Reporting Highlights
- Questioning Checks: Michigan officers expressed concern in 2020 about conflicting drug check outcomes from Averhealth, the corporate doing the testing for the state’s youngster welfare company.
- No Solutions: The corporate didn’t inform Michigan that the lab’s accreditor had positioned it on probation. Averhealth has defended the accuracy of its testing, citing an unbiased evaluate.
- Contained in the Lab: Former workers advised ProPublica the lab was understaffed and had damaged and poorly maintained devices, they usually had been pressured to hurry supply of check outcomes.
These highlights had been written by the reporters and editors who labored on this story.
In 2020, a foster care supervisor in Montcalm County, Michigan, messaged her boss with considerations about drug testing. A father who was working to reunite along with his kids had examined optimistic for methamphetamine with the lab the state had a contract with, Averhealth, and the outcomes contradicted exams ordered by different legislation enforcement companies, she wrote.
“Choose indicated on the report that the problem of Averhealth’s testing outcomes was a state-wide subject and that probate court docket judges all around the state had been having comparable issues.”
Months later, one other official with Michigan’s Division of Well being and Human Providers wrote to colleagues about comparable worries. “We’re struggling to do casework with Averhealth and don’t belief them,” supervisor Sara Winter wrote. “We’re making BIG choices, together with having mother and father depart residence or elimination, and that’s scary to do once you don’t belief who you’re getting providers from.”
The reason for the discrepancies was unknown. However that yr, 2021, Averhealth’s accreditor faulted its practices and positioned the lab on a six-month probation, citing, amongst different points, information manipulation and failed proficiency exams, that are finished to make sure check accuracy.
When state officers caught wind of the investigation and repeatedly inquired about it, they hit a wall. The Faculty of American Pathologists’ Forensic Drug Testing Accreditation Program advised them that “findings of the investigation are stored confidential.” They requested Averhealth’s then-CEO Jason Herzog for all out there studies on the lab. He was out of the workplace, he stated, and promised to “monitor down when I’ve web connection.”
Averhealth didn’t disclose that it had been positioned on probation — its contract didn’t require such notification. And greater than a yr would go earlier than Michigan officers acquired a full image of what accreditors noticed at one of many nation’s largest drug-testing operations for youngster welfare, custody and probation instances.
Michigan’s Division of Well being and Human Providers declined to touch upon the messages its employees despatched relating to Averhealth.
A ProPublica investigation discovered that Averhealth’s lab practices haven’t solely been faulted by its personal accreditor but in addition focused in lawsuits, and prompted Michigan’s youngster welfare company to order its workers to not use Averhealth’s exams as proof in court docket and to withdraw any petitions based mostly solely on the lab’s outcomes.
Six former workers advised ProPublica that the corporate’s central lab facility in St. Louis was mismanaged. The previous workers, who embody two chemists and two lab managers, complained variously of understaffing, damaged and poorly maintained devices, and strain from administration to hurry up the supply of check outcomes, even when some feared they had been compromising accuracy.
In statements and interviews, the corporate defended its practices and denied that management mismanaged its laboratory. “Averhealth supplies correct and forensically defensible check outcomes,” firm CEO Dominique Delagnes stated in a press release. “The integrity of the information and data that we offer is of the best significance to us.” Averhealth’s aim, she stated, is to “reclaim lives, unite households, and strengthen communities” and “not separate kids from their mother and father.”
Delagnes has known as the selection to not inform Michigan officers of the corporate’s probation “a enterprise choice” that was made by Herzog, whom she succeeded as CEO. Averhealth’s accreditor stated the issues it noticed on the lab weren’t regarding sufficient to halt testing.
The corporate attributed the conflicting check outcomes flagged by officers in Montcalm County, Michigan, to completely different technical requirements utilized by different labs, including that it “under no circumstances calls into query the accuracy or reliability of Averhealth’s testing.” It additionally stated that no single check outcome has a big affect on a case. “It normally takes quite a few optimistic exams in addition to different indications of danger earlier than vital penalties are imposed,” an organization spokesperson stated in an interview. The corporate cited an unbiased evaluate by exterior scientists as proof that its protocols are sound, together with the truth that Averhealth by no means misplaced accreditation.
