Medications and Other Substances that Mimic Prohibited Drugs on Urinalysis Drug Tests (Part 1 of a Blog Series)

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
In representing nurses and other licensed health professionals, we constantly discuss positive drug screenings, usually from employer-ordered drug testing, with our clients.  These clients include nurses, pharmacists, dental professionals, mental health counselors, therapists, etc.  Often these individuals need to remember that if they apply for a job with a new employer or are working for a large corporation or the government, they are subject to employer-ordered drug screenings.  Most problems arise when the professional has applied to a hospital or a placement agency for work in a hospital and they must submit to a pre-employment drug test.
The client often contends that the result is a false positive and that some other substance must be responsible for it.

A positive result for any drug for which you do not have a valid prescription from a physician, including marijuana, will cause you to be eliminated from consideration for a new job or terminated from a current position and a complaint against your professional license, which could cause you to lose it.  We are routinely called on to defend such situations.

Series of Blogs to Discuss Substances that Can Mimic Prohibited Drugs on Drug Tests.

In the years I have been doing this, I have encountered many cases in which other substances have caused a positive result for a prohibited substance on a drug screening test.

In this series of blogs, I intend to discuss some of the substances scientifically shown to cause false positives on employer-ordered drug screening tests.  This is the first in the series.

Over-the-Counter Medications Mimicking Amphetamines on Drug Tests.

Following is a discussion of substances that can cause a false positive for amphetamines on a urinalysis drug test.  This material comes from an article in Case Reports in Psychiatry published in 2013. (Ref. 1)
Many prescription pharmaceuticals and over-the-counter (OTC) medications have been previously reported in the literature to cause a false-positive result for amphetamines on urine drug screens. Many OTC medications have been reported in scientific literature to produce false positives for amphetamines on urine drug screenings, chiefly antihistamines.

The OTC medications that have been documented to and are well known as causing false positives for amphetamines on drug tests include nasal decongestants, Vicks inhaler, MDMA (3,4-Methylenedioxy methamphetamine;  commonly known as ecstacy, molly, mandy or X), and pseudoephedrine.  (Refs. 1-5)  Some of these are prohibited medications that cannot be prescribed and are only available as “street drugs” such as MDMA.

Prescription Medications Documented as Mimicking Amphetamines.

Prescription medications known to have mimicked amphetamines on testing include antipsychotics and antidepressants.  (Refs. 1 & 2)
The prescription medications known to cause false-positive amphetamine urine drug screen include fluoxetine, selegiline, ranitidine, trazodone, nefazodone, brompheniramine, phenylpropanolamine, chlorpromazine, promethazine, ephedrine, methamphetamine, and labetalol.  (Refs. 2-5)  However, the fact that the individual taking the drug test might have a prescription for one of these might cause the employer to disqualify the employee or potential employee from consideration for the job.
Bupropion (an atypical antidepressant that inhibits norepinephrine and dopamine re-uptake), is a drug used to treat depression and smoking cessation, but may also be used off-label to treat ADHD.  It has also been documented as causing false positive results for amphetamines on drug screenings.  (Ref. 6)
The drug atomoxetine has metabolites that are similar to those of amphetamines (phenylpropan-1-amine verses phenyl-propan-2-amine).  This could also result in a false positive on a urine drug screen.  (Ref. 1)

 

Other Discussions in Future Blogs.

In future blogs, I intend to discuss false positive claims associated with use of ibuprofen, amoxicillin, coca leaf tea, poppy seeds and other common substances and medications.  Stay tuned.

Contact Experienced Health Law Attorneys in Matters Involving PRN or IPN.

The Health Law Firm’s attorneys routinely represent physicians, dentists, nurses and other health professionals in matters involving PRN or IPN. Our attorneys also represent health providers in Department of Health investigations, before professional boards, in licensing matters, and in administrative hearings.

To contact The Health Law Firm, please call our office at (407) 331-6620 or toll-free at (888) 331-6620 and visit our website at www.ThehealthLawFirm.com.

References:

1. Fenderson JL, Stratton AN, Domingo JS, Matthews GO, Tan CD. Amphetamine positive urine toxicology screen secondary to atomoxetine. Case Rep Psychiatry. 2013;2013:381261. doi: 10.1155/2013/381261. Epub 2013 Jan 30. PMID: 23424703; PMCID: PMC3570929.
(Accessed on May 20, 2023.)
2. Brahm NC, Yeager LL, Fox MD, Farmer KC, Palmer TA. Commonly prescribed medications and potential false-positive urine drug screens. Am J Health Syst Pharm. 2010 Aug 15;67(16):1344-50. doi: 10.2146/ajhp090477. PMID: 20689123.
3. Vincent EC, Zebelman A, Goodwin C, Stephens MM. Clinical inquiries. What common substances can cause false positives on urine screens for drugs of abuse? J Fam Pract. 2006 Oct;55(10):893-4, 897. PMID: 17014756.
4. Rapuri SB, Ramaswamy S, Madaan V, Rasimas JJ, Krahn LE. ‘Weed’ out false-positive urine drug screens. Current Psychiatry. 2006;5(8):107–110. [Google Scholar]
5. Moeller KE, Lee KC, Kissack JC. Urine drug screening: practical guide for clinicians. Mayo Clin Proc. 2008 Jan;83(1):66-76. doi: 10.4065/83.1.66. Erratum in: Mayo Clin Proc. 2008 Jul;83(7):851. PMID: 18174009.
6. Reidy L, Walls HC, Steele BW. Crossreactivity of bupropion metabolite with enzyme-linked immunosorbent assays designed to detect amphetamine in urine. Ther Drug Monit. 2011 Jun;33(3):366-8. doi: 10.1097/FTD.0b013e3182126d08. PMID: 21436763.

 

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law.  He is the President and Managing Partner of The Health Law Firm, which has a national practice.  Its main office is in the Orlando, Florida, area.  www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Ave. Suite 1000, Altamonte Springs, FL 32714, Phone:  (407) 331-6620 Toll-Free: (888) 331-6620.

Current Open Positions with The Health Law Firm.  The Health Law Firm always seeks qualified individuals interested in health law.  Its main office is in the Orlando, Florida, area.  If you are a current member of The Florida Bar or a qualified professional who is interested, please forward a cover letter and resume to: [email protected] or fax them to (407) 331-3030.

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2023 The Health Law Firm. All rights reserved.
By |2024-03-14T09:59:17-04:00October 23, 2023|Categories: Medical Education Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on Medications and Other Substances that Mimic Prohibited Drugs on Urinalysis Drug Tests (Part 1 of a Blog Series)

HCA Healthcare Data Breach May Affect 11 Million Patients

Author HeadshotBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On July 11, 2023, HCA Healthcare, which operates 180 hospitals in the U.S. and Britain, said a hacker may have stolen the personal data of about 11 million patients in a data breach. A press release warned patients that critical personal information had been compromised, including their full name, city, and when and where they last saw a healthcare provider.

What Happened to the Patient Data?

Data samples, including addresses, phone numbers, e-mails, and birth dates, were posted to DataBreaches.net (an online forum popular with cyber crooks) by a hacker trying to sell them. However, after publication, an HCA spokesperson told CNBC that the sample data set published was only a “marketing campaign” (or fake data) and was not an individual patient’s real medical assessment.

Who is Affected?

The hack affects patients in nearly two dozen states, including those from dozens of Florida and Texas facilities. The data also included information on scheduled appointments and the medical departments involved. The hacker also dumped a file online in what appeared to be a failed attempt to extort HCA. It included nearly one million records from the company’s San Antonio division.

