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Running head: PRE-EMPLOYMENT MEDICAL SCREENING

Final Paper

Pre-employment Medical Screening

Validity and Legality of Required Pre-employment Medical Testing

Katheryn C. Olcoz-Ferry

BUS 5070 B Human Resource

Warner University

Author Note

Katheryn Olcoz-Ferry, Department of Graduate Studies, Warner University. Correspondence

concerning this paper should be addressed to Katheryn Olcoz-Ferry, Department of Graduate

Studies, Warner University, Lake Wales, Fl. 33859.

PRE-EMPLOYMENT MEDICAL SCREENING

Contact: [email protected]

Abstract

Employers have the option to screen employees for medical and illicit drug use before they are

hired. Many employers will not hire a candidate until all the results from the tests are back.

Both of these types of tests serve to ensure the safety of workplace, and all who come in contact

with the worker being tested (Pachman, 2009). The employer protects not only itself from harm

done by the afflicted employee but also protects its assets both tangible and nontangible. When

an employee is found to be taking illicit drugs on the job the negative publicity can damage both

the reputation of the business but can also cause irreparable harm to the organization by losing

the trust of the very people it promises to serve. Not only do the affects of illicit drugs have the

potential to harm employees but the infected employees who may transmit diseases are also

risking the health of fellow employees and others who come in contact with them. Therefore,

isn’t it in the best of everyone to test employees who may cause harm to themselves, the workers

around them, and the general public? Are these tests valid and legal? This paper will discuss

these points in an old light but will also attempt to answer some of new questions that are

brought to light.

Keywords: pre-employment medical screening, employment drug screen, drug testing

false positives, Hepatitis C.

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Validity and Legality of Required Medical Exam Pre-employment Medical Testing

History

It has been the standard protocol of many industries to perform pre-employment

physicals. Thirty years ago, many of these exams included a full exam by a physician who ran a

series of tests sometimes including x-rays and blood tests. In addition many organizations

required immunizations against certain diseases. Not much was done with the information that

was collected except to tell the prospective employee they needed more shots if their immunity

was lacking in certain antibodies. However, since the advent of computerized data bases, data

storage, and the availability of more testing such as routine drug screening along with the fact of

collection of medical information, it has become highly private causing a paradigm shift in how

and why tests are given (Pachman, 2009). It was thought back twenty or thirty years ago, an

employee received a free physical exam and no one seemed to mind, after all the data never went

anywhere.

Legal and Ethical Concerns

Privacy Issues. When AIDS entered the arena it impacted the workplace place just by

testing positive for the virus. It was a death sentence for anyone’s career, even though a cure

was found and ways to prevent the spread of the disease; it became a pariah of sorts to the world

of insurance and future employment. Nevertheless, testing continued and found its way into

businesses as a way to screen out illicit drug users and people who may be carrying infectious

diseases. When medical records went electronic, keeping them private became paramount to

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protecting patients from the public domain. Evidence-based medicine is a fairly new concept

promoting sound medical practices and the use of protocols that ensure best medical testing and

data processing, as tools of medical information used in the health care industry (Pachman,

2009). In clinical research data is collected to be used to help find cures and advance medicine,

but when it is used in pre-employment testing is it used to determine if a candidate is fit for a job

and has become the “culture” to accept testing like this, according to Pachman, “There were few

to no validated criteria or research that would support their efficacy” (2009).

The American College of Occupational and Environmental Medicine's (ACOEM's)

Guidelines for Occupational and Environmental Health Programs and Practice highly

recommends pre-employment screening to target applicants who may endanger the safety of

coworkers. However, the screening should include a medical history and worker’s history.

Each job has different pressures and knowing the medical history and demands of the job will

help determine if the job description fits the job applicant (Mosher, et al, 2003).

Validity of Tests

Pre-employment testing can be discriminatory in many ways and some cases unlawful.

