Susan Horton had been a stay-at-home mother for nearly 20 years, and now — pregnant along with her fifth youngster — she felt a hard-won confidence in herself as a mom.
Then she ate a salad from Costco.
It was her ultimate meal earlier than going to Kaiser Permanente hospital in Santa Rosa, in northern California, to provide start in August 2022. It had been an exhausting being pregnant. Her household had simply moved homes, and Horton was nonetheless breastfeeding her toddler. Due to her teenage son’s coronary heart situation, she remained cautious of COVID-19 and prevented crowded locations, even physician’s places of work. Now, already experiencing the clawing pangs of contractions, she pulled out a frozen pizza and a salad with creamy all the things dressing, savoring the hush that fell over the home, the satisfying crunch of the poppy seeds as she ate.
Horton didn’t understand that she can be drug examined earlier than her youngster’s start. Or that the poppy seeds in her salad may set off a optimistic consequence on a urine drug display screen, the fast check that hospitals usually use to verify pregnant sufferers for illicit medication. Many frequent meals and medicines — from antacids to blood strain and chilly medicines — can immediate faulty outcomes.
The morning after Horton delivered her daughter, a nurse informed her she had examined optimistic for opiates. Horton was shocked. She hadn’t requested an epidural or any narcotic ache treatment throughout labor — she didn’t even like taking Advil. “You’re positive it was mine?” she requested the nurse.
If Horton had been examined beneath completely different circumstances — for instance, if she was a authorities worker and required to be examined as a part of her job — she would have been entitled to a extra superior check and to a assessment from a specifically educated physician to substantiate the preliminary consequence.
However as a mom giving start, Horton had no such protections. The hospital rapidly reported her to youngster welfare, and the subsequent day, a social employee arrived to take child Halle into protecting custody.
Kaiser Permanente declined to touch upon Horton’s care. In an announcement, it mentioned the Santa Rosa hospital sometimes will get consent to drug-test sufferers for medical causes, and as a mandated reporter beneath state legislation, it refers potential exposures of newborns to illicit medication to youngster welfare authorities.
The Sonoma County Human Companies Division mentioned, in an announcement, that it evaluates all referrals utilizing “evidence- and research-based” strategies, and if a report is deemed legitimate, it has an obligation beneath state legislation to analyze.
Horton mentioned the expertise made her really feel powerless and terrified.
“They’d a singular piece of proof that I had taken one thing,” she mentioned, “and it was mistaken.”
For many years, state and federal legal guidelines have required hospitals throughout the nation to establish newborns affected by medication within the womb and to refer such instances to youngster protecting companies for potential investigation. To conform, hospitals usually use urine drug screens which are cheap (as little as $10 per check), easy to manage (the affected person pees in a cup), and supply outcomes inside minutes.
However urine drug screens are simply misinterpreted and infrequently mistaken, with false optimistic charges as excessive as 50%, in line with some research. With out affirmation testing and extra assessment, false optimistic outcomes can lead hospitals to wrongly accuse mother and father of illicit drug use and report infants to youngster welfare companies — which can separate newborns from their households, an investigation by The Marshall Mission and Reveal has discovered.
It’s unclear how most of the nation’s 3.6 million births yearly contain drug testing, however well being care consultants mentioned urine screening is ubiquitous. Tens of hundreds of infants are reported yearly to authorities for in utero drug publicity, with no assure that the underlying assessments are correct, our evaluation of federal knowledge reveals.
To report this story, The Marshall Mission interviewed dozens of sufferers, medical suppliers, toxicologists and different consultants, and picked up info on greater than 50 moms in 22 states who confronted stories and investigations over optimistic drug assessments that have been seemingly mistaken. We additionally pored over hundreds of pages of coverage paperwork from each state youngster welfare company within the nation.
Issues with drug screens are well-known, particularly in office testing. However there’s been little investigation of how simply false positives can happen inside labor and supply models, and the way rapidly households can get trapped inside a system of surveillance and punishment.
Hospitals reported ladies for optimistic drug assessments after they ate all the things bagels and lemon poppy seed muffins, or used medicines together with the acid reducer Zantac, the antidepressant Zoloft and labetalol, one of the vital generally prescribed blood strain therapies for pregnant ladies.
After a California mom had a false optimistic for meth and PCP, authorities took her new child, then dispatched two sheriff’s deputies to additionally take away her toddler from her custody, court docket data present. In New York, hospital directors refused to retract a toddler welfare report primarily based on a false optimistic consequence, and as a substitute supplied the mom counseling for her trauma, in line with a recording of the dialog. And when a Pennsylvania girl examined optimistic for opioids after consuming pasta salad, the listening to officer in her case yelled at her to “buck up, get a spine, and cease crying,” court docket data present. It took three months to get her new child again from foster care.
