> To guard against false positives, the Mandatory Guidelines for Federal Workplace Drug Testing Programs, published in 2017, require a codeine cutoff of 2,000 nanograms per milliliter of urine. But the Hackensack University Medical Center's lab, according to Kate's complaint, used a cutoff of 300 ng/ml, less than one-sixth the federal standard. Virtua Voorhees Hospital's lab, according to Kaitlin's complaint, used a cutoff of just 10 ng/ml, 99.5 percent lower than the recommended level.
Using a cutoff that is 200 times more strict than standard drug testing practices without giving the patient any warning that they’ll be tested (and guidance to avoid poppy seed foods) is asking for false positives.
Given that the other cases resulted in six-figure settlements, it’s surprising that this practice continues.
> Using a cutoff that is 200 times more strict than standard drug testing practices without giving the patient any warning that they’ll be tested (and guidance to avoid poppy seed foods) is asking for false positives.
Occam's razor must apply here. They know what they're doing, and doing it intentionally.
I think we're too slow to call it malice sometimes, aren't we? If it doesn't look cartoonishly evil we ascribe it to other intentions, I mean. While it would be more bold to just call it evil, such as: evil by neglience, evil by greed, etc.
>While it would be more bold to just call it evil, such as: evil by neglience, evil by greed, etc.
It might be more bold right now, but the net effect of expanding words to mean stuff it didn't mean before is that words get even more watered down. If "evil" includes people acting negligently, what do you call people who were actually intentionally out to cause harm? Super-evil?
I think there logic is the "but what about the children?" razor. "Save _one_ hytpothetical child, and it's all worth it" is one lemma derived from this principle.
Yeah, but even then usually someone has to benefit. I don't see who benefits. Drug investigators? Picking an arbitrary cutoff looks like plausible stupidity to me... Which is not to say the hospital shouldn't be punished harshly, just that probably no one should go to jail either.
von Hammerstein-Equord, commander of the Reichswehr in the early 1930s was more focussed on outcomes: "One must beware of anyone who is both stupid and hardworking; he must not be entrusted with any responsibility because he will always only cause damage."
In the complaint we can see she tested at just 18 nanograms. Utterly negligent.
> No one explained the details of the test results to Kaitlin at the time, but Kaitlin later learned that the second test conducted on her urine sample reported a finding of 18 nanograms of codeine per milliliter of the sample (18 ng/mL). The laboratory testing Kaitlin’s sample employed a cutoff of 10 ng/mL to determine whether a sample was positive for codeine, a testing cutoff level that is dramatically lower than recommended in Federal guidelines.
> Given that the other cases resulted in six-figure settlements, it’s surprising that this practice continues.
a six figure settlement is a rounding error for these institutions. Given their inefficiency it could easily cost many times that just to change their practices and train doctors to not do the wrong thing.
Funding incentives for child welfare agencies also encourage them to cast a wide net (and miseducated mandatory reporters).
> a six figure settlement is a rounding error for these institutions. Given their inefficiency it could easily cost many times that just to change their practices and train doctors to not do the wrong thing.
They refused to discharge the mother for days and kept the baby in the NICU for an extra week. Average cost per day for the NICU is ~$3k/day. Six-figure settlements aren't enough if they get away with it frequently.
CPS is generally required to investigate any complaint and follow a protocol. The hospital doesn't have a failed drug test since it doesn't meet the guidelines. They're only required to report if they reasonably believe the mother is using drugs. Tests below the guideline level don't provide that basis. It's an unnecessary/false report.
It's the same way that courts grant protection orders or red flag orders - they're supposed to use the basis of something being more likely than not. Yet they consistently "err on the side of caution" and simply grant the order even though it's not actually likely to occur in most cases. Thus we see some lawyers advising their clients to file orders without basis during divorce to gain leverage. I'd love to see the numbers, but I would guess the process is abused or misruled on more often than it's used correctly.
