"Urine Drug Screams, Part 2" by Troy H. Cheek on Apr 20, 2004

In our previous installment, I explained how a hospital I once worked for tried to save money by getting rid of their Occupational Services department. This department contracted with many area companies to provide low-cost urine drug screens to employees were injured on the job. The hospital bean counters later realized that these low-cost urine drug screens and contract negotiations and several full-time employees were actually a small price to pay for getting injured people to come to our facility for treatment instead of going to one of our competitors.

Such services were transferred to our Walk-in Clinic and later to our Emergency Center. Somehow, the several full-time employees who were trained to perform the urine drug screens and negotiate the contracts and fill out the paperwork didn't make the transition with the services.

Not a problem. The highly-trained professionals in our state of the art Emergency Center were no doubt fully qualified to perform such services. After all, they did urine analysis all the time when ordered for medical reasons. How different could this be?

Very different, as it turns out.

First of all, it seemed that just about every local company that we'd contracted with to do urine drug screens or other post-accident testing had also contracted with different laboratories to perform said tests, usually at a substantial discount. All we had to do was let the laboratory know that we were doing the tests at the request of that company, and we'd get the tests done for a fraction of the usual cost. Not cheaply enough for us to make any money, given our loss leader approach on drug sreen pricing to try to bring in more business from these companies, but cheaply enough that it didn't hurt quite so badly.

The Emergency Center staff was used to just dealing with our in-house Lab, so they tried to send the samples there for testing. The Lab was happy to do them, but of course wanted paid. Even within the company, there's a system of such charges and payments just to keep all the bookkeeping on track. The Emergency Center had to pay the Lab, but couldn't bill the patient or the company for the labwork as they already had a contractual agreement to do the drug screen at that loss leader cost.

The staff then tried to make sure that all drug screens provided under such contractual agreements were sent to an outside lab. This actually made things even worse. Without someone to keep track of which company had contracted with which outside lab, the samples usually got sent to the wrong lab, one without a contract. And one without a negotiated discount.

Even worse, samples were sent to outside laboratory "A" with the paperwork used by outside laboratory "B" enclosed. These samples were sent back or even discarded by the outside lab.

There was also the matter of which tests to order. Some companies asked for different things to be tested for. If we tested for something that wasn't requested, we might not get reimbursed for it. Some companies even felt they could not legally view the results of some tests because their drug-free workplace policy did not specify that employees could be tested for those things.

There was a problem with notification of the company if the patient refused to supply a sample for the drug screening. Those drug policies usually include a requirement that you submit to testing when asked or you lose your job. Some of our more free-spirited staff members who didn't agree with the whole concept of drug testing to begin with would accidentally forget to inform the employer of these refusals.

Then there was the problem with chain of evidence. When collecting blood or urine or other samples for medical testing, nobody really cares if three or four different people handle the sample or how long it sits on the desk or if the patient was awake and aware when the sample was taken. The important thing is to get the testing done so that the patient's injuries can be treated as quickly and effectively as possible.

When you're collecting samples for a drug screen that can cost a person his job or deny him disability benefits, chain of evidence suddenly becomes a more important matter. If the sample is passed from person to person, how does the person who ultimately signs off on the package as it is shipped off to the lab actually know who the sample came from? If it was left unattended on a desk, how do we know that someone didn't tamper with it or that someone didn't pick up the wrong sample among the three others that were also on the desk? If the patient wasn't awake to sign a consent form, do we have any legal right to perform the tests, anyway? Might that not be considered an unlawful search and seizure?

For all we know, his religion forbids invasive procedures and we just doomed him and his entire family to Hell for all eternity just by sticking a tube in him to get that sample.

We needed someone who understood the importance of filling out the proper forms in the proper manner. We needed someone who was familiar with rules of evidence. We needed someone who was used to dealing with confidential patient information. We needed someone who was well-versed in the concept of unlawful search and seizure. We needed someone cold-hearted enough to inform an employer that his employee had just refused a test in defiance of policy and could be fired for it. We needed...

"Troy, step into my office."

We needed... Me?

Copyright 2004 by Troy H. Cheek. Reprint with prior written permission only. Comments and questions to $mail:theview$