DOJ Files False Claims Suit Against Nursing Homes Over “Substandard Services and Nonexistent” Care

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

On June 15, 2022, the U.S. Department of Justice (DOJ) announced it has sued three nursing homes in Ohio and Pennsylvania, citing their “grossly substandard skilled nursing services.” The False Claims Act (FCA) complaint against the American Health Foundation (AHF), its affiliate AHF Management Corporation, and three nursing homes alleges the facilities fraudulently billed the Centers for Medicare & Medicaid Services (CMS) for often “nonexistent care.”

According to the complaint, all three AHF nursing homes not only provided substandard nursing home care services that failed to meet required standards of care but also did not maintain adequate staffing levels between 2016 and 2018.

Click here to view the complaint filed by the DOJ in the U.S. District Court for the Eastern District of Pennsylvania.

FCA Violations For “Substandard or Nonexistent Care.”

The government alleged AHF Management and its entities violated the FCA stemming from reimbursements for “grossly substandard” care provided at the Cheltenham, Wilmington Place, and Samaritan nursing homes.

“The defendants knowingly submitted, or caused the submission of, false claims to Medicare and Medicaid for nursing home care and services that were blatantly substandard or nonexistent,” the complaint read. “The Medicare and Medicaid programs provided reimbursement for the claims, but these payments were by mistake as CMS didn’t know the true and full extent of the defendants’ failure to provide patients with proper treatment and care.”

Alleged Patient Conditions and Mistreatment.

Examples of the appalling conditions described in the complaint included housing elderly and medically vulnerable patients in “pest-infested” buildings whose belongings were often stolen; giving residents unnecessary medications, including antibiotic, anti-psychotic, anti-anxiety, and hypnotic drugs; subjecting residents to verbal abuse; neglecting to provide residents with activities or stimulation, and failing to provide needed psychiatric care.

Additionally, the complaint outlines the suicide of a resident who was admitted with a history of self-harm and was later hospitalized after slashing his wrists but still was not provided psychiatric services. Tragically, just weeks after readmission, the resident committed suicide by hanging himself from a bedsheet in a shower room, justice officials said.

“Nursing homes are expected to provide their residents, which include some of our most vulnerable individuals, with quality care and to treat them with dignity and respect,” said Assistant Attorney General Brian M. Boynton, head of the DOJ’s Civil Division in a statement. He continued, “the department will not tolerate nursing homes, or their owners or managing entities, who abdicate these responsibilities and seek taxpayer funds to which they are not entitled.”

To read the DOJ’s press release in full on the case, click here.

The United States’ complaint stems from an investigation that the DOJ initiated as part of its “National Nursing Home Initiative.” The department launched the initiative in March 2020 to identify and investigate nursing homes that provide grossly substandard care.

Click here to learn more about the Justice Department’s nursing home initiative.

The case is United States v. American Health Foundation Inc., case number 2:22-cv-02344, in the U.S. District Court for the Eastern District of Pennsylvania.

Contact Health Law Attorneys Experienced in Handling False Claims Act (FCA) Violations, Investigations, and other Legal Proceedings.

The attorneys of The Health Law Firm represent healthcare providers in defending audits and investigations by the Department of Health and Human Services, the Department of Justice, The Drug Enforcement Administration (DEA), the Florida Department of Health (DOH), Medicaid Fraud Control Unit (MFCU), state boards of medicine, state boards of pharmacy, and state boards of nursing. They also represent health professionals and providers in administrative litigation (state and federal) and civil litigation (state and federal). They represent physicians, nurses, medical groups, nursing homes, home health agencies, pharmacies, dentists, pharmacies, assisted living facilities, and other healthcare providers and institutions in recovery actions and termination from Medicare and Medicaid Programs.

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.

Sources:

D’Annunzio, P.J. “Feds Hit Nursing Home With FCA Suit Over ‘Nonexistent’ Care.” Law360. (June 15, 2022). Web.

Marceas, Kimberly. ‘Grossly substandard’ care leads to False Claims charges for Ohio-based nursing home operator. McKnights Long Term Care News. (June 16, 2022). Web.

“Nursing Homes Face DOJ False Claims Suit Over Standards of Care.” Bloomberg Law. (June 15, 2022). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law is an attorney with 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, Florida 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.

“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 © 2022 The Health Law Firm. All rights reserved.