Federal officers have recognized for many years that urine screens aren’t dependable. Poppy seeds — which come from the identical plant used to make heroin — are so infamous for inflicting positives for opiates that final 12 months the Division of Protection directed service members to cease consuming them. At hospitals, check outcomes usually include warnings about false positives and direct clinicians to substantiate the findings with extra definitive assessments.
But state insurance policies and lots of hospitals are likely to deal with drug screens as unassailable proof of illicit use, The Marshall Mission discovered. Hospitals throughout the nation routinely report instances to authorities with out ordering affirmation assessments or ready to obtain the outcomes.
At the very least 27 states explicitly require hospitals to alert youngster welfare companies after a optimistic display screen or potential publicity, in line with a assessment of state legal guidelines and insurance policies by The Marshall Mission. However not a single state requires hospitals to substantiate check outcomes earlier than reporting them. At the very least 25 states don’t require youngster welfare staff to substantiate optimistic check outcomes, both.
Whereas mother and father usually lack protections, many of the caseworkers who examine them are entitled to affirmation testing and a assessment in the event that they check optimistic for medication on the job, our evaluation discovered.
Well being care suppliers say there are medical causes to check labor and supply sufferers for medication, together with alerting medical doctors to look at a new child for withdrawal signs. Additionally they cite issues about prison and authorized legal responsibility in the event that they fail to report optimistic check outcomes.
Even when a health care provider refutes a optimistic consequence and vouches for his or her affected person, hospitals might report the wrong knowledge anyway to youngster welfare companies.
“It’s nearly like a intestine punch. You come to the hospital and also you see a social work notice in your affected person’s chart,” mentioned Dr. Yashica Robinson, an OB/GYN in Huntsville, Alabama, who has tried and failed a number of occasions to halt youngster welfare stories and investigations of sufferers with false optimistic outcomes. “As soon as that ball is rolling, it’s arduous to cease it,” Robinson mentioned.
No authorities company collects complete knowledge on false optimistic outcomes or what number of pregnant sufferers are examined. And confidentiality legal guidelines that protect medical and youngster welfare data make it tough for the general public to know what number of households are affected.
In 2016, Congress mandated states to submit the variety of “substance-affected” infants to the U.S. Division of Well being and Human Companies. Not all states monitor each case, however from fiscal years 2018 by 2022, medical professionals reported no less than 170,000 infants to youngster welfare companies for publicity to substances, in line with an evaluation by The Marshall Mission. In 2022 alone, greater than 35,000 such instances have been reported, and authorities eliminated greater than 6,000 infants from their households, our evaluation discovered.
The harms of drug testing fall disproportionately on low-income, Black, Hispanic and Native American ladies, who research have discovered usually tend to be examined after they give start, extra more likely to be investigated, and fewer more likely to reunite with their youngsters after they’ve been eliminated.
However the false-positive instances The Marshall Mission recognized embrace mother and father of all socioeconomic lessons and occupations — from a lawyer to a college librarian to a nurse who drug assessments different folks for a dwelling.
“Folks must be involved,” mentioned Dr. Stephen Patrick, a number one neonatal researcher who chairs the Division of Well being Coverage and Administration on the Rollins Faculty of Public Well being in Atlanta. “This might occur to any one among us.”
Drug screens are extra guesswork than actual science. Chemical substances within the assessments rapidly cross-react with urine, flagging something that appears prefer it may very well be a bootleg substance. The assessments are like fishing nets which are forged large and choose up something and all the things that matches, mentioned Dr. Gwen McMillin, a professor on the College of Utah Faculty of Medication and medical director of a drug-testing lab. The issue is that nets additionally ensnare fish that aren’t being focused: compounds which are intently associated to illicit substances or merely look comparable.
“Drug testing outcomes should be confirmed earlier than they go to CPS,” McMillin mentioned. “Actions shouldn’t be taken primarily based on a single drug testing consequence. Interval.”
However generally, even affirmation assessments might be misinterpreted, as Susan Horton discovered.
At first, Horton was puzzled by her optimistic check consequence. She puzzled if her urine might need been combined up with one other affected person’s. Then — “ding ding ding!” — her final meal popped into her head. She informed a nurse in regards to the poppy seeds in her salad, positive that this could resolve her medical doctors’ issues.