There are a plethora of tests used to screen applicants from testing for illicit drugs, alcohol,

psychological testing, and infectious diseases to mention just a few. One of most easily tested

areas is routine drug screen. Obviously no one wants someone who is “high on drugs” taking

care of patients or flying a jetliner. Therefore, it is an important consideration that these tests be

accurate and administered appropriately. The problem lies with the type of testing. One of the

testing kits can screen for 25 tests at one time. The following list demonstrates a kit that many

facilities use to screen applicants.

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Figure 1.

Amphetamines AMP 1000 ng/mL Opiates OPI 300 ng/mLBarbiturates BAR 300 ng/mL Oxycodone OXY 100 ng/mLBenzodiazepines BZO 300 ng/mL Phencyclidine PCP 25 ng/mLBuprenorphine BUP 10 ng/mL Propoxyphene PPX 300 ng/mLCocaine COC 300 ng/mL THC THC 50 ng/mLEcstasy MDMA 500 ng/mL Tricyclic Antidepressants TCA 1000 ng/mLMethadone MTD 300 ng/mLMethamphetamine MET 1000 ng/mL

Source: Biorad (2014)

Figure 1. This chart depicts an example of an array of drugs that can be screened for illicit

drugs. Although these types of screening testing are utilized all the time it does not necessary

mean the candidate is taking illicit drugs. Many illicit drugs, such as the amphetamine group

cross react with many “amines”. Many medications are available in this country contain

amphetamines (Amphetamines, 2014). This list indicates just some of the drugs on the market

for medical care. Many of these drugs are prescribed as stimulants to treat all sorts of medical

conditions such as Attention Deficit Hyperactivity Disorder (ADHD), weight loss, and sinus

issues.

List 1. Amphetamine based drugs

Dexedrine – treatment of ADHD Adderall – treatment of narcolepsy and ADHD Dextroamphetamine – a medication used in the treatment of ADHD that is also

sometimes used to treat narcolepsy. Lisdexamfetamine – used in treatment of ADHD Methamphetamine Dextrostat - treatment of ADHD Ritalin – treatment of ADHD

Source: Amphetamines.com (2014)

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http://amphetamines.com/types/adderall/

http://amphetamines.com/types/methamphetamine/

http://amphetamines.com/types/lisdexamfetamine/

http://amphetamines.com/types/dextroamphetamine/


This list shows drugs that could easily show up in testing for prospective employees.

There are a number of issues with routine drug screens in that it not only detects illicit drugs

such as methamphetamine, but it does not differentiate between illicit, prescribed and over the

counter drugs. In a professional setting, some providers are not even aware that there is

generalized cross reactivity. Ideally, if a drug screen comes back positive for amphetamines,

confirmatory testing should be conducted which would rule out illicit drugs since they are

much more specific in their identification and can pin point exactly which drug was taken.

Therein lies the rub. When preparing for drug screen tests, many questions should be asked,

including “Are you taking anything other than food?” A woman may not realize that the over

counter diet supplement, phenylpropanolamine (Phenylpropanolamine, 2014) is a drug that

cross reacts with the amphetamine group being tested and therefore does not list it as a

medication being taken. Does this discriminate against girls in a certain age group? What

about the sinus sufferer who takes the over counter nasal spray containing the active

ingredient, anti-histamine, they too may not realize this drug cross reacts with the pre-

employment drug screen. Theoretically, the employer doing the hiring should send the sample

in for identification and confirmation where it can be determined exactly which over the

counter drugs is cross-reacting. What if employers do not confirm the tests? What if this

candidate is turned away because the screen is positive but another reason is given to avoid

confrontation? These are a question that must be asked. Many providers do not understand

the validity of such screens and do not take into account which test is positive and what might

cross react. Too many times they assume if a test is positive that person is “on drugs”.

