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
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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
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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
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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
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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)
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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.

Keywords: Legal representation for healthcare professionals, legal representation for nurses, legal representation for pharmacists, legal representation for mental health counselors, legal representation for dentists, legal representation for dental hygienists, legal representation for healthcare professional licenses, employer drug test defense attorney, impaired physicians defense lawyer, legal representation for investigations for investigations against health care professionals, legal representation for Florida DOH and DORA investigations, legal representation for DOH and DORA complaint, legal representation for IPN matters, impaired nurse defense attorneys, legal representation for disruptive physician issues, legal representation for healthcare investigations, Intervention Project for Nurses (IPN) defense attorney, Professionals Resource Network (PRN) defense legal counsel, DOH and DORA investigation defense attorney, drug diversion defense lawyer, DOH complaint defense attorney, Florida impaired practitioners program, PRN defense attorney, IPN matter defense lawyer, disruptive physician issue defense lawyer, health care investigation defense attorney, health professional defense lawyer, healthcare professional license defense attorney, impaired physician defense lawyer, The Health Law Firm reviews, reviews of The Health Law Firm attorneys, peer assistance defense attorney, physician health program defense lawyer, impaired professional defense lawyer

“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: Nursing Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on Medications and Other Substances that Mimic Prohibited Drugs on Urinalysis Drug Tests: Marijuana and THC Imposter Substances (Part 3 of Series)
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Nurses: You Must Insure Your Legal Protection

Attorney and Author George F. Indest III HeadshotBy 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 telling 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 must ensure they are covered with appropriate insurance if this 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 compensate the nurse for her out-of-pocket expenses (travel, postage, etc.), 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 defending 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 the insurance policy’s provisions stating that any coverage must be based on a claim of nursing malpractice.  AVOID THESE INSURERS AT ALL COSTS.  Most complaints against nurses’ license 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.

Our experience has been 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 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.

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

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 that may provide legal defense for the nurse in almost any administrative action. This might include, for example, 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 |2024-03-14T09:59:23-04:00August 14, 2023|Categories: Nursing Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on Nurses: You Must Insure Your Legal Protection
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United States Court of Appeals Denies U.S. Nursing Corporations Indemnification Challenge Against Nurse Staffing Agency

Attorney and Author George F. Indest III 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 remark in their 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 the 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 |2024-03-14T09:59:24-04:00July 31, 2023|Categories: Nursing Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on United States Court of Appeals Denies U.S. Nursing Corporations Indemnification Challenge Against Nurse Staffing Agency
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Medications and Other Substances that Mimic Prohibited Drugs on Urinalysis Drug Tests: Cocaine and Imposter Substances (Part 2 of Series)

Author Headshot

By 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 nurses and other 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.

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 is required to 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 its 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.

Remember to read Part 1 and Part 3 of this blog series! Part 1 deals with substances that may cause a false positive for amphetamines. Part 3 deals with substances that may cause a false positive for Marijuana and THC.

Routine Drug Testing.

Most routine drug tests are “five-panel” urinalysis drug tests to detect marijuana, cocaine, opiates, amphetamines, and phencyclidine. Sometimes a “ten-panel” or “21-panel” test is used, depending on the employer. These drug tests are often immunoassay (IA) tests that screen for the common classes of drugs mentioned above. An IA drug test is typically used to evaluate the use of illegal substances and not prescribed medications or the abuse of prescribed medications. These drug tests will test for the drugs and their metabolites to assess usage.

A false positive is when a drug test detects a substance or metabolite that is not actually one that is from the prohibited drug. Instead, the test detects an imposter substance acting like the one it is looking to detect. Another urinalysis drug test used is a gas chromatography-mass spectrometry (GC/MS) test. This test is considered the “gold standard” of drug tests. But, due to its complexity and its cost, it is typically used only to confirm positive IA test results.

Cocaine False Positives.

Cocaine is known to have one major substance that will yield false positives in drug screens: coca leaf and coca leaf tea. Coca leaf is the source of cocaine, which is a Schedule II narcotic in the United States. Due to cocaine being an illegal substance, coca leaf and coca leaf tea are also illegal in the United States, both for brewing as a tea and for chewing.

Consumption of coca tea and the chewing of its leaves is common in South America, especially where coca leaf is grown in Peru, Bolivia, and Columbia. While coca leaf is illegal in the United States, it is still easily accessible for purchase over the Internet and in other countries. Urine analysis of subjects who ingested coca tea indicated that cocaine and two of its metabolites, benzoylecgonine (BE) and ecgonine methyl ester, were present in varying quantities.

Examples of False Positives from Coca-Leaf Tea.

We have had several clients who screened positive for cocaine on employer-ordered drug tests because of their earlier ingestion of coca leaf tea.

In one case, a nurse was visiting his grandmother from South America. The grandmother had a container of tea bags that looked like regular, commercial tea sold in the United States. He brewed a cup of tea and drank it, not knowing that it was coca leaf tea.

The next day, he had an employer-ordered drug test. His drug test was positive for cocaine. Backtracking to try to determine the source, we discovered the package that the coca leaf tea bags were in. They were clearly labeled “coca leaf” but were not labeled as containing cocaine, being illegal, or with any other warnings. The grandmother had brought these back with her on her last trip to South America.

