How Faulty Drug Tests Can Make You Lose Custody of Your Baby

Susan Horton had been a stay-at-home mother for nearly 20 years, and now — pregnant along with her fifth little one — she felt a hard-won confidence in herself as a mom.

Then she ate a salad from Costco.

It was her closing meal earlier than going to Kaiser Permanente hospital in Santa Rosa, in northern California, to present start in August 2022. It had been an exhausting being pregnant. Her household had simply moved homes, and Horton was nonetheless breastfeeding her toddler. Due to her teenage son’s coronary heart situation, she remained cautious of COVID-19 and averted crowded locations, even physician’s workplaces. Now, already experiencing the clawing pangs of contractions, she pulled out a frozen pizza and a salad with creamy all the things dressing, savoring the hush that fell over the home, the satisfying crunch of the poppy seeds as she ate.

Horton didn’t notice that she could be drug examined earlier than her little one’s start. Or that the poppy seeds in her salad might set off a optimistic consequence on a urine drug display screen, the fast take a look at that hospitals usually use to test pregnant sufferers for illicit medicine. Many frequent meals and medicines — from antacids to blood strain and chilly medicines — can immediate misguided outcomes.

The morning after Horton delivered her daughter, a nurse instructed her she had examined optimistic for opiates. Horton was shocked. She hadn’t requested an epidural or any narcotic ache medicine throughout labor — she didn’t even like taking Advil. “You’re positive it was mine?” she requested the nurse.

If Horton had been examined below totally different circumstances — for instance, if she was a authorities worker and required to be examined as a part of her job — she would have been entitled to a extra superior take a look at and to a assessment from a specifically educated physician to verify the preliminary consequence.

However as a mom giving start, Horton had no such protections. The hospital rapidly reported her to little one welfare, and the following day, a social employee arrived to take child Halle into protecting custody.

Kaiser Permanente declined to touch upon Horton’s care. In an announcement, it mentioned the Santa Rosa hospital sometimes will get consent to drug-test sufferers for medical causes, and as a mandated reporter below state legislation, it refers potential exposures of newborns to illicit medicine to little one welfare authorities.

The Sonoma County Human Companies Division mentioned, in an announcement, that it evaluates all referrals utilizing “evidence- and research-based” strategies, and if a report is deemed legitimate, it has an obligation below state legislation to research.

Horton mentioned the expertise made her really feel powerless and terrified.

“That they had a singular piece of proof that I had taken one thing,” she mentioned, “and it was flawed.”

For many years, state and federal legal guidelines have required hospitals throughout the nation to establish newborns affected by medicine within the womb and to refer such circumstances to little one protecting companies for attainable investigation. To conform, hospitals usually use urine drug screens which are cheap (as little as $10 per take a look at), easy to manage (the affected person pees in a cup), and supply outcomes inside minutes.

However urine drug screens are simply misinterpreted and infrequently flawed, with false optimistic charges as excessive as 50%, in response to some research. With out affirmation testing and extra assessment, false optimistic outcomes can lead hospitals to wrongly accuse mother and father of illicit drug use and report infants to little one welfare businesses — which can separate newborns from their households, an investigation by The Marshall Undertaking and Reveal has discovered.

It’s unclear how most of the nation’s 3.6 million births yearly contain drug testing, however well being care consultants mentioned urine screening is ubiquitous. Tens of hundreds of infants are reported yearly to authorities for in utero drug publicity, with no assure that the underlying assessments are correct, our evaluation of federal information reveals.

To report this story, The Marshall Undertaking interviewed dozens of sufferers, medical suppliers, toxicologists and different consultants, and picked up info on greater than 50 moms in 22 states who confronted experiences and investigations over optimistic drug assessments that had been seemingly flawed. We additionally pored over hundreds of pages of coverage paperwork from each state little one welfare company within the nation.

Issues with drug screens are well-known, particularly in office testing. However there’s been little investigation of how simply false positives can happen inside labor and supply models, and the way rapidly households can get trapped inside a system of surveillance and punishment.

Hospitals reported ladies for optimistic drug assessments after they ate all the things bagels and lemon poppy seed muffins, or used medicines together with the acid reducer Zantac, the antidepressant Zoloft and labetalol, one of the vital generally prescribed blood strain therapies for pregnant ladies.

After a California mom had a false optimistic for meth and PCP, authorities took her new child, then dispatched two sheriff’s deputies to additionally take away her toddler from her custody, courtroom data present. In New York, hospital directors refused to retract a toddler welfare report primarily based on a false optimistic consequence, and as a substitute provided the mom counseling for her trauma, in response to a recording of the dialog. And when a Pennsylvania lady examined optimistic for opioids after consuming pasta salad, the listening to officer in her case yelled at her to “buck up, get a spine, and cease crying,” courtroom data present. It took three months to get her new child again from foster care.