I find this to be very typical of CPS. As they report themselves, they miss the large majority of actual child abuse (and one reason often cited, that children and parents agree actual child abuse is less of a problem ... than CPS. So everyone lies to CPS, and they're essentially only used as a means to hurt others, for example in divorce).
You'd think the reaction to this problem would be to seriously downsize CPS, and raise the threshold for involvement. The opposite is happening.
The hospital we had our last birth at have fentanyl through the epidural or some kind of opiate orally. I really wonder how they can even run these tests unless they don’t use any opiates
Ok, but how do they rule out codeine usage while pregnant? I’m not sure about the US, but in Ireland, small doses of codeine + ibuprofen or paracetamol (acetaminophen) are readily available from pharmacies without a prescription, and as far as I’m aware they’re not strictly recommended against during pregnancy.
Interestingly a few states do offer a Codeine cough syrup without a prescription[0].
From the article: “Codeine regulation varies widely across countries and states. In some states, including North Carolina, Florida, Oklahoma, and Iowa,1,2 pharmacists can dispense a small quantity of cough syrup containing codeine OTC. Based on individual state law, this information may not be logged into the prescription drug monitoring program, which may contribute to providers being unaware of their patients’ use of codeine.”
This is an exceedingly rare practice in the US however.
Interesting. As far as I know only the combinations with a higher strength codeine are prescription only in Ireland. It’s the same in the UK, as far as I know (presumably because it would be nigh impossible to prevent small amounts of cross-border smuggling with the North)z
Most opiates on the other hand, would be rarely prescribed by doctors
Interesting, are you located outside the US? I've lived in Washington state, Utah, Maryland, and briefly in Missouri and Massachusetts, and I've never seen or heard of this happening. (And I am a woman of reproductive age.)
That's dangerously close to the thinking that if you've done nothing wrong, you have nothing to hide.
The US Fourth Amendment right against unreasonable search and seizure means that we, as a society, are OK not detecting all crime. But this doesn't feel like a commonly held value these days. "If we can save just one life..." is considered a valid argument for excessive safety protocols. Not far from "If we can detect just one crime..."
(Not necessarily disagreeing with your point; indeed, maybe that was the thinking.)
That this can happen, of course, to any sane person would be a very strong argument not to interfere, and place the threshold for taking children forcibly away almost at the point they would die without aid, because the vast majority of problems neglect causes are much less bad than the problems CPS causes.
Neglect causes "parentification" [1], where sometimes very young children take responsibility for themselves and sometimes also for others. The one psychological problem children can develop that can actually improve outcomes for them. Essentially if children "succeed" at parentification, it results in good outcomes. So you'd think we would alter society to make it easier for children to take care of themselves (e.g. guarantee medical access for children by themselves WITHOUT referring them to CPS, in abstract a clear, workable, understandable set of rules. Do X, Y and Z (e.g. school) and you get to do what you want, which must of course include telling social services to get the fuck out)
The problem CPS has is that in general, very, very bad parents deliver better results with children than CPS interference. This is partly due to the state of CPS institutions and just how incredibly bad they are, but is also the result of how the human mind works. A constant relationship with even an abusive parent/caregiver is a lot better than many short caregiver relationships, even if those are pretty good ones.
For one, you could temporarily lose your child/parents. Whenever something bad happens to a child and there was an investigation in progress the investigators are criticized. So they've set things up in many states to bias strongly towards briefly taking the child away and placing them with strangers. But that has long-lasting negative impacts on childhood development.
Forget the fact that these hospitals should be aware of the fact poppyseeds can cause false positives, they never should have administered an unauthorized drug test in the first place. That's more horrifying IMO.
I have a feeling many hospital bills include plenty of services the patient didn't ask for. Not proposing the equivalent of a lawyer for medical cases, but it's interesting to think of patients having a fiduciary advocate by their side during medical treatment.
