This text was printed in partnership with The Marshall Mission, a nonprofit information group masking the US prison justice system.
The request from baby welfare authorities appeared innocent sufficient: Order a new child drug check. Dr. Sharon Ostfeld-Johns and her hospital colleagues had achieved it numerous occasions earlier than.
This time, nevertheless, the request gave the physician pause. A affected person at Yale New Haven Well being in Connecticut, the biggest well being system within the state, had stated she’d used marijuana to assist her eat and sleep throughout her being pregnant. The hospital had reported her to baby welfare authorities. Now, an investigator needed Ostfeld-Johns to drug check the new child.
Ostfeld-Johns knew there was no medical purpose to check the newborn, who was wholesome. A drug check would make no distinction to the toddler’s medical care. Nor did she have considerations that the mom, who had different kids at residence, was a neglectful mum or dad. The physician did fear, nevertheless, that the drug check might trigger different issues for the household. For instance, the mom was Black and on Medicaid—race and earnings bias might affect the investigator’s resolution on whether or not to place the kids into foster care.
“Why did I ever order these exams?” Ostfeld-Johns discovered herself questioning about previous instances. She considered her personal son, then in kindergarten, and the way she would really feel if she confronted an investigation over a optimistic check. Finally, she would overview her personal prenatal data and study that she had been examined for medication with out her data or consent. “You attempt to think about what it might be like if it was you,” she stated. “The damage that we do to folks is overwhelming.”
Ostfeld-Johns had encountered this state of affairs many occasions earlier than, however this time, she refused the drug check request. Then she started a analysis course of that, in 2022, led to an overhaul of the Yale New Haven Well being community’s strategy to drug testing newborns. Now, docs are directed to check provided that doing so will inform medical care—a uncommon prevalence, it seems. The hospital additionally created standards for testing pregnant sufferers.
Many docs and nurses throughout the nation have lengthy assumed that drug testing is each a medical and authorized necessity of their care of pregnant sufferers and newborns—despite the fact that most state legal guidelines don’t require it. But drug testing throughout labor is widespread in America, with a optimistic check typically triggering a report back to baby welfare authorities. Ostfeld-Johns and Yale New Haven are amongst a small however growing variety of docs and establishments throughout the nation which have began questioning these drug testing insurance policies. This cadre of docs is pushing hospitals to change into much less reliant on exams and to focus as a substitute on speaking instantly with sufferers to evaluate any dangers to infants.
Nobody appears to be monitoring simply what number of hospitals have revised their testing insurance policies, however over the previous three years, modifications have come to networks throughout the nation, from California to Colorado and Massachusetts. The establishments differ, from massive nonprofit networks and instructing services to personal, for-profit hospitals.
Whereas docs pushing for reform argue that laws remains to be wanted to require hospitals to cut back testing, particular person hospital efforts appear to be spreading. In Colorado, docs labored with a baby abuse prevention nonprofit to distribute a voluntary new coverage as steerage, prompting a number of hospitals to alter their practices. An academic effort, “Doing Proper by Beginning,” convened digital teams of well being care professionals throughout the nation in 2023 to show them their necessities below the legislation. Some contributors have been stunned to study that almost all state legal guidelines don’t truly require hospitals to drug check pregnant sufferers or newborns and are actually questioning the insurance policies of their establishments, suggesting extra reforms might come.
At Yale, Ostfeld-Johns stated she initially confronted resistance to the coverage change. A few of her colleagues feared that by ending near-automatic testing, “we have been in the end going to harm infants,” she stated. “We have been hurting them by stopping identification of substance publicity that occurred throughout being pregnant.” However Ostfeld-Johns stated they discovered they didn’t want the drug exams to determine infants who may, for instance, develop signs of opioid withdrawal that will require particular care.
On the New Haven hospital, the coverage change seems to have curbed pointless baby welfare reviews with out harming infants. After the coverage went into impact, baby welfare referrals from the new child nursery dropped nearly 50 p.c, in line with preliminary information offered by Ostfeld-Johns. On the similar time, the hospital didn’t see an uptick in infants coming again in want of latest therapy for drug withdrawal, she stated. “No infants got here in with uncontrolled withdrawal signs,” she stated. “No security occasions have been recognized.”
The New Haven information is per the anecdotal experiences of suppliers at different establishments. “I don’t suppose we’re lacking infants” who’ve been uncovered to substances, stated Dr. Mark Vining, director of the new child nursery at UMass Memorial Medical Middle close to Boston. The hospital did away with computerized testing of newborns in 2024. On the similar time, Vining stated, it has reported fewer households to baby welfare authorities as a consequence of optimistic exams attributable to hospital-administered medicines like morphine. A new child drug check “not often provides any data that you simply didn’t already know,” he stated.
The brand new insurance policies are starting to upend an strategy that has existed in the US for many years.
Hospitals first started routinely drug testing moms in labor in the course of the Eighties crack cocaine epidemic. The observe expanded in the course of the opioid epidemic, following the passage of a federal legislation in 2003 and one other in 2016, each of which require hospitals to inform baby welfare businesses anytime a child is born “affected by” substances. Federal legislation and legal guidelines in most states don’t require hospitals to drug check new dad and mom or their infants, however hospitals continuously achieve this anyway—typically out of concern that in the event that they don’t, they’ll miss infants who’re in danger.
Widespread drug testing has induced quite a lot of harms. A earlier investigation by The Marshall Mission discovered that urine exams, the kind utilized by most hospitals, are simple to misread and have false optimistic charges as excessive as 50 p.c. Mother and father have been reported to baby welfare authorities over false positives attributable to issues starting from poppy seeds to blood strain treatment. Substances prescribed to sufferers throughout a hospital keep, such because the fentanyl in an epidural, can present up on maternal drug exams and likewise go shortly from mom to child, inflicting infants to check optimistic for medication.
