Caution: Risk of violence with instant tests?
Caution: Risk of violence with instant tests?
Consider risks faced by those doing the testing
Though the risk is only theoretical at this point, an experienced occupational medicine physician raises an alarming issue concerning on-site drug testing. Could the test increase the risk of violence from angry workers who test positive?
The risk of violence must be considered when an occupational health professional is dealing with workers who could lose their jobs by being tested, says Melissa D. Tonn, MD, MBA, MPH, medical director of occupational health services at Memorial/Sisters of Charity Health Network in Houston and Presbyterian Healthcare System in Dallas. Another factor: If the worker is an illegal drug user, the risk of violence rises. Add to this the scenario in which the health provider is at a remote location, possibly working alone. And, finally, consider that privacy must be accorded the worker when collecting the specimen and reading the test results.
When you put all of those factors together, Tonn is concerned that a drug-using worker could lash out at the health care provider when the positive result is read. The immediate test results could be a catalyst for violence, unlike a traditional lab testing situation in which the results are not provided until later.
"I haven't seen that happen with an on-site test, but I have seen lots of violent, volatile people undergoing a drug screen," she says. "It's a concern for me.
The result could be a physical attack on the occupational health nurse or physician; or at the very least, the worker could grab the test sample and destroy it. Then there would be no record of the positive test result, though you should, of course, report the incident to the employer. Tonn also wonders about a situation in which the worker sees the positive test result and refuses to sign the chain of custody paperwork necessary to send the sample on for confirmation testing. The worker normally signs the chain of custody paperwork for traditional laboratory testing, but he or she may be reluctant to do so if it already is apparent that the test is positive.
While Tonn can't show concrete examples of violence, she advises you to plan upfront what steps to take to prevent violent reactions to bad news. For example, a security guard nearby may be a sufficient deterrent. Or you might consider sending two staff members out to handle this kind of testing.
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