It does make some sense to drug test patients, and a doctor does have the wide authority to order tests with some manner of invasiveness. Patients don’t want to disclose illegal drug use, even though these drugs do interact with administered therapies.
> a doctor does have the wide authority to order tests with some manner of invasivene
False. A doctor has zero ability to order tests without patient consent (or consent of a guardian) in the US.
> Patients don’t want to disclose illegal drug use,
This is why medical care should NEVER be directly connected to law enforcement or make conclusions. For a care provider to thing that a patient waking up, handcuffed will make that patient EVER come back for care again is insanity. Medicine should not be about punishment, ever.
> False. A doctor has zero ability to order tests without patient consent (or consent of a guardian) in the US.
Ability isn't the right word, because they absolutely do it. It's unethical and perhaps illegal in some places, but they are able.
I've personally been administered a test non-consensually: I showed up at a hospital with severe pancreatitis, the doctors seemed convinced it was due to alcoholism but I (and my partner who they questioned privately) both reported that I don't drink at all. After several days they suddenly started aggressively treating me, performing tests, etc. I wondered what changed and got hold of my chart-- without my knowledge or consent they took a hair test to assay long term alcohol use and suddenly wanted to treat me when it came back negative.
I get that they needed to exclude an obvious potential cause and couldn't trust the patient to give an honest answer... but the non-consensual test really destroyed my trust. Of course, if they'd asked I would have readily agreed and it isn't as if their skepticism wasn't already apparent.
> I get that they needed to exclude an obvious potential cause and couldn't trust the patient to give an honest answer
I disagree with this resigned acceptance to medical paternalism. The basic situation is that you are the patient, and all care should be per your direction. The doctors' responsibility is to treat you based on what you've told them. If you're actually lying, the responsibility for misdiagnosis rests entirely on you.
Doctors hedging against a patient lying should only ever be considered within this larger backdrop. For example independent of the nonconsensual sample and testing, it was severely unethical for them to have delayed your care by several days while indulging their own curiosity.
That falls under implied consent. In the case where youre unable to give consent, medical providers are given license to provide care that would be considered reasonable and necessary given your condition. Once you are conscious you can withdraw consent for treatment at any time.
A secret drug test on a conscious person who is not showing symptoms of intoxication is pretty far outside of the limits of implied consent.
People can be dependent on all kinds of drugs without symptoms of intoxication.
Irrelevant to know for say, a job (if you can do the work; who cares?) but could be quite relevant if you’re hospitalized, or your new child needs to be treated for withdrawal from it.
That’s irrelevant to legality, which is what I was talking about.
Medical consent is more complicated than just this, and what you’re talking about crosses into doctor patient confidentiality as well.
Suffice it to say that testing patients without informed consent and sharing that data with law enforcement is not something that most ethical review boards would condone.
From a practical and moral point of view this kind of incident is what keeps people from telling their doctor all of the relevant information for best care. If you have a drug problem and think a medical provider will work to have your child taken away if you are honest about it, will you ever seek treatment or be honest?
If you don’t have a drug problem, but still think that what you say to your doctor or kids doctor will get used against you, will you hesitate to get care in the future?
Do you think these mothers will ever interact with another pediatrician with full trust again?
> but still think that what you say to your doctor or kids doctor will get used against you, will you hesitate to get care in the future?
> Do you think these mothers will ever interact with another pediatrician with full trust again?
These are already issues. Only what you share with your lawyer is truly privileged. Everything else might get fanned out in a court.
Indeed, if you talk about your seizure with your doctor, your driver's license might get suspended. If you share that your medical condition isn't stable anymore, you may lose your travel health insurance (or pay for it but still get rejected when you make a claim).
Probably nothing with the cutoffs they're using here, but neonatal opioid abstinence syndrome is absolutely a thing. And not all necessarily by "drug addict" mothers, but lots of legitimate long-term opiate use. But one would hope they would be up-front about the latter at least.
