This text was printed in partnership with The Marshall Venture, a nonprofit information group overlaying the US felony justice system.
Amairani Salinas was 32 weeks pregnant along with her fourth little one in 2023 when medical doctors at a Texas hospital found that her child not had a heartbeat. As they prepped her for an emergency cesarean part, they gave her midazolam, a benzodiazepine generally prescribed to maintain sufferers calm. A day later, the grieving mom was cradling her stillborn daughter when a social employee stopped by her room to ship one other devastating blow: Salinas was being reported to little one welfare authorities. A drug check had turned up traces of benzodiazepine—the very remedy that workers had administered earlier than wheeling her into surgical procedure.
For Victoria Villanueva, pregnant along with her first little one, the drug detected in her child’s system was morphine. Villanueva had arrived at an Indiana hospital at 41 weeks to have her labor induced. To ease the ache of her contractions, medical doctors gave her narcotics. A day later, a social employee instructed the brand new mom, the newborn’s meconium—or first bowel motion—had examined optimistic for opiates. Now, as an alternative of bonding along with her child, Villanueva shook with worry that her new child might be taken away. “I didn’t even know perform,” she recalled.
What occurred to Salinas and Villanueva are removed from remoted incidents. Throughout the nation, hospitals are dishing out medicines to sufferers in labor, solely to report them to little one welfare authorities after they or their newborns check optimistic for those self same substances on subsequent drug exams, an investigation by The Marshall Venture and Reveal has discovered.
The optimistic exams are triggered by medicines routinely prescribed to thousands and thousands of birthing sufferers in the USA yearly. The medication embrace morphine or fentanyl for epidurals or different ache aid, anxiousness medicines, and two completely different blood strain meds prescribed for C-sections.
In a time of rising surveillance and criminalization of pregnant ladies because the finish of Roe v. Wade, the hospital reviews have prompted calls to police, little one welfare investigations, and even the removing of youngsters from their dad and mom.
The reporting for this story included interviews with two dozen sufferers and medical professionals and a overview of a whole lot of pages of medical and courtroom data. Some spoke about circumstances on situation of anonymity as a result of the custody of youngsters is at stake.
“The hospitals are at fault. The clinicians are at fault. Our insurance policies are at fault.”
Dr. Davida Schiff
In New York, a mom with no historical past of drug use misplaced custody of her toddler and new child for 5 months after she examined optimistic for fentanyl that the hospital had given her in her epidural. In Oklahoma, when a mom examined optimistic for meth, sheriff’s deputies eliminated her new child and three different kids. They had been held in foster look after 11 days, till a affirmation check proved that the offender was a heartburn remedy the hospital had given the affected person.
By the point of Villanueva’s hospital keep in 2017, researchers and medical doctors had recognized for years that medicines can quickly go from mom to child, inflicting optimistic drug check outcomes. Two exams from Villanueva’s prenatal visits and one other check performed proper earlier than she went into labor all confirmed the mom had no medication in her system. The morphine given to Villanueva for her contractions was documented in her medical data. However the workers reported her to the state little one welfare company anyway, hospital data present.
Marion Common Hospital in Indiana didn’t reply to requests for remark. Brian Heinemann, a spokesperson for the Indiana Division of Little one Companies, declined to touch upon Villanueva’s case however mentioned coverage has since modified to make sure that drug display screen outcomes alone usually are not used to substantiate an allegation of abuse or neglect.
Kimberly Walton, a spokesperson for the Texas Well being Assets system, declined to reply questions on Salinas’ case however mentioned that medical doctors order drug exams if there’s a concern about affected person well being and that they’re required “to report suspected unlawful drug use that would endanger the well being or security of a kid.”
Hospital drug testing of pregnant ladies, which started within the Eighties and unfold quickly through the opioid epidemic, was supposed partly to assist determine infants who would possibly expertise withdrawal signs and wish additional medical care. Federal regulation requires hospitals to alert little one welfare businesses anytime such infants are born. However a earlier investigation by The Marshall Venture and Reveal discovered that the comparatively cheap pee-in-a-cup exams favored by many hospitals are extremely vulnerable to false positives, errors, and misinterpretation—and plenty of hospitals have did not put in place safeguards that might shield sufferers from being reported over defective check outcomes.
In some circumstances examined by The Marshall Venture, medical doctors and social staff didn’t overview affected person medicines to seek out the reason for a optimistic check. In others, suppliers suspected a drugs they prescribed might be the offender however reported sufferers to authorities anyway.
“How a lot hurt to birthing individuals are we prepared to permit? Our sufferers are being harmed till we are able to get our act collectively,” mentioned Dr. Davida Schiff, whose hospital community, Mass Common Brigham in New England, instituted a brand new coverage this yr that directs suppliers to drug check sufferers, with their consent, solely when medically mandatory. The brand new coverage additionally halted automated reporting of optimistic check outcomes. Hospitals have a accountability to deal with the testing issues, she mentioned. “The hospitals are at fault. The clinicians are at fault. Our insurance policies are at fault.”