In addition, psychological testing is perceived negative if someone is taking anti-

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depressants, which easily show up in drug testing. Would they be discriminated against

because they even listed Prozac as a daily med? Although applicants are asked to list all of the

medications they are taking, just listing certain drugs taken may be perceived as an “unstable”

personality. This kind of information is taken in privacy and kept confidential, or is it.

Poppy seeds can test positive in certain drug screens, such as opiates. How does this

affect an employment screen? If someone eats enough poppy seed in a desert, or on a

MacDonald’s hamburger bun could it cause a false positive opiates? It has happened.

National Institute on Drug Abuse (NIDA) had set the cut-off concentration level for opiate

urine tests at 300 ng/ml for the Federal Workplace Drug Testing Program. However, this level

of testing was misleading and giving false readings. Eating a poppy seed bun at a fast food

restaurant will cause blood levels to reach 250 ng/ml. Most drug screening tests do not

differentiate illicit opiates from innocuous ingestions of poppy seeds. It is even found that

three teaspoons of poppy seed can spike blood levels to over 1,000 ng/ml hours later

(Winchester, 2014).

Legal Issues

While more businesses are held responsible to keep workers safe how far do employers

go to ensure the safety of their workers and the community they serve? Noe reminds us of the

WikiLeaks and Wall Street Insider trading probes have demonstrated how businesses must be

very careful with sensitive information and intellectual property (2014, p. 43). Medical testing

is dangerous in the wrong hands one only has to look back at the history of HIV testing and

the lives it destroyed just by testing someone, not to mention if the test came up positive.

Testing like this will likely influence human resource practices and many HR administrators

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may want to curtail certain types of testing or fall prey to more litigation in relation to

employee’s rights to privacy. Employees have intellectual property rights and employers may

not discuss private information with anyone, this includes medical personnel (Noe, p.43)

Businesses must consider whether or not to perform pre-employment testing in this day

and age. There are many regulatory agencies, such as FMLA, ADA, Affirmative Action, and

EEO to name just a few, and rules that must be examined for the various risks that could

violate the rights of people (Noe, 2014). The question should be asked is, why is the

organization testing and what tests are really pertinent. What will the results reveal and what

do you do with positive results? Is the testing performed because this is the way we have

always done it? Or is there a particular reason for wanting to know.

Another consideration for pre-employment testing is the validity of the tests. Are they

accurate? (Sunoo, 1997). Test kits used by clinical laboratories are time tested, quality

controlled and compared to other more sophisticated test kits. Are some employers using test

kits that have been validated? In addition what about the staff performing the tests? Are they

properly trained?

Purpose of Testing

Many hospital facilities both here and in Southwest England routinely screen for diseases

such as hepatitis, tuberculosis, and check to ensure a person’s immunity is high for measles

mumps and rubella. Both testing for the actual disease and also for immunity against disease

protects the employer and also the public whom they may have close contact. Southwest

England is now testing new recruits for HIV because of an incident where a worker had

contracted the HIV and patients were possibly put at risk, (Spooner, 2009).

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Occupational injuries, employee accidents, and even death have resulted in employees

working while under the influence of drugs or alcohol. According to Kesselring & Pittman

there were 6500 deaths directly related to job injuries, 13.2 million injured workers, and

astounding more than 60,000 disease related deaths, and over 800,000 job related illnesses,

(2002). It is a no wonder that employers want to protect themselves from lawsuits, but also

they need to protect workers from other workers and the general public they may serve.

In 1987 then President Ronald Reagan enacted an Executive Order that required the executive

branch of the federal government to offer a “drug free workplace” (Kesselring & Pittman,

2002). This action prompted many workplaces to implement their testing programs. Along

with economical and quick access to drug screen test kits testing for drugs became the norm.

What are the Costs?

Hepatitis C virus (HCV) infection is very prevalent in the United States. Three million

people, mostly under the age of 50 are affected and it is the leading cause of chronic liver

disease accounting for the most liver transplants (Alter, Seeff, Bacon, Thomas, 2004).

