Drug test without patient consent

[dm72185]

What is the name of your state (only U.S. law)? Maryland
I went to a new doctor regarding a lower back problem. I was sent for MRI and also labs. Doctor discussed with my husband and I what they would been taking blood for. To my surprise, I received an EOB for over $3,000 for blood work. Since I have been doing medical billing for over 11 yrs, I questioned this especially because I have a coinsurance on all out-pt procedures which includes lab work. I find that they did all of the testing discussed during the OV but neglect to inform me that they work going to test me for drugs as well. First of all, is this legal performing this test without my knowledge or for any reason? Second, I would have never consented to this test because this doctor is not my pcp. I only went there because I could not make the 160 mile drive to my primary and this doctor was closer to home. What about my rights? Where the hell do they get off telling me everything but that? Do I have to pay for this?

[ecmst12]

It is legal and within the standard of care. You consented to the treatment which means any tests the doctor deemed necessary. As to why they didn't tell you, I have no idea, you'd have to ask them, but you can't consent to only parts of a doctor's treatment.

[lya]

I disagree. The patient only consented to a urinalysis for detection of infection; the patient did not consent to a drug test.

This was not an emergency situation where the patient was not competent to give consent or to deny consent. The patient had the right to be informed of the intent of the test and had the right to refuse the test. The rule of tacit consent does not apply here; the test was not within what could be reasonably expected to be performed.

If the physician had simply stated, 'we need to check your urine', it is possible that tacit consent would have been given for all testing the doc wished to obtain. The physician went so far as to explain the test and the purpose, stating to check for urinary tract problems. That is consistent with evaluation of back pain.

Checking urine for drugs is reasonable in the scenario presented by another poster with chronic back pain and longterm narcotic drug treatment. Even the poster with chronic pain and longterm narcotic use was allowed to give consent or to deny consent, which he did by leaving without giving a urine specimen.

I would contest paying the fee for the drug screen and would consult with an attorney if the results from the test cause any problem(s) for the patient, ie. even with a trace amount of an illegal substance found in the urine, an RN could lose the right to practice nursing until completing a board-approved rehab program.

[dm72185]

Thank you for your information. I have had some other procedures with this office that are questionable and have notified my insurance company about them. I really got suspicious when I asked the doctor's staff for the orders for the lab work and they said that the office manager would call me back. Seems I go there for one thing and other things are billed. This is why I am so bothered by this. I feel that there should be trust between doctor and patient and in this case, I believe that that trust has been violated. Next time, I will take the 160 mile trip to someone I can trust. Thanks again and God Bless.

[lya]

Without trust, there is no doctor: patient therapeutic relationship. I would seek another MD, too.

Best wishes,

[lealea1005]

Originally Posted by lya

I disagree. The patient only consented to a urinalysis for detection of infection; the patient did not consent to a drug test.

Unless I'm reading it wrong, OP had blood drawn for testing and that testing was discussed with her husband...not her. She was there for lower back pain. She does not state whether the etiology of that back pain (if she knows) or whether it was chronic or acute.

She also states that this was a new Physician, not her usual PCP. Although, the new Physician could have called the PCP for previous medical history, depending upon the symptoms OP presented with, the drug testing may have been appropriate.

Lya, I don't think we're getting the whole story. OP, what were your MRI results?

I agree, if she is unsatisfied with her care at that office, she should find another Physician or make the effort to return to her PCP.

[ecmst12]

I think that if the patient had been told about this test and declined it, then the doctor would have refused to treat her at all. Not sure if this would have been a more acceptable outcome to her.

[lya]

Originally Posted by lealea1005

Unless I'm reading it wrong, OP had blood drawn for testing and that testing was discussed with her husband...not her. She was there for lower back pain. She does not state whether the etiology of that back pain (if she knows) or whether it was chronic or acute.

She also states that this was a new Physician, not her usual PCP. Although, the new Physician could have called the PCP for previous medical history, depending upon the symptoms OP presented with, the drug testing may have been appropriate.

Lya, I don't think we're getting the whole story. OP, what were your MRI results?

I agree, if she is unsatisfied with her care at that office, she should find another Physician or make the effort to return to her PCP.

It was a blood sample that was tested; you're right. The poster stated the physician discussed the purpose of the blood test with "my husband and I".

If the physician had not specifically stated the purpose of the testing, I would be inclined to agree that any test the MD felt appropriate could have been done; that was not the case. He gained consent for 'one thing' but did another; in some situations, maybe even this one, it can be considered battery.

