Despite the relaxation of marijuana laws in Louisiana over the past five years, registered nurses still face serious career risks if they use the drug for recreational or, in some cases, medicinal purposes.
Louisiana’s Employment and Medical Marijuana Task Force heard testimony Tuesday from Shonda Broom, a former nurse who recounted how her off-duty use of cannabis and a single pre-employment drug screen effectively destroyed her 12-year career and permanently labeled her as a criminal.
It was one of a series of meetings the task force has held in an effort to influence the creation of laws to protect workers who use medical marijuana at the recommendation of a physician.
Broom became a registered nurse in 2005 and spent the latter half of her career self-employed, mainly performing home health services for the elderly, until July 2016 when she closed her business and sought work at a hospital. In an interview with the Illuminator, she said she had applied for a job that November with Thibodaux Regional Medical Center and had to take a pre-employment drug urinalysis. She said she hadn’t used marijuana recently and expected to pass the test.
The results came back positive for THC, the active ingredient in cannabis. She later learned that the drug can be detected in one’s urine for several weeks after use. The hospital rescinded its offer of employment, so Broom moved on and sought another job.
For some in other industries, the saga might have ended there with a single missed job opportunity, but for Broom, who was 36 at the time, it was the beginning of the end of her nursing career.
Before applying for a new job, Broom waited about a month to ensure no traces of marijuana were still in her system. She found a new employer and was hired after passing a separate drug screen.
But within five months of working at her new job, Broom told the task force, word of her initial drug screen failure made its way to the Louisiana State Board of Nursing, which launched an investigation.
At the time of that first drug screen, Broom said she had smoked cannabis on occasion to treat depression and high blood pressure but did not yet have a doctor’s prescription or recommendation.
Although the Louisiana Legislature legalized medical marijuana earlier that year, few if any patients were actually receiving the drug because of a quirk in the statute pertaining to the word “prescribe.” The legislature eventually rewrote the law to state that doctors can “recommend” rather than “prescribe” marijuana, thereby circumventing various regulatory hurdles with regard to prescribing a controlled substance. Federal law still designates the plant as a Schedule I drug, which means it has no recognized medical use, even though several states have legalized medical cannabis.
As a result of the state nursing board’s investigation, Broom said she surrendered her professional license rather than accept an involuntary suspension. Her last day of working as a nurse was April 26, 2017.
“Not only can I not work as a nurse, but the discipline shows up on a background check,” she told the panel. “It makes me unemployable across several industries besides health care.”
According to the board’s disciplinary records on the case, Broom could have accepted a temporary suspension and later reapplied for her license, but that process would have required her to complete a rigorous drug treatment program spelled out in a consent order. The requirements listed included, among other things, the completion of a rehabilitation program and a probationary period involving random drug screens, professional monitoring and periodic psychiatric or substance-abuse evaluations — all for a period of five years at her own expense.
Broom would only have been allowed to work in a restricted environment under the direct supervision of a health care professional and would have been prohibited from dispensing medication to patients. Her supervisors would have had to submit quarterly evaluation reports to the nursing board, and she would have had to notify any new employer of the treatment plan. Additionally, the agreement would have required Broom to pay various fines and fees to the nursing board totaling more than $1,200.
Strict discipline seen as success
In a phone interview, Louisiana State Board of Nursing Executive Director Karen Lyon said such disciplinary action is common for nurses who fail a drug screen whether for marijuana, alcohol or harder drugs such as opioids. The terms are typically more rigorous for nurses who used substances while on-duty or showed signs of impairment at the workplace, she said
The board handles discipline on a case-by-case basis. For lesser violations such as using marijuana off-duty, Lyon said, a nurse might be able to apply for reinstatement as soon as six months after their suspension if all stipulations in the consent order are met. They would still remain under probation and have to submit to the drug screens, monitoring and other terms for five years, she said.
Lyon admitted such disciplinary action is strict, but she said the board has seen a successful recovery rate of almost 95% for nurses who agree to those terms.
“We’re trying to have a therapeutic program that keeps patients safe and assists the nurses in recovery,” she said. “Our program is very successful.”
Nurses who have a legitimate medical marijuana recommendation can still be subject to a board investigation if they show signs of impairment or fail a drug screen while on duty. If the nurse can produce a physician’s certification stating they are fit for duty, often the investigation will conclude without disciplinary action, she said.
In those cases, the board might issue a “letter of concern,” which Lyon said is an informal reprimand that the board keeps on file.
For a while, Broom said she felt ashamed of what happened and never talked about it. But as time passed, she got involved with groups that advocate for medical marijuana and saw what she called the absurdity in drug screening and the nursing board’s disciplinary standards.
Broom told the task force that Louisiana’s nursing board is using outdated disciplinary standards much stricter than National Council for State Boards of Nursing (NCSBN) guidelines. See its report below this story.
The NCSBN recommends minimal disciplinary action for situations like Broom’s. Its 2018 guidelines include a variety of case examples for a nurse who tests positive for marijuana. In instances such as Broom’s in which there are no allegations of on-duty impairment and in a jurisdiction where recreational marijuana remains illegal, the NCSBN recommends that nursing boards issue a “non-disciplinary letter of concern” — the same disciplinary standard the Louisiana board applies to nurses who have a physician’s recommendation for the plant.
When asked why the Louisiana nursing board has not adopted the 2018 NCSBN guidelines, Lyon pointed out that the NCSBN is not a regulatory agency. The NCSBN is a membership organization that conducts research and recommends regulatory practices for state nursing boards. Its guidelines are not mandatory, she said.
Broom said she feels the state board isn’t fully aligned with the state legislature’s position on marijuana.
“They’re choosing to ignore it, and their ignorance has cost me a lot,” Broom said, adding that the board has permanently labeled her as some kind of unemployable criminal. “At first glance [on a background check], it looks like I committed fraud and abuse and immediately disqualifies me without an employer looking any further into it. So embarrassing.”
Drug screen shortcomings
Broom also told the task force that licensing boards should stop using drug screens as evidence of impairment — something the task force discussed in previous meetings.
In last week’s meeting, task force member Troy Prevot, a physician’s assistant who conducts employment drug screening, said many workplace policies and government regulations are outdated and still based on the mistaken belief that a positive drug test is an indicator of intoxication.
None of the available laboratory drug tests can indicate precisely when a person used drugs, particularly cannabis. The NCSBN notes this in its guidelines and also states that “current laboratory tests cannot provide any objective threshold that establishes impairment.”
“Somebody could have used [marijuana] for two weeks straight, stopped for two weeks, applied for a job, failed that screening, and their life is destroyed for something that happened over a month ago,” Broom told the panel.
Task force member Peter Robins-Brown, executive director of Louisiana Progress, said he hopes more people like Broom come forward to share their experiences. The task force hopes to find out how many nurses and other professionals have lost their occupational licenses due to failed drug screenings, he said.
Broom now works as a consultant. Her company, D4N Consulting, offers training and assistance to businesses and other organizations that want to develop workplace policies regarding drug screening and employees who are treated with medical marijuana.
“I think the problem is people are still getting punished for off-duty use,” she told the panel. “Let’s be real. People are not sitting on the clock smoking weed…It’s possible, but realistically they’re not just popping gummies in their boss’ face. A lot of the punishment comes from off-duty use.”
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