During the last month my firm has experienced an influx of calls from nurses who have tested positive for alcohol while on an Order with the Texas Board of Nursing. The consequences of testing positive for a prohibited substance, including alcohol, while under a Board Order can be quite severe. This includes an automatic
Recently I have been the attorney of record in nursing license defense matters against the Texas Board of Nursing for a number of registered nurses and licensed vocational nurses (RN & LVN Practice) in cases where a low level EtG test is in issue despite clear indications that these test results are inadequate proof of…
Recently I have had a flurry of cases where Texas nurses are accused of violating their Agreed Board Orders or their Texas Peer Assistance Program for Nurses (TPAPN) contracts due to positive Ethylglucuronide (EtG) tests in the 300 to 500 ng/ml range. In each case the Nurse denied consuming alcohol and corroborating evidence suggested they were sober; nevertheless, TPAPN expelled them from participation and a subsequent BNE investigation ensued against their nursing license.
This is clearly contrary to the admissibility of EtG testing in Court or as valid scientific evidence for the Board of Nurse Examiners to consider regarding these individuals knowing or intentional use of ethyl alcohol (ETOH). Please see my blog post: “What is EtG”. Moreover, it is a clear abuse of the power of both TPAPN and the BNE as they have decided their interpretations and determinations regarding EtG testing validity and use are superior to that of the Courts, SAMSHA and the scientific community at large.
Properly utilized, EtG testing can be an excellent screening tool to confront someone about a positive test. Oftentimes the initial confrontation will yield to an admission of a return to active drinking. However, when denied and all circumstances suggest that sobriety is in tact the EtG test in this range is insufficient in and of itself to prove alcohol consumption.
Ethyl Glucuronide (EtG) is a metabolite created by the body following alcohol consumption. Testing for this metabolite, typically via a urine sample, has become increasingly prevalent in the United States following its initial approval and use in Europe especially by agencies concerned with monitoring an individual for any relapse or return to active drinking. Many favor EtG sampling because it is a “direct” test for alcohol consumption in contrast to older, more traditional tests like Gamma Glutamyl Transferase or Carbohydrate-Deficient Transferrin which look for indirect signs of alcohol use such as liver damage. Further, while older tests generally only become positive following heavy alcohol use, EtG can be present in the urine after only a single drink. Moreover, EtG remains in the body and is detectable in urine three to five days after consumption
Unfortunately, EtG testing has several serious short-comings that limit its viability as an stand-alone objective marker of recent alcohol consumption and relapse. In the area of medical testing, a test is characterized by two qualities: sensitivity and specificity. Sensitivity measures the ability of the test to correctly identify those individuals who do have the condition of interest, here relapse, while specificity measures the ability of the test to correctly identify those persons who do not have the condition of interest. EtG testing has a high sensitivity, that is it has a high probability of correctly identifying as positive an individual who has recently relapsed. However, it also has a low specificity, that is it has a high probability of showing as positive a person who has not recently consumed alcoholic beverages. For example, research has shown that use of everyday items such as bug spray, mouth wash, various over-the-counter medicines, and hand sanitizer can produce positive results. Additionally, without further research, testing facilities have been unable to arrive at a consensus on the level of EtG that should be considered positive for a relapse. The high level of false positives seriously undercuts its status as a viable test for relapse and can easily lend itself to abuse by monitoring agencies such as the Texas Medical Board or the Texas Board of Nursing (Formerly known as the Texas Board of Nurse Examiners).