Drug testing in the workplace (remote deployment)

[tniuqs]

'Ruffems'

Your excellent rapport with the safety people does not jive with what you have been saying on this forum. You blatantly point out how much you disdain those people. You may have a great rapport with those people on one face yet you are completely different in opinion here.

I judge people with their pants straight on not front to back, the ivory tower is the identified problem here.

I agree with you on one of the points you have - if the safety person needs a drug screen then they should do it.

Well success you have seen the light.

But seriously, the test is going to get done right?

Done right ? I dont care its NOT my job unless its for Medical reasons!

So your saying taking a urine sample, taking its temperature, then look at the lines is rocket science ?

Unless you are actualy doing the test and recording the results, aren't you technically just the collector?

Today Sample, tomorrow Tester, if you do not take a stand its push push push.

You never did answer my question earlier, do you do drug testing on other patients, non-employee's?

NO!

Isn't that part of your job?

NO!

IF not then its a moot point but if you are collecting urine samples for drug tests then isn't this the same thing?

Same as What ?

I will test for myoglobin, Tropin, CKMB, BGL, ETCO2, SaO2, take swabs for C+S, sputum samples for C+s... yea know medical stuff, or Metabolic studies of Exhaled CO2, O2 uptake compared to Urine BUN yup is a bit of a stretch but I will to that too if its patient care but I will not release info to a Safety person .. I will just say I need a Medivac as the patients condition warrants it. ;>)

Again, I'm probably missing the point but don't you have about the same chance of going to court on a patient care issue as you do with this issue?

Not if I comply with SOP in regards to confidentially of Health Care Information ... so far I have managed not breached <sheesh> that area.

I seriously don't see what the issue is, other than you not wanting to be a "Drug Cop"

Seriously I am a health Care Provider and not going to commit professional suicide or set presedent for industry, in fact my stance hopefully will make precedent.

I also think that if you refuse to collect the specimen that you can get fired is assinine and totally Retarded. Whoever thought that policy up is indeed a moron.

I will not subject myself to that ALTHOUGH if I did and was fired ... ba da bing ba da boom helo Mr Lawyer ! But were making headway here but its not me refusing to obtain sample. ITS the Patent refusing to provide a sample that results in immediate dismissal.

Safety People will not jeopardize the integrity of my profession of a Health Care Provider and that of Paramedicine btw with more qualifications than the vast majority, 9ps with a lot to lose) with proven good judgement to protect the interests/liability of the Prime Contractor in very "serious" medical situations.

Can you explain how a safety person would jeopardize the integrity of a health care provider? I think that at times we healthcare providers do more to jeopardize it than anyone else.

Disclosure of Health Care Information, Treatment, PMHX, or Medications that they "may" be on is a breach of Confidentiality. Do I wish to be burned at the Stake for something that I do not believe in and is hugely controversial in Human Rights Law's ?

Yes, I would comply with the lay persons request. If that lay person was speaking for my employer and he had the power to ask me to do something, if it didn't cause a life or limb problem, I'd do what he asked.

Like a sheep to the slaughter, so do you disclose confidential information to a passer by or a media person too ?

IF the employee is clean, then it's all good right? IF they are not clean, and what I mean by clean is that they don't test positive or if they do thenthey have a doctors note showing that what they are taking was prescribed by that doctor. IF they are dirty then do you really want them working at all?

Clean or not its not my job I have very little intent on making societal changes I just deal with the fall out ! So you want to be the person to establish this .... perhaps apply to Law Enforcement then (just saying)

morals aside, a impaired worker is much more likly to cause an accident then a non-impaired worker. More likely to die on the job than a non impaired worker.

Impaired by what again ? ... the evidence is VERY clear that fatigue, stress, and over-tired contribute far more an influence in the workplace.

QUOTE: Drug testing is not a substitute for a good accident prevention program.

[Just Plain Ruff]

Yes, I would comply with the lay persons request. If that lay person was speaking for my employer and he had the power to ask me to do something, if it didn't cause a life or limb problem, I'd do what he asked.

Like a sheep to the slaughter, so do you disclose confidential information to a passer by or a media person too ?

The passerby or the media does not speak for my company. I was referring to someone who was from the employer.

If they had the need to know and were part of the patients care, then yes I am by policy required to discuss the patient. BUT they have to have a bona fide need to know, they have to be part of this patients care and they have to be a member of the organization I work at. If they don't fall under the above then they do not get told anything.