Horton’s data present Kaiser ran her urine pattern by a second check, and this time it got here again optimistic for one opiate specifically: codeine. That shouldn’t have been shocking — poppy seeds, like those in Horton’s salad, are derived from the opium poppy plant and comprise codeine.
To distinguish between salad dressing or bagels and illicit medication, toxicologists have lengthy really useful testing urine for the presence of a compound referred to as thebaine, which is present in poppy seeds, however not in heroin. There’s no indication that the hospital carried out and even knew in regards to the thebaine check, leaving suppliers with no solution to show or disprove Horton’s claims.
“Mother and pop insistent {that a} Costco salad with poppyseed dressing is accountable,” a health care provider wrote in her notes. One other physician wrote: “We’re unable to confirm whether or not this might lead to a optimistic check.”
Quickly, a number of medical doctors and nurses filed into Horton’s room. They mentioned hospital coverage dictated that Halle stay there for 5 days to be monitored for potential drug withdrawal signs — “for child’s security,” a health care provider informed Horton.
In contrast to most different states that require hospitals to report optimistic drug assessments, California legislation says a optimistic check alone “isn’t in and of itself a adequate foundation for reporting youngster abuse or neglect.” However due to COVID-19 and her son’s coronary heart situation, Horton had additionally missed some prenatal appointments, which many suppliers see as a pink flag for drug use. A hospital social employee famous the missed appointments and determined to file a report.
In an announcement about its practices usually, Kaiser mentioned it all the time conducts a “multi-faceted evaluation” previous to submitting a report back to CPS, which is accountable for reviewing the data and investigating.
Horton insisted that conserving her child on the hospital was pointless. “I’m not a drug addict,” she mentioned she pleaded. Determined for assist, her husband referred to as the police, who declined to oppose hospital directives, data present.
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When the caseworker arrived, the couple refused to signal a security plan or enable the particular person to interview their youngsters and examine their residence. So the caseworker instantly obtained a choose’s order and positioned child Halle into short-term custody within the hospital, earlier than discharging her to her grandparents, who have been ordered to oversee Horton along with her youngster.
A number of days later, Horton stood silently in court docket, wearing pants that clung uncomfortably to her still-healing physique, feeling as if her motherhood was on trial. A caseworker informed the choose it might be harmful to launch Halle to her mother and father, and Horton agreed to a different drug check. A employee adopted her to the toilet and watched her urinate in a cup.
By then, caseworkers and medical doctors had privately acknowledged that poppy seeds may have triggered Horton’s optimistic check consequence. However in court docket the caseworker didn’t point out that. As a substitute, she argued that Horton’s purported drug use had “triggered severe bodily hurt” to her youngster.
The company mentioned beneath state legislation it could possibly’t touch upon particular person instances. Talking typically, it mentioned a single optimistic drug check, false or in any other case, doesn’t warrant an investigation, and that there must be “a reported statement of impression to the kid.”
When office drug testing was launched within the Eighties, unions and civil rights teams decried the error charges of drug screens and the way firms have been firing staff over false optimistic outcomes. In response, federal authorities mandated safeguards for workers, together with requiring affirmation assessments and a assessment from a specifically educated physician to find out whether or not a meals or treatment may have triggered a optimistic consequence.
A federal medical advisory committee in 1993 urged well being care suppliers who drug check pregnant sufferers to undertake the identical rigorous requirements. However amid the “crack child” panic, the concept of defending moms didn’t catch on.
Hospital drug testing insurance policies range extensively. Many services, comparable to Kaiser in Santa Rosa, check each single labor-and-delivery affected person. Different hospitals flag solely sure folks, comparable to these with restricted prenatal care, hypertension, even unhealthy tooth, consultants say. At many hospitals, the choice is as much as medical doctors and nurses, who might view a mom’s tattoos, matted clothes or pressured demeanor with suspicion. Research have discovered that the choice to check is rife with class and race bias.
“Those that seem like they’ve much less sources, folks would possibly say, ‘Properly, they give the impression of being extra seemingly to make use of medication,’” mentioned Dr. Cresta Jones, an affiliate professor and maternal-fetal drugs specialist on the College of Minnesota Medical Faculty.
Hospitals usually have full discretion over whether or not or to not display screen for medication, however as soon as a optimistic result’s in hand, the choice to report turns into extra sophisticated. Legal guidelines and insurance policies in no less than 12 states explicitly require hospitals to ship display screen outcomes to youngster welfare companies, even when they aren’t confirmed, in line with The Marshall Mission’s assessment.
