Four years after their daughter died after checking into Bournewood Hospital in Brookline for drug-rehabilitation treatment, an Arlington family is proceeding with a lawsuit that charges the institution gave her a powerful combination of pharmaceuticals and then did not monitor her properly for adverse effects

Nora Tosti, 23, had been dead for an estimated six hours when a hospital employee found her body early on Dec. 8, 2005, although the hospital's policy required staff to check on patients and make sure they were breathing every half-hour, according to court records. Investigations by both the state Department of Mental Health and Department of Public Health found Bournewood had not followed its own protocol in monitoring the young woman.

Depositions in the civil lawsuit, which was filed last year by Barbara and Allan Tosti, Nora's parents, in Middlesex Superior Court, are scheduled to begin this month. Earlier this year, a medical malpractice tribunal determined that it could proceed through the legal system

In the years since their daughter's death, the Tostis have lobbied state officials to require electronic monitoring of patients, like their daughter, who are given medications to counter drug-withdrawal symptoms.

Nora Tosti was discovered dead two days after she checked herself into Bournewood, a private facility off South Street that focuses on psychiatric and chemical-dependency treatments. An autopsy labeled her cause of death as "chronic substance abuse" and found that none of the drugs administered by the hospital were at toxic levels. The Department of Public Health report also concluded, based partly on the autopsy results, that Tosti did not die from the medications she received at Bournewood

The family's lawsuit, however, includes a report from Dr. Errol Green, a specialist in emergency medicine, pharmacy and therapeutics at Tufts Medical Center, who states that the combination of drugs Bournewood staff gave Nora Tosti likely caused a fatal heart arrhythmia. She was given methadone and other drugs, according to hospital records. The drugs can cause potentially fatal heart problems, according to Dr. Mark J. Albanese, director of the addictions treatment services at Cambridge Health Alliance, who also wrote a report for the lawsuit

The lawsuit names as defendants First Psychiatric Planners Inc., the company that owns Bournewood; Dr. Jennifer Jenks, the Bournewood psychiatrist who it says ordered a regimen of drugs designed to help wean Nora Tosti off addictive drugs; and the mental health counselor who it says was responsible for checking on Tosti every half-hour during the night she died. Lawyers for Bournewood Hospital and the other defendants did not return calls requesting a comment on the lawsuit.

In court papers, all of the defendants have denied any wrongdoing. The hospital says that Tosti died from chronic substance abuse, as the autopsy found. Jenks says that Tosti was made aware of any risks and consented to her treatment at Bournewood.

The Tostis have been campaigning for a requirement that electronic devices be used to monitor the vital signs of patients undergoing drug-withdrawal treatments.

On the first anniversary of Nora's death, the Tostis and others held a vigil outside Bournewood Hospital. They and another Massachusetts family whose son died in similar circumstances at a different hospital met last year with JudyAnn Bigby, secretary of the state's Executive Office of Health and Human Services.

The Tostis say that if hospital staff had been alerted as soon as their daughter went into distress, she might have been saved

"Right now, the monitoring system is 1800s," Al Tosti said. "It involves half-hour checks where someone walks in and determines you're breathing."
In their lawsuit, the Tostis allege that Bournewood failed to follow that policy. And, they say, Nora should not have been given drugs for opiate withdrawal, including methadone, since she showed no signs of requiring the treatment.

The Tostis do not mention electronic monitoring, which is not standard practice in psychiatric hospitals, in their lawsuit. But they contend that changing the protocol could save lives

"A lot of this is even wireless," said Al Tosti, a financial adviser for municipalities. "You can do this very inexpensively. If someone goes into cardiac arrest, you know two seconds later."
Nora Tosti had struggled with drug abuse for many years, though she was also doing well in school, according to her parents, who said she had enrolled in a medical assistant program at Clark University's Computer Career Institute in Cambridge and was getting good grades. She had previously worked at an assisted-living residence in Arlington and wanted more training.

But her demons still haunted her. She had long struggled with being adopted, and with learning disabilities. She went to Bournewood after she had appeared in Concord District Court on drug-possession charges and was given the choice of voluntary or involuntary commitment for substance-abuse treatment, according to court records

"We knew she was struggling with drug problems," said Barbara Tosti, a licensed mental health counselor. "We didn't know how severe it was."
Her parents said they were relieved when she checked herself into Bournewood; they thought she was safe. Now they hope they can change the system

"There's nothing we can do to have our daughter return to us," Al Tosti said. "She's gone. But if we can do something to prevent this from happening to others, at least our daughter will not have died in vain."
Kathleen Burge can be reached at kburge@globe.com.