 

By |2024-03-14T09:59:18-04:00October 5, 2023|Categories: Health Facilities Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on DOJ Files False Claims Suit Against Nursing Homes Over “Substandard Services and Nonexistent” Care

Iowa Appellate Court Reverses $6 Million Nursing Home Negligence Decision Because of Hearsay Testimony

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 June 21, 2023, the Iowa Court of Appeals overturned the verdict in a nursing home negligence case that awarded $6 million in compensation and damages to the plaintiff. The case was reversed and remanded for a new trial because the trial court judge admitted inadmissible hearsay testimony into evidence. The testimony being appealed was that of staff members who claimed to have heard “reports” and “rumors” of alleged abuse by a nurse on staff toward not only the resident in question but other residents.
Hearsay in Iowa law is defined as “a statement, other than one made by the declarant while testifying at the trial or hearing, offered to prove the truth of the matter asserted.” Click here to read the Iowa Rules of Evidence concerning hearsay. This is the same definition used by the federal and most other courts.
Essentially, hearsay is when someone repeats something they heard from another person and presents it as if they know it to be true. Hearsay is often equated to rumor. Hearsay is not admissible due to the nature of speculation required in making such a statement, the fact that such statements are inherently unreliable and that the actual witness is not in court to answer questions about it. Thus there is no way for a party or the judge to test the credibility of the actual witness or determine facts that may have influenced the observation and statement.
Hearsay is considered unreliable because the person who knows what happened (who saw what happened or heard what happened) is not to be questioned about it. Therefore, there is no way to know what really happened for sure.
Details of the Case. 
In this case, the estate of the former nursing home resident, who succumbed to her injuries after a fall in the nursing home, claimed adult abuse and that negligence caused a wrongful death. In its defense, the nursing home focused on the alleged abuse by a nurse on the staff. The statements challenged in the appeal included testimony made by six nursing home staff members that residents, other unnamed employees, and an Iowa Department of Inspections and Appeals surveyor told them that the nurse in question had been physically rough with and swore at residents.
The employees testifying did not actually witness any such incidents. They were only testifying about someone else’s words (“hearsay”). 
The trial court admitted these statements, allegedly not for their truth, but in an attempt to show that abuse had been reported and there had not been any follow-up investigation. The appellate court stated that this was not a valid reason to admit inadmissible hearsay into evidence because the estate must prove that the conduct existed to prevent the jury from engaging in rampant speculation based on unreliable hearsay evidence.
People in today’s society, yes, even judges, often forget this basic principle of law. With all of the fabricated lies being put out as “news” on some news channels, Internet rumors running rampant, and politicians making egregiously false statements, it’s often hard to remember how to distinguish a fact from an unreliable rumor or hearsay.
This is one of the problems with hearsay. It is often just gossip and rumor, which change from person to person. Especially egregious conduct, criminal activity, and salacious acts become increasingly exaggerated with each retelling. The founding fathers in English and American law realized the inherently unreliable nature of such “evidence.”
Under the hearsay rule, the Court of Appeals agreed with the nursing home that the statements being challenged were inadmissible hearsay evidence that influenced the jury’s verdict. Due to this, the court reversed the verdict and remanded the case for a new trial. To read the court’s opinion in full, click here.
Contact Experienced Health Law Attorneys.
The Health Law Firm routinely represents health professionals and health facilities in civil and administrative litigation. We also represent physicians, nurses, and other health providers in investigations, regulatory matters, licensing issues, board hearings, inspections, and audits involving the DEA, Department of Health (DOH), and other law enforcement agencies. Its attorneys include those who are board-certified by The Florida Bar in Health Law as well as licensed health professionals who are also attorneys.  We represent medical students, interns, resident physicians, and fellows in disputes with their graduate medical education (GME) programs.  We represent clinical professors and instructors in contract disputes, employment disputes, clinical privileges matters, and other disputes with their employers.  We often act as the physician’s personal counsel in medical malpractice litigation.
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. Hartley Brooks is a law clerk with the health law firm. 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.
Attorney Positions with The Health Law Firm. The Health Law Firm always seeks qualified attorneys interested in health law practice. Its main office is in the Orlando, Florida, area. If you are a member of The Florida Bar and are interested, forward a cover letter and your resume to: [email protected] or fax 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.

