"Urine Drug Screams, Part 6" by Troy H. Cheek on Apr 26, 2004

Welcome to Part 6 of my 5-part series on urine drug screens. I'd like to take a moment to remind everybody that due to confidentiality laws in my line of work (Healthcare Security), there are limits to what I can reveal about people I deal with. Rather than take a chance at revealing something I shouldn't, I just avoid the matter altogether. All patients and staff members I refer to in my articles are fictional, literary inventions designed to help illustrate a general class or type of situations that I have encountered. Heck, pretty much any person I mention in any article is fictional.

Sometimes, I'm not even sure that I really exist.

I like to point this out occasionally because any time I mention an old girlfriend, including a fictional one that I made up just for that fictional story about that fictional event, half a dozen women write in mad at me that I just shared that intimate moment with the entire world.

But, enough of that. Back to the UDS!

I eventually decided that I could boil all my problems down to two basic scenarios. The first is when someone on the medical staff decided that they didn't want me to do the UDS, even though policy or contractual arrangement required it. The other is when someone on the medical staff decided that I had to do the UDS, even though policy or contractual arrangement or even federal law forbade it.

Scenario #1:

"Security, please come to the Emergency Center for a UDS."

"Where's the patient?" I asked.

"Bed 1, but I don't think he wants a UDS," the nurse answered.

I checked and, sure enough, he didn't. I went to call the company.

"What are you doing," the nurse asked.

"Calling his employers to inform them that he has declined to provide a sample for the drug screen in violation of their drug-free workplace policy." Nice hold music.

"Oh, don't do that. You shouldn't get him in trouble like that."

"I'm not the one getting him in trouble. It's their company policy and he's fully aware of the consequences." I gave up on hold and checked to see if there was a different number I could call.

"Why should they care? It's none of their business. What does it matter if comes to work stoned? Who does it hurt?"

That made me stop dialing. "Well, today, it hurt him and the three other guys involved in that accident."

"You're making an unwarranted assumption," she hmphed at me. "How do you know his drug use had anything to do with the accident?"

"Actually, I don't," I admitted. "I don't even know if he actually uses drugs or alcohol of any kind, though I kind of doubt that he was stone cold sober when he decided to drive a forklift off a loading dock. Regardless, it's up to his employers to make that decision. I just gather evidence or, in this case, report that I can't."

I ignored her and kept looking for phone numbers. I found one, but she was still talking. "And it's not like all illegal drugs are bad," she finished. "What do you know about drugs, anyway?" Or, at least, stopped to take a breath.

"I know that I'm the guy you call when you need somebody to hold down a patient who's overdosed, or injured himself badly but doesn't realize it because he's so hopped up on Goofenthol that he won't feel anything in his extremities until next week. I'm also a child of the Sixties. Heck, my mother even named me Troy H. Cheek."

"What's your name have to do with drugs?" the nurse demanded.

"Hey, nice initials, man," the patient complimented.

"Thanks," I answered. I smirked while the patient explained to the nurse that my initials, THC, were also shorthand for the active ingredient in marijuana and related substances.

The patient also said that after thinking it over, he'd rather take his chances with a UDS than let a refusal speak for him. Good deal.

Scenario #2:

"Security, please come to the Emergency Center for a UDS."

I went and asked about the patient. The details are unimportant, but for the sake of the story lets assume that he was unable or unwilling to supply a sample for the urine drug screen. I told the nurse that.

"Well, we'll have to get the sample somehow," was the response. "Think we can bluff him into thinking that you're a cop?"

"Nope." First thing I always do is identify myself as a security officer, and then I assure the patient that he's in no trouble and under no kind of compulsion. I tell him that he has to deal with me becasue I'm the only one available right now who's taken the training class.

"Does he still have that portable urinal in there?" No, and I can't take a sample from one, anyway. "Can we give him a lot of coffee and tell him the bathrooms are out of order?" That would be unethical and probably illegal. "If we get a few more guards up here, can you hold him down while I insert a catheter into his bladder?" I shuddered. I also told him that was definitely illegal.

"Well, we have to take measures of some kind, else we won't get a UDS done on him."

I nodded. "Yes, that happens sometimes." I kind of like it when it does. There's a lot less paperwork involved.

"No, we have to get a sample!"

I made the mistake of asking why. The nurse spent a good 20 minutes explaining to me. It all boils down to money.

First of all, if we don't complete a UDS, then we can't charge his insurance for a UDS. Or, more accurately, the insurance of the company he works for. I didn't understand this at all, as these contractually required drug screens are actually provided at a loss to the hospital.

But it gets better. The drug screens are provided at a loss to encourage companies to send injured employees to us. If we don't force a UDS, the company may decide to send their injured employees to some other facility, costing us the money we make in treating their injuries.

Also, if we don't get the UDS done, the company's insurance might deny our claim for the entire cost of treatment. Since we failed to live up to our contractual obligations. (I pointed out that the patient refusing to allow a UDS was covered in the contract, but he ignored me.)

It was hinted that urine drug screens being performed quickly and properly was an item that would come up on the nurse's yearly appraisal. By failing to force a UDS, I could be costing him money when it comes time to hand out raises. I coudln't see why it would be an item on his appraisal, when I was the one who actually had the training and actually did the work. I also wondered why it wasn't an item on mine.

Finally, the nurse just thought the patient was hiding something and wanted to know what it was. I told him we sent the samples to an outside lab and it would be weeks before the results came back, and not to the nurse. He said that was okay. He'd just look up the patient's records in a few weeks and copy the results.

I ended up having to write a very long report after that conversation. Remember what I said before about confidentiality laws? He doesn't work there anymore.

For better or worse, circumstances eventually changed at work so that Security was no longer in charge of the UDS process. And, for better or worse, circumstances eventually changed at work so that I no longer worked there. But that's a story for another day.

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