Patient data breaches are not uncommon, but they can vary in scope and effect. HCA’s breach did not include critical medical records. The company said that the breached data originated at an external storage location exclusively used to automate the formatting of e-mail messages.

HCA Healthcare will offer credit monitoring and identity protection services for patients who have been impacted. But in the meantime, the company is encouraging everyone to look out for spam calls, texts, or e-mails, targeting them for fraud and scams.

For more information on this topic, read one of my prior blogs.

Contact Health Law Attorneys Experienced in Representing Health Care Professionals and Providers.

At the Health Law Firm, we provide legal services for all healthcare providers and professionals. This includes physicians, nurses, dentists, psychologists, psychiatrists, mental health counselors, home health agencies, hospitals, ambulatory surgical centers, social workers, assisted living facilities, and other healthcare providers. It includes resident physicians and fellows, medical students, medical school professors, and clinical staff. We represent health facilities, individuals, groups, and institutions in contracts, sales, mergers, and acquisitions. The lawyers of The Health Law Firm are experienced in complex litigation and both formal and informal administrative hearings. We also represent physicians, nurses, and mental health professionals in investigations for alleged wrongdoing, patient complaints, and Department of Health investigations.

To contact The Health Law Firm, please call our office at (407) 331-6620 or toll-free at (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.

Sources:

Bajak, Frank. “HCA Healthcare says data breach may affect 11 million patients in 20 states.” Associated Press (AP). (July 11, 2023). https://apnews.com/article/data-breach-hca-healthcare-hack-identity-theft-507d8b8915dd934a5be4bd6fb853dfb1

Galarza, Monica. “HCA Healthcare data breach impacts millions of patients, dozens of Florida facilities. Here’s what to know.” CNBC. (July 11, 2023). https://www.nbcmiami.com/news/business/money-report/hca-healthcare-data-breach-impacts-millions-of-patients-dozens-of-florida-facilities-heres-what-to-know/3069139/#:~:text=HCA%20Healthcare%20released%20a%20statement,locations%20of%20the%20patients’%20appointments

Goswami, Rohan. “HCA Healthcare patient data stolen and for sale by hackers.” CNBC.
(July 10, 2023). https://www.cnbc.com/2023/07/10/hca-healthcare-patient-data-stolen-and-for-sale-by-hackers.html

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law; he is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.

Current Open Positions with The Health Law Firm. The Health Law Firm always seeks qualified individuals interested in health law. Its main office is in the Orlando, Florida, area. If you are a current member of The Florida Bar or a qualified professional who is interested, please forward a cover letter and resume to: [email protected] or fax them to (407) 331-3030.

The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2023 The Health Law

By |2024-03-14T09:59:18-04:00October 10, 2023|Categories: Nursing Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on HCA Healthcare Data Breach May Affect 11 Million Patients

United States Court of Appeals Denies U.S. Nursing Corporations Indemnification Challenge Against Nurse Staffing Agency

Author HeadshotBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law, and Hartley Brooks, Law Clerk, The Health Law Firm
On May 18, 2023, the United States Court of Appeals for the Sixth Circuit affirmed a U.S. district court’s decision to deny U.S. Nursing Corporation a new trial. The appellate court stated that the opposing counsel’s closing argument and the erroneous preclusion of evidence had no substantial effect on the trial’s outcome; thus, there was no reversible error.
The First Lawsuit.
The original lawsuit filed in state court concerned a patient suing Appalachian Regional Healthcare, Inc., for exacerbating his spinal injury. He claimed that a nurse transported him from a car into the emergency room without first stabilizing and immobilizing him, which caused further damage. When the incident occurred, the nurses on staff were two employees of Appalachian Regional and one supplied by U.S. Nursing Corporation to the hospital.
 The court granted a motion that dismissed the Appalachian Regional nurses as defendants because no evidence in the record alleged that they moved the patient. As the trial neared, the court granted another motion prohibiting the parties from introducing evidence that the Appalachian Regional nurses moved the patient from the truck into the emergency room.
This earlier state court lawsuit concluded with Appalachian Regional Healthcare paying $2 million in settlement and incurring $823,522.71 in legal fees.
It is important to note that when U.S. Nursing supplied its nurse to Appalachian Regional, they entered into an agreement that stated U.S. Nursing would indemnify and defend Appalachian Regional for the negligence of any of its employees assigned to Appalachian Regional. The settlement was reached, Appalachian Regional Healthcare demanded that U.S. Nursing indemnify it, but the staffing company refused to do so. In response, Appalachian Regional Healthcare, Inc., sued U.S. Nursing for the $2,823,522.71 state court settlement it paid.
The First Appeal.
In its first appeal, U.S. Nursing argued that the opposing counsel made an inappropriate closing statement when they stated no evidence showed the Appalachian Regional Healthcare nurses moving the patient and that U.S. Nursing had not argued that such evidence existed. U.S. Nursing claimed this statement was inappropriate because it was prohibited from admitting evidence that showed Appalachian Regional Healthcare nurses having moved the patient. The appellate court decided that U.S. Nursing did not have a full and fair opportunity to litigate the issue, so the appellate court remanded to the district court to determine if the error required a new trial.
The nurse staffing company argued that it was incorrectly prohibited from introducing evidence regarding the other nurses on duty and the possibility that they could have been the ones to move the patient. U.S. Nursing also argued that the opposing counsel exploited the court’s error in their closing statements, though the district court never addressed this claim. However, the appellate court asserted that the evidence excluded would not have caused a different outcome at trial, so no new trial was granted.
The Second Appeal.
In its second appeal, U.S. Nursing argued that the district court abused its discretion when it determined the evidentiary error did not affect the trial. The Sixth Circuit Court of Appeals found that the excluded evidence did very little to support U.S. Nursing’s argument, and excluding this evidence did not affect U.S. Nursing’s substantial rights. However, the court stated that the opposing counsel misled the jury with their statements. The remarks did not constitute an error significant enough to warrant a new trial since Appalachian Regional Healthcare, Inc., was highly likely to prevail, despite counsel’s comments.
Contact Health Law Attorneys Experienced in Representing Nurses and Other Healthcare Professionals.
The Health Law Firm’s attorneys routinely represent nurses, pharmacists, pharmacy technicians, dentists, dental assistants, physicians, physician assistants, mental health counselors, and other health providers. We also provide legal representation for employers in EEOC complaints, workplace discrimination complaints, and suits involving harassment or discrimination complaints. We also provide legal representation in Department of Health, Board of Medicine, Board of Nursing investigations and complaints, DORA investigations and complaints. We provide litigation services in state and federal courts and state and federal administrative hearings.
To contact The Health Law Firm please call (407) 331-6620 or Toll-Free at (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.
Source:
About the Authors: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620; Toll-Free (888) 331-6620
Hartley Brooks is a law clerk at The Health Law Firm. She is preparing to attend law school.
Current Open Positions with The Health Law Firm. The Health Law Firm always seeks qualified individuals interested in health law. Its main office is in the Orlando, Florida, area. If you are a current member of The Florida Bar or a qualified professional who is interested, please forward a cover letter and resume to: [email protected] or fax them to (407) 331-3030.
“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2023 George F. Indest III. All rights reserved.
By |2024-03-14T09:59:19-04:00October 4, 2023|Categories: Medical Education Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on United States Court of Appeals Denies U.S. Nursing Corporations Indemnification Challenge Against Nurse Staffing Agency

Medications and Other Substances that Mimic Prohibited Drugs on Urinalysis Drug Tests (Part 1 of a Blog Series)

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
In representing nurses and other licensed health professionals, we constantly discuss positive drug screenings, usually from employer-ordered drug testing, with our clients.  These clients include nurses, pharmacists, dental professionals, mental health counselors, therapists, etc.  Often these individuals need to remember that if they apply for a job with a new employer or are working for a large corporation or the government, they are subject to employer-ordered drug screenings.  Most problems arise when the professional has applied to a hospital or a placement agency for work in a hospital and they must submit to a pre-employment drug test.
The client often contends that the result is a false positive and that some other substance must be responsible for it.