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)

Florida Nursing Students Sue College For Deceptive NCLEX Scheme

Author Headshot, smiling in dark blue suit with red tie in front of a light tan backgroundBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On December 2, 2022, four nursing students from HCI College (formerly Health Career Institute) in Florida filed a federal class action lawsuit against the school. The students claim the school conducted a “malicious scheme” to block 95% of students from graduating and taking the National Council Licensure Examination (NCLEX). The lawsuit also accuses the nursing school of misrepresenting its accreditation status and NCLEX passage rates.

Critical Details Of The Lawsuit.

The class action, brought by four named plaintiffs, was filed in Federal Court in West Palm Beach. The plaintiffs are demanding to have their loans canceled, and payments refunded and are seeking an injunction to allow all students to take the NCLEX exam.

The suit claims that HCI College misrepresented its accreditation status and lied about its NCLEX pass rates. It also states that it deliberately attempted to prevent students from graduating and taking the NCLEX by unfairly dropping them from the program or forcing them to pay to retake classes that HCI argued were non-transferrable. According to the filing, the school is accused of only graduating students who showed the highest likelihood of passing the NCLEX, thus fraudulently inflating the program’s pass rates.

A History of Alleged Questionable Conduct.

In 2018 and 2019, HCI was put on probation by the Florida Board of Nursing for having NCLEX pass rates below state standards for nursing programs. When they failed to obtain accreditation, the Florida BON terminated the nursing program on August 7, 2019.

Rather than attempt to improve the nursing program and apply for reinstatement, the school allegedly created a “new” program and obtained a different state identification number. They used the same curriculum and same instructors as before, but the “new” program allowed the poor pass rates of prior graduates to be wiped clean.

Then, the college was able to use the guise of this “new” program to mislead students and hide their termination status, lack of accreditation, and the dismal NCLEX pass rates of the “old” program.

The bottom line: creating a “new” program would theoretically buy the college five more years to meet BON accreditation requirements. Despite this, HCI continued to charge students approximately $50,000 in tuition and fees to complete their unfortunately subpar ASN program. Click here to view the plaintiff’s class action and learn more about this case.

HCI College disputes these claims and alleges a disgruntled former faculty member initiated the suit. You can read a statement issued on their website on the status of their Florida accreditation and the fake nursing diploma scheme here.

Key Takeaways From This Case.

This lawsuit and the recent fake nursing diploma scams in Florida highlight the adverse effects of insufficient regulation and oversight in Florida’s nursing education programs. Many nurses and nursing students contact our law firm for legal representation who are in very similar situations to the ones who brought the class action suit.

One must remember that Florida is a hotbed of fraud. Florida laws have always been slanted toward protecting fraudsters and con men. Perhaps the members of the Florida Legislature seem to have the attitude of “There but for fate go I.” Who knows? Corporate laws that allow the creation of shell corporations and companies and allow their owners to remain anonymous abound in Florida. It has always, in recent memory, been known as a “debtor’s haven” where people who owe others money could flee in order to avoid being held civilly liable for their debts.

 

Don’t Wait! Contact Health Law Attorneys Experienced in Investigations Against Nurses and Nursing Students.

The attorneys of The Health Law Firm provide legal representation to nurses, nursing students, Advanced Practice Registered Nurses (APRNs), CRNA’s and other health professionals in Department of Health (DOH) investigations, license defense hearings, Department of Justice (DOJ) investigations, board of nursing investigations, formal and informal administrative hearings, emergency suspension orders, emergency restriction orders, appeals and other types of investigations of health professionals and providers.

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.

Sources:

Roberts, Ayla. “4 Nursing Students Sue Florida College For Alleged NCLEX Scheme.” Nurse.org. (January 23, 2023). Web.

Bean, McKenzie. “Students sue Florida nursing school, alleging they were blocked from NCLEX.” Becker’s Hospital Review. (February 3, 2023). Web.

“4 Nursing Students Sue Their School Over Deceptive Scheme.” Nurse News Today. (February 13, 2023). Web.

Press Release. “Nursing Students Sue Florida For-Profit School, HCI College, for Deceitful Scheme to Block Students From Taking Licensing Exam and Trap Them in Debt.” The Project on Predatory Student Lending. (February 3, 2023). Web.

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 The Health Law Firm. All rights reserved.