For hospitals, value can be a difficulty. Whereas urine screens are low-cost, the gear wanted to run a affirmation check prices a whole lot of hundreds of {dollars}, along with the price of professional personnel and lab certification. Some hospitals contract out affirmation testing — a lower-cost different — however getting outcomes can take days, lengthy after many households are able to go residence.
Medical doctors, nurses and hospital social staff face an uncomfortable predicament: Do they ship the infant residence to what they consider may very well be an unsafe atmosphere, or do they name authorities?
“God forbid the infant goes residence, withdraws and dies, we’re going to be held answerable for that,” mentioned Dr. Adi Davidov, an obstetrician at Staten Island College Hospital, which drug assessments each birthing affected person.
State obligatory reporting legal guidelines add to the strain on medical doctors and nurses. These legal guidelines impose prison legal responsibility on suppliers who fail to report, whereas additionally defending physicians who report “in good religion” — insulating hospitals from lawsuits if check outcomes are mistaken.
Even when medical doctors have the flexibility to order a affirmation check, they don’t all the time accomplish that. Many misread optimistic screens as definitive proof of drug use.
When Grace Smith had her fourth youngster in 2021 at St. Luke’s College Hospital, an hour north of Philadelphia, she was taking prescribed marijuana and Vyvanse, a drugs for consideration deficit hyperactivity dysfunction. The drugs comprises amphetamine, however the hospital’s drug display screen outcomes didn’t differentiate between meth and amphetamine, in line with medical data. The day after Smith delivered her son, a health care provider informed her that she and her child had examined optimistic for meth and that the hospital had notified youngster protecting companies.
Smith’s husband Michael requested the physician to assessment his spouse’s medical data to substantiate her prescription, in line with the physician’s notes. The physician argued that wasn’t her function. “I defined that our duty as healthcare staff was to report the case” to youngster welfare authorities, she wrote, including that the company “would conduct any investigation that was mandatory.”
When Michael Smith informed the physician they have been leaving with their child, the hospital referred to as the police. An officer escorted the mother and father out, with out their new child, a police report reveals. The Smiths mentioned the police informed them they’d be arrested in the event that they returned.
St. Luke’s College Well being Community declined to reply questions from The Marshall Mission, saying in an e mail that the hospital “complies with all guidelines and laws concerning drug testing and reporting” and that the new child’s welfare “is all the time our major concern.”
4 days after the Smiths’ son was born, Monroe County Youngsters and Youth Companies informed the hospital it was OK to launch the infant to his mother and father. However the investigation remained open. It wasn’t till the Smiths paid greater than $3,500 for a lawyer— and practically $300 for a affirmation drug check that got here again destructive — that the company closed their case. The company declined to remark.
The Smiths filed a lawsuit in 2022 towards St. Luke’s. In its response, the hospital acknowledged that it had not given Grace a affirmation check, however denied violating the Smiths’ privateness or civil rights. A choose dismissed the go well with in 2023, saying partly that the Smiths didn’t sufficiently argue their claims.
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Many suppliers erroneously assume that youngster welfare companies confirm a father or mother’s drug use. However authorities caseworkers sometimes lack the experience to precisely interpret drug check outcomes. State coverage manuals seldom point out the opportunity of false positives. It usually falls on mother and father to show their very own innocence.
As a nurse in South Carolina, Ashley Riley mentioned she frequently drug-tested sufferers in an habit remedy program, flagged defective assessments, and despatched out optimistic screens for affirmation. However when she herself screened optimistic for opiates after delivering her son in 2023, Riley mentioned the hospital declined to order a affirmation check, then reported her to authorities.
Riley and her husband, Jeffrey, insisted the optimistic consequence was from lemon poppy seed muffins that she had eaten all through her being pregnant. As proof, Jeffrey Riley texted the investigator a receipt for the muffins, research on false positives attributable to poppy seeds, and the 2023 memo from the Division of Protection urging service members to keep away from poppy seeds.
“At no time limit was there anyone in there that was even making an attempt to advocate for my spouse, apart from me,” he recalled.
At first, he thought his efforts have been working. The caseworker acknowledged in his notes having seen the poppy seeds and famous that the report “may very well be falsified.”
However the caseworker nonetheless insisted the couple signal a security plan, advising them that their two youngsters can be positioned in foster care until they assigned a “protector” — a accountable grownup who would supervise them with their youngsters always. This continued for 45 days earlier than the case was closed as unfounded.
“We have been responsible till confirmed harmless,” Ashley Riley mentioned.
The hospital even charged $424 for the problematic urine check. Hospital officers didn’t reply to a number of interview requests.