[dm72185]

The doctor was specific in explaining each test with me, my husband was present and had questions of his own. If she would have said that she wanted to perform a drug test, I would have asked it's relevance to my chief complaint. If it was medically necessary, than I would have agreed. I question everything because I do not want the out of pocket expense of unnecessary medical tests. She was specific about everything, including her tx plan. That tx included anti-inflammatory medication and physical therapy. So where does the drug test come in? I thought that she was looking for RA, lyme, west nile and thyroid. If she thought that I had a drug problem, than she should have addressed that with me. I had to find out through my insurance company what was done. She would not discuss my results until my appointment on 10/9. I really feel violated. To add insult to injury, the MA at the doctor's office today explained each test that was written on the order written out by the doctor. The conversation ended when I told her that I felt that my privacy was in question. At that time she would not discuss anything further with me and said that the HIPPA law prevented her from doing so. Hello! She just gave me a run down of all the tests the doctor ordered on me over the phone. Why stop now. No one responded to my concerns regarding this matter. You better believe that I will not be going back there.

[ajkroy]

I am thinking of this in a different way: how many "new" patients come on their first visit complaining of backache or headache? If the doctor thought the patient might be drug-seeking or doctor-shopping, the physician might want to check to see if the patient actually had controlled substances in her system before potentially prescribing more. It is my experience that a great many doctors are covering themselves in the event of a suit (Conrad Murray aside ). And it is possible that a drug screen consent was obtained in the initial paperwork. Doctors I have worked for included it in the consent for anyone who receives (or may potentially receive) scripts for controlled substances.

That said, I think $3000 for bloodwork is outrageous.

[dm72185]

I have copies of new pt info that they gave me. Nothing indicating drug testing on any of the paper work. They also had copy of primary care address & phone info so they could get my med hx if necessary. I requested an x-ray or mri to find out what the problem was with my back. Drugs never came into play.

[lealea1005]

Originally Posted by lya

It was a blood sample that was tested; you're right. The poster stated the physician discussed the purpose of the blood test with "my husband and I".

If the physician had not specifically stated the purpose of the testing, I would be inclined to agree that any test the MD felt appropriate could have been done; that was not the case. He gained consent for 'one thing' but did another; in some situations, maybe even this one, it can be considered battery.

Well, duh....I did read it wrong after all...and I swear I read it three times before responding. Sorry 'bout that, Lya.

[lealea1005]

Originally Posted by dm72185

I have copies of new pt info that they gave me. Nothing indicating drug testing on any of the paper work. They also had copy of primary care address & phone info so they could get my med hx if necessary. I requested an x-ray or mri to find out what the problem was with my back. Drugs never came into play.

Not trying to be snarky, but a medical biller with the experience you claim to have would know it's HIPAA, not HIPPA. Although your new patient info may not have addressed drug testing specifically, I'll bet it did give permission...something to the effect of "any treatment the Physician deems necessary" to come to an accurate diagnosis.

I did not see an answer to my question....what was the result of your MRI? What was the treatment outcome of your visit? Meds? PT?

[dm72185]

MRI results state that there is bulging of discs and arthritis L1-L5 & S1 and hip is out of alignment pressing on nerve. Treatment is physical therapy and naproxsen. She was specific (detailed) explaining the lab tests. Looking for RA, Lyme, West Nile and checking thyroid. As far as the documents are concerned, name, address and insurance info, privacy act and authorization for medical records release. There is nothing on any of these documents to indicate that they would be performing such a test. These document do not request any existing medical problems, previous surgeries or medications that most physicians ask for in the beginning, like a summary of your med. hx. I was surprised when I filled out the medical documentation because there was not much information that they requested. The receptionist said that they would get that all of that info from me when I got back in the room with doctor. The point that I am trying to make is the "right to know". Disclosing this information would have been good. I found out that they did this through my insurance company (EOB). Doctor waiting until my 10/9 appointment to give me results of lab. You can image my surprise when I questioned the billing and they mentioned drug test. You can not tell someone that you are doing one thing and do another. I'm too old and too tired for this crap. Bottom line, I expect full disclosure from the doctor if I am footing the bill.

[lealea1005]

Bottom line, I expect full disclosure from the doctor if I am footing the bill.

And I would request such at your Oct.9 visit. Personally, I think it ridiculous that a Physician waits weeks to give a patient lab results when it could easily be done via telephone...unless, of course, the results are serious..then they should be given in person.

It is not unusual for the Physician to personally take a full medical history at your first visit instead of relying upon a form you filled out.

Again, it not the "test" specifically...it is treatment in any way the Physician deems necessary to accurately diagnose your problem. If a drug screen was within the standard of care (and, IMHO, with your presentation it was), then there's nothing inappropriate, especially given that this Physician was new to your case.