Advance consent isn't legally or ethically valid unless it's informed and the procedure is actually medically necessary and appropriate. Being tested actively contrary to your own interests would never, ever qualify.
How much do you want to bet that social services has an exception to this? Such an exception would enable them to make extra money and "think of the children" ...
>doctor does have the wide authority to order tests with some manner of invasiveness.
That they have the authority doesn't mean they should have the authority. There is nothing more sacrosanct that bodily autonomy. It doesn't matter if the doctor "knows better" or the medical testing you don't opt in for could potentially lead to worse medical outcomes for you. If you are an adult, it should be your right to decide what testing and procedures are performed on you - full stop.
There are at least 5 separate issues at play here, but the one most front-and-center in my mind is that under no circumstance should any medical procedure be done on any person in the US without informed consent of the person, their guardian, or their medical PoA.
Even if a procedure is "medically necessary", that does not give doctors the permission to do that procedure without your informed consent. When a procedure is not "medically necessary", it's even worse. There are people who refuse "medically necessary" procedures every day in this country on numerous different grounds, including religious grounds, and this is deeply legally protected and well upheld in case law.
There is no valid justification for the behavior of these hospitals.
Collection of a sample could generously be considered a medical "procedure" done on a person. But if a sample has already been collected for other purposes, testing said sample for an additional purpose can't be even generously said to be a medical procedure done on a person.
The lack of informed consent as to what will happen with a collected sample is the thing. It's also incredibly stupid, as without informed consent a person can't think to tell the collector that they've recently eaten a poppyseed bagel, and thus their results will be tainted.
No. If the goal is to stop this practice, then the doctors and administrators responsible should lose their licenses and be criminally prosecuted. Money and civil cases do not solve all problems. The responsible parties must be accountable for their criminal actions.
Chances are the hospitals are following the law. A hospital isn't going to risk losing its license because someone ate the wrong muffin at the wrong time.
They don't "need to be sued out of existence" any more than their thousands of patients need to have their healthcare provider yanked out from under them.
The law should be changed to give them some discretion.
> To guard against false positives, the Mandatory Guidelines for Federal Workplace Drug Testing Programs, published in 2017, require a codeine cutoff of 2,000 nanograms per milliliter of urine. But the Hackensack University Medical Center's lab, according to Kate's complaint, used a cutoff of 300 ng/ml, less than one-sixth the federal standard. Virtua Voorhees Hospital's lab, according to Kaitlin's complaint, used a cutoff of just 10 ng/ml, 99.5 percent lower than the recommended level.
The law declares a specific threshold concentration level, and they are using a level 1/200th of that. They absolutely should suffer severe recompense and punative damages for doing that.
Laws should not allow discretion. That is how you get abuse and discrimination through selective enforcement. If a law would be intolerable and inhumane with 100% enforcement, then that is how you know it shouldn't exist in the first place, and is in fact still intolerable and inhumane even with discretion and selective enforcement.
In this case, the law doesn't in fact exist, and no selective enforcement is needed. The law already does not say that eating poppy seeds is illegal, because that doesn't approach the level to trigger the law.
Is it not illegal to perform nonconsensual, nonemergency testing on people? The people that authorized this at the hospital should go to prison for that imo.
I won't answer the question directly, but I will say that it is possible and that you shouldn't try:
many people have died while doing this, because the seeds carry an unknown and highly variable amount of poppy latex. One may use some amount and feel nothing, but later use the same amount with a different batch of seeds and rapidly OD (usually fatal for opioid naive people).
This is especially a problem due to the potentially long delay of come-up, which is why many folks die after redosing (believing that the first dose did nothing or wasn't sufficient).
Lastly, baked goods containing poppy seeds do not pose any danger, as high heat destroys basically all the alkaloids.