Will Batchelor, a spokesperson for the South Carolina Division of Social Companies, wrote in an announcement that the company has an obligation to analyze as soon as a hospital has filed a report, and that it “exercised acceptable restraint” by not eradicating the kid from the house.
“As a result of the protection of a kid is at stake, DSS has to proceed its investigation past seeing a receipt for poppy seed muffins,” Batchelor wrote.
Even when a father or mother has a affirmation check and her personal physician’s phrase testifying to a false optimistic consequence, authorities might maintain investigating.
When Melissa Robinson, an elementary faculty librarian in Huntsville, Alabama, screened positive for cocaine in early 2024, the information shocked her and her medical doctors. Robinson had prevented something throughout her being pregnant that may very well be dangerous, even chilly cuts — which can carry micro organism — and had no historical past of drug use. Due to the optimistic check, employees informed Robinson she was not allowed to breastfeed her daughter, hospital data present, and so they reported her to Alabama’s youngster welfare company, the Division of Human Assets. Robinson mentioned a caseworker informed her that she in all probability wouldn’t be allowed to be alone along with her child — her husband must supervise.
A number of days later, a affirmation check got here again destructive for any substances. With proof that she had not used cocaine, Robinson assumed the case can be closed. As a substitute, the company continued to analyze, inspecting her residence and even requiring her husband to take a drug check, she mentioned.
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Alabama’s youngster welfare company mentioned they’re required to reply instantly to a hospital report and “make security choices counting on present and most accessible info.”
When the infant was two weeks outdated, the company closed the case, citing inadequate proof. However the allegations will stay on Robinson’s document for no less than 5 years.
“To have such a fantastic expertise tainted by one thing like that, it’s tough,” Robinson recalled. “In truth, it’s turned me into anyone completely different.”
Some medical teams and suppliers have taken steps to cut back pointless youngster welfare stories. The American Faculty of Obstetricians and Gynecologists advises hospitals to make use of a screening questionnaire reasonably than drug assessments to establish individuals who might have substance abuse issues. The group additionally recommends that hospitals get hold of consent from sufferers, explaining the potential penalties of a optimistic consequence — together with if the hospital is required to report it to authorities. Quite a lot of giant hospitals have adopted some model of these suggestions.
After a research at Staten Island College Hospital in New York discovered a excessive charge of false positives, directors introduced the affirmation testing in-house. They mentioned outcomes come again inside a day or two, reasonably than the week that’s typical for outdoor assessments, which permits suppliers to attend earlier than contacting youngster welfare.
“Any time you act on a check that’s not 100%, you run the chance of inflicting extra hurt than good,” mentioned the hospital’s Dr. Davidov. “If you will get CPS concerned with a mom who did nothing mistaken, is an efficient citizen, that’s harming her. It’s harming her expertise, it’s harming her capability to handle her new child.”
In recent times, advocacy teams have filed lawsuits towards hospitals for testing with out express consent, which has led some state officers and lawmakers to talk out towards the testing. However in many of the U.S., it stays frequent observe to report households primarily based on unconfirmed optimistic screens. A lot of the ladies interviewed by The Marshall Mission signed common consent varieties on the hospital, however mentioned they have been by no means knowledgeable explicitly they’d be drug examined, nor {that a} optimistic consequence may very well be reported to authorities.
For Susan Horton, her household’s ordeal has created an undercurrent of concern that programs by her every day life.
After the court docket listening to in August 2022, youngster welfare staff took the infant to Horton’s aged in-laws and barred Horton and her husband from being alone with their new child whereas the company investigated. Lastly, nearly two weeks after their daughter was born, the company withdrew its petition and a choose dismissed the case, permitting the Hortons to deliver child Halle residence.
One afternoon final spring, Horton took her daughter, now a toddler, exterior. Halle giggled as her mom chased her across the entrance yard, her little ft splashing in a small mud gap. This was the life Horton had envisioned years in the past — a quiet place within the California countryside the place her youngsters may delight on this planet round them. And but, Horton couldn’t assist however bear in mind the investigation that destroyed her household’s peace of thoughts — and her vanity.
“I had a variety of confidence in how I mom and the way I father or mother,” she mentioned, including later: “Now in my head, I’m all the time questioning my decisions.” She puzzled aloud what neighbors would say in the event that they noticed her daughter enjoying within the mud, if somebody would possibly accuse her of being a nasty father or mother.
“I simply all the time have that looming feeling that at any second CPS may come knocking and take my youngsters away.”
Hearken to our podcast model of this investigation, produced with Reveal.