A positive result for any drug for which you do not have a valid prescription from a physician, including marijuana, will cause you to be eliminated from consideration for a new job or terminated from a current position and a complaint against your professional license, which could cause you to lose it.  We are routinely called on to defend such situations.

Series of Blogs to Discuss Substances that Can Mimic Prohibited Drugs on Drug Tests.

In the years I have been doing this, I have encountered many cases in which other substances have caused a positive result for a prohibited substance on a drug screening test.

In this series of blogs, I intend to discuss some of the substances scientifically shown to cause false positives on employer-ordered drug screening tests.  This is the first in the series.

Over-the-Counter Medications Mimicking Amphetamines on Drug Tests.

Following is a discussion of substances that can cause a false positive for amphetamines on a urinalysis drug test.  This material comes from an article in Case Reports in Psychiatry published in 2013. (Ref. 1)
Many prescription pharmaceuticals and over-the-counter (OTC) medications have been previously reported in the literature to cause a false-positive result for amphetamines on urine drug screens. Many OTC medications have been reported in scientific literature to produce false positives for amphetamines on urine drug screenings, chiefly antihistamines.

The OTC medications that have been documented to and are well known as causing false positives for amphetamines on drug tests include nasal decongestants, Vicks inhaler, MDMA (3,4-Methylenedioxy methamphetamine;  commonly known as ecstacy, molly, mandy or X), and pseudoephedrine.  (Refs. 1-5)  Some of these are prohibited medications that cannot be prescribed and are only available as “street drugs” such as MDMA.

Prescription Medications Documented as Mimicking Amphetamines.

Prescription medications known to have mimicked amphetamines on testing include antipsychotics and antidepressants.  (Refs. 1 & 2)
The prescription medications known to cause false-positive amphetamine urine drug screen include fluoxetine, selegiline, ranitidine, trazodone, nefazodone, brompheniramine, phenylpropanolamine, chlorpromazine, promethazine, ephedrine, methamphetamine, and labetalol.  (Refs. 2-5)  However, the fact that the individual taking the drug test might have a prescription for one of these might cause the employer to disqualify the employee or potential employee from consideration for the job.
Bupropion (an atypical antidepressant that inhibits norepinephrine and dopamine re-uptake), is a drug used to treat depression and smoking cessation, but may also be used off-label to treat ADHD.  It has also been documented as causing false positive results for amphetamines on drug screenings.  (Ref. 6)
The drug atomoxetine has metabolites that are similar to those of amphetamines (phenylpropan-1-amine verses phenyl-propan-2-amine).  This could also result in a false positive on a urine drug screen.  (Ref. 1)

 

Other Discussions in Future Blogs.

In future blogs, I intend to discuss false positive claims associated with use of ibuprofen, amoxicillin, coca leaf tea, poppy seeds and other common substances and medications.  Stay tuned.

Contact Experienced Health Law Attorneys in Matters Involving PRN or IPN.

The Health Law Firm’s attorneys routinely represent physicians, dentists, nurses and other health professionals in matters involving PRN or IPN. Our attorneys also represent health providers in Department of Health investigations, before professional boards, in licensing matters, and in administrative hearings.

To contact The Health Law Firm, please call our office at (407) 331-6620 or toll-free at (888) 331-6620 and visit our website at www.ThehealthLawFirm.com.

References:

1. Fenderson JL, Stratton AN, Domingo JS, Matthews GO, Tan CD. Amphetamine positive urine toxicology screen secondary to atomoxetine. Case Rep Psychiatry. 2013;2013:381261. doi: 10.1155/2013/381261. Epub 2013 Jan 30. PMID: 23424703; PMCID: PMC3570929.
(Accessed on May 20, 2023.)
2. Brahm NC, Yeager LL, Fox MD, Farmer KC, Palmer TA. Commonly prescribed medications and potential false-positive urine drug screens. Am J Health Syst Pharm. 2010 Aug 15;67(16):1344-50. doi: 10.2146/ajhp090477. PMID: 20689123.
3. Vincent EC, Zebelman A, Goodwin C, Stephens MM. Clinical inquiries. What common substances can cause false positives on urine screens for drugs of abuse? J Fam Pract. 2006 Oct;55(10):893-4, 897. PMID: 17014756.
4. Rapuri SB, Ramaswamy S, Madaan V, Rasimas JJ, Krahn LE. ‘Weed’ out false-positive urine drug screens. Current Psychiatry. 2006;5(8):107–110. [Google Scholar]
5. Moeller KE, Lee KC, Kissack JC. Urine drug screening: practical guide for clinicians. Mayo Clin Proc. 2008 Jan;83(1):66-76. doi: 10.4065/83.1.66. Erratum in: Mayo Clin Proc. 2008 Jul;83(7):851. PMID: 18174009.
6. Reidy L, Walls HC, Steele BW. Crossreactivity of bupropion metabolite with enzyme-linked immunosorbent assays designed to detect amphetamine in urine. Ther Drug Monit. 2011 Jun;33(3):366-8. doi: 10.1097/FTD.0b013e3182126d08. PMID: 21436763.

 

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law.  He is the President and Managing Partner of The Health Law Firm, which has a national practice.  Its main office is in the Orlando, Florida, area.  www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Ave. Suite 1000, Altamonte Springs, FL 32714, Phone:  (407) 331-6620 Toll-Free: (888) 331-6620.

Current Open Positions with The Health Law Firm.  The Health Law Firm always seeks qualified individuals interested in health law.  Its main office is in the Orlando, Florida, area.  If you are a current member of The Florida Bar or a qualified professional who is interested, please forward a cover letter and resume to: [email protected] or fax them to (407) 331-3030.

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2023 The Health Law Firm. All rights reserved.
By |2024-03-14T09:59:19-04:00September 21, 2023|Categories: Health Facilities Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on Medications and Other Substances that Mimic Prohibited Drugs on Urinalysis Drug Tests (Part 1 of a Blog Series)

United States Court of Appeals Denies U.S. Nursing Corporations Indemnification Challenge Against Nurse Staffing Agency