> In this work, it was found that in harvested poppy seeds, and thermally processed poppy seeds (with and without a food matrix), if used in normal levels would not exceed the recommended acute reference dose. It was also shown that the levels of all alkaloids reduce when thermally processed, in comparison with harvested, untreated seeds.
But basically a lot. Which is why poppies are processed for heroin. Not eaten straight.
You will probably die trying if you go that route. The 'high' chemicals are in the fleshy, sappy part of the fruit. Some traces may remain on the seed.
This time it was a high-thébaine batch, but no reason it couldn’t have been a high-morphine batch.
The thébaine is found in the pod the same way as morphine is, not the seed itself. But if the seeds aren’t washed enough and the variety isn’t a low alkaloid one…
Not sure how much the manufacturers test. Obviously one wasn’t testing for thébaine.
The chemicals are on the seeds as well, sometimes to a significant degree, unless they're processed before sale. You're right about the danger of trying it.
Making opium is extremely easy. Basically you grow legal poppy flowers and cut a small incision in the seed pod and collect the sap. Then you dry it and you’re ready to start your own den
The image in the text shows a bagel with some poppy seed sprinkled on it. If I compare that to poppy seed strudel[0] the amount of seed on that picture is laughable. I wonder what would the test show after a few slices of said strudel. Are those strudels available in USA?
I had to do a USA federally mandated drug test for a license once and one of the questions they ask before administering is if you have had poppy seeds recently.
You can get yummy puppy seed cake rolls from any Polish bakery. The international fresh market nearby when I used to live got them from Polish bakeries on Milwaukee Ave in Chicago. My dad used to make a really good poppy seed coffee cake, too.
Eh. I kinda understand the origin of semi-nanny state US has been turning into. Medical facility is just one of the places that can ( and sometimes is legally obligated to ) report you for even suspected transgression. The rules are sometimes difficult to follow to the letter so the general approach is to 'report and let god sort them out' ( in the case of financial industry, if you are interested in Orwellian language, it was called 'defensive' filing ).
This is where we are. We are not here by accident. Each time a 'feel good' proposal was made, 'for the children' argument countered any reasoned argument against it. I am a parent and I already had a taste of this intrusion into my life by our kid's doctor ( she asked me whether I have guns in my house -- and my wife answered before I could even say 'It is not your business' ).
It is going to get worse until it sufficiently pisses off the population. We are not there yet.
Because it isn't really a problem with the tests but rather the interpretation of the test. They're not actually false positives — poppy seeds do contain opiates. The problem is assuming that detecting opiates at a very low level implies a drug habit and not a deli habit
Heroin is made from poppy seeds. We decided that eating small amounts of the seeds is delicious, and injecting small amounts of the paste is multi-year prison sentence. The test can only test for (a protein found in) the seeds.
I presume because the seeds do contain trace amounts.
ISTR New Scientist doing a fun article many decades ago about all the psychoactive items in a traditional British afternoon tea. Quite a lot of laudanum in some varieties of lettuce
it's mostly a problem with screens, simple, inexpensive tests that should only be used a precursor to running an expensive test involving mass spectrometers.
usually the manufacturer of the screening test mentions this in the documentation, that nobody feels like reading. certainly not the administrators implementing/enforcing the policies.
I'd love to see a study that tried to estimate to that extent absurd, invasive, and overly protective nannie policies cause people to choose to not have children at all, contributing to declining birth rates?
How many kids never get to exist at all because the government and other institutions have made it ever more obnoxious, even personally dangerous, to have one?
There’s considerable debate over whether even China’s “One Child” policy had any direct effect or it just happened to coincide with a natural decline in birth rates that would’ve happened in China regardless.
If it’s not even clear that an incredibly blunt government policy had that much of a direct effect, I’m not sure what research could possibly turn up for other nations.
