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Blood Drug Testing

Dr. Larry Gentilello, who heads the trauma and surgical critical care unit at Beth Israel Deaconess Hospital (Boston, MA), says that testing and counseling trauma patients whose conditions resulted from alcohol or drug use could prevent future visits to the emergency room (ER). In 38 states and the District of Columbia, however, doctors often do not test for alcohol and drug use because of laws that allow insurers to refuse to pay medical costs, which can run into thousands of dollars, if the client was under the influence of alcohol or narcotics. According to an article in The Wall Street Journal (February 26, 2003), these "decades-old" laws discourage trauma and emergency room doctors from doing routine blood alcohol tests or 'tox screens' on suspect patients because the hospital and doctor may not get paid if the insurer decides to deny coverage.

Removing these laws from the books and encouraging doctors to counsel trauma patients who are intoxicated can actually prevent these patients from incurring alcohol-related injuries in the future. Dr. Gentilello completed a three-year, federally-funded study of over 700 Seattle trauma patients with alcohol-related injuries. The study was published in the Annals of Surgery in 1999. His study showed that "the patient group that received 30 minutes of counseling at the hospital experienced a 47% reduction in serious injuries requiring trauma-center admission in the following three years, plus a 48% reduction in less-serious injuries requiring ER care." Dr. Gentilello says that counseling trauma patients with substance abuse problems could save billions of dollars in health care costs each year. Substance abuse is the root cause of up to half of all trauma-center visits.

Insurers contend that the costs of claims would rise if they have to cover all the injuries of people under the influence of drugs or alcohol. In addition, the Health Insurers Association of America, a trade group, says that "doctors who won't order tests and counseling for alcoholics and drug abusers because of financial concerns are guilty of a 'shocking abdication of responsibility.'" Although Maryland, North Carolina, and Vermont have repealed these inhibiting laws, the legislatures of New York, Arizona, and, interestingly, Washington (the site of Dr. Gentilello's study) have failed to do so.

Zimmerman, Rachel. why Trauma Units Seldom Test Patients for Alcohol, Drugs. The Wall Street Journal 26 February 2003

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