Race and sophistication bias may also affect drug testing, with a number of research discovering that low-income, Black, Latina, and Indigenous girls are most certainly to be examined. Yale New Haven Hospital discovered that, earlier than the drug testing coverage change, Black infants in its care have been twice as seemingly as White infants to be examined at start. Research elsewhere have discovered that racial disparities prolong to baby welfare instances and removals as properly, with Black, Latino, and Indigenous infants being much less prone to be reunited with their dad and mom as soon as eliminated.
In lots of hospitals, the exams will not be usually used to make medical choices. As a substitute, exams have change into an inexpensive, quick strategy to assess whether or not a mum or dad could be a hazard to their baby.
“We must be doing medical exams for medical causes, not prison, punitive, prosecutorial causes,” stated Dr. Christine Gold, a pediatrician who works on the College of Colorado Hospital system close to Denver. Even for that function, Gold famous, drug exams fall brief. “It’s a actually poor-quality check,” she stated. It can’t inform docs how typically somebody used a substance throughout being pregnant, if a affected person has an habit, or if the drug use affected their potential to mum or dad. “Toxicology exams will not be parenting exams,” Gold stated.
In 2020, Colorado lawmakers eliminated optimistic drug exams at start from the checklist of causes for hospitals to mechanically report a household to baby welfare authorities. However many hospitals continued to check pregnant sufferers and newborns, prompting Gold to guide the hassle to launch steerage in 2023 that encourages hospitals within the state to check solely when medically essential. Now all the College of Colorado Well being system is reforming its coverage on testing pregnant sufferers, and others within the state are reportedly contemplating modifications.
As a substitute of computerized drug exams, the revised insurance policies use screening questionnaires, which gather sure data from sufferers, reminiscent of their household’s historical past of drug use and the affected person’s personal historical past and frequency of use. Researchers and main medical teams say these questionnaires are efficient at figuring out somebody with an habit or prone to growing one, which will help docs steer dad and mom into therapy or decide whether or not a child may want additional medical care. Some hospitals proceed to drug check sufferers below sure circumstances. For instance, at UMass Memorial, pregnant sufferers with recognized substance use issues and new sufferers with none prenatal care are nonetheless drug examined.
The rising motion to restrict drug testing is a supply of optimism for a lot of docs. However its success hinges partly on docs constructing extra significant relationships with their sufferers, so the folks they deal with really feel inclined to confide about substance use and in the end comply with enter therapy. “That’s actually the aim right here,” stated Dr. Katherine Campbell, chief of obstetrics at Yale New Haven Hospital. “We’re making an attempt to cut back substance use dysfunction in reproductive-age folks.”
Which will embrace asking a affected person for knowledgeable consent to undergo a drug check and medical personnel being clear about each the aim of the check and its potential authorized penalties.
However some of these conversations could be difficult. In addition they require longer appointments, one thing many medical establishments are unable or unwilling to supply. “The system is about as much as make it troublesome for us to actually develop a understanding and trusted relationship with a household,” stated Dr. Lauren Oshman, a household doctor on the College of Michigan Medical Faculty in Ann Arbor.
By comparability, urine exams are quick and sometimes contain little interplay with sufferers.
“It takes longer to speak to somebody and actually perceive than it does to position an order and have the particular person give a urine pattern,” Campbell stated.
The brand new insurance policies additionally don’t resolve different issues. After Oshman and colleagues found that clinicians at Michigan Medication ordered drug exams for Black newborns extra typically than for White newborns, the hospital community modified its coverage in 2023 to require testing of infants solely in sure circumstances. However early information signifies the brand new coverage had no impression on the racial disparities in testing and reporting.
One purpose, in Oshman’s view, is that Michigan legislation requires the reporting of a affected person whom a supplier “is aware of or suspects” has uncovered their new child to “any quantity” of a managed substance, whether or not authorized or unlawful. That features marijuana, which is authorized in Michigan. When the well being community crew dug into the info, it discovered that for nearly half of all low-risk sufferers whose infants examined optimistic, the one drug detected was marijuana, and the sufferers have been most certainly to be Black. Most marijuana-only instances don’t lead to findings of abuse or neglect by baby welfare authorities, in line with the crew’s analysis. However hospitals are nonetheless required to report these sufferers, Oshman stated.
“And that received’t change till the state legislation modifications,” she added.
Hospitals in most different states face related challenges. A overview by The Marshall Mission discovered that no less than 27 states explicitly require hospitals to alert baby welfare businesses after a optimistic display or potential publicity—although not a single state requires affirmation testing earlier than a report.
Many hospitals which have modified their insurance policies are in states that don’t require reporting optimistic exams to baby welfare authorities. In each Colorado and Connecticut, for instance, hospitals are required to report a mum or dad provided that suppliers have recognized different security considerations. In Connecticut, suppliers fill out an anonymized type that enables the state to gather information on substance-exposed newborns with out requiring a baby welfare report.
However even in states that don’t require reporting optimistic exams, drug testing stays ubiquitous. For instance, the New York Division of Well being suggested hospitals in 2021 to check labor-and-delivery sufferers solely when “medically indicated” and solely with their consent. However girls proceed to report nonconsensual drug testing at hospitals throughout the state, which has led to them being reported to baby welfare authorities over false optimistic and inaccurate outcomes, The Marshall Mission has discovered.
These challenges present that decreasing the results of drug testing might require a multipronged strategy, from legislative reforms to coverage revisions and enforcement, specialists say.
“We’re simply at first,” Oshman stated. “That is the beginning of making a system that gives that reliable care.”
