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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.
Contact: katheryn.olcozferry@go.warner.edu

PRE-EMPLOYMENT MEDICAL SCREENING
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
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
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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.
Figure 1.
Amphetamines AMP 1000 ng/mL Opiates OPI 300 ng/mL
Barbiturates BAR 300 ng/mL Oxycodone OXY 100 ng/mL
Benzodiazepines BZO 300 ng/mL Phencyclidine PCP 25 ng/mL
Buprenorphine BUP 10 ng/mL Propoxyphene PPX 300 ng/mL
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Cocaine COC 300 ng/mL THC THC 50 ng/mL
Ecstasy MDMA 500 ng/mL Tricyclic Antidepressants TCA 1000 ng/mL
Methadone MTD 300 ng/mL
Methamphetamine 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)
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
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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-
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
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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 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
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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).
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,
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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
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
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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.
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.
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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.
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-
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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, 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
http://search.proquest.com/docview/222251283?accountid=35797
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
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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
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
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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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