Health care must build trust, not undermine it

Trust, transparency, and consent are the foundations of good health care. When a patient walks into my office seeking psychiatric care, they may be in one of the most vulnerable moments in their life. This is especially true for my pregnant patients who are navigating growing restrictions to their bodily autonomy, as well as a raging maternal mortality crisis. This reality makes it all the more important for pregnant New Yorkers to feel safe seeking care.

A practice known as "test-and-report" does the exact opposite.

"Test-and-report" refers to the practice of drug testing and screening pregnant women and their newborns and reporting positive results to child protective services. This is often performed without the patient’s informed consent which directly contradicts what we as clinicians and top medical societies know about the importance of transparency in health care. Yet, it remains a routine practice in hospitals across the country, including in New York.

Despite the fact that people of all races use substances at virtually the same rate, low-income Black and Latino women and their newborns are disproportionately targeted by this practice.

I urge the State Legislature to pass — and Gov. Kathy Hochul to sign — the Maternal Health, Dignity, and Consent Act. The bill is simple. It requires health care providers to obtain written and verbal informed consent from pregnant women before drug testing and screening them or their newborns.

In 2020, New York City Health+Hospitals, the largest municipal hospital system in the country, implemented a citywide policy requiring informed consent for drug testing pregnant women and newborns. Meanwhile, New York Department of Health clinical guidelines specifically call for collaborative and informed decision-making with pregnant and postpartum patients before substance use screening to ensure more consistent implementation.

As a psychiatrist, I work every day to earn the trust of my patients. When a patient trusts me, they’re more likely to openly share their struggles. This information makes me better equipped to help them stay healthy. Mutual trust and transparency is in everyone’s best interest.

"Test-and-report" breaks mutual trust and transparency. Drug testing a patient without their consent — and often without their knowledge — makes patients feel betrayed by their providers. And when people don’t trust their health care providers, they are likely to avoid care altogether. This is in no one’s best interest.

For somebody who is pregnant, the fear created by practices like "test-and-report" can be deadly; pregnant New Yorkers who don’t receive prenatal care are three to four times more likely to die. Mental health issues are a leading cause of pregnancy-related death in New York City, which makes psychiatric care especially critical.

Newborns whose parents don’t receive prenatal care are three times more likely to have a low birth weight and five times more likely to die than newborns whose parents do get care. Making pregnant women feel safe seeking care is always best for newborn health.

"Test-and-report" also doesn’t facilitate the treatment that a parent may need or want. Attempts to force people into substance use treatment, especially by a health care provider who just betrayed their trust, won’t work. Mental health professionals know treatment starts with trust.

The Maternal Health, Dignity, and Consent Act ensures that health care providers treat substance use like any other medical condition by discussing it openly and managing it collaboratively with their patients. That’s what leads to better outcomes — for parents, for babies, and for families.

This guest essay reflects the views of Frank G. Dowling, a board-certified psychiatrist and associate professor of psychiatry at Stony Brook University School of Medicine.