Maggie Downs: I Went to the Hospital to Give Birth…And Tested Positive for Meth

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Will Truman

Will Truman is the Editor-in-Chief of Ordinary Times. He is also on Twitter.

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  1. Avatar DensityDuck
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    says:

    Uncomplicated guilt-free objectively-provable hate looks kind of tough when you’re on the wrong side of it.Report

  2. Avatar Michael Cain
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    says:

    In this age of electronic medical records, what are the odds that the false-positive meth-test result can successfully be purged from everywhere?

    I fight with my general care physician’s staff once a year because I test somewhat high for serum creatinine and their system wants to classify me as stage three kidney disease. Three years ago, for a different reason, a specialist put me through a much more complete set of tests (most of which I paid for, as the insurance wouldn’t cover it) and came up with the result that my kidneys are perfectly normal, I just test high. It seems to be impossible to put an override on the creatinine diagnosis result into the general-care people’s system, so each year I have to remind them to go look at what they put in the “comments” field last year after they read the specialist’s report again.Report

  3. Avatar Kazzy
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    says:

    “At what point do the rights of my child outweigh my own?”

    This seems to be the money question. While they could have — and probably should have — been more compassionate seeing as how both mother and baby were their patients, both mother and baby are their patients and it is prudent — perhaps even ethically and legally necessary — that they took the steps they did.

    A friend of a friend’s baby died during the first year. During the investigation, it was discovered that mom was an alcoholic and drank during the pregnancy. Her history of alcohol and drug use/abuse was well known but no one knew it happened during the pregnancy. A number of other alarms went off as well. Their older child was taken away (put in custody first off paternal grandparents and then dad absent mom) while the investigation went on. Friends were angered and apalled… Yes this woman had problems but she meant no harm and loved her daughters and they knew her.

    Always the party pooper, I said, “But imagine something tragic happens to the other kid. To everyone who doesn’t know her (and even some who do), they’ll be tearing apart the system for giving that monster back another child to kill.”

    We need to hear stories like this. But we also need to recognize that doctors and nurses don’t have the luxury of erring on the side of being sensitive when a baby’s health is involved. Discretion… Compassion… Decency… Respect… Yes extend all that to all patients. But given good reason to believe a child’s health is at risk, taking steps as they did seems not only justified, but right.Report

    • Avatar greginak in reply to Kazzy
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      says:

      Dealing with competing rights of parent and child is the really difficult issue that is often hard to square.

      Years ago when i worked in a rehab we had a woman in group who told how she hated the CPS worker for taking her kids away due to heavy substance abuse. She called the CPS worker every name she could think of. The other people in group confronted her reminding her that she had an admitted major drinking problem which her kids hated and had begged her to stop. She completely agreed. She said it was good that CPS took her kids away because she was not safe to have them and they placed her kids with her family so they were safe and with people she knew and trusted. She was dedicated in treatment and wanted to stay sober, but she still hated the CPS worker.Report

      • Avatar Kazzy in reply to greginak
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        says:

        I imagine CPS workers often have to choose the best of several shitty options.

        There is probably room for a discussion about why better options aren’t available (at least in some cases) but that takes us in a different direction.

        I don’t think this woman’s anger is unjustified. But that doesn’t necessarily mean anyone did anything “wrong”.Report

        • Avatar greginak in reply to Kazzy
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          says:

          Yeah, pick the best of crappy options is often a regular day for a CPS worker. I have a lot of sympathy for what they do but i’ve also had conversations with CPS workers where i found myself stifling projectile profanity. Even when they do the right thing in a good way that often means someone hates them. And Gosh knows most people are going to hate them no matter what for something or other.Report

          • Avatar Michael Cain in reply to greginak
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            says:

            When I was on the state legislature’s staff, during the interim between sessions I made field trips to observe agencies whose budgets were in my portfolio. After observing a post-court counseling session for CPS, I sat in my car and cried. No kid should have to go through being bounced around between a mom who’s in and out of drug rehab, a dad who’s in and out of county lockup, and two sets of grandparents who despise each other.Report

            • Avatar greginak in reply to Michael Cain
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              says:

              Yeah that is one of the things that often hampers CPS work. They really have to try to keep kids with family if they pull them away from one parent. But sometimes the family is almost as much of a problem so the kids end up in only slightly less bad situations.Report

        • Avatar Chip Daniels in reply to Kazzy
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          says:

          CPS workers, public defenders, CSI labs, health inspectors, auditors…

          What they all have in common is that they are tasked with an enormous task, and given wide ranging powers to effect them, yet are lacking the one thing that would legitimately improve the situation, which is more time for analysis and evaluation.