It stands to reason that hepatitis testing is routinely performed on new recruits. The tests will

indicate if the recruit has the disease or has had the disease and developed immunity. If you

have antibodies against the disease, it means either you exposed or had the disease and now

have immunity against the disease. This should be a good thing yet I question the efficacy of

such testing. Once the tests are performed the results become part of the electronic medical

record. Since there are privacy barriers, no one should see the results except the employer,

right? However, those records are open to insurance companies looking for history and any

reason not to insure a prospective client. Since Obama Care, having a previous medical

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condition does not enter into the picture whether a candidate is picked up or not, however,

optional insurance such as long term care, or life insurance policies will question anyone with

Hepatitis C antibodies. They require further invasive testing which could label a candidate for

life. Shouldn’t this kind of testing be optional? If the candidate has no symptoms and has

never shown symptoms and carries the antibody around forever, should they be penalized and

labeled “not fit to be insured” forever, that in itself is staggering.

Emotional Costs

There is another issue that is not taken into consideration when a worker is testing for

these diseases. Life insurance policies and medical insurance both short term and long term

care insurance companies will not insure anyone who is chronically infected with hepatitis C.

Even though the virus can lay dormant in the body for 30, 40 50 years and never cause any

symptoms. The statistics are difficult to come by but the outcome is nevertheless the same,

some insurance companies will not insure anyone with Hep C. Now consider the nurse who

has worked all her life to purchase a home but cannot secure life insurance to protect her

family. Or consider the worker who wants to save his family financial pain and suffering by

enrolling in long term care. These asymptomatic people have no recourse. The emotional

cost of not being able to get life insurance or long-term care insurance can be distressing.

Financial Costs.

For most employers, workmen compensation (WC) costs make up two to 10 percent of

payroll costs ((Rhodes & Rhodes, 2002). Most employers will strategize loss prevention and

control measures to cut down on the injury and accident rates. The goal is to reduce to

insurance claims and to manage injuries as they happen.

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What is the cost of running these tests? Testing is performed at the expense of the

employer. The cost can be expensive because the tests are usually chain of custody type

testing and sent out to specialized laboratories. What is done with these new recruits that have

tested positive for diseases such as hepatitis? Organizations do not always notify the employee

the outcome of tests. This is because some places just do not understand the interpretation of

the testing. If an employer tests all new recruits this cost in the millions for a large company.

The cost to the workers is an ever-present privacy issue. When tests are run on urine samples,

a wealth of information can be obtained in addition to the drugs in question. These types of

samples contain all the ingredients produce information on a person that is unwarranted such

as, DNA, pregnancy, HIV, and other diseases.

Workers who are tested for medical diseases are particularly vulnerable to breach of

privacy. Not only are drugs being screened, by the way only show if they are present and not

in what amount, but medical testing is performed that could cost hundreds of thousands of

dollars against the person being tested. What is the emotional cost of breach of privacy? It is

priceless.

Limitations of These Studies

This is just a short paper on a very intriguing subject. There really is no way of knowing

how many employees test positive for certain pre-employment tests or how many employers

neglect to communicate vital information medical to candidates. There are no statistics that I

could find that indicate how much is lost due to rejection by insurance companies or how

many people are rejected for employment due to testing positive for medications that should

not have influenced HRM in the first place.

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Discussion

Employers are under tremendous pressure to hire the right person for the right job. Once

an recruit enters the domain of pre-employment testing some employers may assume that

allowing one recruit to fly under the radar by hiring in haste will cost them down the line by

higher accident rates, eventually experiencing a rise in worker’s compensation (WC) costs

(Rhodes & Rhodes, 2002). It is very difficult finding the candidates with the “right stuff”

while reducing costs and increasing production. However, as a manager is my duty

investigate all questionable results and to look at the whole person before coming to any

conclusion. Pre-employment testing is vital to the security and safety of everyone. Testing

for illicit drugs and infectious diseases should be part of the hiring process. As technology

advances so do methods of testing and storing that data. As technology becomes more

sophisticated so do the hackers who feed off the data that is stored. As HRM becomes more