In a perfect world Squint, the drug test would be done off site and done after the treatment for the medical condition was completed. The safety officer should be the one doing it but you didn't seem to have that chance.

When I said Done Right I didn't mean it was going to be done correctly.

I meant that the drug test was going to be done. No way out of it. not that it would be done right.

Does that make more sense.

[Richard B the EMT]

I think I need another clarification point.

Are we talking about an in-house EMT or Paramedic doing some kind of "Routine" medical, like a company annual physical, or as an in-house medical responder, now being asked to draw blood for substance abuse (someone called it Drugs Of Abuse, or DOA) testing on either a scheduled or unannounced random basis, as requested by supervisory personnel over both the medical person and the employee?

[tniuqs]

Yes, I would comply with the lay persons request. If that lay person was speaking for my employer and he had the power to ask me to do something, if it didn't cause a life or limb problem, I'd do what he asked.

Clarification: The representative (company man) is NOT entitled to Personal Health Information, I am sub contracted for medical and they are subcontracted for Safety they are not the prime contractor AND we have more legal acts and legislation than you can imagine.

Did You read the links ?

If they had the need to know and were part of the patients care, then yes I am by policy required to discuss the patient. BUT they have to have a bona fide need to know, they have to be part of this patients care and they have to be a member of the organization I work at. If they don't fall under the above then they do not get told anything.

They are NOT a part of Patient Care unless holding an IV bag is considered care.

So Your company policy states you can discuss a Patients PMHX or abuse problem ... NOT BUYING IT.

Besides Safety is NOT a part of the Patients Care and its Clear in this Jurisdiction that the "Medical Provider" is has complete and ultimate control. The responsibility for "root cause" and investigation re the "Incident" is the Safety Officer and in a court of Law (in passing) are considered biased as they are on the "company" payroll.

In a perfect world Squint, the drug test would be done off site and done after the treatment for the medical condition was completed. The safety officer should be the one doing it but you didn't seem to have that chance.

Zactly a third part should do the testing and they do in the VAST majority of cases in Industry here ... this (situation) is recipe for an EPIC FAIL.

When I said Done Right I didn't mean it was going to be done correctly.

I meant that the drug test was going to be done. No way out of it. not that it would be done right.

Does that make more sense.

Back at you but good point what if I do it wrong ? ...Mr. meth head boy stays on the job operating a 100 ton Crane am I at a liability risk ?

What if its positive (false or true) guaranteed a 3 day course on "how to" is going to be a huge question in a court room.

BUT I have dodged that bullet and will continue to protect the rights of my patient (clean or not) its not my moral responsibility to single handedly change societal issues.

BTW this IS BC and the right to pack around a small amount > 30 gms of BC Bud with "dump it out by most RCMP (Fine)" or a maximum of 1000 CDN pesos ... again that's MAX ... its typically more like > $200.00 as a fine.

The "green industry" is billions of dollars in BC.

Do I personally agree with the tolerance in operating anything other than a TV remote and a bag of Chips .. NO it makes you stupid, then again so does a case of beer and you don't test urine for beer !

Well If you will excuse me its my gardening "weeding time" ... Spuds, Beans and Tomatoes that is !

Edited July 20, 2010 by tniuqs

[Just Plain Ruff]

Damn, way to read into my remarks about the policy and procedure of drug testing.

Let me reiterate for you

If the employer comes to me and says for me to do a drug test on a patient or a employee then yes I will do it.

NOWHERE did I say that I give protected information out to that layperson. You jumped the shark on that one.

I said I only do the test.

LIke I said, we are both arguing both sides of this and you are getting pissed and nearly personal yet I've not done the same to you.

Let's just end this discussion here and now and if you wish to discuss further without resorting to veiled personal affronts we can go to pm's.

[tniuqs]

Pissed No .. Passionate YES.

I will not test anyone for something that is not directly covered under medical protocol and for the benefit of the patient.

If the employer comes to me and says for me to do a drug test on a patient or a employee then yes I will do it.

NOWHERE did I say that I give protected information out to that layperson.

Ok I will bite ... what IS or IS NOT protected information ?

cheers

[Just Plain Ruff]

Yes, I would comply with the lay persons request. If that lay person was speaking for my employer and he had the power to ask me to do something, if it didn't cause a life or limb problem, I'd do what he asked.

Clarification: The representative (company man) is NOT entitled to Personal Health Information, I am sub contracted for medical and they are subcontracted for Safety they are not the prime contractor AND we have more legal acts and legislation than you can imagine.