By |2024-03-14T09:59:21-04:00September 5, 2023|Categories: Health Facilities Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on Florida Nursing Students Sue College For Deceptive NCLEX Scheme

Iowa Appellate Court Reverses $6 Million Nursing Home Negligence Decision Because of Hearsay Testimony

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 June 21, 2023, the Iowa Court of Appeals overturned the verdict in a nursing home negligence case that awarded $6 million in compensation and damages to the plaintiff. The case was reversed and remanded for a new trial because the trial court judge admitted inadmissible hearsay testimony into evidence. The testimony being appealed was that of staff members who claimed to have heard “reports” and “rumors” of alleged abuse by a nurse on staff toward not only the resident in question but other residents.
Hearsay in Iowa law is defined as “a statement, other than one made by the declarant while testifying at the trial or hearing, offered to prove the truth of the matter asserted.” Click here to read the Iowa Rules of Evidence concerning hearsay. This is the same definition used by the federal and most other courts.
Essentially, hearsay is when someone repeats something they heard from another person and presents it as if they know it to be true. Hearsay is often equated to rumor. Hearsay is not admissible due to the nature of speculation required in making such a statement, the fact that such statements are inherently unreliable and that the actual witness is not in court to answer questions about it. Thus there is no way for a party or the judge to test the credibility of the actual witness or determine facts that may have influenced the observation and statement.
Hearsay is considered unreliable because the person who knows what happened (who saw what happened or heard what happened) is not to be questioned about it. Therefore, there is no way to know what really happened for sure.
Details of the Case. 
In this case, the estate of the former nursing home resident, who succumbed to her injuries after a fall in the nursing home, claimed adult abuse and that negligence caused a wrongful death. In its defense, the nursing home focused on the alleged abuse by a nurse on the staff. The statements challenged in the appeal included testimony made by six nursing home staff members that residents, other unnamed employees, and an Iowa Department of Inspections and Appeals surveyor told them that the nurse in question had been physically rough with and swore at residents.
The employees testifying did not actually witness any such incidents. They were only testifying about someone else’s words (“hearsay”). 
The trial court admitted these statements, allegedly not for their truth, but in an attempt to show that abuse had been reported and there had not been any follow-up investigation. The appellate court stated that this was not a valid reason to admit inadmissible hearsay into evidence because the estate must prove that the conduct existed to prevent the jury from engaging in rampant speculation based on unreliable hearsay evidence.
People in today’s society, yes, even judges, often forget this basic principle of law. With all of the fabricated lies being put out as “news” on some news channels, Internet rumors running rampant, and politicians making egregiously false statements, it’s often hard to remember how to distinguish a fact from an unreliable rumor or hearsay.
This is one of the problems with hearsay. It is often just gossip and rumor, which change from person to person. Especially egregious conduct, criminal activity, and salacious acts become increasingly exaggerated with each retelling. The founding fathers in English and American law realized the inherently unreliable nature of such “evidence.”
Under the hearsay rule, the Court of Appeals agreed with the nursing home that the statements being challenged were inadmissible hearsay evidence that influenced the jury’s verdict. Due to this, the court reversed the verdict and remanded the case for a new trial. To read the court’s opinion in full, click here.
Contact Experienced Health Law Attorneys.
The Health Law Firm routinely represents health professionals and health facilities in civil and administrative litigation. We also represent physicians, nurses, and other health providers in investigations, regulatory matters, licensing issues, board hearings, inspections, and audits involving the DEA, Department of Health (DOH), and other law enforcement agencies. Its attorneys include those who are board-certified by The Florida Bar in Health Law as well as licensed health professionals who are also attorneys.  We represent medical students, interns, resident physicians, and fellows in disputes with their graduate medical education (GME) programs.  We represent clinical professors and instructors in contract disputes, employment disputes, clinical privileges matters, and other disputes with their employers.  We often act as the physician’s personal counsel in medical malpractice litigation.
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. Hartley Brooks is a law clerk with the health law firm. 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.
Attorney Positions with The Health Law Firm. The Health Law Firm always seeks qualified attorneys interested in health law practice. Its main office is in the Orlando, Florida, area. If you are a member of The Florida Bar and are interested, forward a cover letter and your resume to: [email protected] or fax 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.