In 2023, a bunch of oldsters filed a lawsuit alleging that check outcomes had been faulty, which prevented them from seeing their kids and in some instances brought on them to lose custody completely. “Averhealth’s false optimistic outcomes have had a devastating affect,” in line with the grievance, which cited “substantial emotional misery, together with anxiousness, melancholy, stress and sleeplessness.” Averhealth denied the allegations within the lawsuit, which it attributed to “opportunistic plaintiffs’ attorneys hoping for a windfall settlement and plaintiffs looking for to flee the implications of their optimistic exams,” in line with a press release. Averhealth settled the lawsuit in September.
ProPublica interviewed greater than 50 folks concerned in household court docket or legal proceedings who stated they had been examined by Averhealth and had obtained what they believed had been inaccurate outcomes. Some stated they’d tried to dispute the findings by presenting in court docket detrimental check outcomes from different labs — one of many solely methods to formally dispute a court-ordered drug check, and a technique usually really useful by attorneys. However exams from completely different labs are troublesome to check, and judges don’t at all times give credence to contradictory outcomes.
“After a number of investigations and a probationary interval, no entity or particular person has discovered any materials inaccuracy in Averhealth’s reported check outcome,” the corporate stated in a press release.
After the lab’s probation was made public, Michigan’s and Georgia’s companies overseeing youngster welfare reduce ties with Averhealth. Michigan’s Division of Well being and Human Providers stated in a press release that its “contract with Averhealth has expired and now we have not used Averhealth since March 2022.” The Georgia Division of Household & Kids Providers advised ProPublica in a press release that it didn’t renew the contract when it resulted in 2023 “resulting from a wide range of dangers recognized” throughout an evaluation.
The lab’s issues went past what the accreditor discovered, a few of the former workers advised ProPublica. And people issues continued after the probation interval ended, they stated.
Different authorities purchasers are sticking with the corporate. “They’ve been a valued companion of the Judicial Department,” stated a spokesperson for the Judicial Department of Arizona in Maricopa County, whose Grownup Probation and Household Courtroom order 7,000-10,000 exams a month from the corporate.
The corporate that grew to become Averhealth was based in 1995 by former California police officer Rick McIntire, who spent his profession in undercover narcotics and seen medication as a societal menace. Drug testing was booming, with courts getting federal grants to implement packages. Medical labs had been billing $600 a check, McIntire recalled. He noticed a chance to cost much less and earn money on quantity.
There may be subsequent to no regulation of court-ordered drug testing by the federal authorities, states or the courts. At one level, McIntire stated, a hospital lobbyist sought laws in California to ban labs like McIntire’s. McIntire stated he satisfied lawmakers that testing doesn’t require scientific experience. “It was decided that that is non-diagnostic in nature,” he stated, that means it isn’t used to find out medical circumstances. “Due to this fact, it doesn’t require any particular licensing — you generally is a businessman.”
In 2011, McIntire bought his firm to funding bankers Herzog, Jeff Herr and David Keys, who later renamed it Averhealth. The trio, who didn’t reply to requests for remark, had no lab expertise however specialised in mergers and acquisitions. Their aim, McIntire recollects from conversations with them, was to develop and promote. In 2019, 5 Arrows Capital Companions, a non-public fairness fund and arm of Rothschild & Co., acquired a majority stake. It valued Averhealth at $150 million, in line with a deposition of Herzog for the mother and father’ lawsuit towards the corporate.
With new funding, Averhealth “centered on progress by acquisition” of regional labs, “simply attempting to mainly get new contracts,” one former finance staff member stated in an interview. The previous worker requested to not be named to guard their job prospects. (5 Arrows and Rothschild & Co. didn’t reply to requests for remark.)
Averhealth markets its science because the gold normal. Its St. Louis lab is overseen by Ph.D. toxicologists and “is run by very devoted and competent workers below properly thought out pointers,” present lab director Tonya Mitchell stated in an e mail. Firm advertising and marketing supplies say it has the potential to detect when samples are diluted by dishonest test-takers and to check for rising and obscure medication.