The dangers from giving medicines to birthing sufferers after which testing them for illicit substances have been properly documented. A 2022 examine by researchers at Massachusetts Common Hospital discovered that 91 % of ladies given fentanyl of their epidurals examined optimistic for it afterward. Different research have discovered that moms can rapidly go these medicines on to their infants. A child’s optimistic drug check “can’t and shouldn’t be used to determine fentanyl drug abuse in moms,” mentioned Athena Petrides, the lead researcher of one of many research at Brigham and Girls’s Hospital in Boston.
Regardless of these warnings, hospitals usually lack insurance policies requiring suppliers to overview a affected person’s data to see what medicines they obtained earlier than reporting them to authorities. Necessary reporting legal guidelines shield medical doctors from legal responsibility for reviews made “in good religion,” even when they change into flawed. And toxicologists and medical doctors say many medical doctors lack the time and experience wanted to adequately interpret drug check outcomes.
“It’s not one thing routinely taught in medical faculty and even residency,” mentioned Dr. Tricia Wright, an OB-GYN and professor at College of California, San Francisco Medical Middle who makes a speciality of substance use problems in being pregnant. “It’s all as much as people, who make their very own interpretations.” In 2021, Wright helped change the coverage at her hospital, one of many nation’s main instructing amenities, to direct medical doctors to not drug check sufferers except medically mandatory.
Whereas drug exams may also help pediatricians decide deal with an toddler who could expertise withdrawal signs, many OB-GYNs say that optimistic drug check outcomes don’t usually inform the mom’s medical care, so that they have little purpose to dwell on them.
As an alternative, at many hospitals, it’s social staff—liable for contacting little one welfare businesses—who’re extra seemingly to concentrate to drug check outcomes. Some hospitals require social staff to mechanically file a report for any optimistic check, whereas different amenities first carry out an evaluation to find out whether or not a dad or mum may be a danger to the newborn.
However hospital social staff are sometimes overworked, mentioned Kylie Haines, who manages a program for pregnant ladies with opioid use dysfunction at Vanderbilt College Medical Middle, one of many high maternity instructing hospitals within the nation. Social staff usually have even much less coaching than medical doctors on drug testing and little authority to query check outcomes, she mentioned. Investigating the reason for a optimistic drug check will not be thought-about a part of their job.
“We’re not medical suppliers,” mentioned Haines, a licensed social employee herself. “We will’t interpret drug screens.”
The timing of the exams may make it tough to interpret them. In concept, the very best time to take a urine pattern for drug testing is when a affected person arrives on the hospital, earlier than receiving medicines. However it is not uncommon for hospitals to check urine samples taken from a birthing affected person’s catheter bag or to request a urine pattern after medicines have already been administered, suppliers mentioned.
New child drug exams can add one other layer of complexity. Whereas urine exams can detect potential drug use over a interval of days, testing the newborn’s meconium can uncover illicit substances going again months. Meconium exams are broadly thought-about to be the gold customary for new child drug testing as a result of they will point out potential drug use earlier in being pregnant, a doable signal of habit.
However in some circumstances, there isn’t a method to inform whether or not a child’s optimistic check was attributable to a drugs the hospital distributed or a substance the mom used earlier. Nor do such exams inform suppliers how a lot or how often an individual could have used medication—for instance, if a affected person used substances prior to now however stopped when she realized she was pregnant. “You really don’t know,” Schiff mentioned, “which is form of a multitude.”
“It makes me sick to think about all of the mothers which have come via and mentioned they don’t use fentanyl and we don’t consider them.”
Lisa Grisham
Medicines resembling morphine or fentanyl have led some sufferers to get flagged as opioid customers. Ephedrine and phenylephrine, medicines for low blood strain which are generally prescribed throughout C-sections, have prompted false positives for meth. The Marshall Venture additionally discovered that ladies had been questioned over optimistic drug exams after hospitals gave them sedatives resembling benzodiazepines or barbiturates.
When ladies are flagged by a optimistic drug check consequence, different facets of their lives can rapidly come below suspicion. Medical situations or beginning issues that may be related to habit—resembling hypertension, a placenta that separates earlier than beginning, or a untimely beginning—could mistakenly be seen as additional proof {that a} pregnant affected person used medication. By the lens of a optimistic drug check, even one thing as innocuous as lacking some prenatal appointments turns into potential proof {that a} mom is a danger to her child. And sufferers who had traumatic experiences giving beginning could abruptly discover themselves below menace.