In another case, someone had given a pharmacist a gift basket containing crackers, honey, teas and other different food products. A box of various different teas was included in the gift basket.

The pharmacist sampled the different teas at different times. However, when her employer ordered a drug test, it came back positive for cocaine. The pharmacist was suspended.

Backtracking to find the reason for the positive drug test, we located the gift basket’s label and contents and the tea box, showing that the coca leaf tea was included. The gift basket had been assembled in a foreign country and shipped to the pharmacist from outside the United States.

Amoxicillin and False Positives for Cocaine.

Amoxicillin is also rumored to be a potential source for a cocaine false positive for a urinalysis drug screening. However, a study in the Journal of Analytical Toxicology 2008 seemed to find otherwise. The results from the study found amoxicillin to be an unlikely imposter substance, although the scientific validity of the study might be questioned.

The study tested 33 urine samples from subjects who had been administered a course of amoxicillin. 31 urine samples tested negative; however, two tested positive for BE, a cocaine metabolite. The amount in the two samples that tested positive for the cocaine metabolite was less than 150 nanograms per milligram, the federal cut-off for cocaine. Therefore, the study concluded that amoxicillin is unlikely to cause a false positive urinalysis drug test for cocaine. Click here to read the full study.

I personally take issue with this conclusion. A big red flag here, however, is that this study does show that two out of the 33 samples were, in fact, positive for a cocaine metabolite, or at least its imposter. That’s six percent (6%) of the universe tested. With the millions of people who take amoxicillin every day, that equates to a pretty large number. If one million people each day are on amoxicillin, then this means 60,000 of them could test positive for cocaine on a urinalysis test.

The Centers for Disease Control (CDC) states that in 2019, 54.1 million prescriptions for amoxicillin were written in the U.S. If the same percentage were applied to this group, then 3,346,000 people would test positive for cocaine.

Furthermore, the drug screening tests used by many employers, especially those used by state-sponsored provider health programs or peer assistance programs such as the Florida Intervention Project for Nurses (IPN) and the Florida Professional Resources Network (PRN), often use a much lower cut-off level than the federal level.

One must also question whether the study used statistically significant samples and whether it would be considered scientifically valid. From the small numbers, it probably isn’t. However, it did produce some evidence that amoxicillin can cause a false positive for cocaine.

Other Discussions in Future Blogs.

Remember to read Part 1 and Part 3 of this blog series! Part 1 deals with substances that may cause a false positive for amphetamines. Part 3 deals with substances that may cause a false positive for Marijuana and THC.

Sources:

Algren M.D, Adam D., Micheal R. Christian M.D.. “Buyer Beware: Pitfalls in Toxicology Laboratory Testing.” Missouri Medicine: The Journal of the Missouri State Medical Association. (May 2015). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6170116/

“Can I Bring Coca Leaves into the United States?” U.S. Customs and Border Protection. (21 June 2023). https://help.cbp.gov/s/article/Article-725?language=en_US#:~:text=It%20is%20illegal%20to%20bring,in%20Bolivia%2C%20Peru%20and%20Colombia.

Centers for Disease Control and Prevention. Outpatient antibiotic prescriptions–United States, 2019. https://www.cdc.gov/antibiotic-use/data/report-2019.html (accessed June 30, 2023)

“Cutoff levels for drugs and drug metabolites.” 10 Code of Federal Regulations Section 26.133. https://www.ecfr.gov/current/title-10/chapter-I/part-26/subpart-G/section-26.133 (accessed 6/30/2023, last amended 6/26/2023)

Jenkins, Amanda J., Teobaldo Llosa, Ivan Montoya, and Edward J. Cone. “Identification and Quantitation of Alkaloids in Coca Tea.” Forensic Science International. (9 February 1996). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2705900/#:~:text=This%20study%20has%20shown%20that,urine%20drug%20test%20for%20cocaine.

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

Raouf PharmD., Mena, Jeffrey J. Bettinger PharmD, and Jeffrey Fudin PharmD. “A Practical Guide to Urine Drug Monitoring.” Federal Practitioner. (2018). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6368048/

Reisfield, G. M., Haddad, Johannsen, Voorhees, Chronister, Goldberger, Peele, & Bertholf. “Failure of amoxicillin to produce false-positive urine screens for cocaine metabolite.” Journal of analytical toxicology, 32(4), 315–318. (2008). https://academic.oup.com/jat/article/32/4/315/750650

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

The Health Law Firm’s attorneys routinely represent nurses, pharmacists, counselors, physicians, dentists, and other health professionals in matters involving allegations of impairment, drug diversion, and drug abuse, and referrals to the Intervention Project for Nurses (IPN), the Professional Resource Network (PRN), physician health programs, and peer assistance program.

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 |2024-03-14T09:59:26-04:00July 11, 2023|Categories: Nursing Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on Medications and Other Substances that Mimic Prohibited Drugs on Urinalysis Drug Tests: Cocaine and Imposter Substances (Part 2 of Series)
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“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A.
The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 2022 The Health Law Firm. All rights reserved.
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