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)

Iowa Appellate Court Reverses $6 Million Nursing Home Negligence Decision Because of Hearsay Testimony

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 June 21, 2023, the Court of Appeals of Iowa overturned the verdict in a nursing home negligence case that awarded $6 million in compensation and damages to the plaintiff. The case was reversed and remanded for a new trial because inadmissible hearsay testimony was admitted into evidence by the trial court judge. The testimony being appealed was that of staff members who claimed to have heard “reports” and “rumors” of alleged abuse by a nurse on staff toward, not only the resident in question but other residents as well.

Hearsay in Iowa law is defined as “a statement, other than one made by the declarant while testifying at the trial or hearing, offered to prove the truth of the matter asserted.” Click here to read the Iowa Rules of Evidence concerning hearsay.  This is the same definition used by the federal courts and most other courts.

Essentially, hearsay is when someone repeats something they heard from another person and presents it as if they know it to be true. Hearsay is often equated to rumor. Hearsay is not admissible due to the nature of speculation required in making such a statement, the fact that such statements are inherently unreliable, and the fact that the actual witness is not in court to answer questions about it. Thus there is no way for a party or the judge to test the credibility of the actual witness or determine facts that may have influenced the observation and statement.

Hearsay is considered unreliable because the person who actually knows what happened (who saw what happened or heard what happened) is not present to be questioned about it. Therefore, there is no way to know what really happened for sure.

Details of the Case. 

In this case, the estate of the former nursing home resident, who succumbed to her injuries after a fall in the nursing home claimed adult abuse and that negligence caused a wrongful death. In its defense, the nursing home focused on the alleged abuse by a nurse on the staff. The statements that were challenged in the appeal included testimony made by six members of the nursing home staff that residents, other unnamed employees, and an Iowa Department of Inspections and Appeals surveyor told them that the nurse in question had been physically rough with and swore at residents.

The employees testifying did not actually witness any such incidents. They were only testifying as to what they had heard someone else say (“hearsay”).

The trial court admitted these statements, allegedly not for their truth, but in an attempt to show that abuse had been reported and there had not been any follow-up investigation. The appellate court stated that this was not a valid reason to admit inadmissible hearsay into evidence because the estate must show clear proof that the conduct existed in order to prevent the jury from engaging in rampant speculation based on unreliable hearsay evidence.

People in today’s society, yes, even judges, often forget this basic principle of law. With all of the completely fabricated lies being put out as “news” on some news channels, with Internet rumors running rampant, and with politicians making egregiously false statements, it’s often hard to remember how to distinguish a fact from unreliable rumor or hearsay.

This is one of the problems with hearsay. It is often just gossip and rumor which change from person to person. Especially egregious conduct, criminal activity, and salacious acts become more and more exaggerated with each retelling. The founding fathers in English and American law realized the inherently unreliable nature of such “evidence.”

Under the hearsay rule, the Court of Appeals agreed with the nursing home that the statements being challenged were inadmissible hearsay evidence that influenced the jury’s verdict. Due to this, the court reversed the verdict and remanded the case for a new trial. To read the court’s opinion in full, click here.

Contact Experienced Health Law Attorneys.

The Health Law Firm routinely represents health professionals and health facilities in civil and administrative litigation. We also represent physicians, nurses, and other health providers in investigations, regulatory matters, licensing issues, board hearings, inspections, and audits involving the DEA, Department of Health (DOH), and other law enforcement agencies. Its attorneys include those who are board certified by The Florida Bar in Health Law as well as licensed health professionals who are also attorneys.  We represent medical students, interns, resident physicians, and fellows in disputes with their graduate medical education (GME) programs.  We represent clinical professors and instructors in contract disputes, employment disputes, clinical privileges matters, and other disputes with their employers.  We often act as the physician’s personal counsel in medical malpractice litigation.
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: 

Kang, Y. Peter. “Iowa Court Overturns $6M Nursing Home Negligence Verdict.” Law360. (June 22, 2023). https://www.law360.com/health/articles/1691891?nl_pk=0cbd4c0b-c6c8-416a-9e67-b4affa63b102&utm_source=newsletter&utm_medium=email&utm_campaign=health&utm_content=2023-06-23&nlsidx=0&nlaidx=9

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. Hartley Brooks is a law clerk with the health law firm. 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.

Attorney Positions with The Health Law Firm. The Health Law Firm is always looking for qualified attorneys interested in health law practice. Its main office is in the Orlando, Florida, area. If you are a member of The Florida Bar and are interested, forward a cover letter and your resume to: [email protected] or fax 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.