Author HeadshotBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law, and Hartley Brooks, Law Clerk, The Health Law Firm
On May 18, 2023, the United States Court of Appeals for the Sixth Circuit affirmed a U.S. district court’s decision to deny U.S. Nursing Corporation a new trial. The appellate court stated that the opposing counsel’s closing argument and the erroneous preclusion of evidence had no substantial effect on the trial’s outcome; thus, there was no reversible error.
The First Lawsuit.
The original lawsuit filed in state court concerned a patient suing Appalachian Regional Healthcare, Inc., for exacerbating his spinal injury. He claimed that a nurse transported him from a car into the emergency room without first stabilizing and immobilizing him, which caused further damage. When the incident occurred, the nurses on staff were two employees of Appalachian Regional and one supplied by U.S. Nursing Corporation to the hospital.
 The court granted a motion that dismissed the Appalachian Regional nurses as defendants because no evidence in the record alleged that they moved the patient. As the trial neared, the court granted another motion prohibiting the parties from introducing evidence that the Appalachian Regional nurses moved the patient from the truck into the emergency room.
This earlier state court lawsuit concluded with Appalachian Regional Healthcare paying $2 million in settlement and incurring $823,522.71 in legal fees.
It is important to note that when U.S. Nursing supplied its nurse to Appalachian Regional, they entered into an agreement that stated U.S. Nursing would indemnify and defend Appalachian Regional for the negligence of any of its employees assigned to Appalachian Regional. The settlement was reached, Appalachian Regional Healthcare demanded that U.S. Nursing indemnify it, but the staffing company refused to do so. In response, Appalachian Regional Healthcare, Inc., sued U.S. Nursing for the $2,823,522.71 state court settlement it paid.
The First Appeal.
In its first appeal, U.S. Nursing argued that the opposing counsel made an inappropriate closing statement when they stated no evidence showed the Appalachian Regional Healthcare nurses moving the patient and that U.S. Nursing had not argued that such evidence existed. U.S. Nursing claimed this statement was inappropriate because it was prohibited from admitting evidence that showed Appalachian Regional Healthcare nurses having moved the patient. The appellate court decided that U.S. Nursing did not have a full and fair opportunity to litigate the issue, so the appellate court remanded to the district court to determine if the error required a new trial.
The nurse staffing company argued that it was incorrectly prohibited from introducing evidence regarding the other nurses on duty and the possibility that they could have been the ones to move the patient. U.S. Nursing also argued that the opposing counsel exploited the court’s error in their closing statements, though the district court never addressed this claim. However, the appellate court asserted that the evidence excluded would not have caused a different outcome at trial, so no new trial was granted.
The Second Appeal.
In its second appeal, U.S. Nursing argued that the district court abused its discretion when it determined the evidentiary error did not affect the trial. The Sixth Circuit Court of Appeals found that the excluded evidence did very little to support U.S. Nursing’s argument, and excluding this evidence did not affect U.S. Nursing’s substantial rights. However, the court stated that the opposing counsel misled the jury with their statements. The remarks did not constitute an error significant enough to warrant a new trial since Appalachian Regional Healthcare, Inc., was highly likely to prevail, despite counsel’s comments.
Contact Health Law Attorneys Experienced in Representing Nurses and Other Healthcare Professionals.
The Health Law Firm’s attorneys routinely represent nurses, pharmacists, pharmacy technicians, dentists, dental assistants, physicians, physician assistants, mental health counselors, and other health providers. We also provide legal representation for employers in EEOC complaints, workplace discrimination complaints, and suits involving harassment or discrimination complaints. We also provide legal representation in Department of Health, Board of Medicine, Board of Nursing investigations and complaints, DORA investigations and complaints. We provide litigation services in state and federal courts and state and federal administrative hearings.
To contact The Health Law Firm please call (407) 331-6620 or Toll-Free at (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.
Source:
About the Authors: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620; Toll-Free (888) 331-6620
Hartley Brooks is a law clerk at The Health Law Firm. She is preparing to attend law school.
Current Open Positions with The Health Law Firm. The Health Law Firm always seeks qualified individuals interested in health law. Its main office is in the Orlando, Florida, area. If you are a current member of The Florida Bar or a qualified professional who is interested, please forward a cover letter and resume to: [email protected] or fax them to (407) 331-3030.
“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2023 George F. Indest III. All rights reserved.
By |2024-03-14T09:59:20-04:00September 21, 2023|Categories: Health Facilities Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on United States Court of Appeals Denies U.S. Nursing Corporations Indemnification Challenge Against Nurse Staffing Agency

Nurses: You Must Insure Your Legal Protection

author headshot against a tan backgroundBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

I have news for you:  You need professional liability insurance!  But you only need the kind that includes professional liability insurance coverage, and in the amount of $25,000 or more.

Are you a traveling nurse?  Are you a nurse who works for a hospital or nursing home?  Are you a nurse who works in a doctor’s office?  Are you the nurse who is going to tell me:  “I think I have insurance coverage through my employer?”–WRONG!  Not professional license complaint defense insurance. You need to personally purchase your nursing professional liability insurance containing professional license defense coverage.   If you have yet to purchase this, you don’t have this.

The Insurance Coverage You Really Need.

Though many nurses pursue a career in nursing hoping that they will never face a complaint or disciplinary charges, any event not within a nurse’s control can lead to an investigation or administrative action. Nurses need to ensure they are covered with appropriate insurance if this ever occurs. In our opinion, based on decades of representing nurses, the primary reason that a nurse should purchase a professional liability insurance policy is to obtain coverage for the legal defense against complaints of licensing and disciplinary action commenced against a nurse.

License defense coverage pays the legal fees and costs associated with defending a nurse when an investigation is initiated that may result in action against her nursing license or disciplinary action against the nurse. Coverage is usually available when the nurse receives written notice that an investigation by a state agency has been initiated. It will also cover formal complaints against the nurse, informal hearings before the Board of Nursing, and formal administrative hearings before an administrative law judge. Such investigations, complaints, and administrative action may be opened based on events, including patient complaints, hotline calls, Code 15 reports, nursing home, and home health agency surveys, abuse investigations by the Department of Children and Families (DCF), newspaper articles, copies of lawsuits, and many other sources. It is far more likely that a nurse will be involved in one of these types of actions than being sued for nursing negligence.

You Want Insurance that Meets These Criteria.

Good professional liability policies, which provide coverage for licensure defense, will usually also compensate the nurse for her out-of-pocket expenses (travel, postage, etc.) that she incurs, as well as lost wages because of working time missed for hearings, depositions, etc. However, the maximum coverage available under such policies for licensure defense is usually limited to approximately $25,000. This amount will usually be sufficient to provide for most of the legal fees and costs involved in the defense of such a case.

Crucial to Check and Make Sure That Claims For Insurance Coverage Do Not Have to Be Linked to Malpractice Complaints.

Many professional liability insurance companies try to get off the hook on covering nurses on complaints against the nurse’s license, relying on provisions of the insurance policy that state that any coverage must be based on a claim of nursing malpractice.  AVOID THESE INSURERS AT ALL COSTS.  Most complaints against nurses’ licenses do not involve a claim made for nursing malpractice. To be sure, ask your insurer in writing ahead of time and get the answer in writing.  By the way, you never have this problem with Nurses Service Organization (NSO) Insurance or CPH & Associates Insurance.

Who Files the Most Complaints Against Nurse’s Licenses? Employers.

It has been our experience that most complaints against nurses’ licenses are made by their former employer and/or former recruiting company.  Think about it, is your employer going to pay for insurance that covers you and provides you a defense in the event that the employer files a complaint against your license. The answer is “NO” regardless of what you think.

You are on your own.  Buy your own insurance.  It is very cheap and it will be there when you need it.

Even if the nurse is still employed (unlikely in the vast majority of cases) many employers will not provide legal representation if the matter involves licensing or disciplinary action against the nurse.  This could force the nurse to fund all the fees and costs associated with her defense. However, some larger corporations with sound risk management programs will provide the nurses with legal representation, but this is a rare exception.

For Traveling Nurses and Agency Nurses, Your Own Personal Insurance is a Must.

Suppose you are an agency nurse, a home health agency nurse, a nursing home nurse, an independent duty nurse, or a large hospital chain does not employ you. In that case, you should consider nursing liability insurance mandatory. Complaints of negligence against nurses working in these positions are far more likely. This may be because of the high turnover of nurses in some healthcare facilities (such as nursing homes), or because the nurse is no longer employed at the facility when the investigation begins (for example, in the case of an agency nurse). Additionally, agency nurses may only work in a facility for a short period, making them less familiar with the facility’s policies and procedures and not a part of the permanent team of nurses who may have established relationships and are more likely to cover for each other.

As previously mentioned, several different proceedings may be covered by the licensure defense coverage provided in professional liability insurance.  Defense of accusations of HIPAA privacy breaches is the most used one, followed closely by deposition representation.

