHIN document sets the baseline at one person per 15 residents in a facility licensed for Withdrawal Management. However, that person must have the proper training.

“For every 15 residents receiving detoxification services, a program shall have a minimum of 1 staff, at all times, physically on duty, awake, certified in providing cardiopulmonary resuscitation and first aid, and trained in the use of naloxone.”

This one employee is usually in addition to many other staff members who may not have this type of training. Facilities would usually set their own staffing levels beyond just one clinical staff member, based on the patient’s needs and accepted healthcare standards.

The level of staffing is another key factor in many wrongful death lawsuits filed against the corporate owners of drug rehabs. Families can question the hiring and firing practices if their loved ones were allowed to pass away while in the care of a facility.

Families can question if an owner purposely cut staff to unsafe levels to boost profits. If this can be proven, families have a much better chance to hold a facility liable and to earn the support they need for the years ahead.

DHCS Staff Qualifications, Training, and Supervision

Drug treatment center owners aren’t just responsible for the number of staff members available.

They are also responsible for hiring qualified and background-checked candidates.

They must provide proper supervision for patients and training for everyone who works inside the walls of a secure drug rehab facility.

These are some of the other staffing requirements highlighted in the BHIN 21-001 document:

• Clinical staff, including LPHA Physician and Non-Physician, must provide services within the California State scope of practice statutes.
• Professional staff, including registered and certified alcohol and other drug counselors, must adhere to all requirements in the California Code of Regulations (CCR), Title 9, Chapter 8.
• Non-professional staff shall receive appropriate on-site orientation and training prior to performing assigned duties.
• Non-professional staff will be supervised by clinical, professional, and/or administrative staff.
• Clinical, professional, and non-professional staff are required to have work experience and any necessary training at the time of hiring and throughout employment.
• Clinical and/or professional staff conducting level of care assessments, determining the appropriate level of care for residents, and providing direct treatment services must complete ASAM training.

Contact Us if Your Loved One Was Allowed to Die in a Drug Rehab

A patient who dies while in the care of a drug rehab facility is not at fault. Facility owners and lawyers will tell you it was a medical emergency and couldn’t be prevented, but that’s just their standard tactic for escaping blame.

Attorney Martin Gasparian offers a free, confidential consultation to families who lost a loved one. It’s a no-risk, no-obligation way to find out what a wrongful death case would be worth and how to hold a negligent treatment center fully responsible.