Did You read the links ? NOPE DID NOT - don'thave time to read a bunch of links. Should I, yep probably but I'm not naive enough to believe you'd read a bunch of links I would post.

If they had the need to know and were part of the patients care, then yes I am by policy required to discuss the patient. BUT they have to have a bona fide need to know, they have to be part of this patients care and they have to be a member of the organization I work at. If they don't fall under the above then they do not get told anything.

They are NOT a part of Patient Care unless holding an IV bag is considered care.

So Your company policy states you can discuss a Patients PMHX or abuse problem ... NOT BUYING IT. Yes if that person I'm discussing the patient with has a direct involvement in patient care. No different in you talking to someone at a facility that you are medevacing the patient out to. It's called continuity of care and giving a patient report. To reiterate - they have to be directly involved in that patients care to get any info out of me

Besides Safety is NOT a part of the Patients Care and its Clear in this Jurisdiction that the "Medical Provider" is has complete and ultimate control. The responsibility for "root cause" and investigation re the "Incident" is the Safety Officer and in a court of Law (in passing) are considered biased as they are on the "company" payroll.

In a perfect world Squint, the drug test would be done off site and done after the treatment for the medical condition was completed. The safety officer should be the one doing it but you didn't seem to have that chance.

Zactly a third part should do the testing and they do in the VAST majority of cases in Industry here ... this (situation) is recipe for an EPIC FAIL.

When I said Done Right I didn't mean it was going to be done correctly.

I meant that the drug test was going to be done. No way out of it. not that it would be done right.

Does that make more sense.

Back at you but good point what if I do it wrong ? ...Mr. meth head boy stays on the job operating a 100 ton Crane am I at a liability risk ?

What if its positive (false or true) guaranteed a 3 day course on "how to" is going to be a huge question in a court room. So what if you do it wrong? isn't that what a second lab testing which is much more thorough than the first in place for? to protect the person being tested. It would be terrible if you did it wrong but mistakes do happen. That's what the courts are for, to sort out mistakes, and in the end the person by your own account are going to be in court anyway.

BUT I have dodged that bullet and will continue to protect the rights of my patient (clean or not) its not my moral responsibility to single handedly change societal issues. So when you are asked to give information about a patient and you refuse to do so then aren't you causing a delay in the patient treatment. You are in essence saying that you don't give protected patient information out to anyone. That attitude is an epic fail. There are people in the continuing care of the patient that need the info you have. Surely you are not withholding that info from those people are you?

BTW this IS BC and the right to pack around a small amount > 30 gms of BC Bud with "dump it out by most RCMP (Fine)" or a maximum of 1000 CDN pesos ... again that's MAX ... its typically more like > $200.00 as a fine.

The "green industry" is billions of dollars in BC.

Do I personally agree with the tolerance in operating anything other than a TV remote and a bag of Chips .. NO it makes you stupid, then again so does a case of beer and you don't test urine for beer !

Pissed No .. Passionate YES.

I will not test anyone for something that is not directly covered under medical protocol and for the benefit of the patient.

Ok I will bite ... what IS or IS NOT protected information ?

cheers

All medical information gathered while treating the patient.

Is a drug test part of that? If the drug test is being done as part of the medical treatment then yes it is protected.

If the drug test is being done as a part of a safety program and drug testing per the policy of the company then I don't believe so. But I do get your point, if you are asked to do the test while you are treating the patient then it would probably be covered under the protected information but I'm sure that the courts might not see it that way.

Just because you in the course of your treatment collect the urine that will be used in the safety part of this patient I don't believe that that is truly covered under protected patient information.

Maybe in canada it is.

But the places I've worked at that have required that I get a drug screen done after an injury these tests have been collected by the nurses in the ER or by a third party that came to the ER and took my sample after I got my treatment.

In the USA, I'd suspect that the courts would not consider the drug screen performed by the company to be considered part of the patient record or patient care. I could be wrong and I have been in the past.

I don't have a canadian clue on what is considered right in your country.

[rock_shoes]

Yes, I would comply with the lay persons request. If that lay person was speaking for my employer and he had the power to ask me to do something, if it didn't cause a life or limb problem, I'd do what he asked.

With regard to the topic at hand I absolutely would not comply with such a “lay person’s” request. I’ll try to simplify exactly why Squint and I take such a stance.

1) If for any reason our respective regulatory bodies (both Alberta College of Paramedics and BC Emergency Medical Assistant Licensing Branch for the two of us) where made aware of any such actions our registrations/licenses would almost certainly be revoked. I can get another job. I can’t work at all without a registration/license. It’s becoming quite clear over the course of this thread that Canadian patient confidentiality laws are a little more “iron-clad” than they are in some other countries.

