Drug-siphoning HCW raises alarm about drug testing

Experts say test is deterrent, but not cure-all

Consider this a cautionary tale about pre-placement drug testing: In February, a nurse at Georgetown University Medical Center in Washington, DC, reported that she had walked in on a radiation technician who was siphoning the painkiller fentanyl from a patient’s infusion pump. The technician was immediately fired and was later arrested on felony charges of tampering with consumer products.

Soon after the discovery, the hospital sent letters to some 500 patients who had undergone interventional radiology procedures, advising them to have their blood tested for possible exposure to infectious diseases. (The technician may have used discarded needles when he replaced the drug with saline.) The hospital termed the risk of infection "extremely low," but told patients, "Georgetown is committed to the health and well-being of its patients, and we believe you should receive these tests and the reassurance they can provide."

Georgetown University Medical Center was not conducting pre-employment drug testing at the time. While experts say drug testing cannot prevent such incidents from occurring, Georgetown’s policy quickly came under fire. Some patients have filed suit against the hospital. Meanwhile, the Georgetown incident may prompt other hospitals to review their policies on substance abuse and drug testing. (For information on substance abuse programs in hospitals, see Hospital Employee Health, April 2000, p. 42.)

"Pre-employment drug testing does not always detect drug use, as drug users are very adept at finding ways to successfully pass’ such tests," said Georgetown spokeswoman Amy DeMaria in a written response to questions from HEH. "Nevertheless, Georgetown is committed to looking for ways to improve patient care, and, as such, a committee of senior Medical Center leaders is now examining our policies."

Employee health experts agree that drug testing has limited usefulness as a way of "catching" substance abusers. But they say hospitals should conduct pre-placement drug testing simply as a deterrent.

"A hospital has a very special set of expectations in the minds of the public, and they have a very special set of obligations as an employer," says Rick Wade, senior vice president at the American Hospital Association in Washington, DC. In its "Substance Abuse Policies for Healthcare Institutions," the AHA "strongly encourages" health care facilities to include drug and alcohol testing in a broader substance abuse program.

"Our impression is that the vast majority of hospitals do this, for public trust and confidence, liability, and patient safety," says Wade. "In the environment we’re in today, you simply can’t afford to do anything else."

Drug tests have limitations

If drug testing is effective, it isn’t because the tests themselves are foolproof. Most health care facilities test for the major categories of abused and illegal drugs. But a potential or current employee could be abusing a drug that isn’t a part of the standard testing regimen, or could stay clean long enough for the drug to fully metabolize, making it undetectable.

Nonetheless, knowing that a drug test will be conducted may be enough to keep some abusers from applying. Michael Wald, MD, medical director of occupational medical services at Long Beach (CA) Memorial Medical Center, recalls when he was medical director at an aerospace company that was trying to find workers in a tight labor market. He put up a sign in the human resources department that the company would drug-test. "There were 50 people waiting to apply, and the room cleaned out," he says. "The entire room got up and left."

According to reports in the Washington Post, the radiation technician had worked at a hospital in suburban Maryland, but left when administrators asked him to take a drug test. He began working at Georgetown about a year later.

The AHA recommends pre-employment testing, for-cause testing, and post-accident testing. Policies should clearly spell out the standard for for-cause and post-accident testing, AHA says.

Even so, employee health professionals should understand the limitations of testing, advises Kathleen McAndrews, MSN, ARNP, COHN-S, CCM, department director and nurse practitioner in occupational medicine at Dartmouth Hitchcock Medical Center in Lebanon, NH.

"It’s my belief that the way to detect [substance abuse] is through prevention and increased awareness and education in behaviors and signs and symptoms," McAndrews says.

In the Georgetown case, "he would have been caught if someone worked around him who had more awareness about what the signs and symptoms are," McAndrews says.

Beware of false-positive tests

There’s a flip side of drug testing that presents its own set of liabilities. If you accuse someone of abusing drugs, you should be sure of your conclusions, cautions Wald.

"Drug-testing programs are designed to deter people from abusing hard drugs such as heroin, marijuana, cocaine, methamphetamines, and things like that," he says. "The purpose of drug testing is not to do a gotcha’ on some guy who took his wife’s Tylenol with codeine because he banged himself with a hammer. It’s much better to err on the side of calling somebody a negative who’s really a positive than to call someone a user who’s really not," says Wald.

The poppy seeds on a bagel can metabolize as morphine and show up at the highly sensitive levels used in drug testing. Hemp oil, which can be purchased at health food stores for cooking, can make someone test positive for marijuana.

Instead of just relying on a single test, employee health professionals should look at the results as part of a medical evaluation.

"Drug testing is a program of deterrence," says Wald. "Unfortunately, most people don’t get it. They think they’re supposed to be rooting out drug users. Some people want to approach drug testing from almost a Wild West perspective. All drug testing is rife with abuse and the potential for abuse."

Wade agrees that the detection of substance abuse should be part of a broader focus on patient safety and employee health. "This is not about finding people and punishing people. This is about protecting patients," he says. "We don’t want to destroy careers. We want to keep people healthy."

Meanwhile, Wade points out a silver lining in the Georgetown incident: Security in the pharmacy was apparently tight and access to drugs was limited. "The only way this employee could get it was to be right there next to the bedside taking it away," he says. But he adds, "[That] demonstrates that if someone wants to get their hands on something, they can find a way to do it."