What Can A Hospital Do With Drug Screen Info?
April 4, 2011 4:10 PM   Subscribe

What can the hospital do with drug test results that are positive?

This question made me think about the drug testing procedures at hospitals, specifically in the ER. The OP in that situation said he did not agree to those tests and just signed a generic consent form.

I understand why a hospital would want to know what drugs were in your system - better diagnosis, less chance of adverse effects with new medication, et cetera. However, what do they do with these results if they come back positive? I am assuming that they have no obligation to inform the police, but what about if the patient in question is in a situation where they must remain drug free (probation, government job, etc)?

Can a judge subpoena a hospitals' records?

Does the health insurance company find out? Would this be cause enough to raise rates or drop you from their coverage? Would future health insurers be privy to this information?
posted by amicamentis to Health & Fitness (13 answers total) 5 users marked this as a favorite
I’m doing a social work internship at a hospital right now. In our ER all the records say in bold lettering right on the tox results that there was not a proper “chain of custody” process for the U/A toxicology. It goes onto say that the results are for medical treatment purposes only and would not be appropriate for other use as it was not done with the appropriate chain of custody process. This is in California, I’m not sure how it would work in other states.
posted by Palmcorder Yajna at 4:39 PM on April 4, 2011 [1 favorite]

Response by poster: Additional question: do they do full drug tests on children as well? What is the procedure for a positive result?
posted by amicamentis at 4:55 PM on April 4, 2011

Speaking from Canada here, so the health insurance stuff doesn't really apply. The following is offered as observation with no specific endorsement or criticism...

FWIW, I've never seen drug results reported to a probation officer or government employer. I have seen Emerg docs send alerts to the Ministry of Transportation when someone has done something/has a condition that make it dangerous for them to drive, and this can include everything from seizures to alcohol or drug addiction. The drug test may factor in to such disclosure to the Ministry of Transportation, but the problem is often pretty evident, or disclosed by the patient, so the drug or alcohol test result is just extra info and the results are not disclosed per se. I have also seen drug testing results be disclosed to the Children's Aid Society, but not simply due to such results alone - such disclosure would be in the context of a more global child protection concern (example: house fire - child is severely burned due to parental neglect - parent is also burned and tested for the usual things - parent is obviously under the influence of something and tests positive for an illicit substance - Children's Aid is called due to concerns about neglect and the drug issue is brought up).

Overall, though, Emerg staff see a lot and don't really care if you're using drugs, as long as you're straight with them - so reporting people for drug use is not high on their list. You can expect to significantly raise your risk of being reported to an official body if you are brought to, or attend, the emergency department while you are intoxicated and simultaneously doing a thing that could be dangerous if done while intoxicated (driving, flying a plane). If you're not driving, flying a plane, or caring for a newborn, and happen to test positive for something, there is little reason (beyond possible medical implications) for anyone to care.
posted by analog at 4:59 PM on April 4, 2011 [1 favorite]

With babies, they test the first stool (meconium) for evidence of the mother's drug use during pregnancy. On the basis of this CPS will get involved.
posted by TorontoSandy at 5:05 PM on April 4, 2011

If the hospital called the police for every ER patient who tested positive on a drug screen, the police would probably have a station in the ER. They do not. Draw what conclusion you will. The police would in any case need to have a subpoena or warrant to get that information, and as Palmcorder Yajna notes, it would be subject to evidentiary rules.

I believe it's not illegal to have mood-altering drugs in your system unless you are driving. (Being high doesn't count as possession under the law, in other words.) There is "public intoxication," which you could conceivably get nabbed for if you are behaving erratically, but that's usually a misdemeanor in jurisdictions where it is a crime at all. In the U.S. it is entirely up to the state to set such laws.

In Montana, for example, not only is public intoxication not a crime, it is illegal for the police to even keep a record that you were detained for being a danger to yourself or others (which they can do in such cases). Very much in keeping with what I know of Montana...

Your insurance company does get copies of your medical records (this stipulation is part of the insurance policy). What they do with this information in the case of a positive result for illegal drugs, I'm not sure. There is probably regulation or law (varying from state to state, naturally) that would set limits to what they could do.

If you previously stated on an application for insurance that you had not used illegal drugs in some past time period, and some test result indicates that you were obviously lying, conceivably they could use that information to cancel your policy. It is difficult to imagine a situation in a medical test would irrefutably reveal past use, however. They would have to do a hair test, and there's no reason for a doctor to do so.
posted by kindall at 5:07 PM on April 4, 2011

They usually do not run them on children under 14. If they suspected drug use as the cause of symptoms they would. If we have someone under 18 with a postive test, a child welfare call is made. If an adult is positive and the drug use resulted in the injury/trauma that brought them to the ER, we offer drug rehab services in the community. If the adult is positive and has young children and there are other concerns we might make a report to child welfare too. Drug use alone isn't a reportable condition (again here in California).