          After a scandal a few years back, it was reported that CPS workers here in the LA area have upwards of 90 cases each.

          There isn’t any way anyone can possibly handle a load like that, yet to my knowledge they haven’t drastically increased funding or manpower, so when I read cases like the article here, I envision a lab somewhere where they have massive piles of samples, devoting the bare minimum of time for each one, if that.

          I also know that the author is actually very lucky- it appears she is middle class, educated, articulate, and well connected enough to get her story out there.Report

          • Avatar Saul Degraw in reply to Chip Daniels
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            says:

            @chip-daniels

            I am thinking about all the back log on drug tests and the huge scandal from Massachusetts a few years ago about the lab tech that would just fake it and the hundreds or thousands of drug convictions that needed to be overturned/appealed.

            I am also thinking about how different ideologies have different endgoals. The liberals see these problems and want to expand budgets so CPS can hire more people. Libertarians wonder why we keep the program, etc.Report

            • Avatar greginak in reply to Saul Degraw
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              says:

              FWIW, i’ve met some Ak Libertarians who are completely fine with CPS. They want it and see it as a basic function. If there is problem with CPS critics its that just dont’ really know much about the topic past torrid news reports and scandals.Report

              • Avatar Will Truman in reply to greginak
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                says:

                Except, of course, the ones who do.

                I *will* get her to write about it on the site one of these days.

                But yeah, when I floated the idea that things would be better if only they had more money, she thought it was the funniest thing she heard in a long time. (At least, as it pertains to LA County.)Report

              • Avatar greginak in reply to Will Truman
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                says:

                Oh heck…didn’t see you over there. Yeah there are plenty of good criticisms of CPS depending on where you live and they need good critics. I tend to see more of the kind of who don’t know or understand though, but that is they way it is with everything.
                I’m sure it would be an interesting read.Report

              • Avatar Saul Degraw in reply to Will Truman
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                says:

                So how does your friend think we should get kids out of abusive or potentially dangerous situations?Report

              • Avatar Will Truman in reply to Saul Degraw
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                says:

                With more caution than is presently exhibited.

                Telling her the problem with the CPS is that they don’t get enough money is like telling an ACLU lawyer that the problem with our criminal justice system is that prosecutors and investigators don’t have big enough budgets.Report

              • Avatar LeeEsq in reply to Will Truman
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                says:

                A bigger budget and more staffing for CPS could encourage even more aggressive tactics rather than wiser administration.Report

              • Avatar Kazzy in reply to Will Truman
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                says:

                As I alluded to, it seems to me that focusing solely on CPS is to be remarkably myopic.

                In the situation I described, CPS wanted to see the mom take certain steps to get herself back together… some sort of drug/alcohol counseling, therapy, a job. But they couldn’t provide or offer her much in the way of actually securing any of these services because that fell outside their purview. From what I understood of the situation, CPS was working really hard to do the right thing but was limited and had to take steps they probably didn’t want to.Report

              • Avatar greginak in reply to Will Truman
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                says:

                The general budget problem with CPS is that they lack needed resources as Kazzy is noting below. I’ve seen cases where local CPS wanted to get someone into rehab and the parent wanted to go. But OCS only has limited number of beds reserved at the local rehabs so the person had to wait since CPS was paying. Telling a parent to wait four months for rehab is a recipe for problems. But the CPS only had so much money to reserve beds, the rest went to people with insurance. There are a variety of limited resource issues that often hamper CPS’s. Of course that is very dependent on the individual state. We are actually pretty lucky here because the Alaska Native/ Native American folk have a lot of resources of their own.Report

      • Avatar Francis in reply to greginak
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        says:

        And, on the other hand, my wife just got assigned a new murder case. (all of the following is alleged, not proven.) A woman with bi-polar disorder and a history of self-medicating got completely hammered, again, drove drunk, again, and this time killed one of her own kids in the ensuing car accident and badly maimed another.