Federal officers have recognized for many years that urine screens aren’t dependable. Poppy seeds — which come from the identical plant used to make heroin — are so infamous for inflicting positives for opiates that final yr the Division of Protection directed service members to cease consuming them. At hospitals, take a look at outcomes usually include warnings about false positives and direct clinicians to verify the findings with extra definitive assessments.

But state insurance policies and lots of hospitals are inclined to deal with drug screens as unassailable proof of illicit use, The Marshall Undertaking discovered. Hospitals throughout the nation routinely report circumstances to authorities with out ordering affirmation assessments or ready to obtain the outcomes.

At the least 27 states explicitly require hospitals to alert little one welfare businesses after a optimistic display screen or potential publicity, in response to a assessment of state legal guidelines and insurance policies by The Marshall Undertaking. However not a single state requires hospitals to verify take a look at outcomes earlier than reporting them. At the least 25 states don’t require little one welfare staff to verify optimistic take a look at outcomes, both.

Whereas mother and father usually lack protections, a lot of the caseworkers who examine them are entitled to affirmation testing and a assessment in the event that they take a look at optimistic for medicine on the job, our evaluation discovered.

Well being care suppliers say there are medical causes to check labor and supply sufferers for medicine, together with alerting medical doctors to observe a new child for withdrawal signs. In addition they cite issues about prison and authorized legal responsibility in the event that they fail to report optimistic take a look at outcomes.

Even when a physician refutes a optimistic consequence and vouches for his or her affected person, hospitals could report the inaccurate information anyway to little one welfare businesses.

“It’s virtually like a intestine punch. You come to the hospital and also you see a social work be aware in your affected person’s chart,” mentioned Dr. Yashica Robinson, an OB/GYN in Huntsville, Alabama, who has tried and failed a number of instances to halt little one welfare experiences and investigations of sufferers with false optimistic outcomes. “As soon as that ball is rolling, it’s laborious to cease it,” Robinson mentioned.

No authorities company collects complete information on false optimistic outcomes or what number of pregnant sufferers are examined. And confidentiality legal guidelines that defend medical and little one welfare data make it troublesome for the general public to grasp what number of households are affected.

In 2016, Congress mandated states to submit the variety of “substance-affected” infants to the U.S. Division of Well being and Human Companies. Not all states observe each case, however from fiscal years 2018 by way of 2022, medical professionals reported a minimum of 170,000 infants to little one welfare businesses for publicity to substances, in response to an evaluation by The Marshall Undertaking. In 2022 alone, greater than 35,000 such circumstances had been reported, and authorities eliminated greater than 6,000 infants from their households, our evaluation discovered.

The harms of drug testing fall disproportionately on low-income, Black, Hispanic and Native American ladies, who research have discovered usually tend to be examined after they give start, extra more likely to be investigated, and fewer more likely to reunite with their kids after they’ve been eliminated.

However the false-positive circumstances The Marshall Undertaking recognized embrace mother and father of all socioeconomic lessons and occupations — from a lawyer to a college librarian to a nurse who drug assessments different folks for a residing.

“Individuals ought to be involved,” mentioned Dr. Stephen Patrick, a number one neonatal researcher who chairs the Division of Well being Coverage and Administration on the Rollins Faculty of Public Well being in Atlanta. “This might occur to any considered one of us.”

Drug screens are extra guesswork than precise science. Chemical compounds within the assessments rapidly cross-react with urine, flagging something that appears prefer it could possibly be a bootleg substance. The assessments are like fishing nets which are forged broad and choose up something and all the things that matches, mentioned Dr. Gwen McMillin, a professor on the College of Utah Faculty of Medication and medical director of a drug-testing lab. The issue is that nets additionally ensnare fish that aren’t being focused: compounds which are intently associated to illicit substances or merely look comparable.

“Drug testing outcomes have to be confirmed earlier than they go to CPS,” McMillin mentioned. “Actions shouldn’t be taken primarily based on a single drug testing consequence. Interval.”

However typically, even affirmation assessments might be misinterpreted, as Susan Horton discovered.

At first, Horton was puzzled by her optimistic take a look at consequence. She puzzled if her urine might need been blended up with one other affected person’s. Then — “ding ding ding!” — her final meal popped into her head. She instructed a nurse in regards to the poppy seeds in her salad, positive that this might resolve her medical doctors’ issues.

