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Thursday, April 23, 2015

The High Cost of Drug Testing Pregnant Women In Question

“Twelve percent of moms come to us with a positive screen and twelve percent of babies ... the percentage of mothers and babies with a positive toxicology screen has increased over the years, since SOMC started looking at the percentages in 2006 ... 12% peak now."

--Jone Stone, nurse manager of Southern Ohio Medical
Center’s (SOMC) Maternity Department

(Wayne Allen. "Babies exposed to substance abuse." Portsmouth Daily Times. April 21, 2015)

Innocent babies born addicted -- what could be more heartbreaking? In a county where the epidemic of drug abuse stifles our ability to understand the graces of human dignity, we must face facts. And, the facts are that 12 percent of expectant moms and their babies test positive for harmful drugs.

Yet, like most proactive measures, drug testing has some questionable outcomes. Both prospective mothers and babies have certain rights. It is my understanding that with utmost compassion for innocent lives, our local hospital requires very expensive drug screening of all local mothers-to-be, and 88 percent of these women test negative for abuse. This begs the question: "Exactly how does drug testing pregnant women serve the private and public needs?"

Serious questions have surfaced about the practice. Some see the required testing as a violation of Fourth Amendment rights barring unreasonable search and seizure. Others question the morality of forcing physicians to fulfill the role of law enforcement officers in the course of treating pregnant women.

However, it seems here, in Scioto County, most pregnant women simply abhor paying the tremendous costs of the screening. And, who can blame them?

If I may, allow me to post some information from Facebook friends to illustrate the concern about the cost:

Response #1

"Eighty-eight percent do NOT test positive- yet ALL mothers are tested (me included). I am STILL paying on drug testing. My drug testing costs alone were over 3000.00 when I had (baby's name) in 2013. I am all for testing and prevention, however, not everyone should be financially punished."

Response #2

"In a 6 day period (3 triage checkups in the OB), I was tested 3 times for cocaine and all the other screenings they do. It costs very little to do the actual screening, but for the markup for the hospital being so far above the actual ends up being nearly $700.00 just in lab work. (I had my) background checked and no reason to be screened for drugs...yet (I am) paying large bills because of 12% of moms who can't make better choices? It makes me sick that the rest of us are punished because of the bad choices of a few."

Response #3

"These tests are performed on EVERY pregnant woman who enters the hospital EVERY time she is there. For those of us who actually have to pay...that is very costly!!! Also, it seems like a Medicaid payout!!!"

Response #4

"When I contacted my insurance company, they said, 'that is not a common practice. We will need to look further into that.' I called about them not paying for all of the tests.

"The sad thing is that the main development happens during the first trimester. If a person is addicted to drugs, seeking help when learning of her pregnancy is probably not going to happen. I am 100% for protecting the innocent. I think all high school kids should see a newborn screaming, crying and shaking through withdrawals (it's beyond awful) or maybe watch a school aged student who cannot focus or sit still in's a sad situation for everyone. I would like to know what percentage of babies who were truly 'helped' by this practice of mandatory drug testing. For further clarification, I do think it's important to test-- yes everyone...however, find a grant to cover the cost for those who have to pay."

Response #5

"I am a nurse practitioner. And I can provide a simple explanation for why they do this testing at the hospital. And that explanation is GREED. There are 2 types of drug tests that can be used which are screening and confirmation. A 12 panel screening test will cost about 3-5 dollars per test depending on the volume that you purchase. And the other is confirmation which costs about 100 dollars per drug tested. The only difference is sensitivity. I am all for testing every patient this day and age but at 3-5 dollars per test I can live with myself and only do confirmations if necessary. But testing every pregnant woman at the OB office and the hospital using the confirmation method is completely ludacris and has no place in todays healthcare where costs need to be contained.

"Just my opinion and this is a topic that I have done a lot of research on because of the amount of money involved. And according to the CDC there are approximately 4 million births in the U.S. per year, and at 1000 dollars per screening and 2 screenings per pregnancy at a minimum that is over an 8 billion dollar industry just testing pregnant women for drugs."

The Supreme Court

Supreme Court ruled very recently that hospitals cannot test pregnant women for drugs without their consent and turn the results over to police.

