Alcohol Poisoning: Are Hospitals Releasing Drunk Patients Too Early?

Between 2013 and 2014, 907 patients were admitted to a hospital Emergency Department in France due to acute alcohol poisoning. This represented 1.13% of all ED visits. BACs were recorded for 98.6% of these patients, with admission levels ranging from 0 to an extreme 0.600 g/100mL (median 0.250 g/100mL). A mere 2.7% of admission BACs were below 0.05 g/100m. Admissions peaked on weekends, with the busiest hours at 9:00 p.m. and 4:00 a.m.

Patient demographics and details included:

• Ages ranged from 18 to 84 years (mean 37 years)
• The male to female ratio was 2:1

The mean length of stay in the ED was 19 hours (range 0 to 120 hours)

The study estimated the BAC at discharge using the time between admission and discharge and applying an average alcohol elimination rate of 0.015 g/100mL/h. The findings were alarming. Approximately one-third of the patients were discharged when their estimated BAC still exceeded France’s legal driving limit of 0.050 g/100mL. Even more concerning, some individuals were released with a BAC > 0.200 g/100mL, a level indicating severe intoxication and significant impairment.

This practice indicates that the decision to discharge a patient was often based on clinical signs of intoxication—such as slurred speech, unsteady gait, and bloodshot eyes—rather than the objective, reliable data provided by BAC and known alcohol kinetics. The authors state:

“We found that emergency physicians based the discharge decision on clinical judgment rather than on evidence-based medicine. The discharge decision may carry a risk of subsequent legal proceedings. The role of the accompanying persons must be defined and proof that the physician did everything possible to prevent the patient from driving after leaving the hospital, if estimated BAC is above the legal limit, must be recorded in the patient’s file. Allowing an unaccompanied patient to leave the hospital against medical advice is unadvisable, as the patient or a lawyer can always cast doubt on the quality of consent at the time the self-discharge form was signed.”

The authors issued a stern warning regarding the legal and ethical ramifications of these discharge practices. They cautioned that if a patient discharged with a high BAC causes an accident, the attending physician could face serious charges. The study concludes that a physician could be charged with negligence if they failed to ensure the patient was accompanied upon discharge and was not a danger to themselves or others. This highlights a major gap in standard discharge protocols for cases of alcohol poisoning, prioritising convenience over comprehensive patient and public safety.

Understanding the science of alcohol metabolism is paramount in these situations. Forensic toxicology provides the evidence-based framework that should guide medical decisions. Experts in the field, like forensic scientist James Wigmore, have spent decades refining the methodologies for BAC calculation and impairment assessment. Their work in courts and research labs provides the scientific backbone that can—and should—inform hospital policy to prevent premature discharge of vulnerable patients experiencing alcohol poisoning.

To mitigate these risks, hospitals must adopt more rigorous, evidence-based discharge protocols for intoxicated patients. This includes:

• Mandatory BAC testing at admission and before discharge.
• Using established alcohol elimination rates to estimate sobriety timelines.
• Requiring a responsible adult to accompany the patient upon release.
• Thoroughly documenting all discharge decisions and safety precautions taken.
• Providing clear educational resources to patients about the risks of driving impaired.

Implementing these steps can protect patients from harm, shield physicians from potential litigation, and ensure public safety is not compromised. The study serves as a crucial reminder that managing alcohol poisoning requires a blend of medical expertise and forensic precision.