2) I absolutely will not violate my own professional ethics for the sake of a “safety hand” who, as mentioned previously, is in no way shape or form actually dedicated to improving worker safety. These positions have been used almost exclusively as a means of blame re-direction should an incident actually occur.

3) Again, as already noted, best evidence with regard to improving worker safety points in a multitude of directions other than employer based drug testing.

4) What is the legal definition of impaired as it applies to various drugs/medications of abuse? Levels causing impairment can vary wildly from person to person. Paramedics, who in many cases work excessively long shifts, are “impaired” to some degree on a regular basis themselves.

In a perfect world Squint, the drug test would be done off site and done after the treatment for the medical condition was completed. The safety officer should be the one doing it but you didn't seem to have that chance.

Why should Squint be willing to take on that liability when clearly you agree that it should be the safety officers responsibility?

But the places I've worked at that have required that I get a drug screen done after an injury these tests have been collected by the nurses in the ER or by a third party that came to the ER and took my sample after I got my treatment.

Were said nurses ever privy to the results of the ensuing tests? Were they ever expected to release those results to anyone other than other health care providers involved in your continuing care? Sample collection vs. sample results reporting. The “safety officer” in question is expecting Squint to collect the sample, perform the test, and provide his interpretation of the results. The instant Squint provides his interpretation of the results to anyone other than another health care provider involved in a patients continuing care, he violates patient confidentiality.

[Just Plain Ruff]

Thanks for the clarification Rock. but I don't believe squint ever said (and if he did and I missed it then I apologize) but I don't believe he ever said he ran the test and read the results.

If that part was left out then you can understand my being out of the loop on this whole thing.

I do agree with it being the laypersons responsibility to obtain the specimen but if the layperson is asking squint to do it and it lines up with the policy manual then he should be able to collect the sample.

Running the test is one thing, collecting it is entirely another.

Again, if I misunderstood or missed Squint telling me and the community that he had to run the test also then I apologize but if he did not give that piece of the pie then you can see where I was coming from.

No the nurses and myself with collecting the tests never saw what the results were. If Squint was running the tests and then seeing the results then it's part of the medical record and should not be released.

But I will again say that if the test is not done as part of a patient care procedure and is collected as a company required item for drug testing then there is no protected health information being passed on because Squint did not see the results. All he did was collect the specimen.

I'm the first to admit when I'm wrong and also when I mis-read things so if I did then I'm duly chastised. If I did not misread or miss the info then I don't stand corrected.

Unfortunately the damage has been done, he's out of a job for standing on principles and I truly admire him for that. Integrity is the name of the game.

[BushyFromOz]

So your position is that you would comply with a "lay persons" ie Sub Contracted Safety Persons (point being they are separate entity) if they then request to test "with prejudice" by requesting a sample of urine from your "patient" and bet your house that then once that door is open .. then test urine for DOA.

Fact: A refusal of a "patient" to provide a sample would result in immediate termination of the workers right to work.

Further a "false positive sample" would land you in court in a wrongful dismissal suit (civil law) a "false negative sample" could return a worker to the job. Please remember on mass spec one can determine accurate levels of a "banned substance" or "medically prescribed rx" ... add to that only ETOH has legal identifiable "impaired" levels.

So Bushy your prepared to represent yourself (on your own coin) in a court that has NOTHING to do with patient care AND highly likely breaches Paramedic Patient confidentiality issues (no test court case quite yet) ... over what again ?

Further Legal FYI: In Canada no signed "waiver" of your rights (ie privacy of health information) can be used in a court of law it becomes a "doodle" with a good Lawyer, it also could burn the employer in the end and be considered "signed under duress or protest" just saying no way to tell.

To top it all off this WILL result shooting the Safety People in the foot, putting in place a most serious barrier for diligent reporting not only minor incidents but minor first aids that can be "treat and release" avoiding the entire medical legal mess.

So Bushy your on board with a self defeating policy that most likely infringes on the patients rights to privacy and disagrees with evidence based research, proving that this Drug testing in the workplace pointless,(se prior link) and your willing to put your licence/registration/careerer on the line. All this when you were actually hired under the auspice of delivering Primary Health Care and Medivac Services.

Contact me off server and I have a job for you.

Squint, with a rant like that I'm not even going to bother replying

how dissappointing.

Edited July 20, 2010 by BushyFromOz