This text was printed in partnership with The Marshall Undertaking, a nonprofit information group overlaying the US prison justice system.
The request from youngster welfare authorities appeared innocent sufficient: Order a new child drug take a look at. Dr. Sharon Ostfeld-Johns and her hospital colleagues had carried out it numerous instances earlier than.
This time, nonetheless, 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 mentioned she’d used marijuana to assist her eat and sleep throughout her being pregnant. The hospital had reported her to youngster welfare authorities. Now, an investigator needed Ostfeld-Johns to drug take a look at the new child.
Ostfeld-Johns knew there was no medical cause to check the infant, who was wholesome. A drug take a look at would make no distinction to the toddler’s medical care. Nor did she have considerations that the mom, who had different youngsters at house, was a neglectful guardian. The physician did fear, nonetheless, that the drug take a look at 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 determination on whether or not to place the youngsters into foster care.
“Why did I ever order these checks?” Ostfeld-Johns discovered herself questioning about previous circumstances. She considered her personal son, then in kindergarten, and the way she would really feel if she confronted an investigation over a constructive take a look at. Finally, she would evaluation 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 will be like if it was you,” she mentioned. “The harm that we do to individuals is overwhelming.”
Ostfeld-Johns had encountered this situation many instances earlier than, however this time, she refused the drug take a look at 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, medical doctors are directed to check provided that doing so will inform medical care—a uncommon incidence, it seems. The hospital additionally created standards for testing pregnant sufferers.
Many medical doctors 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—although most state legal guidelines don’t require it. But drug testing throughout labor is widespread in America, with a constructive take a look at usually triggering a report back to youngster welfare authorities. Ostfeld-Johns and Yale New Haven are amongst a small however rising variety of medical doctors and establishments throughout the nation which have began questioning these drug testing insurance policies. This cadre of medical doctors is pushing hospitals to grow to be much less reliant on checks and to focus as a substitute on speaking straight 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 range, from massive nonprofit networks and educating services to personal, for-profit hospitals.
Whereas medical doctors pushing for reform argue that laws continues to be wanted to require hospitals to cut back testing, particular person hospital efforts appear to be spreading. In Colorado, medical doctors labored with a youngster abuse prevention nonprofit to distribute a voluntary new coverage as steerage, prompting a number of hospitals to vary 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 underneath the legislation. Some individuals had been shocked to study that almost all state legal guidelines don’t truly require hospitals to drug take a look at pregnant sufferers or newborns and at the moment are questioning the insurance policies of their establishments, suggesting extra reforms might come.
At Yale, Ostfeld-Johns mentioned she initially confronted resistance to the coverage change. A few of her colleagues feared that by ending near-automatic testing, “we had been finally going to harm infants,” she mentioned. “We had been hurting them by stopping identification of substance publicity that occurred throughout being pregnant.” However Ostfeld-Johns mentioned they discovered they didn’t want the drug checks to determine infants who would possibly, 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 youngster welfare studies with out harming infants. After the coverage went into impact, youngster welfare referrals from the new child nursery dropped virtually 50 %, in line with preliminary knowledge supplied by Ostfeld-Johns. On the identical time, the hospital didn’t see an uptick in infants coming again in want of latest therapy for drug withdrawal, she mentioned. “No infants got here in with uncontrolled withdrawal signs,” she mentioned. “No security occasions had been recognized.”
The New Haven knowledge is according to the anecdotal experiences of suppliers at different establishments. “I don’t suppose we’re lacking infants” who’ve been uncovered to substances, mentioned Dr. Mark Vining, director of the new child nursery at UMass Memorial Medical Heart close to Boston. The hospital did away with computerized testing of newborns in 2024. On the identical time, Vining mentioned, it has reported fewer households to youngster welfare authorities on account of constructive checks brought on by hospital-administered drugs like morphine. A new child drug take a look at “hardly ever provides any info that you just didn’t already know,” he mentioned.
The brand new insurance policies are starting to upend an strategy that has existed in america for many years.
Hospitals first started routinely drug testing moms in labor throughout the Nineteen Eighties crack cocaine epidemic. The apply expanded throughout the opioid epidemic, following the passage of a federal legislation in 2003 and one other in 2016, each of which require hospitals to inform youngster welfare companies anytime a child is born “affected by” substances. Federal legislation and legal guidelines in most states don’t require hospitals to drug take a look at new dad and mom or their infants, however hospitals incessantly achieve this anyway—usually out of concern that in the event that they don’t, they’ll miss infants who’re in danger.
