Substituted specimen

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Substituted specimen

Post by barbaracoplowitz » Tue May 25, 2010 12:28 am

A physician applicant for a hospitalist position presented a urine specimen for a drug screen. The specimen's temperature was outside of range. He was told to drink water and that a repeat urine sample would need to be obtained. While sitting in the waiting area he admitted to one of the nurses that he had not had enough urine in the cup so he had added water from a drinking cup he had brought unobserved into the bathroom. As the staff physician and MRO in the employee health department of the hospital I was called to speak with the applicant. He told me he needed a certain amount of urine for the test. He was very busy and did not have time to sit around drinking water to produce enough. He said he figured adding the water would just dilute the urine but the tests could still be run. I told him as a physician he should have known better. It should be noted that he was already drinking water when he came to the exam an hour late. I determined this was a substituted specimen and a refusal to test making the applicant ineligible for hire at our hospital. Would you agree?

Robert Swotinsky MD
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Re: Substituted specimen

Post by Robert Swotinsky MD » Tue May 25, 2010 9:46 am

I agree that the outcome is a refusal to test based on the donor having admitted to having substituted the specimen.

When it comes to errors of judgement (as opposed to more obvious attempts to cheat), and perhaps because I'm a physician and realize that physicians are problem solvers, I worry that the donor may have unwittingly sabotaged his test without malfeasance. I say this even though the donor probably (and inaccurately) signed a certification statement on the CCF saying that he did not adulterate or substitute the specimen. Most employers have policies that allow discretion, e.g., "...may result in disciplinary action up to and including termination." I would be interested in knowing if the employer has such a policy, and if the employer would be willing to retest the donor and, if he tests negative, allow him to work subject to follow-up testing (monitoring) for a year.

But, I do agree w/declaring it a refusal to test. When in doubt, follow the rules. (Or, cite the federal rules as a standard of practice applicable to this nonregulated test.) To do otherwise in this case would be to make yourself at least partly responsible for any drug-related malfeasance that may subsequently occur.

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