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Health leaders say fentanyl testing change will save children's lives

Fentanyl exposure in young children gets overlooked because there is no national mandate for screening for it as part of standard drug testing.
Health leaders say fentanyl testing change will save children's lives
Posted at 11:10 AM, Nov 01, 2023

Clutching her light-up toy microphone, 2-year-old Hailey Goding scampered in circles around the living room as she laughed and softly sang along with a Disney tune from the movie "Frozen.”  

A bright, toothy smile filled the little girl’s face as her brown eyes twinkled with delight during the joyful moment captured on a 14-second home video in 2020.  

It would be among the final recordings her family would gather of the little girl.  

Nearly six months later, she was dead of fentanyl poisoning. 

“It was heartbreaking,” said Ursula Picciano, Hailey’s grandmother. “It ripped the heart right out of my chest.” 

Hailey’s death in June 2021 occurred after a series of preventable mistakes and tragic decisions, including her mother’s nearly day-long delay in calling 911.  

According to police records obtained by Scripps News, Hailey’s mother Hillary Goding told police she had snorted drugs through a straw and later watched Hailey put the straw in her mouth.  

Tests confirmed Hailey ingested a deadly dose of fentanyl. 

According to an arrest affidavit, the little girl had become lethargic with “’raspy’ breathing,” but Goding decided not to transport Hailey to the hospital because “she was concerned the people at the hospital would take Hailey away.” 

Instead, over the course of 16 hours, Goding is seen on surveillance footage carrying her limp child in and out of an apartment building in Old Town, Maine, where she lived.  

When she called 911, it was too late to save the little girl’s life. 

Goding is now serving 19 years in prison for her daughter’s death. 

“There’s so many emotions. There’s sadness. There’s anger,” said Picciano. “I’m mad that the system failed Hailey.” 

Scripps News reviewed Hailey Goding’s case along with nearly 300 other recent fentanyl poisonings among babies, toddlers and small children to find common trends that might shine light on ways to prevent deaths and save lives.  

In at least half the cases Scripps News analyzed, there were warning signs in which police or case workers were made aware of potential concerns about drug issues or child abuse.  

As in many of the cases Scripps News analyzed, Hailey’s case exposed multiple red flags before her deadly overdose. A year prior to her death, she suffered another fentanyl poisoning in her mother’s care, and her extended family members made repeated calls to child welfare workers and police to express concern, but none of those warnings were enough to save Hailey’s life. 

A state review of the incident found “potential opportunities for improvement” while clearing any child protective workers of wrongdoing. 

The state agency responsible for child welfare also took steps to provide new drug recognition and screening training to its staff while working to embed substance use disorder clinical experts in child welfare regions throughout the state of Maine.  

Maine’s Office of Child and Family Services is also working on permitting caseworkers to carry the opioid antidote naloxone (also known as Narcan), according to Jackie Farwell, a state spokesperson. The agency is also considering allowing caseworkers to distribute naloxone to families. Child welfare offices will also be able to provide lockboxes to families for the safe storage of drugs, according to Farwell. 

Hailey’s case also helped expose a drug testing gap in the health care system. 

Now, health leaders and government officials are recommending a policy change that they insist will save lives. 

Health leaders make recommendation

In August 2023, Maine’s Governor’s Office of Policy Innovation and the Future sent a letter to hospital leaders, substance use providers and pharmacy communities urging hospitals to include fentanyl screening in their standard drug testing protocol “so optimal care can be provided to patients and to ensure the safety and wellbeing of children in the home.” 

Many hospitals do not routinely screen for the synthetic opioid when they’re drug testing a patient for substances, but the move will “no doubt” save lives, according to Mark Moran, the chairman of Maine’s Child Death and Serious Injury Review Panel. 

His group first recommended this change in its 2022 annual report after reviewing Hailey’s case and several others. 

“If the test includes [a screening for] fentanyl, then you have a reasonable ability to rely on that result as positive or negative, illustrating the presence or absence of fentanyl in their system,” said Moran. “If it doesn’t, I think there’s a risk that people are falsely reassured that the substance is not present when in fact it could be. It just wasn’t tested for,” he said. 

Hailey’s initial testing didn’t show fentanyl

A year before Hailey died of fentanyl poisoning, she survived another fentanyl overdose, but initial hospital testing did not screen for fentanyl, so it did not immediately reveal the drug in her system. 

During that occasion, Hailey’s mother claimed the little girl had picked up a drug-contaminated piece of foil at a local playground and put it in her mouth. 

“The emergency department could only test for seven substances; fentanyl was not one of these substances,” according to a state review of the incident. 

Doctors transferred the child to a second hospital where a more comprehensive test revealed the deadly substance in Hailey’s system.  

Hailey survived, but the incident is raising awareness about the limitations in some testing. 

“If a child is brought in, that’s the first thing they should do. They should test them just to see,” said Picciano. 

Moran said it is crucial to learn a child’s health circumstances as quickly as possible to provide appropriate support and services to the child and family. 