On the other hand, ive also heard a decent amount about native undocumented Chinese women from the same policies. A large number of undocumented native Chinese women popped into existence from those policies when they started reaching college age, and others into corporate business which we do know about. But how many more merely work local service jobs under the table, or got married and became a homemaker. Living in a more rural area with a more traditional lifestyle would already have incentivized women into those rolls, and then more would just want to stay hidden for fear of government appraisal, and there is no clear or obvious record of those people.
But the examples I had in mind were parents getting prosecuted for letting their children outside unsupervised (several stories on HN in the last year or two), or examples in this thread like overzealous mandatory reporting in the original article or someones pediatric doctor becoming a problem after asking if they have guns in their home.
Anecdotally I know people for whom concerns about invasive bureaucracies caused them to choose to delay or not have children, as well as people who relocated to places which they thought had better practices before doing so. Anecdotes don't count for much but I think it's not controversial that have many policies that are ineffective. Any policy that doesn't actually protect children but imposes a risk or cost on parents is probably a net reduction on the production of new adults, but maybe only a very small one.
He was open and made a recommended investigation contingent or knowledge of the risks.
And she could decide the invasiveness of peeing on a stick is not worth the benefit of being able to have an x-ray.
On the other hand no offer was made. A test was illegally applied (even if you can force someone to have a test they must know about it), incorrectly interpreted with unjustly severe outcome.
Also, you can be a celibate lesbian nun and in some countries you can't get prescribed valproate without having a coil or implant. Seems much more problematic.
> Generally speaking, postmenopausal pregnancy is unlikely, although not entirely impossible. HRT will not trigger the ovaries to produce new eggs. If a woman has remaining eggs after menopause, HRT might trigger the release of an egg. There are few reports of postmenopausal women conceiving naturally, but this is very rare.
"She had no idea that her urine would be tested for drugs, which resulted in a terrifying, monthslong investigation aimed at determining if she was a fit mother." I dont think she should be surprised; you give up rights when you become incarcerated.
Of course someone being reported for neglect is going to lie. What proof do they have that it was poppy seeds? Do they have hair tests etc showing zero opiate use?
>The day after Kate learned that she was suspected of using opioids—five days after she gave birth—the hospital "refused to discharge" her, the complaint says. That afternoon, DCPP caseworkers separately interrogated Kate and her husband, Jesse. Kate agreed to a second urine test, which came up negative. She was finally released that evening, but her baby did not come home until October 1, "ten days after her birth and five days after DCPP cleared Kate to bring her baby home."
> Although the DCPP "cleared Kate and Jesse to take baby A.L. home," the hospital kept the baby for another five days, and the agency's investigation continued. It included a "Certified Alcohol and Drug Counseling evaluation" and yet another urine test, which was "negative for all substances." In November, Kate received a letter saying the DCPP had concluded that "the allegation of neglect was 'unfounded.'"
>The day after Kate learned that she was suspected of using opioids—five days after she gave birth—the hospital "refused to discharge" her, the complaint says.
That was unlawful detention, by the way. By fraud, under false color of authority, and/or by force. They have no authority to hold anybody against their will (with very specific exceptions having to do with mental state and not applicable here).
> She was finally released that evening, but her baby did not come home until October 1, "ten days after her birth and five days after DCPP cleared Kate to bring her baby home."
That was kidnapping, by the way.
We're talking about actual felonies here. Not that you can get prosecutors interested in that kind of crime, but it's still true.
Because the presumption of innocence is a cornerstone of our legal framework. It's been well known for a while now that poppy seeds can trigger false positive results in a drug test, and it's not a particularly uncommon component of foodstuffs, so it constitutes reasonable doubt.
There's much worse problem that when the poppy seed false positives get enough exposure, real criminals are going to use poppy seed doubt, and get away with it it their lawyers are good enough.
Using a cutoff that is 200 times more strict than standard drug testing practices without giving the patient any warning that they’ll be tested (and guidance to avoid poppy seed foods) is asking for false positives.
Given that the other cases resulted in six-figure settlements, it’s surprising that this practice continues.