Staff believed the patient's altered behavior was due to possible drug withdrawal. Although the symptoms are similar, there are distinct differences between hypovolemic shock secondary to blood loss and acute opioid withdrawal. With a thorough examination, the staff should have been able to recognize this difference. The Clinical Opiate Withdrawal Scale (Wesson, DR and Ling, W., 2003) would have been the appropriate objective measurement tool to accurately evaluate the patient. Another breach of duty was failing to carry out the CT scan in an appropriate amount of time. The doctor had a high index of suspicion that the patient was bleeding internally, however the CT scan was not completed until the following morning. Finally, the patient admitted to having a substance abuse problem, but a drug screening was not ordered. If he had been they would have seen that there were no opiates in his system and he tested positive for alcohol and benzodiazepines. The fact that the patient died from internal bleeding shows that there was damage. The patient's death was directly linked to the delay in finding the correct diagnosis and the inability to determine the extent of the internal bleeding from which it came