Christopher Totten, a former enterprise growth supervisor who pitched the corporate’s providers within the Southeast, known as Averhealth the Apple of judicial drug testing. Its strategies are an unlimited enchancment on — and considerably dearer than — the in-house labs nonetheless utilized by some rural courts, the place nonscientists use instantaneous exams and don’t at all times affirm the accuracy of the outcomes, he stated.
Averhealth doesn’t publicly disclose its whole consumer record or whole revenues from the numerous state companies it serves. However in 2019, for instance, the Michigan Division of Well being and Human Providers agreed to a five-year contract valued at an estimated $27 million to do testing for its youngster welfare system. And Massachusetts budgeted greater than $5 million final fiscal yr for the corporate to check probationers, in line with public data.
The corporate boasts that its innovation extends past lab work. Its Aversys software program, which randomizes testing schedules and collects information on test-takers, options “predictive analytics” that “ID sufferers in danger for relapse — earlier than they relapse,” the corporate web site acknowledged in 2023. Averhealth stated it did this by monitoring when folks known as in to see if they might be required to check that day or in any other case interacted with its test-scheduling system.
Dependancy consultants say they’re doubtful of such claims. “To my data, there may be completely no scientific information to assist the notion that irregularity in logging in to an app predicts relapse,” stated Katie Witkiewitz, a professor of psychology and the director of the College of New Mexico Middle on Alcoholism, Substance Use, and Addictions. Based on a former worker with data of Averhealth software program, the corporate didn’t accumulate information to assist this advertising and marketing declare. “I noticed no proof of them monitoring end result information on relapse,” stated the previous worker, who requested to not be named to guard their job prospects within the business.
After being contacted by a reporter, the corporate faraway from its web site the declare that it may “ID sufferers in danger for relapse.”
The corporate stated in a press release that “the web site is frequently up to date, and regardless, Averhealth has by no means claimed to foretell {that a} relapse will occur. It has solely ever claimed that its software program can determine these in danger.”
Considered one of Averhealth’s greatest promoting factors is velocity: The corporate guarantees to report outcomes by the following enterprise day. This requires its assortment facilities across the nation to ship hair, saliva and urine samples in a single day to Missouri, the place the lab runs 24 hours a day.
Three former lab workers — a lab tech, a chemist and a lab supervisor — advised ProPublica that they frequently labored 12- and even 14-hour shifts and nonetheless couldn’t meet the deadlines.
Stress to hurry up supply of outcomes got here from the highest, stated one other lab supervisor, who labored at Averhealth in 2022. The supervisor, who requested to stay nameless to guard their job prospects, stated lab devices had been frequently in disrepair and out of service, which made assembly deadlines troublesome. The supervisor met frequently with Delagnes, who was COO on the time, and different higher administration. The supervisor recollects them saying, “The purchasers are calling and screaming, ‘What are you going to do to get these outcomes by?’ And infrequently my reply was, ‘The devices are damaged once more. I don’t have sufficient folks.’” The supervisor was uncertain whether or not instrument upkeep affected the accuracy of check outcomes.
A former worker named Stephen Penn, a chemist who additionally labored on the firm in 2022, stated he skilled comparable deadline pressures. “They emphasised velocity over accuracy,” he stated. When making ready samples for testing, “I used to be all in favour of getting it finished properly. However the push was to get it finished quick.” Penn, who has over 20 years of expertise in labs, left Averhealth “due to the velocity subject.”
One other chemist, Jennifer Picker, who labored at Averhealth from January of 2021 to July of 2022, stated that when loading samples onto an instrument that confirms outcomes, known as a excessive efficiency liquid chromatograph, she was pressured to hurry as much as the purpose that she nervous samples can be linked to the improper individual. “I used to be at all times terribly gradual and meticulous in regards to the placement of my pattern on the HPLC. And there have been a whole lot of complaints about that I wasn’t quick sufficient. And I’m like, ‘No approach. That is that affected person’s life.’”