The Cost of Professional Liability Coverage is Minimal.

Nurses can purchase liability coverage rather inexpensively. For example, an excellent insurance policy providing coverage for nurses is available through the Nurses Service Organization (NSO) Insurance for less than $100 per year. CPH & Associates Insurance is also inexpensive and competitive.  Professional liability coverage provided by this type of insurance represents a bargain at these rates.

Focusing on Protecting the Nurse’s Individual Interests.

Perhaps most importantly, the nurse should have an attorney focusing only on her interests in defending her against any negligence or licensing complaint. A nurse with her own professional liability insurance coverage will be able to hire a separate, independent attorney, and often, the insurer will allow her to pick her attorney.


Important Considerations When Purchasing Liability Insurance Protection.

First and foremost is to be sure that a claim for defense of your professional license is covered by your insurance even when there is no separate claim or complaint for damages for malpractice or negligence.  Ask your broker or insurer to give you written acknowledgment of this, if your policy is unclear.

A close second is the amount of coverage for license defense that the insurer provides.  $25,000 is the absolute minimum and may not be enough.  Look for $35,000 or $50,000 coverage or buy two different policies from two different companies.

Third is how broad the coverage is and whether it also covers other types of administrative complaints and proceedings that might be brought against you such as discrimination complaints, HIPAA breach of privacy complaints, certification board complaints, and other similar proceedings.

Some professional liability insurers have a “broad form” of coverage which may provide legal defense for the nurse in almost any type of administrative action. This might include, for example, the defense of a discrimination complaint filed against the nurse with the Florida Commission on Human Relations (FCHR) or the U.S. Equal Employment Opportunity Commission and for Medicare and Medicaid complaints.

Other companies limit coverage to only actions that may result in disciplinary action against the nurse’s license. The nurse should always attempt to get the broadest coverage available for disciplinary defense and licensure defense coverage.

Additionally, the nurse should inquire whether she will be allowed to select her own attorney. Many insurance companies contract certain law firms to provide legal services on their cases for a reduced fee. The insurance company may require you to use one of its own hired attorneys or even one of its in-house attorneys, which it employs directly.

Given the limited number of attorneys with experience handling nursing law issues and malpractice cases, the nurse should attempt to obtain coverage through a company that allows her to choose her attorney.


In Our Opinion, License Defense Coverage Is the Most Important Reason to Purchase Insurance.

The most important reason to purchase professional liability insurance is the licensure defense coverage. A nurse does not want to risk losing her nursing license because she was unsuccessful at defending an investigation complaint against her license or did not have the resources to do so. Since there are far more complaints filed each year against nurses’ licenses than there are nursing malpractice lawsuits filed, it is far more likely that a working nurse will need legal defense of a licensure complaint investigation.

Contact Health Law Attorneys Experienced in Representing Nurses.

The Health Law Firm’s attorneys routinely represent nurses and nurse practitioners in Department of Health (DOH) investigations, in appearances before the Board of Nursing (BON) in licensing matters, in formal and informal administrative hearings, and in many other legal matters. We represent nurses across the U.S., and throughout Florida.

To contact The Health Law Firm please call (407) 331-6620 or toll-free (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.


About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Suite 1000 Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.

Current Open Positions with The Health Law Firm. The Health Law Firm always seeks qualified individuals interested in health law. Its main office is in the Orlando, Florida, area. If you are a current member of The Florida Bar or a qualified professional who is interested, please forward a cover letter and resume to: [email protected] or fax them to (407) 331-3030.

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2023 George F. Indest III.  All rights reserved.

By |2024-03-14T09:59:21-04:00September 6, 2023|Categories: Nursing Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on Nurses: You Must Insure Your Legal Protection

United States Court of Appeals Denies U.S. Nursing Corporations Indemnification Challenge Against Nurse Staffing Agency

Author HeadshotBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law, and Hartley Brooks, Law Clerk, The Health Law Firm
On May 18, 2023, the United States Court of Appeals for the Sixth Circuit affirmed a U.S. district court’s decision to deny U.S. Nursing Corporation a new trial. The appellate court stated that the opposing counsel’s closing argument and the erroneous preclusion of evidence had no substantial effect on the trial’s outcome; thus, there was no reversible error.
The First Lawsuit.
The original lawsuit filed in state court concerned a patient suing Appalachian Regional Healthcare, Inc., for exacerbating his spinal injury. He claimed that a nurse transported him from a car into the emergency room without first stabilizing and immobilizing him, which caused further damage. When the incident occurred, the nurses on staff were two employees of Appalachian Regional and one supplied by U.S. Nursing Corporation to the hospital.
 The court granted a motion that dismissed the Appalachian Regional nurses as defendants because no evidence in the record alleged that they moved the patient. As the trial neared, the court granted another motion prohibiting the parties from introducing evidence that the Appalachian Regional nurses moved the patient from the truck into the emergency room.
This earlier state court lawsuit concluded with Appalachian Regional Healthcare paying $2 million in settlement and incurring $823,522.71 in legal fees.
It is important to note that when U.S. Nursing supplied its nurse to Appalachian Regional, they entered into an agreement that stated U.S. Nursing would indemnify and defend Appalachian Regional for the negligence of any of its employees assigned to Appalachian Regional. The settlement was reached, Appalachian Regional Healthcare demanded that U.S. Nursing indemnify it, but the staffing company refused to do so. In response, Appalachian Regional Healthcare, Inc., sued U.S. Nursing for the $2,823,522.71 state court settlement it paid.
The First Appeal.
In its first appeal, U.S. Nursing argued that the opposing counsel made an inappropriate closing statement when they stated no evidence showed the Appalachian Regional Healthcare nurses moving the patient and that U.S. Nursing had not argued that such evidence existed. U.S. Nursing claimed this statement was inappropriate because it was prohibited from admitting evidence that showed Appalachian Regional Healthcare nurses having moved the patient. The appellate court decided that U.S. Nursing did not have a full and fair opportunity to litigate the issue, so the appellate court remanded to the district court to determine if the error required a new trial.
The nurse staffing company argued that it was incorrectly prohibited from introducing evidence regarding the other nurses on duty and the possibility that they could have been the ones to move the patient. U.S. Nursing also argued that the opposing counsel exploited the court’s error in their closing statements, though the district court never addressed this claim. However, the appellate court asserted that the evidence excluded would not have caused a different outcome at trial, so no new trial was granted.
The Second Appeal.
In its second appeal, U.S. Nursing argued that the district court abused its discretion when it determined the evidentiary error did not affect the trial. The Sixth Circuit Court of Appeals found that the excluded evidence did very little to support U.S. Nursing’s argument, and excluding this evidence did not affect U.S. Nursing’s substantial rights. However, the court stated that the opposing counsel misled the jury with their statements. The remarks did not constitute an error significant enough to warrant a new trial since Appalachian Regional Healthcare, Inc., was highly likely to prevail, despite counsel’s comments.
Contact Health Law Attorneys Experienced in Representing Nurses and Other Healthcare Professionals.
The Health Law Firm’s attorneys routinely represent nurses, pharmacists, pharmacy technicians, dentists, dental assistants, physicians, physician assistants, mental health counselors, and other health providers. We also provide legal representation for employers in EEOC complaints, workplace discrimination complaints, and suits involving harassment or discrimination complaints. We also provide legal representation in Department of Health, Board of Medicine, Board of Nursing investigations and complaints, DORA investigations and complaints. We provide litigation services in state and federal courts and state and federal administrative hearings.
To contact The Health Law Firm please call (407) 331-6620 or Toll-Free at (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.
Source:
About the Authors: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620; Toll-Free (888) 331-6620
Hartley Brooks is a law clerk at The Health Law Firm. She is preparing to attend law school.
Current Open Positions with The Health Law Firm. The Health Law Firm always seeks qualified individuals interested in health law. Its main office is in the Orlando, Florida, area. If you are a current member of The Florida Bar or a qualified professional who is interested, please forward a cover letter and resume to: [email protected] or fax them to (407) 331-3030.
“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2023 George F. Indest III. All rights reserved.
By |2024-03-14T09:59:22-04:00September 1, 2023|Categories: Dental Law Blog, The Health Law Firm Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on United States Court of Appeals Denies U.S. Nursing Corporations Indemnification Challenge Against Nurse Staffing Agency

