Once upon a time, I took an International Public Health class. As part of this class, the professor was teaching us about false positives and false negatives (false positives = test results that say you have something when you do not, false negatives = test results that say you don’t have something when you do), and he asked which one we’d prefer in an initial screening test for disease. Most of the class said false positives…better to initially believe you have something and be told later you don’t, right? He agreed that we were likely right…in the US at least. However, he explained, in other countries this may not be the case. In some areas, even an initial suggestion that you had something like HIV could lead to some major fallout…spouse leaving, getting let go from your job, etc…that may not be easy to correct even once the final results were in. The problem is not always what a patient will do with information, but rather what others might do with the information.
I thought of this today when I read this story about a new mom in Pennsylvania who got her 3 day old baby taken away because she had eaten a bagel before going in to labor. Yeah, you read that right. The bagel happened to contain poppy seeds, and it turns out this caused her to test positive for opiates, which caused the hospital to report her, which caused her to have her daughter ripped out of her hands right after she got home. Now, this story didn’t make a tremendous amount of sense to me, so I read through the whole lawsuit (the hospital settled). A few details that fill in some of the blanks:
- This hospital has mandatory drug testing for all moms in labor. This is actually not standard practice…my hospital for example only did this if there was cause. No behavior on the part of the mother triggered this.
- The cutoff used for the initial screening test is low…100 nanograms/uL. In contrast the cutoff for say, Olympic athletes is 1000 nanograms/uL. For federal drug testing, it’s 2000 nanograms/uL for codeine, and 4000 for morphine. The mother’s levels were 300 nanograms/uL on the initial test, and 500 on the confirmatory test.
- The doctor who saw the mom and baby thought they were fine, so didn’t even tell them about the test results. She assumed they were a false negative.
- The hospital reported these positive tests to state, whose policy states that two positive drug tests are all that’s needed to take the child away. They did no other investigation prior to removing the child.