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.

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)

Nursing Students Sue Florida School For Deceptive NCLEX Scheme

Author Headshot, smiling in dark blue suit with red tie in front of a light tan backgroundBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On December 2, 2022, four nursing students from HCI College (formerly Health Career Institute) in Florida filed a federal class action lawsuit against the school. The students claim the school conducted a “malicious scheme” to block 95% of students from graduating and taking the National Council Licensure Examination (NCLEX). The lawsuit also accuses the nursing school of misrepresenting its accreditation status and NCLEX passage rates.

Critical Details Of The Lawsuit.

The class action, brought by four named plaintiffs, was filed in Federal Court in West Palm Beach. The plaintiffs are demanding to have their loans canceled, and payments refunded and are seeking an injunction to allow all students to take the NCLEX exam.

The suit claims that HCI College misrepresented its accreditation status and lied about its NCLEX pass rates. It also states that it deliberately attempted to prevent students from graduating and taking the NCLEX by unfairly dropping them from the program or forcing them to pay to retake classes that HCI argued were non-transferrable. According to the filing, the school is accused of only graduating students who showed the highest likelihood of passing the NCLEX, thus fraudulently inflating the program’s pass rates.

A History of Alleged Questionable Conduct.

In 2018 and 2019, HCI was put on probation by the Florida Board of Nursing for having NCLEX pass rates below state standards for nursing programs. When they failed to obtain accreditation, the Florida BON terminated the nursing program on August 7, 2019.

Rather than attempt to improve the nursing program and apply for reinstatement, the school allegedly created a “new” program and obtained a different state identification number. They used the same curriculum and same instructors as before, but the “new” program allowed the poor pass rates of prior graduates to be wiped clean.

Then, the college was able to use the guise of this “new” program to mislead students and hide their termination status, lack of accreditation, and the dismal NCLEX pass rates of the “old” program.

The bottom line: creating a “new” program would theoretically buy the college five more years to meet BON accreditation requirements. Despite this, HCI continued to charge students approximately $50,000 in tuition and fees to complete their unfortunately subpar ASN program. Click here to view the plaintiff’s class action and learn more about this case.

HCI College disputes these claims and alleges a disgruntled former faculty member initiated the suit. You can read a statement issued on their website on the status of their Florida accreditation and the fake nursing diploma scheme here.

Key Takeaways From This Case.

This lawsuit and the recent fake nursing diploma scams in Florida highlight the adverse effects of insufficient regulation and oversight in Florida’s nursing education programs. Many nurses and nursing students contact our law firm for legal representation who are in very similar situations to the ones who brought the class action suit.

One must remember that Florida is a hotbed of fraud. Florida laws have always been slanted toward protecting fraudsters and con men. Perhaps the members of the Florida Legislature seem to have the attitude of “There but for fate go I.” Who knows? Corporate laws that allow the creation of shell corporations and companies and allow their owners to remain anonymous abound in Florida. It has always, in recent memory, been known as a “debtor’s haven” where people who owe others money could flee in order to avoid being held civilly liable for their debts.

 

Don’t Wait! Contact Health Law Attorneys Experienced in Investigations Against Nurses and Nursing Students.

The attorneys of The Health Law Firm provide legal representation to nurses, nursing students, Advanced Practice Registered Nurses (APRNs), CRNA’s and other health professionals in Department of Health (DOH) investigations, license defense hearings, Department of Justice (DOJ) investigations, board of nursing investigations, formal and informal administrative hearings, emergency suspension orders, emergency restriction orders, appeals and other types of investigations of health professionals and providers.

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.

Sources:

Roberts, Ayla. “4 Nursing Students Sue Florida College For Alleged NCLEX Scheme.” Nurse.org. (January 23, 2023). Web.

Bean, McKenzie. “Students sue Florida nursing school, alleging they were blocked from NCLEX.” Becker’s Hospital Review. (February 3, 2023). Web.

“4 Nursing Students Sue Their School Over Deceptive Scheme.” Nurse News Today. (February 13, 2023). Web.

Press Release. “Nursing Students Sue Florida For-Profit School, HCI College, for Deceitful Scheme to Block Students From Taking Licensing Exam and Trap Them in Debt.” The Project on Predatory Student Lending. (February 3, 2023). Web.

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.

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