Averhealth acknowledged that it emphasizes velocity however added that it’s not on the expense of accuracy. “Averhealth requires its workers to work effectively to fulfill its prospects’ manufacturing requirements and required turnaround instances,” the corporate stated in a press release. “Importantly, delaying check outcomes might result in a miscarriage of justice, as litigants’ instances are delayed and probably endanger kids and the neighborhood who depend on the court docket system, in cooperation with Averhealth, to maintain them secure.” Delagnes stated in a sworn assertion offered to ProPublica that she has “by no means positioned velocity over accuracy in our lab testing, nor have I ever directed anybody else to take action.”
Picker, the chemist, shared documentation to assist her allegation that normal lab practices weren’t adopted at Averhealth, together with a photograph of a pipette upkeep log. Chemists had been to finish the logs day by day to confirm instrument efficiency. However in line with Picker, this didn’t occur. She famous that the picture exhibits every day’s required checks had been signed in the identical ink and handwriting. “I watched folks fill this out retroactively,” she stated.
Picker additionally shared a photograph of urine samples exterior the biohazard lab space, sitting on a desk subsequent to private objects and snacks. This was a violation of coverage, she stated, citing notices posted within the lab stating that specimens had been to not be eliminated.
Averhealth denied that lab devices had been damaged or poorly maintained and that workers crammed out upkeep logs retroactively. Relating to the picture of a pipette upkeep log, the corporate stated: “The identical worker can be accountable for filling out the log, so it makes good sense that they might have the identical handwriting and use the identical pen at their workstation.”
Averhealth initially advised ProPublica that eradicating samples from the lab’s biohazard space and leaving them on a desk subsequent to private objects and snacks was not a coverage violation. Picker had a “basic misunderstanding of the lab safety and pattern integrity process,” it stated. “There was no mishandling.” When offered with images of an indication on a lab door saying to not take away samples from the realm, an organization consultant stated: “At any firm there are going to be situations the place probably insurance policies aren’t adhered to on occasion. I’m not conscious that it is a vital subject for Averhealth.”
The corporate described Picker as “a disgruntled former worker pushing a false narrative” whose time on the firm “was marked by repeated disciplinary points, together with bullying different workers and failing to report back to work.” The corporate stated in a press release, “Picker struggled to fulfill her workload, not due to firm calls for, however as a result of the remedy she was taking left her sleepy, torpid, and incessantly absent.”
Picker denied that she had disciplinary points or struggled to fulfill her workload. Whereas she did take an allergy medication at work, she stated it didn’t have an effect on her efficiency. Picker stated she resigned when her grievance in regards to the misplaced urine samples was not taken severely. Averhealth didn’t touch upon Picker’s causes for resigning.
The corporate additionally questioned Penn’s declare that the corporate “emphasised velocity over accuracy.” In a press release, Averhealth stated that Penn “didn’t elevate any considerations about Averhealth earlier than or after his resignation.” The corporate additionally famous that Penn is “intently related to Ms. Picker.” (Penn rents residing house in Picker’s residence.)
“I had made up my very own thoughts in regards to the firm and separating from them,” stated Penn. “What I noticed, that they positioned velocity over accuracy, didn’t have something to do with my relationship with Jennifer.”
Penn stated he didn’t convey his considerations to the corporate as a result of “I didn’t assume it will make a distinction.”
Essentially the most consequential and public criticism of Averhealth has come from Sarah Riley, a professor of pathology at Saint Louis College, who was employed because the lab’s director in September 2020. After seven weeks in that function, she abruptly resigned and filed a federal whistleblower lawsuit.
The Division of Justice investigated Riley’s claims and pursued a case, however selected to intervene on solely a few of the allegations.
Based on the DOJ, the corporate had billed Michigan’s Division of Well being and Human Providers for exams it didn’t carry out: Averhealth’s contract required it to verify all optimistic drug exams utilizing a second technique; the federal government alleged it had examined samples solely as soon as.
Averhealth agreed to pay the DOJ $1.3 million to settle the case in June 2024. The corporate didn’t admit wrongdoing.
“We imagine Averhealth absolutely carried out below the MDHHS contract,” Delagnes stated in a press release to ProPublica. “Averhealth settled the matter to keep away from the associated fee and distraction of litigation.” The corporate stated in a press release that as a result of the DOJ investigated however didn’t intervene on Riley’s declare that its exams had been inaccurate, Averhealth outcomes are correct.
