Patients won't be the only ones giving urine samples if hospitals begin testing employees for drug use.
Nurses, doctors and others applying for work at the 68 hospitals in the state could soon face the same drug-testing as do airline pilots and football players.
About a quarter of the hospitals already test for drugs before hiring staff, said Richard Wade, vice president for communications for the Maryland Hospital Association, a trade organization made up of public and private hospitals.
A substance-abuse task force of the association is working on a policy that recommends that hospitals require pre-employment drug tests for all staff and physicians applying for privileges, Wade said. Also, the guidelines may recommend random testing of current staff, he said.
Carroll County General Hospital does not routinely test employees for drugs, but is exploring such a policy, said Elizabeth Fuss, CCGH infection control/employee health nurse.
"I'm in the process of doing a lot of research on drug-testing. Probably in the next several months we will be addressing the issue," Fuss said.
"If I put myself on the other side and I would be a patient, I certainly would want the people treating me to be alert mentally and physically," said Dale Middleton, a vice president at CCGH.
He said the hospital already tests employees if there is reason to believe the employee has a drug or alcohol problem, such as after a drug-related arrest. State law allows pre-employment and random drug-testing, he said. A policy would not have to be negotiated with the staff, which has no union.
Fuss has attended seminars in which speakers have advocated drug-testing for hospital employees because of the trust the public places in them.
"The comment made was, 'Why should we put that requirement on (an airline pilot), but not expect the people who deliver our health care to follow the same requirement?' " Fuss said.
The hospital has not decided whether to test physicians, who are not employed by CCGH. They, instead, have privileges to see their patients there or contracts to provide services to the hospital.
Dr. Edward Carter, radiologist and president of the hospital's medical staff, said that if the hospital were to require testing of all employees, physicians probably would be under pressure to be tested also.
"Individual rights have to be preserved, but on the other hand we certainly are responsible for public safety and well-being. I see both sides and probably fall down the middle of it," Carter said.
Proponents argue that the drug-testing policies are needed to ensure public confidence in the health system. Critics contend that testing violates employees' privacy rights.
The American Nurses Association opposes mandatory drug-testing for registered nurses, saying it violates their constitutional rights to privacy, said Cynthia Cizmek, director of communications.
"We do give qualified support to testing when there is reasonable suspicion and objective evidence that their job performance is, or has been, impaired by alcohol or drug use," Cizmek said.
Middleton said a policy might focus more on employees who work directly with patients or in the pharmacy, than, say, the housekeeping staff.
"To me, it's very important that it be done right," Fuss said, adding that any policy CCGH develops must be fair to avoid discrimination against one employee or group of employees.
"It's also important to have an employee-assistance program connected with any kind of testing," Fuss said.
Such programs help employees with substance abuse as well as other mental-health problems. The hospital has no formal assistance program, she said.
In Maryland, the debate over testing was sparked partly by the Johns Hopkins University Medical Center's controversial decision this year to begin mandatory alcohol- and drug-testing of all physicians and employees.