“wired” it is easy to lose touch with the people they serve. Noe points out; HRM in

administration is decreasing as technology is used for many administrative purposes (Noe,

2014). While this is a good strategy more people need to be trained to interpret the data that is

populating their screens. It cannot be left up to the computer to differentiate a good hire from

a bad hire just by collecting some tests. These tests must be scrutinized along with the real

person, in real time. Let us not forget to get to know the people we are interviewing and to

treat them with dignity and respect. Pre-employment testing must be strategized, scrutinized,

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and validated before they are performed. Each test needs to be revisited to qualify the reason

they are being used and then the implications of positives carefully thought out and studied to

justify their very existence.

References:

Alter, M. J., Seeff, L. B., Bacon, B. R., Thomas, D. L., & al, e. (2004). Testing for

hepatitis C virus infection should be routine for persons at increased risk for infection. Annals of

Internal Medicine, 141(9), 715-7. Retrieved from

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Amphetamines.com. (n.d.). Retrieved November 30, 2014, from

http://amphetamines.com/list-of-amphetamines/

Bio-Rad, TOX/See Rapid Urine Drug Screen Tests. (n.d.). Retrieved November 30,

2014, from http://www.bio-rad.com/en-us/product/tox-see-rapid-urine-drug-screen-tests

Kesselring, R. G., & Pittman, J. R. (2002). Drug testing laws and employment injuries.

Journal of Labor Research, 23(2), 293-301. Retrieved from


Minton-Eversole, T. (2010). Avoiding bias in pre-employment testing. HRMagazine,

55(12), 77-78,80. Retrieved from http://search.proquest.com/docview/815590613?

accountid=35797

Moshe, S., Slodownik, D., & Merkel, D. (2003). Value of preemployment medical

assessments for white-collar workers. Archives of Environmental Health, 58(11), 723-7.

Retrieved from http://search.proquest.com/docview/201275445?accountid=35797

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http://www.bio-rad.com/en-us/product/tox-see-rapid-urine-drug-screen-tests


Noe (2014-01-17). Human Resource Management. McGraw-Hill/Irwin. Kindle Edition.

Sunoo, B. P. (1997). Weighing the pros and cons of pre-employment testing. Workforce,

76(3), 125. Retrieved from http://search.proquest.com/docview/219767576?accountid=35797

Neal, K. R., Dornan, J., & Irving, W. L. (1997). Prevalence of hepatitis C antibodies

among healthcare workers of two teaching hospitals. who is at risk? British Medical Journal,

314(7075), 179-80. Retrieved from http://search.proquest.com/docview/203994514?

accountid=35797

Pachman, J. (2009, May 6). WHO Evidence base for pre-employment medical screening.

Retrieved November 29, 2014, from http://www.who.int/bulletin/volumes/87/7/08-052605/en/

Phenylpropanolamine, (2014), Wikipedia. Retrieved, November 29, 2014 from

http://en.wikipedia.org/wiki/Phenylpropanolamine

Rhodes, D. P., & Rhodes, L. H. (2002). Best hiring practices aid accident prevention:

Fewer accidents lead to lower workers' compensation costs. Professional Safety, 47(10), 46-52.

Retrieved from http://search.proquest.com/docview/200387028?accountid=35797

Spooner, M. H. (2003). HIV testing now compulsory for new NHS staff. Canadian

Medical Association.Journal, 168(5), 600. Retrieved from


Winchester Hospital, True or false: eating poppy seed pastries can lead to a positive drug

test for heroin. (n.d.). Retrieved November 30, 2014, from

http://www.winchesterhospital.org/health-library/article?id=156998

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http://en.wikipedia.org/wiki/Phenylpropanolamine

http://www.who.int/bulletin/volumes/87/7/08-052605/en/

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