Mark Johnson, who was Averhealth’s CEO from 2022 to 2024, stated in an interview that Averhealth conducting only one check on the Michigan samples “didn’t affect reliability as a result of we went to a extra superior check,” a check sometimes used to verify an preliminary optimistic outcome. Through the DOJ investigation, the corporate’s enterprise “carried out properly” and the quantity of exams it carried out continued to develop, Johnson added.
Riley obtained a $228,586 whistleblower award from the DOJ settlement. She declined to remark for this text about her expertise at Averhealth.
In February 2021, Riley was known as to testify in a Michigan courtroom by a lawyer representing a mother attempting to reunite together with her youngsters within the foster system. The mother had examined optimistic for marijuana with Averhealth, however exterior lab exams had discovered no proof of drug use.
In court docket, Riley stated that she had resigned from Averhealth after discovering what she thought of to be issues with the lab’s accuracy. She testified that the lab routinely failed to make use of correct quality control on its affirmation exams. Such exams, supposed to definitively show optimistic outcomes, are carried out on subtle lab devices known as mass spectrometers. Based on Riley’s testimony, Averhealth technicians weren’t utilizing the tools correctly as a result of they “had been below great strain” to report outcomes rapidly.
“Did you convey these considerations to the eye of the administration of Averhealth?” the Michigan mother’s lawyer requested.
She had, Riley stated. “Their response was, ‘Thanks for bringing us your considerations. Please don’t change something at the moment. We have now contractual time agreements to get the information out, and we simply need to get the information out.’”
The choose within the case, Lisa McCormick, declined to toss the contested Averhealth check outcomes. “Dr. Riley’s testimony was speculative and didn’t present the Courtroom with any particular examples,” she wrote in her opinion. The choose later terminated the mother’s parental rights, in line with court docket paperwork, citing missed drug exams and failure to learn from providers, amongst different points. Termination of parental rights, which is often irreversible, means kids may be adopted by different households.
In 2024, Riley was deposed in Foulger vs. Avertest, the lawsuit introduced by the mother and father who alleged their check outcomes had been incorrect. She once more testified that the lab’s emphasis on velocity was problematic. “Dominique and I had weekly calls, at the least weekly, typically it was greater than that,” Riley stated of the CEO, “and the emphasis was at all times on getting the outcomes out earlier than anything.” Her concern about velocity was echoed by the previous workers interviewed by ProPublica.
Averhealth denied Riley’s allegations about its lab practices and stated that her testimony exhibits she misunderstood its science. Riley has estimated that Averhealth’s fee of inaccurate exams may very well be as excessive as 30%. Within the 2024 deposition, she stated the way in which the lab used calibrators was flawed and contributed to those errors. Calibrators make sure the measurements produced by mass spectrometers are right.
However Averhealth stated that she didn’t grasp how the lab distinguishes between optimistic and detrimental exams, and that its course of had been endorsed by lab regulators.
The choose within the mother and father’ case expressed doubts that Riley’s allegations about accuracy would maintain up in court docket. Earlier than the case was settled, the choose wrote in an order, “At trial the Courtroom could find yourself sustaining an objection to her opinion that thirty p.c of Averhealth’s exams are unreliable until Plaintiffs lay ample basis to clarify why her thirty p.c estimate (which presumably arises solely out of testing hair samples for THC) is dependable as to different types of exams for different medication.”
Riley’s allegations triggered investigations by a number of exterior scientists.
In January of 2021, Michigan’s Division of Well being and Human Providers employed an unbiased agency, Wagner Toxicology Associates, to audit Averhealth’s lab and deal with judges’ considerations about Riley’s allegations. Two toxicologists, who had been unaware of Riley or her complaints, spent two days within the lab “to verify that the laboratory personnel had been performing their laboratory work in accordance with their laboratory guide,” they wrote. “A comparatively small variety of studies was audited throughout the go to, and the reporting course of was noticed.” Wagner Toxicology issued a nine-page report stating that Averhealth’s scientists had been competent and adopted process, and that the lab’s outcomes may very well be “scientifically supported and forensically defended in court docket.”