Other than that the doctor's only use the information to decide what to prescribe/use as course of treatment. I've never seen anyone report anything to a place of employment, to the DMV, or to any place else.
posted by Palmcorder Yajna at 5:07 PM on April 4, 2011 [1 favorite]

The short answer is not much. Offhand, there are at least two issues here: HIPAA and physician-patient privilege. HIPAA prevents physicians and hospitals from releasing medical information without your consent. This includes, in most circumstances, reporting your positive drug test to the police, employers, and other third parties. I think they can legally pass the information on to health insurers (I'm not certain of this though, and some states may have more specific requirements), but this isn't routinely done by any means.

Physician-patient privilege, along with the professional standard of confidentiality, is the other issue at play here. In most states, medical records cannot be subpoenaed without the consent of the patient. It is always possible the judge could specifically order the records to be turned over, but the defense would certainly object and would have grounds to appeal if privilege was violated. A doctor could lose his license for reporting a positive drug test result to an employer or anyone else without permission, as that would be a serious breach of confidentiality.

One exception might be that doctors are required in (I think) every state to report suspicion of child abuse to the appropriate child welfare agency for investigation. Some states specifically require reporting when an infant or child tests positive for drugs. In other states, it might not be required, but a doctor might make a report if he/she reasonably suspected abuse. This usually happens with newborns. If a parent tests positive, that might, in combination with the doctor's other observations, be grounds to make a report, but I believe the physician could only reveal as much information as reasonably necessary; in other words "I believe child X broke his arm when he was was left alone with parent X who was under the influence and unable to care properly for the child."
posted by zachlipton at 5:13 PM on April 4, 2011

If a child is tested and turns up positive, not only is the call made to CPS, but CPS can request copies of the child's medical records at the hospital for use in the case. I just got my foster (soon to be adopted) kiddo's medical records and see that drug testing occurred at birth. Those records came from the hospital. I'll be able to get kiddo's records from the pediatrician when I switch practices with the finalization of the adoption.
posted by onhazier at 5:20 PM on April 4, 2011

I see hospital records from clients in two occasions on criminal cases: 1) When it is helpful to my client, in which case, I get them from my client or subpoena the hospital and get them. 2) When it is helpful to the government in prosecuting my client, in which case the state manages to bring them in and pretty much ignore privacy laws.

I would never assume that what happens in the hospital is private. Experience has taught me otherwise.
posted by Happydaz at 6:00 PM on April 4, 2011 [3 favorites]

Many of the above comments about no legal action can be based on ER drug testing do NOT hold true for pregnant women. Under the guise of newborn protection, many states have authorized prenatal/perinatal drug testing of all pregnant women, complete with reporting guidelines. The end of this column at American Pregnancy Association states that as of 2008 that South Carolina has prenatal drug abuse as a criminal offense and that some states use to terminate parental rights. On page 4 of this pdf, Guttmacher gives all state requirements as of 2000. Guttmacher data may be superceded by the Supreme Court decision of 2001 that as far as this non-lawyer can tells authorizes such testing as long as the patient is informed. And I'll bet you pretty much anything that such authorization is buried in the fine print of all the paperwork you fill out when you present into the ER for care or begin care with a private OB/midwife.

All in all, I'm nth'ing what TorontoSandy, analog and Happddaz state.
posted by beaning at 6:21 PM on April 4, 2011 [3 favorites]

In terms of the adult drug testing, the situation is really more in the other direction (in terms of reporting). As an ER doctor, we don't typically do anything with the drug testing results except for base medical care on it. Not only that, but even people who come in from car accidents with high blood alcohol levels don't get reported to the police - some other posts have implied that if you were driving under the influence you would be reported for that, but I've never seen it happen. As far as I can tell, not much happens to them. It makes me sad. Many a time I have been watching a patient 'sleep it off' with their car keys at the bedside and thought about what I could do to prevent them from driving drunk again, especially because telling them they could kill someone that way doesn't seem to be effective. I've seen countless drunk drivers and only once have I ever received a call from the police saying that they were pressing charges for drunk driving and wanted to know if I could come to court. I never heard anything more, so I don't think the case went through. My career in medicine has been fairly short thus far so if anyone out there has a good solution on how to deal with this situation, I would love to hear it.
posted by treehorn+bunny at 8:40 PM on April 4, 2011

I'm an employment lawyer and when the doctors are doing an employment-related drug test, they have always gotten a HIPPA waiver.
posted by Ironmouth at 9:30 PM on April 4, 2011

Further to treehorn+bunny: Where I work (a big Canadian city), I have seen emerg docs report people who drink and drive to the Ministry of Transportation under the auspices of this policy. This doesn't instigate a criminal charge, but the Ministry of Transportation will most likely rescind the individual's driver's license. In my experience, most emergency dept reporting for driving under the influence is done via the Ministry of Transportation rather than the police. Check out the specific form on that page which is used to report. Are you U.S.-based? Do you have a similar process? However, FWIW - though it happens less than the above process, I have seen police parked in my emerg with a big machine testing someone's alcohol level for a specified amount of time in order to be able to use the results in court.
posted by analog at 8:32 AM on April 5, 2011

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