In a 6-3 ruling, the court said drug testing by a public hospital in Charleston, S.C., violated the Fourth Amendment of the Constitution — which bars unreasonable search and seizure — even though the hospital was trying to prevent women from harming their fetuses by using crack cocaine.

(Geraldine Sealey. "Drug-Testing Pregnant Women Nixed." ABC News. March 21, 2015)

Under the Constitution, if women don't agree to the tests, a warrant is necessary, the court ruled.

Writing for the court, Justice John Paul Stevens said:

"While the ultimate goal of the program may well have been to get the women in question into substance abuse treatment and off of drugs, the immediate objective of the searches was to generate evidence for law enforcement purposes in order to reach that goal."

When hospitals gather evidence of possible illegal activity from their patients, "they have a special obligation to make sure that the patients are fully informed about their constitutional rights," Stevens said.

Stevens' opinion was joined by Justices Sandra Day O'Connor, David H. Souter, Ruth Bader Ginsburg and Stephen G. Breyer. Justice Anthony M. Kennedy filed a separate opinion concluding the drug tests were unconstitutional.

In the past, the Supreme Court has allowed drug testing without a warrant or individual suspicion when the government can demonstrate a "special need." To fit this category, the state must establish its policy is not designed to help law enforcement and that those being searched have a lower expectation of privacy.

But the ruling of March 21, 2015, means that drug testing of pregnant women without their consent, even to protect their unborn children, cannot be considered a "special need."

The Evident

Studies have shown that pregnant women who abuse drugs are much more likely to give birth to healthy babies if they receive prenatal care, even if they do not stop using drugs during pregnancy.

Still, well-meaning hospitals that fail to inform patients of their rights may be open to civil liability for monetary damages. Of course, testing policies that are developed with law enforcement agencies, employing their protocols, are more likely to be deemed unrelated to treatment -- physicians shouldn't be asked to fulfill the role of law enforcement officers.

(Kristin Pulatie. "The Legality of Drug-Testing Procedures or Pregnant Women."
AMA Journal of Ethics. Volume 10. January 2008)

Pulatie, Interim Director at Montrose County Health & Human Services, writes ...

"Ultimately, to preserve constitutional rights and the ethical patient-doctor relationship, drug testing policies should encourage open communication between patient and physician, emphasize the availability of treatment options, and advocate for the health of woman and child."

As far as the high costs of drug testing at SOMC and other hospitals, I am at a loss for why the screening should be so expensive. It seems outrageous. I think most costs at the hospital are very high, and if you are like me, even with decent insurance, I pay 20 percent of any treatment I have done.

It seems that the recent ruling by the Supreme Court not only prevents health institutions from mandatory drug testing of pregnant women but also opens the door for women who have already incurred these bills to fight for some kind of adjustment of payment or other compensation.

Still, advocates of mandatory testing like Cheryl Steinberg of Palm Partners Recovery Center give reasons for their stand that include monetary considerations ...

"By requiring drug testing as well as offering treatment programs for those testing positive, we can intervene and ensure the health of the mother as well as the child. This will also positively impact the community and society at large if we are to be proactive about this. Think of the costs incurred for treating children with long-lasting issues that result from their mothers’ drug use."

I think the bottom line for most concerned mothers-to-be is expressed in "Response #5" above. Drug testing is good and beneficial, but the cost is outrageous and indicative of patient-gouging health care treatments. Even if it impossible to discern drug abusers with questionnaires and similar non-invasive screenings, why should the vast majority of pregnant women pay exorbitant fees for something as simple as a drug test?

To close, here is a final response to the costs:

"I was tested for illegal drugs 4 times during my pregnancy and again when I was admitted for delivery. I was not allowed to opt out of any of it. I have never done a single drug in my life, don’t smoke, don’t drink. So to me one test should have sufficed to see that I was telling the truth.

"Despite having some insurance, I know exactly who paid for those unnecessary tests. Me. I have the bills sitting here to proove it. At delivery I was screened for 8 illegal substances at a cost of $100.32 a test. That’s $802.56 in unnecessary testing. Not to mention wasting people’s time who had to run the tests. And I would assume that since the tests were all processed the same each time, that’s $802 times 5 tests total. And every single one confirmed I don’t do drugs."

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