That's the question you should ask a pregnant woman who shows up at your door step in a fit of perspiration, shouting profanities and, well, just acting whacked out. My wife, a nurse, works in the front lines of OB medicine. As I understand it, if there is probable cause to suspect illicit drug use by the staff, they may draw a drug screen. Should this test turn positive, social workers may get involved and potentially remove the infant upon birth and place him/her into foster care.
Contrast this to another hospital in town that has a blanket policy excluding anyone from drawing a drug screen without consent from the mother. Apparently a lawsuit in years past resulted in this blanket policy. I don't know any of the details. I did a little review on the nature of this issue and found a Supreme Court ruling in 2001 striking down a hospital's ability to screen the women without their consent. There are likely specifics to this hospital's policy which was struck down as unconstitutional.
Regardless, what we have now are two large health systems in the city. One allows their employees to screen pregnant moms they suspect are using drugs, without their consent. The other allows their employees to screen pregnant moms only if the moms consent. Now, if I'm a crack smoking, marijuana doping, heroin popping kinda gal, which hospital do you think I'm going to? Am I going to the one where my needle tracks and my bulging eyes and my racing heart creates enough suspicion to have a screen drawn? Or am I going to the hospital that has to ask me.
"Ma'am, are you smoking crack?"
"No I"m not", she says, in a fit of rage.
"OK then."
End of discussion. Baby is sent home with cracked out mommy. And the sad thing is, all the cracked out mommies will come to this hospital, knowing they will not screen. A perverse incentive to continue using, up until and through their day of delivery. Babies entering the world in painful withdrawal, then getting sent home to a life of perpetual destruction.
One only has to ask the administrators of the no screen policy,
"Ma'am, are you smoking crack?"
Contrast this to another hospital in town that has a blanket policy excluding anyone from drawing a drug screen without consent from the mother. Apparently a lawsuit in years past resulted in this blanket policy. I don't know any of the details. I did a little review on the nature of this issue and found a Supreme Court ruling in 2001 striking down a hospital's ability to screen the women without their consent. There are likely specifics to this hospital's policy which was struck down as unconstitutional.
Regardless, what we have now are two large health systems in the city. One allows their employees to screen pregnant moms they suspect are using drugs, without their consent. The other allows their employees to screen pregnant moms only if the moms consent. Now, if I'm a crack smoking, marijuana doping, heroin popping kinda gal, which hospital do you think I'm going to? Am I going to the one where my needle tracks and my bulging eyes and my racing heart creates enough suspicion to have a screen drawn? Or am I going to the hospital that has to ask me.
"Ma'am, are you smoking crack?"
"No I"m not", she says, in a fit of rage.
"OK then."
End of discussion. Baby is sent home with cracked out mommy. And the sad thing is, all the cracked out mommies will come to this hospital, knowing they will not screen. A perverse incentive to continue using, up until and through their day of delivery. Babies entering the world in painful withdrawal, then getting sent home to a life of perpetual destruction.
One only has to ask the administrators of the no screen policy,
"Ma'am, are you smoking crack?"
The way around screening mom is to screen baby, at least at my hospital and where I trained (different city, same state).
ReplyDeleteAt our place, all newborns, without mother having more than 3 prenatal care visits, get a urine tox.
ReplyDeleteThe ruling occurred while I was in residency. So it is not illegal to test moms without their consent. It is illegal to turn the information over to legal authorities. Best practice would probably be to test those who are suspicious in order to best treat mom and baby. One could argue that notifying child and family services would be mandated..... but in the case of Furgeson v. City of Charleston you would be wrong.
ReplyDeleteExcellent example of the frustrating influence of the law in medicine. Because of that ruling for a year I had to spend an extra 5 hours a month in court mandated compliance training (yawn).
In reality, there's no reason why the discussion has to end with "No I'm not." The CNN piece regrettably elides the difference between drawing blood tests without consent, and drawing them despite the refusal of the mother and then turning them over to the police, as was already noted.
ReplyDeleteAnyways, I'm much less scared by the specter of "perverse incentives" without any evidence that patients at one hospital get inferior care. One might wonder if the true perverse incentive would come from generalizing consentless testing, which may catch more of the crack-addicted mothers who show up for prenatal care, but overall make things worse by driving more of them away from hospitals altogether.