Medications and Other Substances that Mimic Prohibited Drugs on Urinalysis Drug Tests (Part 1 of a Blog Series)

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
In representing nurses and other licensed health professionals, we constantly discuss positive drug screenings, usually from employer-ordered drug testing, with our clients.  These clients include nurses, pharmacists, dental professionals, mental health counselors, therapists, etc.  Often these individuals need to remember that if they apply for a job with a new employer or are working for a large corporation or the government, they are subject to employer-ordered drug screenings.  Most problems arise when the professional has applied to a hospital or a placement agency for work in a hospital and they must submit to a pre-employment drug test.
The client often contends that the result is a false positive and that some other substance must be responsible for it.

A positive result for any drug for which you do not have a valid prescription from a physician, including marijuana, will cause you to be eliminated from consideration for a new job or terminated from a current position and a complaint against your professional license, which could cause you to lose it.  We are routinely called on to defend such situations.

Series of Blogs to Discuss Substances that Can Mimic Prohibited Drugs on Drug Tests.

In the years I have been doing this, I have encountered many cases in which other substances have caused a positive result for a prohibited substance on a drug screening test.

In this series of blogs, I intend to discuss some of the substances scientifically shown to cause false positives on employer-ordered drug screening tests.  This is the first in the series.

Over-the-Counter Medications Mimicking Amphetamines on Drug Tests.

Following is a discussion of substances that can cause a false positive for amphetamines on a urinalysis drug test.  This material comes from an article in Case Reports in Psychiatry published in 2013. (Ref. 1)
Many prescription pharmaceuticals and over-the-counter (OTC) medications have been previously reported in the literature to cause a false-positive result for amphetamines on urine drug screens. Many OTC medications have been reported in scientific literature to produce false positives for amphetamines on urine drug screenings, chiefly antihistamines.

The OTC medications that have been documented to and are well known as causing false positives for amphetamines on drug tests include nasal decongestants, Vicks inhaler, MDMA (3,4-Methylenedioxy methamphetamine;  commonly known as ecstacy, molly, mandy or X), and pseudoephedrine.  (Refs. 1-5)  Some of these are prohibited medications that cannot be prescribed and are only available as “street drugs” such as MDMA.

Prescription Medications Documented as Mimicking Amphetamines.

Prescription medications known to have mimicked amphetamines on testing include antipsychotics and antidepressants.  (Refs. 1 & 2)
The prescription medications known to cause false-positive amphetamine urine drug screen include fluoxetine, selegiline, ranitidine, trazodone, nefazodone, brompheniramine, phenylpropanolamine, chlorpromazine, promethazine, ephedrine, methamphetamine, and labetalol.  (Refs. 2-5)  However, the fact that the individual taking the drug test might have a prescription for one of these might cause the employer to disqualify the employee or potential employee from consideration for the job.
Bupropion (an atypical antidepressant that inhibits norepinephrine and dopamine re-uptake), is a drug used to treat depression and smoking cessation, but may also be used off-label to treat ADHD.  It has also been documented as causing false positive results for amphetamines on drug screenings.  (Ref. 6)
The drug atomoxetine has metabolites that are similar to those of amphetamines (phenylpropan-1-amine verses phenyl-propan-2-amine).  This could also result in a false positive on a urine drug screen.  (Ref. 1)

 

Other Discussions in Future Blogs.

In future blogs, I intend to discuss false positive claims associated with use of ibuprofen, amoxicillin, coca leaf tea, poppy seeds and other common substances and medications.  Stay tuned.

Contact Experienced Health Law Attorneys in Matters Involving PRN or IPN.

The Health Law Firm’s attorneys routinely represent physicians, dentists, nurses and other health professionals in matters involving PRN or IPN. Our attorneys also represent health providers in Department of Health investigations, before professional boards, in licensing matters, and in administrative hearings.

To contact The Health Law Firm, please call our office at (407) 331-6620 or toll-free at (888) 331-6620 and visit our website at www.ThehealthLawFirm.com.

References:

1. Fenderson JL, Stratton AN, Domingo JS, Matthews GO, Tan CD. Amphetamine positive urine toxicology screen secondary to atomoxetine. Case Rep Psychiatry. 2013;2013:381261. doi: 10.1155/2013/381261. Epub 2013 Jan 30. PMID: 23424703; PMCID: PMC3570929.
(Accessed on May 20, 2023.)
2. Brahm NC, Yeager LL, Fox MD, Farmer KC, Palmer TA. Commonly prescribed medications and potential false-positive urine drug screens. Am J Health Syst Pharm. 2010 Aug 15;67(16):1344-50. doi: 10.2146/ajhp090477. PMID: 20689123.
3. Vincent EC, Zebelman A, Goodwin C, Stephens MM. Clinical inquiries. What common substances can cause false positives on urine screens for drugs of abuse? J Fam Pract. 2006 Oct;55(10):893-4, 897. PMID: 17014756.
4. Rapuri SB, Ramaswamy S, Madaan V, Rasimas JJ, Krahn LE. ‘Weed’ out false-positive urine drug screens. Current Psychiatry. 2006;5(8):107–110. [Google Scholar]
5. Moeller KE, Lee KC, Kissack JC. Urine drug screening: practical guide for clinicians. Mayo Clin Proc. 2008 Jan;83(1):66-76. doi: 10.4065/83.1.66. Erratum in: Mayo Clin Proc. 2008 Jul;83(7):851. PMID: 18174009.
6. Reidy L, Walls HC, Steele BW. Crossreactivity of bupropion metabolite with enzyme-linked immunosorbent assays designed to detect amphetamine in urine. Ther Drug Monit. 2011 Jun;33(3):366-8. doi: 10.1097/FTD.0b013e3182126d08. PMID: 21436763.

 

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law.  He is the President and Managing Partner of The Health Law Firm, which has a national practice.  Its main office is in the Orlando, Florida, area.  www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Ave. Suite 1000, Altamonte Springs, FL 32714, Phone:  (407) 331-6620 Toll-Free: (888) 331-6620.

Current Open Positions with The Health Law Firm.  The Health Law Firm always seeks qualified individuals interested in health law.  Its main office is in the Orlando, Florida, area.  If you are a current member of The Florida Bar or a qualified professional who is interested, please forward a cover letter and resume to: [email protected] or fax them to (407) 331-3030.

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2023 The Health Law Firm. All rights reserved.
By |2024-03-14T09:59:22-04:00August 23, 2023|Categories: Mental Health Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on Medications and Other Substances that Mimic Prohibited Drugs on Urinalysis Drug Tests (Part 1 of a Blog Series)

Substances and Medications that Mimic Prohibited Drugs on Urinalysis Drug Tests: Pot and THC Imposter Substances (Part 3 of Series)

Attorney and Author headshot sitting in dark suit against a tan backgroundBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm

When representing licensed health professionals, our firm often encounters issues regarding positive drug tests that employers request. These clients include nurses, pharmacists, dental professionals, mental health counselors, therapists, etc. Job seekers should be aware that employers, particularly large companies and government organizations, may require drug tests as part of the hiring process. Medical and nursing students should be aware that prior to beginning clinical rotations in a hospital or medical facility, they will be given a drug screening test.

