Standard of Care
The treatment delivered by the unsupervised trainees at Columbia was one of light sedation and the heavy use of restraints. This cruel and continuous use of restraints to control agitation was a violation of the Law of New York State as well as the hospital's own Restraint Protocol. The treatment was a "cold turkey" withdrawal in which the victim was tied up, illegally.
The interested reader can find the correct treatment of Seth's condition in an article first printed in the American Journal of Psychiatry titled "Diagnosis and Treatment of Drug Dependence of the Barbiturate Type" (Amer. J. Pschiat. 125: 6, December 1968). The treatment of acute withdrawal from Xanax is the same as that described in the article. From page 764 of the Journal:
"If delirium has already developed when the patient is first seen, the immediate aim of treatment is not stabilization but heavy sedation with pentobarbital or Phenobarbital, sufficient to suppress agitation, insomnia, and hyperpyrexia. Such heavy sedation is maintained for three to five days with appropriate supportive medical and nursing care, after which the degree of sedation is lightened gradually and slow reduction of the barbiturate is carried out as in the stabilized patient."
In the 1990's, this same treatment standard was repeated in the widely respected Handbook of Drug Therapy in Psychiatry, Second Edition, by Jerrold G. Bernstein, M.D. From page 534 in the sections on treatment of withdrawal:
"In the event that seizures or other manifestations of sudden withdrawal appear during or following detoxification, it is important to administer barbiturates, preferably Phenobarbital or amobarbital, IM in a sufficient dose to produce considerable sedation."
The correct and humane treatment was to totally sedate. Seth's prolonged agitation was instead controlled by the illegal use of restraints. Immobilized and in an agitated state of panic, he developed metabolic\autonomic instability. Given the multiple risk factors, the formation of emboli was one predictable consequence of the negligent care delivered by the unsupervised trainees.
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