In 2023, Salinas was nonetheless in a haze of grief after delivering her stillborn child when she discovered she can be reported to little one welfare authorities. Salinas had no concept the hospital had given her the benzodiazepine for which she examined optimistic and denied utilizing the remedy. She had additionally examined optimistic for Delta-9, a authorized hemp-derived product, which she mentioned she had purchased on the grocery retailer. However quickly, Salinas discovered herself below a monthslong investigation, making an attempt to battle off paralyzing despair whereas processing her grief and caring for her different kids.
“I nonetheless have three stay kids. They nonetheless have to eat. They nonetheless have to rise up for college. They nonetheless want their mother,” Salinas recalled pondering as she was being questioned.
Officers closed the case about 4 months later as “unsubstantiated.” However it wasn’t till a yr later that Salinas learn via her medical data with a Marshall Venture reporter and found the reason for the optimistic check.
Marissa Gonzales, a spokesperson for the Texas Division of Household and Protecting Companies, declined to debate Salinas’ case, citing confidentiality legal guidelines.
Salinas mentioned she questioned why little one welfare staff weren’t spending their time investigating allegations of precise little one abuse. “Why are you giving your consideration to this one that’s an excellent mother, who hasn’t performed something, as an alternative of a kid who may very well be in peril?”
Lately, research have discovered that drug exams aren’t essentially one of the best ways to determine somebody with a substance use downside—a easy screening questionnaire can be efficient. Main medical teams advise hospitals to make use of questionnaires as an alternative of common drug exams. However hospital drug testing—and reporting—of labor and supply sufferers stays ubiquitous.
In no less than 27 states, hospitals are required by regulation to alert little one welfare businesses a couple of optimistic check or a possible publicity to the newborn. However not a single state requires hospitals to verify check outcomes earlier than reporting them. Hospitals routinely contact authorities with out ordering affirmation exams or ready to obtain the outcomes.
Not each state explicitly requires reporting a optimistic check, however many hospitals accomplish that anyway. In 2022 alone, greater than 35,000 infants had been reported to little one welfare authorities as substance-exposed, federal knowledge exhibits, with no assure that the underlying check outcomes had been correct.
“I couldn’t even actually get pleasure from correctly my little one being born.”
Victoria Villanueva
“The system is primed for a report,” mentioned Dr. Mishka Terplan, an OB-GYN in Maryland and a number one researcher on substance use problems throughout being pregnant. “To gradual it down, or to cease it, takes effort.”
The implications of a defective drug check may be particularly extreme for individuals with histories of habit, who’re much less more likely to be believed after they protest that the optimistic check was attributable to a hospital remedy. On this setting, a affected person’s phrase is usually pitted in opposition to a single drug check, and it’s as much as a person physician, nurse, or social employee to determine whether or not to ferret out the reality.
Lisa Grisham, a nurse in Arizona, recalled the case of a affected person in restoration for opioid use dysfunction who examined optimistic for fentanyl. The lady insisted that one other nurse had given her the remedy throughout labor, though it was not listed in her hospital data. Grisham, the director of a hospital program for substance-exposed infants at Banner College Medical Middle in Tucson, took it upon herself to analyze and finally tracked down the nurse, who confirmed the affected person’s rationalization.
“It makes me sick to think about all of the mothers which have come via and mentioned they don’t use fentanyl and we don’t consider them,” Grisham mentioned.
Villanueva was 18, newly married, and nonetheless engaged on her GED when she gave beginning to her first child. As a toddler, she had been taught to be trustworthy with medical suppliers. So throughout hospital admission, she instructed a nurse that she had briefly experimented with medication resembling marijuana and acid when she was 15. She hadn’t used medication since, she mentioned.
When she was admitted, Villanueva took a drug check that got here again unfavorable for any illicit substances—the identical consequence as the 2 drug exams from her prenatal appointments. Then she obtained medication to induce labor, and her contractions started. They had been so painful, Villanueva recalled, that she was relieved when a nurse instructed her she was giving her morphine.
The day after Villanueva gave beginning, an investigator with the Indiana Division of Little one Companies arrived. The hospital had knowledgeable the company about Villanueva’s “historical past of drug use,” in response to medical data. With out her data, Villanueva mentioned, the hospital additionally despatched her daughter’s meconium for testing, which discovered the morphine.
Villanueva was sure that her hospital data would show she had obtained morphine, and she or he was proper. The drug check outcomes even said, “Medicine administered throughout labor and supply could also be detected in meconium.”
However even after the investigator obtained the hospital data, Villanueva mentioned, the company required her to undergo extra drug exams and permit inspections of her dwelling. Lastly, after a number of weeks, the company closed the case, Villanueva recalled.
Solely after the investigators had been out of her life did Villanueva really feel that she might lastly enjoy her child’s beginning and permit herself to be glad.
“I couldn’t even actually get pleasure from correctly my little one being born,” she recalled. “Till after the very fact, after they had been gone.”
The Marshall Venture reporters Weihua Li, Andrew Rodriguez Calderón, Nakylah Carter, and Catherine Odom contributed to this story.
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