These issues are particularly relevant when a health professional has applied to a hospital, a medical organization, or a placement agency for work in a hospital and must submit to a pre-employment drug test. The client often contends that a positive result is a false positive and that some other substance must be responsible for it.

A positive result for any drug for which you do not have a valid prescription from a physician, including marijuana, can have severe and far-reaching consequences. It could result in being eliminated from consideration for a new job or termination from a current position. It can also result in a complaint against your professional license, which could lead to suspension or revocation. This could be devastating to your career and your future job prospects. Our firm is routinely called on to defend health professionals in such situations.
This blog series will discuss the potential causes for false positive results on THC drug tests and marijuana’s changing legal status on employer-ordered drug testing.

Remember to read Part 1 and Part 2 of this blog series! Part 1 deals with substances that may cause a false positive for amphetamines. Part 2 deals with substances that may cause a false positive for cocaine.

Marijuana (THC) False Positives.

The primary psychoactive chemical in cannabis is delta-9-tetrahydrocannabinol commonly referred to as just tetrahydrocannabinol or THC. Urine drug screens are designed to detect 11-nor-delta-9-tetrahydrocannabinol-9-carboxylic acid (9-carboxy-THC). THC can be detected in urine for up to three (3) days for single usage but up to four to six (6) weeks after stopping long-term heavy use.

A false positive drug test occurs when the test detects a substance that is not there. This false detection is due to cross-reactivity with the urine drug tests.

Imposter substances for cannabinoids on urinalysis drug tests include cannabidiol (CBD) oil and other hemp products, HIV medications, ibuprofen, and other non-steroidal anti-inflammatory drugs, proton pump inhibitors, and baby wash products.

CBD is the second most prevalent active ingredient in marijuana. CBD is directly derived from hemp plants. Products made from hemp plants can have trace amounts of THC, even if THC is not on the label. Long-term regular use of CBD oil and other hemp products can build up enough THC in the body to test positive for marijuana and THC on urinalysis drug tests. Vitamin B supplements, like riboflavin, are made with hempseed oil and can also produce positive THC results. Despite the THC in the hemp plant, hemp products were legalized in 2018 under the Federal Farm Bill.

HIV and AIDS medications, like efavirenz and dronabinol, can produce positive urine drug tests for marijuana. Efavirenz is a potent antiretroviral medication used to treat HIV infections and dronabinol is used to treat loss of appetite and weight loss in people with HIV/AIDS. Dronabinol is also used to treat nausea and vomiting in chemotherapy patients. Dronabinol is classified as a cannabinoid because it is a synthetic THC that was legalized for medical use in 1985, which is why it can cause positive THC drug test results.

Pain medications, like ibuprofen and other non-steroidal anti-inflammatory drugs (NSAIDs), are over-the-counter medications that treat pain and fever. Ibuprofen medicines, like Motrin and Advil, and naproxen medications, like Aleve and Naprosyn, are NSAIDs that may produce positive THC results on urinalysis drug tests.

Proton pump inhibitors are used to treat heartburn symptoms and gastroesophageal reflux disease (GERD). Pantoporazole, a specific proton pump inhibitor medication, may cause positive drug test results for THC.

Commonly used infant and newborn soap products, like CVS Night-Time Baby Bath and Head-to-Toe Baby Wash, may cause THC-positive drug test results. Some health professionals speculate that positive THC drug test results are due to baby wash products containing ingredients with a chemical structure similar to THC.

Other discussions in future blogs.

In future blogs, I intend to discuss false positive drug results associated with poppy seeds, sleep aids, antidepressants, and other commonly used substances and medications.

If you haven’t read the first two installments of this blog series, click here for part one and here for part two! As stated above, Part 1 deals with substances that may cause a false positive for amphetamines. Part 2 deals with substances that may cause a false positive for cocaine.

Contact Experienced Health Law Attorneys in Matters Involving PRN or IPN.

The Health Law Firm’s attorneys routinely represent physicians, dentists, nurses, and other health professionals in matters involving PRN or IPN. Our attorneys also represent health providers in Department of Health investigations, before professional boards, in licensing matters, and in administrative hearings.

To contact The Health Law Firm, please call our office at (407) 331-6620 or toll-free at (888) 331-6620 and visit our website at www.ThehealthLawFirm.com.

Sources:

Algren, Adam and Micheal Christian. “Buyer Beware: Pitfalls in Toxicology Laboratory Reporting.” National Library of Medicine. (May-June 2015). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6170116/#:~:text=Heavy%2C%20daily%20cannabis%20users%20can,ethacrynic%20acid%2C%20and%20baby%20soaps.

Cotton, Steve, et al. “Unexpected interference of baby wash products with a cannabinoid (THC) immunoassay.” PubMed. (June 2012). https://pubmed.ncbi.nlm.nih.gov/22465236/

Gragnolati, Amy. “These 10 Medications Can Cause a False Positive on Drug Tests.” GoodRx Health. (14 July 2022). https://www.goodrx.com/drugs/side-effects/these-medications-can-cause-a-false-positive-on-drug-tests

Grinspoon, Peter. “Cannabidiol (CBD): What we know and what we don’t.” Harvard Health Publishing, (21 September 2021). https://www.health.harvard.edu/blog/cannabidiol-cbd-what-we-know-and-what-we-dont-2018082414476

“Marijuana Legality by State.” DISA. (1 August 2023). https://disa.com/marijuana-legality-by-state

Olsson, Regan. “What Medications Can Cause False Positives on Drug Tests?” Banner Health. (7 January 2023). https://www.bannerhealth.com/healthcareblog/teach-me/what-can-cause-false-positives-on-drug-tests

O’Donnell, Brian, et al. “StatPearls: Dronabinol.” National Library of Medicine. 2023. https://www.ncbi.nlm.nih.gov/books/NBK557531/

Rodriguez, Austin, et al. “Employer Drug-Testing Policies Must Evolve With State Law.” Law360. (19 July 2023). https://www.law360.com/health/articles/1696737?nl_pk=0cbd4c0b-c6c8-416a-9e67-b4affa63b102&utm_source=newsletter&utm_medium=email&utm_campaign=health&utm_content=2023-07-20&read_main=1&nlsidx=0&nlaidx=26

Saltiman, Alec, et al. “False-Positive Interferences of Common Urine Drug Screen Immunoassays: A Review.” Journal of Analytical Toxicology, Volume 38, Issue 7. (September 2014) Pages 387-396, https://academic.oup.com/jat/article/38/7/387/2798054

“The Best Defense For Positive Drug Test.” Overland. (12 May 2023). https://overlandiop.com/how-to-dispute-a-false-positive-drug-test-result/

About the Authors: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620; Toll-Free (888) 331-6620

Hartley Brooks is a law clerk at The Health Law Firm. She is preparing to attend law school.

Current Open Positions with The Health Law Firm. The Health Law Firm always seeks qualified individuals interested in health law. Its main office is in the Orlando, Florida, area. If you are a current member of The Florida Bar or a qualified professional who is interested, please forward a cover letter and resume to: [email protected] or fax them to (407) 331-3030.

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2023 George F. Indest III. All rights reserved.