Horton’s data present Kaiser ran her urine pattern by way of a second take a look at, and this time it got here again optimistic for one opiate particularly: codeine. That shouldn’t have been shocking — poppy seeds, like those in Horton’s salad, are derived from the opium poppy plant and include codeine.

To distinguish between salad dressing or bagels and illicit medicine, toxicologists have lengthy really useful testing urine for the presence of a compound known as thebaine, which is present in poppy seeds, however not in heroin. There’s no indication that the hospital carried out and even knew in regards to the thebaine take a look at, leaving suppliers with no approach to show or disprove Horton’s claims.

“Mother and pop insistent {that a} Costco salad with poppyseed dressing is accountable,” a physician wrote in her notes. One other physician wrote: “We’re unable to confirm whether or not this might lead to a optimistic take a look at.”

Quickly, a number of medical doctors and nurses filed into Horton’s room. They mentioned hospital coverage dictated that Halle stay there for 5 days to be monitored for attainable drug withdrawal signs — “for child’s security,” a physician instructed Horton.

Not like most different states that require hospitals to report optimistic drug assessments, California legislation says a optimistic take a look at alone “is just not in and of itself a enough foundation for reporting little one abuse or neglect.” However due to COVID-19 and her son’s coronary heart situation, Horton had additionally missed some prenatal appointments, which many suppliers see as a pink flag for drug use. A hospital social employee famous the missed appointments and determined to file a report.

In an announcement about its practices on the whole, Kaiser mentioned it all the time conducts a “multi-faceted evaluation” previous to submitting a report back to CPS, which is liable for reviewing the data and investigating.

Horton insisted that holding her child on the hospital was pointless. “I’m not a drug addict,” she mentioned she pleaded. Determined for assist, her husband known as the police, who declined to oppose hospital directives, data present.

When the caseworker arrived, the couple refused to signal a security plan or enable the individual to interview their kids and examine their dwelling. So the caseworker instantly obtained a choose’s order and positioned child Halle into short-term custody within the hospital, earlier than discharging her to her grandparents, who had been ordered to oversee Horton along with her little one.

A couple of days later, Horton stood silently in courtroom, wearing pants that clung uncomfortably to her still-healing physique, feeling as if her motherhood was on trial. A caseworker instructed the choose it could be harmful to launch Halle to her mother and father, and Horton agreed to a different drug take a look at. A employee adopted her to the lavatory and watched her urinate in a cup.

By then, caseworkers and medical doctors had privately acknowledged that poppy seeds might have prompted Horton’s optimistic take a look at consequence. However in courtroom the caseworker didn’t point out that. As an alternative, she argued that Horton’s purported drug use had “prompted critical bodily hurt” to her little one.

The company mentioned below state legislation it will possibly’t touch upon particular person circumstances. Talking typically, it mentioned a single optimistic drug take a look at, false or in any other case, doesn’t warrant an investigation, and that there must be “a reported commentary of affect to the kid.”

When office drug testing was launched within the Nineteen Eighties, unions and civil rights teams decried the error charges of drug screens and the way corporations had been firing staff over false optimistic outcomes. In response, federal authorities mandated safeguards for workers, together with requiring affirmation assessments and a assessment from a specifically educated physician to find out whether or not a meals or medicine might have prompted a optimistic consequence.

A federal medical advisory committee in 1993 urged well being care suppliers who drug take a look at pregnant sufferers to undertake the identical rigorous requirements. However amid the “crack child” panic, the thought of defending moms didn’t catch on.

Hospital drug testing insurance policies differ extensively. Many amenities, corresponding to Kaiser in Santa Rosa, take a look at each single labor-and-delivery affected person. Different hospitals flag solely sure folks, corresponding to these with restricted prenatal care, hypertension, even dangerous enamel, consultants say. At many hospitals, the choice is as much as medical doctors and nurses, who could view a mom’s tattoos, matted clothes or harassed demeanor with suspicion. Research have discovered that the choice to check is rife with class and race bias.

“Those that appear to be they’ve much less sources, folks would possibly say, ‘Effectively, they appear extra seemingly to make use of medicine,’” mentioned Dr. Cresta Jones, an affiliate professor and maternal-fetal drugs specialist on the College of Minnesota Medical Faculty.

Hospitals usually have full discretion over whether or not or to not display screen for medicine, however as soon as a optimistic result’s in hand, the choice to report turns into extra sophisticated. Legal guidelines and insurance policies in a minimum of 12 states explicitly require hospitals to ship display screen outcomes to little one welfare businesses, even when they don’t seem to be confirmed, in response to The Marshall Undertaking’s assessment.