Widespread drug testing has triggered a wide range of harms. A earlier investigation by The Marshall Undertaking discovered that urine checks, the sort utilized by most hospitals, are straightforward to misread and have false constructive charges as excessive as 50 %. Mother and father have been reported to youngster welfare authorities over false positives brought on by issues starting from poppy seeds to blood strain remedy. Substances prescribed to sufferers throughout a hospital keep, such because the fentanyl in an epidural, can present up on maternal drug checks and likewise go shortly from mom to child, inflicting infants to check constructive for medication.
Race and sophistication bias can even affect drug testing, with a number of research discovering that low-income, Black, Latina, and Indigenous girls are more than likely to be examined. Yale New Haven Hospital discovered that, earlier than the drug testing coverage change, Black infants in its care had been twice as probably as White infants to be examined at delivery. Research elsewhere have discovered that racial disparities prolong to youngster welfare circumstances and removals as effectively, with Black, Latino, and Indigenous infants being much less more likely to be reunited with their dad and mom as soon as eliminated.
In lots of hospitals, the checks will not be sometimes used to make medical selections. As an alternative, checks have grow to be an inexpensive, quick approach to assess whether or not a guardian may be a hazard to their youngster.
“We needs to be doing medical checks for medical causes, not prison, punitive, prosecutorial causes,” mentioned Dr. Christine Gold, a pediatrician who works on the College of Colorado Hospital system close to Denver. Even for that function, Gold famous, drug checks fall brief. “It’s a actually poor-quality take a look at,” she mentioned. It can’t inform medical doctors how usually somebody used a substance throughout being pregnant, if a affected person has an dependancy, or if the drug use affected their skill to guardian. “Toxicology checks will not be parenting checks,” Gold mentioned.
In 2020, Colorado lawmakers eliminated constructive drug checks at delivery from the record of causes for hospitals to routinely report a household to youngster 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 crucial. Now the whole College of Colorado Well being system is reforming its coverage on testing pregnant sufferers, and others within the state are reportedly contemplating modifications.
As an alternative of computerized drug checks, the revised insurance policies use screening questionnaires, which gather sure info from sufferers, similar to 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 dependancy or susceptible to creating one, which will help medical doctors steer dad and mom into therapy or decide whether or not a child would possibly want additional medical care. Some hospitals proceed to drug take a look at sufferers underneath sure circumstances. For instance, at UMass Memorial, pregnant sufferers with identified 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 medical doctors. However its success hinges partly on medical doctors constructing extra significant relationships with their sufferers, so the individuals they deal with really feel inclined to confide about substance use and finally comply with enter therapy. “That’s actually the aim right here,” mentioned 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 individuals.”
Which will embody asking a affected person for knowledgeable consent to undergo a drug take a look at and medical personnel being clear about each the aim of the take a look at and its potential authorized penalties.
However a lot of these conversations will be difficult. In addition they require longer appointments, one thing many medical establishments are unable or unwilling to offer. “The system is ready as much as make it tough for us to essentially develop a figuring out and trusted relationship with a household,” mentioned Dr. Lauren Oshman, a household doctor on the College of Michigan Medical Faculty in Ann Arbor.
By comparability, urine checks are quick and sometimes contain little interplay with sufferers.
“It takes longer to speak to somebody and actually perceive than it does to put an order and have the individual give a urine pattern,” Campbell mentioned.
The brand new insurance policies additionally don’t clear up different issues. After Oshman and colleagues found that clinicians at Michigan Drugs ordered drug checks for Black newborns extra usually than for White newborns, the hospital community modified its coverage in 2023 to require testing of infants solely in sure circumstances. However early knowledge signifies the brand new coverage had no affect on the racial disparities in testing and reporting.
One cause, 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 workforce dug into the info, it discovered that for nearly half of all low-risk sufferers whose infants examined constructive, the one drug detected was marijuana, and the sufferers had been more than likely to be Black. Most marijuana-only circumstances don’t end in findings of abuse or neglect by youngster welfare authorities, in line with the workforce’s analysis. However hospitals are nonetheless required to report these sufferers, Oshman mentioned.
“And that received’t change till the state legislation modifications,” she added.
Hospitals in most different states face comparable challenges. A evaluation by The Marshall Undertaking discovered that at the very least 27 states explicitly require hospitals to alert youngster welfare companies after a constructive display screen 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 constructive checks to youngster welfare authorities. In each Colorado and Connecticut, for instance, hospitals are required to report a guardian provided that suppliers have recognized different security considerations. In Connecticut, suppliers fill out an anonymized kind that permits the state to gather knowledge on substance-exposed newborns with out requiring a baby welfare report.
However even in states that don’t require reporting constructive checks, 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 youngster welfare authorities over false constructive and inaccurate outcomes, The Marshall Undertaking 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, consultants say.
“We’re simply originally,” Oshman mentioned. “That is the beginning of making a system that gives that reliable care.”