Michigan’s company didn’t know the separate, confidential investigation by Averhealth’s accreditor was additionally underway. That investigation, launched after Riley despatched a letter to the accreditor, would attain completely different conclusions in regards to the lab’s operations.
Averhealth’s accreditor is the forensic drug testing program on the Faculty of American Pathologists, a non-public skilled group that gives knowledgeable oversight to forensic labs. In early 2021, the group’s toxicologists reviewed 1000’s of pages of information from Averhealth’s lab and located “quite a few” issues with hair, urine and oral fluid testing. “This laboratory has many high quality assurance points within the areas of high quality management and proficiency testing,” Arthur Zebelman, commissioner of the forensic drug testing program, wrote in a 2021 e mail to colleagues that was later made public in a lawsuit.
CAP substantiated Riley’s allegations. In a letter, it acknowledged that these allegations had been: “concern relating to unacceptable high quality assurance of mass spectrometry confirmatory testing”; “failure to observe procedures as written”; “concern relating to the manipulation of instrument calibrations”; and “concern relating to the evaluate of high quality management outcomes.”
CAP knowledgeable Averhealth it was on probation “based mostly on the laboratory’s lack of steady compliance” with “high quality administration” requirements.
The aim of the investigation was to examine whether or not the lab adopted correct protocols, to not confirm the accuracy of all of the exams Averhealth had reported. However the query of false positives and false negatives did come up.
Inside emails present CAP scientists mentioned how issues within the lab may affect check outcomes however didn’t attain a particular conclusion about whether or not the problems they discovered would affect accuracy. “The laboratory doesn’t appear to have an issue with false optimistic outcomes,” one toxicologist wrote, including that its course of for figuring out the amount or focus of medicine “is at instances unacceptable and they don’t appear to take the well timed decision of such issues severely sufficient.” One other toxicologist concerned within the audit appeared to disagree. “Qualitative reporting errors might exist,” that toxicologist wrote, citing “imprecision and lack of quantitative accuracy.” A qualitative reporting error is a detrimental check that’s reported as a optimistic, or vice versa.
The probation lasted six months, throughout which the lab continued testing. “CAP didn’t discover any check outcomes that had been incorrectly reported and didn’t require Averhealth to rereport outcomes with a special outcome,” the corporate stated in a press release.
In an interview, Zebelman defended permitting Averhealth to proceed testing whereas on probation. The lab was forthcoming with data and cooperated with inspectors to repair errors, he stated, emphasizing that CAP membership is a “voluntary, instructional program for laboratory enchancment. We’re not attempting to create gotcha moments.”
Michigan’s Division of Well being and Human Providers repeatedly requested Averhealth in regards to the investigation, in line with public data reviewed by ProPublica. CAP advised the state company that the findings can be stored confidential.
Herzog, then Averhealth’s CEO, made the choice to not disclose that it was on probation, in line with Delagnes, the present CEO, who stated as a lot in a deposition within the mother and father’ lawsuit towards the corporate. “I’m not attempting to go the buck. It was a enterprise choice that began with him,” she stated.
(CAP advised ProPublica that authorities companies might require labs to be extra clear about accreditation points. A baby welfare company might, for example, contractually require a lab to mechanically notify it of accreditors’ revocations and probations. However most companies haven’t finished that, stated Denise Driscoll, CAP’s senior director for accreditation and regulatory affairs.)
In July of 2021, after a nonroutine inspection, CAP lifted the probation, writing that “the allegations are being appropriately addressed.”
Seven months after Averhealth’s probation ended, in 2022, Michigan’s Division of Well being and Human Providers discovered from the DOJ that Averhealth was below investigation and had issues with accreditation. The Michigan company instantly halted testing with Averhealth and advised its employees to ignore the corporate’s ends in any instances the place they had been the one proof, in line with court docket paperwork. (CAP agreed to offer Michigan’s Division of Well being and Human Providers data associated to the probation after Michigan had already halted testing.)
Averhealth didn’t touch upon the company directing its employees to ignore its drug exams as proof.