For hospitals, value can also be a difficulty. Whereas urine screens are low cost, the tools wanted to run a affirmation take a look at prices lots of of hundreds of {dollars}, along with the price of professional personnel and lab certification. Some hospitals contract out affirmation testing — a lower-cost various — however getting outcomes can take days, lengthy after many households are able to go dwelling.

Docs, nurses and hospital social staff face an uncomfortable predicament: Do they ship the infant dwelling to what they imagine could possibly be an unsafe setting, or do they name authorities?

“God forbid the infant goes dwelling, withdraws and dies, we’re going to be held responsible for that,” mentioned Dr. Adi Davidov, an obstetrician at Staten Island College Hospital, which drug assessments each birthing affected person.

State necessary reporting legal guidelines add to the strain on medical doctors and nurses. These legal guidelines impose prison legal responsibility on suppliers who fail to report, whereas additionally defending physicians who report “in good religion” — insulating hospitals from lawsuits if take a look at outcomes are flawed.

Even when medical doctors have the flexibility to order a affirmation take a look at, they don’t all the time achieve this. Many misread optimistic screens as definitive proof of drug use.

When Grace Smith had her fourth little one in 2021 at St. Luke’s College Hospital, an hour north of Philadelphia, she was taking prescribed marijuana and Vyvanse, a medicine for consideration deficit hyperactivity dysfunction. The medication incorporates amphetamine, however the hospital’s drug display screen outcomes didn’t differentiate between meth and amphetamine, in response to medical data. The day after Smith delivered her son, a physician instructed her that she and her child had examined optimistic for meth and that the hospital had notified little one protecting companies.

Smith’s husband Michael requested the physician to assessment his spouse’s medical data to verify her prescription, in response to the physician’s notes. The physician argued that wasn’t her function. “I defined that our accountability as healthcare staff was to report the case” to little one welfare authorities, she wrote, including that the company “would conduct any investigation that was obligatory.”

When Michael Smith instructed the physician they had been leaving with their child, the hospital known as the police. An officer escorted the mother and father out, with out their new child, a police report reveals. The Smiths mentioned the police instructed them they’d be arrested in the event that they returned.

St. Luke’s College Well being Community declined to reply questions from The Marshall Undertaking, saying in an e mail that the hospital “complies with all guidelines and laws concerning drug testing and reporting” and that the new child’s welfare “is all the time our main concern.”

4 days after the Smiths’ son was born, Monroe County Youngsters and Youth Companies instructed the hospital it was OK to launch the infant to his mother and father. However the investigation remained open. It wasn’t till the Smiths paid greater than $3,500 for a lawyer— and practically $300 for a affirmation drug take a look at that got here again unfavourable — that the company closed their case. The company declined to remark.

The Smiths filed a lawsuit in 2022 in opposition to St. Luke’s. In its response, the hospital acknowledged that it had not given Grace a affirmation take a look at, however denied violating the Smiths’ privateness or civil rights. A choose dismissed the go well with in 2023, saying partly that the Smiths didn’t sufficiently argue their claims.

Many suppliers erroneously assume that little one welfare businesses confirm a father or mother’s drug use. However authorities caseworkers sometimes lack the experience to precisely interpret drug take a look at outcomes. State coverage manuals seldom point out the potential for false positives. It usually falls on mother and father to show their very own innocence.

As a nurse in South Carolina, Ashley Riley mentioned she recurrently drug-tested sufferers in an dependancy remedy program, flagged defective assessments, and despatched out optimistic screens for affirmation. However when she herself screened optimistic for opiates after delivering her son in 2023, Riley mentioned the hospital declined to order a affirmation take a look at, then reported her to authorities.

Riley and her husband, Jeffrey, insisted the optimistic consequence was from lemon poppy seed muffins that she had eaten all through her being pregnant. As proof, Jeffrey Riley texted the investigator a receipt for the muffins, research on false positives brought on by poppy seeds, and the 2023 memo from the Division of Protection urging service members to keep away from poppy seeds.

“At no cut-off date was there anyone in there that was even making an attempt to advocate for my spouse, apart from me,” he recalled.

At first, he thought his efforts had been working. The caseworker acknowledged in his notes having seen the poppy seeds and famous that the report “could possibly be falsified.”

However the caseworker nonetheless insisted the couple signal a security plan, advising them that their two kids could be positioned in foster care until they assigned a “protector” — a accountable grownup who would supervise them with their kids always. This continued for 45 days earlier than the case was closed as unfounded.

“We had been responsible till confirmed harmless,” Ashley Riley mentioned.

The hospital even charged $424 for the problematic urine take a look at. Hospital officers didn’t reply to a number of interview requests.

