USDTL drug testing laboratory claims to advance the”Gold Standard in Forensic Toxicology.” “Integrity: Results that you can trust, based on solid science” is listed as a corporate value. “Unlike other laboratories, our drug and alcohol testing begins and ends with strict chain of custody.” “When people’s lives are on the line, we don’t skip steps.” Joseph Jones, Vice President of Laboratory Operations explains the importance of chain-of-custody in this USDTL video presentation.
Dr. Luis Sanchez, M.D. recently published an article entitled Disruptive Behaviors Among Physicians in the Journal of the American Medical Association discussing the importance of of a “medical culture of safety” with “clear expectations and standards.” Stressing the importance of values and codes-of-conduct in the practice of medicine, he calls on physician leaders “commit to professional behavior.”
Sanchez is Past President of the Federation of State Physician Health Programs (FSPHP). According to their website the FSPHP “serves as an educational resource about physician impairment, provides advocacy for physicians and their health issues at local, state, and national levels, and assists state programs in their quest to protect the public.” In addition the FSPHP “helps to establish monitoring standards.” The FSPHP is the umbrella organization of the individual State PHPs.
Sanchez is also the previous Medical Director of the Massachusetts state PHP, Physician Health Services, Inc. (PHS). According to their website PHS is a “nonprofit corporation that was founded by the Massachusetts Medical Society to address issues of physician health. PHS is designed to help identify, refer to treatment, guide, and monitor the recovery of physicians and medical students with substance use disorders, behavioral health concerns, or mental or physical illness.”
PHPs recommend referral of physicians if there are any concerns such as getting behind on medical records. As PHS Associate DirectorJudith Eaton explains “when something so necessary is not getting done, it is prudent to explore what else might be going on.” If the PHP feels that doctor needs an assessment they will send that doctor to a “PHP-approved” facility “experienced in the assessment and treatment of health care professionals.” The physician must comply with any and all recommendations of the assessment center. To assure this the physician must sign a monitoring contract with the PHP (usually five years). USDTL is one of the labs PHPs have contracted with for forensic drug and alcohol testing.
Forensic Drug and Alcohol Tests: The Need For Integrity and Accountability of the Sample
“Forensic” drug-testing differs from “clinical” drug-testing in how the results are used. “Clinical” tests are used for medical purposes in diagnosing and treating a patient.
A “forensic” test is used for non-medical purposes. It is not used for patient care, but for detecting licit and illicit substances in those who should not be using them. Pre-employment and employee assistance and professional monitoring programs are examples.
Forensic testing is held to a higher standards because the consequences of a positive result can be grave and far reaching. A positive forensic test can result in loss of rights of the individual being tested and his or her loved ones. Mistakes are unacceptable.
The Federation of State Medical Boards Policy on Physician Impairment supports this position stating “chain-of-custody forensic testing is critical” (page 14) and the “use of a Medical Review Officer (MRO) for screening samples and confirming sample results” (page 21).
Any and all drug testing requires chain-of-custody. The custody-and-control form is given the status of a legal document because it has the ability to invalidate a test that lacks complete information. Chain-of-custody provides assures specimen integrity. It provides accountability.
The job of the MRO is to ensure that the drug testing process is followed to the letter and reviews the Custody and Control form for accuracy. The MRO also rules out any other possible explanations for a positive test (such as legitimately prescribed medications). Only then is the test reported as positive.
The legal issues involved in forensic testing mandate MRO review. According to The Medical Review Officer Manual for Federal Workplace Drug Testing Programs
“the sole responsibility of the MRO is to”ensure that his or her involvement in the review and interpretation of results is consistent with the regulations and will be forensically and scientifically supportable.”
“Fatal flaws” such as lack of chain-of-custody form, missing tamper proof seal, missing signatures, or a mismatch of the sample ID and chain of custody ID invalidate the test. It is not reported. Tight chain-of-custody and MRO review is critical for the accountability and integrity of the sample.
The Medical Review Officer Certification Council provides a certification process for MROs. They also follow their own Code of Ethics. In accordance with these standards PHS has an MRO to review all positive tests. As added assurance the FSPHP guidelines state that all positive tests must be approved by the Medical Director.
Regulation and the Medical Profession–The need for Integrity and Accountability in Physician Leadership and Health Care Policy.
Good leadership requires correct moral and ethical behavior of both the individual and the organization. . Integrity is necessary for establishing relationships of trust. It requires a true heart and an honest soul. People of integrity instinctively do the “right thing” in any and all circumstances. The majority of doctors belong to this group.
Adherence to ethical codes of the profession is a universal obligation. It excludes all exceptions. Without ethical integrity, falsity will flourish.
The documents below show fraud. It is intentional. All parties involved knew what they were doing, knew it was wrong but did it anyway. The schism between pious rhetoric and reality is wide.