More than 140 nurses, pharmacists and others in a program for substance-abusing medical professionals tested positive on drug or alcohol screenings, but the results were disregarded because a state subcontractor was using the wrong standard, officials said.
The problem continued for 10 months until the company that runs the program recently alerted the state. All the while, most of the medical workers were allowed to keep practicing, although state officials couldn't say how many were seeing patients.
Paul Riches, deputy director for enforcement and compliance for the state Department of Consumer Affairs, said his agency takes the problem seriously but knows of no patients who were harmed as a result.
Virginia-based Maximus Inc. receives $2.5 million annually to run California's confidential "diversion programs" serving hundreds of licensed nurses, dentists, pharmacists, veterinarians, osteopaths and others. Participants generally have either admitted drug and alcohol abuse or been referred to the program after being caught.
Maximus subcontracted its drug testing to Pennsylvania-based First Lab, which in turn subcontracted to Kansas-based Clinical Reference Lab. From at least December 2009 until August, that company used the wrong standard in assessing results.
For healthcare professionals with known substance-abuse problems, strict abstinence from drug or alcohol is required, officials said. Instead, they said, the company used a lesser standard similar to that for the U.S. Department of Transportation, which allows workers such as truck drivers to indulge in alcohol or other substances when they are not working.
One consumer watchdog said that even if the amounts detected were small, the mistake was unacceptable.
"These are not just social drinkers; these are confirmed substance abusers who have a license to provide healthcare, and they were allowed to practice on potentially dozens of patients each day for 10 months with faulty drug testing," said Julianne D'Angelo Fellmeth, administrative director at the Center for Public Interest Law at the University of San Diego School of Law.
Maximus said 146 people had "unconfirmed positives" on their drug tests, meaning the person had some banned substance in his or her system. Some of them could have had valid explanations such as a medical condition that required a prescription painkiller. But the cases should have been flagged for further review.
To confirm whether the tests were valid, state officials briefly considered doing hair follicle tests but abandoned the idea because those tests detect only substances going back 90 days.
Instead, they have retested all 146 people and are reviewing all aspects of their cases. Maximus is paying for the tests.
They are also consulting workplace monitors who oversee practicing clinicians to be sure they haven't exhibited any unusual behavior suggesting substance abuse, officials said.
Lisa Miles, vice president of corporate communications for Maximus, which also administers parts of the state Healthy Families and Medi-Cal programs, said the company "instantly initiated" a plan to fix the problem during a routine review in August.
The lapse is the latest in a string of problems at California's diversion programs.
Last year, a Times investigation into the program for nurses found participants who practiced while intoxicated, stole drugs from the bedridden and falsified records to cover their tracks. In 2007, the Medical Board of California abolished its diversion program for doctors after five audits found it wasn't working.
A June audit by the Department of Consumer Affairs found that Maximus does not always report positive drug tests to the appropriate board in a timely manner, meaning healthcare professionals can keep working even after positive tests. The audit also found that in more than half the cases reviewed, Maximus did not keep enough records that established that substance-abusing healthcare professionals were complying with all terms of the program.
The department said that despite these issues, Maximus was generally in compliance with its contract. Miles said Maximus has already acted on all of the auditors' recommendations.
But State Sen. Gloria Negrete McLeod (D-Chino), who chairs the Senate's Business, Professions and Economic Development Committee, said she has questions about Maximus' performance. "My concern is the program is not providing the appropriate oversight or monitoring," she said. "We want to make sure that all the patients are safe from anybody who would abuse any substance."
Advocates for providers are concerned as well.
"The nurses want to comply and move on with their lives, and now, because of this, it makes it more difficult to satisfy the board that they are drug- and alcohol-free," said Tracy Green, a lawyer who represents professionals in the program. "The nurses relied on the drug test just as much as the nursing board did."