        The prosecutor is not amused and is charging murder.

        The cherry on this particular sundae is that no one ever told her that one of her own kids was dead until the public defender assigned to represent her at arraignment (not my wife) was reviewing the charges with her before going before the judge. Yes, she learned of the death and maiming of her children from her defense lawyer.

        Yes, the mental health care system sucks. Yes, CPS sucks. And yet … now there’s this tragedy.Report

  4. Avatar greginak
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    says:

    Jumping back into this post due to a pile of records i was just going through. In a case i have now the mom had multiple positive drug tests while pregnant. She admitted to heroin use and had quite a bit of a history of multi drug use. CPS got involved and took custody. Flash forward 18 months. Mom has completed drug treatment and the dad also had an assessment but didn’t need treatment. In this case mom and dad aren’t together so that adds a dynamic. Mom has plenty of time with the child. She seems to be clean and doing well as is dad. CPS is out of the pic after dad seemed fine and mom completed treatment.Report

  5. Avatar James K
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    says:

    This article leaves me with two questions.
    1) Is it standard procedure to test pregnant women for methamphetamine without any reason to suspect them of having used it? If so, why? If not, why was Downs tested?
    2) I wonder what the false positive rate for those drugs tests is. I especially wonder if the test is precise enough to be used on the general public, who will have a very low prior probability of being a meth user.Report

    • Avatar Will Truman in reply to James K
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      says:

      Hey @james-k I asked my wife about this. She said that whether it’s standard procedure at some hospitals, but only those that deal persistently with high-risk populations. Of the five places she’s worked, only one had such a policy (though she believes it would be warranted where she now works).

      The rest of the time it’s at physician discretion, and for the most part the doctors tend to do it a lot. There’s no evidentiary proof threshold or anything. They can do it for any reason and no reason. Sometimes it’s simply a matter that they’re getting a blood workup done for some other reason and while they’re getting the sample they check that box, too. The more they know, the better, and there are liability concerns if they could have gotten a test that might have prevented a bad outcome and didn’t. So most get tested.Report

      • Avatar James K in reply to Will Truman
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        says:

        @will-truman

        Thanks for that. Troubling that you can be subjected to a test without consent that can lead to CPS action, which has similarly severe consequences as a criminal sanction but without the same procedural rights.Report

        • Avatar Will Truman in reply to James K
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          says:

          The law doesn’t look at it as “consequences” for the parent so much as “safety of the child.”

          Which is where I think a lot of people get turned around on the issue. They view the CPS as social workers who are interested in the public good. Which is certainly not a bad way to look at it. But they do not look at the CPS as I do, which is basically as cops who go to judges seeking outcomes that do punish parents (as well as their kids, sometimes).Report

    • Avatar Troublesome Frog in reply to James K
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      says:

      I wonder how many people understand the important probability issue you raised. Most people don’t realize that claims like “99% accurate” are meaningless. Of those who do, many still think that if you flag positive on a test with a 1% false positive rate, the probability that you really are on meth is 0.99.

      It’s pretty easy to teach people how the base rate fallacy works, but I doubt that most of the critical decision makers in this process have had that lesson. Most people seem to think that these tests are CSI magic.Report

      • Avatar Brandon Berg in reply to Troublesome Frog
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        says:

        I vaguely remember a study finding that most doctors couldn’t correctly answer simple questions about the implications of a positive test given the test’s false positive rate and the prevalence of the condition being tested for among the general population.

        Ah, here it is. Not as bad as I remembered, since most (but not enough) of the attending physicians got it right. And small sample size.Report

        • Avatar Troublesome Frog in reply to Brandon Berg
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          says:

          I’m wondering about people who gave answers that weren’t the right answer but also weren’t 95%. Like it looks like two of the physicians answered something like 90%. I’ve seen this sort of pathology before: if you don’t know how to get the answer, you take the numbers you have and mash them together with randomly chosen operators and use that to generate a guess, just hoping that it might be right. Sort of a weird numerology thing.

          I’ll might be willing to let the 95% thing slide because at least there’s some reasoning behind it that you could explain. But the 90% doctors? I want to know who they are so I can avoid them.Report

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