Will Batchelor, a spokesperson for the South Carolina Division of Social Companies, wrote in an announcement that the company has an obligation to research as soon as a hospital has filed a report, and that it “exercised acceptable restraint” by not eradicating the kid from the house.

“As a result of the protection of a kid is at stake, DSS has to proceed its investigation past seeing a receipt for poppy seed muffins,” Batchelor wrote.

Even when a father or mother has a affirmation take a look at and her personal physician’s phrase testifying to a false optimistic consequence, authorities could preserve investigating.

When Melissa Robinson, an elementary college librarian in Huntsville, Alabama, screened pos​​itive for cocaine in early 2024, the information shocked her and her medical doctors. Robinson had averted something throughout her being pregnant that could possibly be dangerous, even chilly cuts — which can carry micro organism — and had no historical past of drug use. Due to the optimistic take a look at, workers instructed Robinson she was not allowed to breastfeed her daughter, hospital data present, they usually reported her to Alabama’s little one welfare company, the Division of Human Sources. Robinson mentioned a caseworker instructed her that she most likely wouldn’t be allowed to be alone along with her child — her husband must supervise.

A couple of days later, a affirmation take a look at got here again unfavourable for any substances. With proof that she had not used cocaine, Robinson assumed the case could be closed. As an alternative, the company continued to research, inspecting her dwelling and even requiring her husband to take a drug take a look at, she mentioned.

Alabama’s little one welfare company mentioned they’re required to reply instantly to a hospital report and “make security choices counting on present and most accessible info.”

When the infant was two weeks outdated, the company closed the case, citing inadequate proof. However the allegations will stay on Robinson’s report for a minimum of 5 years.

“To have such a lovely expertise tainted by one thing like that, it’s troublesome,” Robinson recalled. “Honestly, it’s turned me into anyone totally different.”

Some medical teams and suppliers have taken steps to cut back pointless little one welfare experiences. The American School of Obstetricians and Gynecologists advises hospitals to make use of a screening questionnaire somewhat than drug assessments to establish individuals who could have substance abuse issues. The group additionally recommends that hospitals get hold of consent from sufferers, explaining the potential penalties of a optimistic consequence — together with if the hospital is required to report it to authorities. Various massive hospitals have adopted some model of these suggestions.

After a research at Staten Island College Hospital in New York discovered a excessive fee of false positives, directors introduced the affirmation testing in-house. They mentioned outcomes come again inside a day or two, somewhat than the week that’s typical for outdoor assessments, which permits suppliers to attend earlier than contacting little one welfare.

“Any time you act on a take a look at that’s not 100%, you run the chance of inflicting extra hurt than good,” mentioned the hospital’s Dr. Davidov. “If you’re going to get CPS concerned with a mom who did nothing flawed, is an effective citizen, that’s harming her. It’s harming her expertise, it’s harming her skill to deal with her new child.”

In recent times, advocacy teams have filed lawsuits in opposition to hospitals for testing with out specific consent, which has led some state officers and lawmakers to talk out in opposition to the testing. However in a lot of the U.S., it stays frequent follow to report households primarily based on unconfirmed optimistic screens. Many of the ladies interviewed by The Marshall Undertaking signed basic consent varieties on the hospital, however mentioned they had been by no means knowledgeable explicitly they’d be drug examined, nor {that a} optimistic consequence could possibly be reported to authorities.

For Susan Horton, her household’s ordeal has created an undercurrent of worry that programs by way of her every day life.

After the courtroom listening to in August 2022, little one welfare staff took the infant to Horton’s aged in-laws and barred Horton and her husband from being alone with their new child whereas the company investigated. Lastly, virtually two weeks after their daughter was born, the company withdrew its petition and a choose dismissed the case, permitting the Hortons to carry child Halle dwelling.

One afternoon final spring, Horton took her daughter, now a toddler, outdoors. Halle giggled as her mom chased her across the entrance yard, her little ft splashing in a small mud gap. This was the life Horton had envisioned years in the past — a quiet place within the California countryside the place her kids might delight on the planet round them. And but, Horton couldn’t assist however bear in mind the investigation that destroyed her household’s peace of thoughts — and her shallowness.

“I had a whole lot of confidence in how I mom and the way I father or mother,” she mentioned, including later: “Now in my head, I’m all the time questioning my selections.” She puzzled aloud what neighbors would say in the event that they noticed her daughter enjoying within the mud, if somebody would possibly accuse her of being a nasty father or mother.

“I simply all the time have that looming feeling that at any second CPS might come knocking and take my kids away.”

Hearken to our podcast model of this investigation, produced with Reveal.