If a drug screen is negative but never tested a child for fentanyl, “we, the system, run the risk of not being able to protect that child adequately,” he said. “Perhaps that’s a child who would go home or would be continually exposed to the caregiving environment where that ingestion might have happened.” 

A similar poisoning in Baton Rouge

A Scripps News investigation examined a similar incident in Baton Rouge, Louisiana. An initial standard hospital drug test did not screen 2-year-old Mitchell Robinson III for fentanyl.  

Although he responded to Narcan, the boy returned to the same environment in which he was initially exposed, and he overdosed again.  

Doctors recognized the boy’s response to Narcan and ordered more comprehensive drug testing that included a screen for fentanyl. 

Despite the positive test results days later, no caseworker ever assessed Mitchell, in person, before he overdosed a third time and died. 

The boy’s mother pleaded not guilty to a second-degree murder charge for his death. 

“You think about the multiple things that could have happened – that should have happened,” said Sen. Regina Barrow, a Louisiana state legislator who represents Mitchell’s hometown.  

“What should have happened with the Department [of Children and Family Services]? What should have happened with the parents? What should have happened in the community? And did they step up? Because ultimately, I believe it’s all of our responsibility,” she said. 

Barrow, who chairs Louisiana’s Select Committee on Women and Children, convened hearings to address system failures involving Louisiana’s Department of Children and Family Services. 

“We didn’t do enough. We, being the state, didn’t do enough to make sure that child was safe,” she said. 

The agency developed a new safety policy that would ensure immediate face-to-face contact from a welfare worker when it received a safety referral from a health care provider. 

But Scripps News discovered that the new policy did not prevent another similar incident near New Orleans this year. 

In that case, a baby girl was revived with Narcan only to be returned to the same environment where she was first poisoned, where police said she again suffered another incident and was again revived with Narcan. Initial drug tests from the first incident did not reveal fentanyl in her system.  

“To me, that should’ve been a no-brainer, that should have been something that would have been implemented through rule changing,” Barrow said of the idea of conducting fentanyl testing on a child who responds to Narcan to confirm the presence of the drug. 

Barrow told Scripps News she would convene additional hearings and explore possible legislation to address the testing gaps. 

“While I do believe that [the employees at the Department of Children and Family Services] have made strides to correct a lot of the issues, I’m learning that we still have a lot of gaping holes in the whole process,” said Barrow.

Changes in several states but no national mandate

California and Maryland enacted recent laws requiring fentanyl screening to be included as part of standard drug testing protocols at hospitals, but there is no national law or regulation that requires this type of testing. 

Scripps News found health leaders and professionals who review child fatality reports in several states — including Nevada, Washington, Connecticut, Colorado and Pennsylvania — have raised concerns about screening for fentanyl in recent months. 

In Nevada, for example, members of the Nevada Executive Committee to Review the Death of Children said it would like to “encourage all hospitals within the state to begin testing for fentanyl as part of the standard drug testing panels.  As fentanyl is becoming more prevalent in our state, we have seen an increase in the number of children who have suffered a near-fatal or fatal event due to accidental ingestion of this substance. There is a significant delay in determining fentanyl ingestion as a cause of unresponsiveness in children which leads to incorrect medical treatment, inaccurate assessments, and/or ongoing safety issues.” 

Hospital and medical associations share perspectives

A national standard for fentanyl testing would be “preferable,” according to the American Academy of Emergency Medicine's president, Dr. Jonathan Jones. The group, also known as AAEM, is the “specialty society of emergency medicine,” according to its website.   

“Ideally fentanyl should be included when it is determined that a pediatric patient would benefit from a drug screen,” Jones said. “Particularly in the case of potential fatal overdose or otherwise unexplained altered mentation, fentanyl should be considered as a possible cause and if available, testing for fentanyl should be performed,” he said in an email to Scripps News. 

Jones said “significant resources” would need to be put in place to make a national standard possible, but the organization “fully supports increasing availability of fentanyl testing.” 

“The caveat is that adding any new testing technology results in expenses. Many hospitals, especially in rural areas, are struggling, and some have closed,” he said. “While I cannot speak to the exact costs of fentanyl urine testing, the retail costs can approach $100. I would assume that the cost to hospitals would be much less but not negligible. We fully support increased fentanyl testing, but costs must still be considered or somehow offset, possibly with federal assistance, particularly to rural hospitals.” 

The American Hospital Association, a group representing nearly 5,000 hospitals, health care systems and health providers, and 43,000 individual members, said it supports “evidence-based” guidelines for treatment of patients, according to Colleen Kincaid, a spokesperson. 

“As far as a federal law mandating any such testing, any considerations on whether we’d support something like that in the future would be driven by clinical evidence,” she wrote in an email. “It’s important to appreciate that testing every child with any symptom related to overdose (such as lethargy) without any other indicator of exposure to fentanyl for an overdose could consume and divert critical health care resources.” 

Kincaid said when children are involved, hospitals must follow other laws when it comes to screening and testing. “For example,” she said, “their parent or guardian has to consent to a drug screen.” 

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