 

By |2024-03-14T09:59:23-04:00August 16, 2023|Categories: Marijuana Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on Substances and Medications that Mimic Prohibited Drugs on Urinalysis Drug Tests: Pot and THC Imposter Substances (Part 3 of Series)

Medications and Other Substances that Mimic Prohibited Drugs on Urinalysis Drug Tests: Marijuana and THC Imposter Substances (Part 3 of Series)

Attorney and Author headshot sitting in dark suit against a tan backgroundBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm

When representing licensed health professionals, our firm often encounters issues regarding positive drug tests that employers request. These clients include nurses, pharmacists, dental professionals, mental health counselors, therapists, etc. Job seekers should be aware that employers, particularly large companies and government organizations, may require drug tests as part of the hiring process. Medical and nursing students should be aware that prior to beginning clinical rotations in a hospital or medical facility, they will be given a drug screening test.

These issues are particularly relevant when a health professional has applied to a hospital, a medical organization, or a placement agency for work in a hospital and must submit to a pre-employment drug test. The client often contends that a positive result is a false positive and that some other substance must be responsible for it.

A positive result for any drug for which you do not have a valid prescription from a physician, including marijuana, can have severe and far-reaching consequences. It could result in being eliminated from consideration for a new job or termination from a current position. It can also result in a complaint against your professional license, which could lead to suspension or revocation. This could be devastating to your career and your future job prospects. Our firm is routinely called on to defend health professionals in such situations.
This blog series will discuss the potential causes for false positive results on THC drug tests and marijuana’s changing legal status on employer-ordered drug testing.

Remember to read Part 1 and Part 2 of this blog series! Part 1 deals with substances that may cause a false positive for amphetamines. Part 2 deals with substances that may cause a false positive for cocaine.

Marijuana (THC) False Positives.

The primary psychoactive chemical in cannabis is delta-9-tetrahydrocannabinol commonly referred to as just tetrahydrocannabinol or THC. Urine drug screens are designed to detect 11-nor-delta-9-tetrahydrocannabinol-9-carboxylic acid (9-carboxy-THC). THC can be detected in urine for up to three (3) days for single usage but up to four to six (6) weeks after stopping long-term heavy use.

A false positive drug test occurs when the test detects a substance that is not there. This false detection is due to cross-reactivity with the urine drug tests.

Imposter substances for cannabinoids on urinalysis drug tests include cannabidiol (CBD) oil and other hemp products, HIV medications, ibuprofen, and other non-steroidal anti-inflammatory drugs, proton pump inhibitors, and baby wash products.

CBD is the second most prevalent active ingredient in marijuana. CBD is directly derived from hemp plants. Products made from hemp plants can have trace amounts of THC, even if THC is not on the label. Long-term regular use of CBD oil and other hemp products can build up enough THC in the body to test positive for marijuana and THC on urinalysis drug tests. Vitamin B supplements, like riboflavin, are made with hempseed oil and can also produce positive THC results. Despite the THC in the hemp plant, hemp products were legalized in 2018 under the Federal Farm Bill.

HIV and AIDS medications, like efavirenz and dronabinol, can produce positive urine drug tests for marijuana. Efavirenz is a potent antiretroviral medication used to treat HIV infections and dronabinol is used to treat loss of appetite and weight loss in people with HIV/AIDS. Dronabinol is also used to treat nausea and vomiting in chemotherapy patients. Dronabinol is classified as a cannabinoid because it is a synthetic THC that was legalized for medical use in 1985, which is why it can cause positive THC drug test results.

Pain medications, like ibuprofen and other non-steroidal anti-inflammatory drugs (NSAIDs), are over-the-counter medications that treat pain and fever. Ibuprofen medicines, like Motrin and Advil, and naproxen medications, like Aleve and Naprosyn, are NSAIDs that may produce positive THC results on urinalysis drug tests.

Proton pump inhibitors are used to treat heartburn symptoms and gastroesophageal reflux disease (GERD). Pantoporazole, a specific proton pump inhibitor medication, may cause positive drug test results for THC.

Commonly used infant and newborn soap products, like CVS Night-Time Baby Bath and Head-to-Toe Baby Wash, may cause THC-positive drug test results. Some health professionals speculate that positive THC drug test results are due to baby wash products containing ingredients with a chemical structure similar to THC.

Other discussions in future blogs.

In future blogs, I intend to discuss false positive drug results associated with poppy seeds, sleep aids, antidepressants, and other commonly used substances and medications.

If you haven’t read the first two installments of this blog series, click here for part one and here for part two! As stated above, Part 1 deals with substances that may cause a false positive for amphetamines. Part 2 deals with substances that may cause a false positive for cocaine.

Contact Experienced Health Law Attorneys in Matters Involving PRN or IPN.

The Health Law Firm’s attorneys routinely represent physicians, dentists, nurses, and other health professionals in matters involving PRN or IPN. Our attorneys also represent health providers in Department of Health investigations, before professional boards, in licensing matters, and in administrative hearings.

To contact The Health Law Firm, please call our office at (407) 331-6620 or toll-free at (888) 331-6620 and visit our website at www.ThehealthLawFirm.com.

Sources:

Algren, Adam and Micheal Christian. “Buyer Beware: Pitfalls in Toxicology Laboratory Reporting.” National Library of Medicine. (May-June 2015). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6170116/#:~:text=Heavy%2C%20daily%20cannabis%20users%20can,ethacrynic%20acid%2C%20and%20baby%20soaps.

Cotton, Steve, et al. “Unexpected interference of baby wash products with a cannabinoid (THC) immunoassay.” PubMed. (June 2012). https://pubmed.ncbi.nlm.nih.gov/22465236/

Gragnolati, Amy. “These 10 Medications Can Cause a False Positive on Drug Tests.” GoodRx Health. (14 July 2022). https://www.goodrx.com/drugs/side-effects/these-medications-can-cause-a-false-positive-on-drug-tests

Grinspoon, Peter. “Cannabidiol (CBD): What we know and what we don’t.” Harvard Health Publishing, (21 September 2021). https://www.health.harvard.edu/blog/cannabidiol-cbd-what-we-know-and-what-we-dont-2018082414476

“Marijuana Legality by State.” DISA. (1 August 2023). https://disa.com/marijuana-legality-by-state

Olsson, Regan. “What Medications Can Cause False Positives on Drug Tests?” Banner Health. (7 January 2023). https://www.bannerhealth.com/healthcareblog/teach-me/what-can-cause-false-positives-on-drug-tests

O’Donnell, Brian, et al. “StatPearls: Dronabinol.” National Library of Medicine. 2023. https://www.ncbi.nlm.nih.gov/books/NBK557531/

Rodriguez, Austin, et al. “Employer Drug-Testing Policies Must Evolve With State Law.” Law360. (19 July 2023). https://www.law360.com/health/articles/1696737?nl_pk=0cbd4c0b-c6c8-416a-9e67-b4affa63b102&utm_source=newsletter&utm_medium=email&utm_campaign=health&utm_content=2023-07-20&read_main=1&nlsidx=0&nlaidx=26

Saltiman, Alec, et al. “False-Positive Interferences of Common Urine Drug Screen Immunoassays: A Review.” Journal of Analytical Toxicology, Volume 38, Issue 7. (September 2014) Pages 387-396, https://academic.oup.com/jat/article/38/7/387/2798054

“The Best Defense For Positive Drug Test.” Overland. (12 May 2023). https://overlandiop.com/how-to-dispute-a-false-positive-drug-test-result/

About the Authors: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620; Toll-Free (888) 331-6620

Hartley Brooks is a law clerk at The Health Law Firm. She is preparing to attend law school.

Current Open Positions with The Health Law Firm. The Health Law Firm always seeks qualified individuals interested in health law. Its main office is in the Orlando, Florida, area. If you are a current member of The Florida Bar or a qualified professional who is interested, please forward a cover letter and resume to: [email protected] or fax them to (407) 331-3030.

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