OB-GYN-L Messages for September, 2006: drug screening

drug screening

From:

Babycatchers@aol.com

Mon Sep 4 17:24:42 2006

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I have a quick question and what I think may be a big problem.

Is anyone else doing urine drug screens as a routine part of prenatal care? It seems that the other providers in my rural area are doing a urine screen during pregnancy. So now we are getting all the patients that are abusing or train wrecks waiting to happen. Our administration talked to the lawyers and they said as long as we test everyone, then we can do RDS screens on all OBs at least once. If they are posi tive, we then refer them to the treatment centers in the area and our DHHR Right From The Start Program. Positive test patients are then referred for a social service consult at delivery and the peds test the baby. Someone around here said the ACOG standards changed to approve of RDS, but I can't find any references.

I have some moral and ethical heartburn with this situation, but I am not quite sure what I need to do. We have to report the drug use if the baby is positive at birth, but in WV there is not a mandatory reporting law for pregnancy. The treatment options are scarce. If they are medicaid, then there is an outpatient treatment center with once a week meetings. If they are private, most insurances will not pay for therapy. According to administration, as long as I give the referral information to the pt (phone numbers, contacts), then we are covered legally.

An example that has us sick with worry: 35 yo G6 P3 TAB X 2 who does not have custody of her children because of drug abuse. She was still abusing (but didn't admit to anything but THC), alcoholic (she had CUT DOWN to one case of beer per day). I did the initial OB intake and physical. When she came back a week later for US with our OB, she had a fetal demise. The OB did a D&C, but she continued to bleed and bleed. The only IV line they could get was a leg vein. She had a lateral tear on the cervix that he thought was the cause, but it didn't stop after repair. During the course of the train wreck the general surgeon came in and put in a central line. By the time he opened her belly,she had 3000 cc blood in the belly. DIC and it is a long mountain road downhill. After God knows how many units of PRBCs and everything else he could think of- he did an emergency hyst. She still bled and he packed her belly and flew her off to our referral center. They removed packing, opened and repacked, removed the packing and the opened her again and found a ruptured spleen. Then they did an uterine artery embolism and she finally quit bleeding. But she is still in hepatic and renal failure. I forgot to mention that she was Hep C positive with no treatment. They said the only way to save her is a liver transplant and she is not a candidate.

I have done 3 new OBs in the last week that are almost as bad. That is why the administration wants to do the RDS on the first visit or for the already established patients, once at their next visit. I think it is knee jerk cover our butts reaction, but I don't blame them. WV is one of the highest litigation states and it is next to impossible to get malpractice already.

Suggestions? If ACOG standards have changed, can someone give me the reference please.

Thank you, Vicki

Vicki Smith, CNM, MSN West Virginia Midwives- changing the world one baby at a time.

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