Alexandra Hodor’s kids were put into the foster system three years ago after she overdosed on heroin. She’d been using opiates to cope with PTSD after a difficult pregnancy with her youngest son and a delivery at 25 weeks that almost killed them both. Soon, Hodor was back in the hospital. After nurses revived her with Narcan, Michigan’s Department of Health and Human Services opened an investigation into abuse and neglect.
That was a wake-up call for Hodor, a 33-year-old single mom of three. She says she got sober, partly by taking medication to block the pleasurable effects of opiates. She started attending parenting and substance abuse classes and waited tables, all while taking full-time courses toward a degree in social work. But one obstacle kept Hodor from reunifying with her children: weekly random drug tests that often came back positive for cocaine.
“I know no one will believe me, because an addict is an addict,” Hodor said. “But I wasn’t doing coke.”
The tests were administered by drug-testing giant Averhealth, a private equity–backed company that works across 34 states and runs up to 8,000 tests a day, including most of the ones used in Michigan’s child welfare cases. Hodor’s situation is a relatively common one in family and drug treatment courts as well as in probation and parole: Someone with a history of substance use swears they’re sober, but drug tests show otherwise. The vast majority of the time, they’re not believed.
But it wasn’t just former drug users challenging Averhealth’s results—so was one of its own scientists.
Averhealth’s former lab director Sarah Riley testified during a family court case last year that up to 30 percent of the company’s test results submitted to the state of Michigan were wrong, including both false positives and false negatives, according to a court transcript obtained by VICE News through a Freedom of Information Act request.
“Did you say 30 percent, ma’am?” the judge asked her. “Three zero,” Riley replied.
Although Averhealth denies that anyone involved in cases using its tests has brought up concerns, judges and caseworkers were writing to their superiors behind the scenes, with stories of clients who had seemingly erroneous results, according to internal emails obtained by VICE News. In three counties, courts also dramatically reduced testing or stopped using Averhealth altogether.
“We don’t trust them,” one Michigan Department of Health and Human Services (DHHS) supervisor wrote to her colleagues in January 2021 about Averhealth. “We are making BIG decisions, including having parents leave home or removal, and that’s scary to do when you don’t trust who you’re getting services from. Is there a different agency we can use?”
In March 2022, Michigan’s DHHS, which encompasses the office known colloquially as child protective services, suspended its $27 million contract with Averhealth for 90 days. “Effective immediately, [we] will discontinue the use of Averhealth for substance use testing,” the agency wrote in a memo to offices around the state. The suspension is now extended through Sept. 7, a Michigan DHHS spokesperson told VICE News.
But Averhealth’s drug tests don’t just determine whether someone loses their children. The company also contracts with police departments, probation and parole offices, and drug treatment courts around the country; its tests can put people in prison and get them hired or fired from jobs. In two other states, recipients of Averhealth’s drug tests who also say their results were wrong have sued the company.
Averhealth told VICE News in an email that it had no idea why Michigan had suspended its contract. In an independent investigation commissioned by Michigan’s DHHS in December 2020, investigators found that the company’s results were scientifically accurate and forensically defensible. Averhealth also intends to file suit against Michigan for breach of contract and making “defamatory statements” about the quality of its testing, according to legal filings it shared with VICE News.
"Averhealth has—and remains to this day—willing to address any specific concerns about any test results provided on any Michigan sample,” a spokesperson said, “and is fully prepared to defend and validate its processes and protocols.”
Do you have information about Averhealth’s tests? You can reach out to Alice Hines via email at firstname.lastname@example.org or securely on Signal at +1.814.621.3116.
But for people like Hodor, the stakes couldn’t be higher. Growing up in the foster system herself, she always wanted to be the kind of parent she didn’t have. Her rainbow-colored hair often makes cameos in the TikToks she records with her kids, whom she calls her reason for being.
“If Averhealth is determined to have screwed up all these tests, that is a nightmare situation for everyone involved,” said Evelyn Calogero, a defense attorney who represents parents in Michigan child protective services cases. “Rights were terminated. Kids were adopted. You’re talking trauma to everybody.”
Hodor says her kids are now often withdrawn and depressed during visitations. She’s also in debt after spending more than $15,000 on independent drug testing and legal representation to challenge Averhealth’s results and reunify with her kids. Two of them were placed with family members, one with a foster family. Even if her children are allowed to come home, they’ll never get back the time they lost with their mother.
“We have to rebuild relationships,” Hodor said. “There is just irreplaceable damage.”
Averhealth uses a two-pronged approach to drug testing, according to documents from the company and Michigan’s DHHS obtained by VICE News.
Here’s how it works: A parent like Hodor goes into an office in their neighborhood and spits on a swab. The office, a subcontractor of Averhealth, then ships the oral fluid sample to the company’s central lab in St. Louis.
The first test, called an immunoassay, narrows down what drugs the parent may have used with rough accuracy. That step works like a COVID antigen or drug-store pregnancy test: The saliva sample mixes with a chemical reagent, which then turns a certain color to indicate likely results. If the presumptive result is positive, Averhealth then uses a more precise test, called mass spectrometry, to confirm it. Unlike the immunoassay tests, mass spectrometry uses instruments that can separate and identify individual drugs in a sample by their chemical fingerprints.
That’s all standard practice in the industry, even outside Averhealth. But an otherwise foolproof process becomes less so when steps are skipped, and scandals are more common than you might think. In New York State prisons, an investigation published in 2022 found that inmates were being punished and put into solitary confinement because initial screening results came back positive for the opiate buprenorphine. As it turned out, the test maker had failed to disclose internal research showing over-the-counter cold medicine, antacid, and even stevia could trigger false positive results. At the same time, prison managers were skipping spectrometry confirmation altogether. A court-watching nonprofit found a similar situation in New Orleans in 2018, when only immunoassays were used. Neither of the scandals involved Averhealth.
But in Michigan, the problem was different, according to Riley, who oversaw testing at Averhealth’s central lab. As she testified in the Michigan court, the company was botching the quality controls on its spectrometry test, a process known to be the gold standard in the industry.
“Rights were terminated. Kids were adopted. You’re talking trauma to everybody.”
Quality controls are basically dummy tests to ensure a lab’s instruments are correctly functioning. They work by testing samples with known quantities of meth, coke, or various drugs alongside samples from real people. The idea is that when instruments fail to detect the correct level of known drugs, none of its results can be trusted.
In February 2021, the lawyer for a mom under investigation by the state of Michigan called Riley as a witness during her case challenging her Averhealth test results. The mom’s results had come back positive for weed, but a hair follicle test commissioned independently was negative, according to her lawyer, Gregory Crockett. Averhealth’s positive test for cannabis was ultimately admitted as reliable by the judge.
Riley, who has a Ph.D. in biochemistry and molecular biology, explained during her testimony obtained by VICE News that spectrometry instruments are only accurate if properly calibrated. Temperature and many other tiny and constantly changing environmental variables can shift results, so machines are constantly checked with so-called “quality controls.”
But Averhealth was trusting the results even when the quality control tests failed—and reporting erroneous results to the state of Michigan, according to Riley. She came upon the errors soon after starting her role.
“This practice of ignoring failures was commonplace,” she testified. “So when the sample that was run was prepared with known quantities and known drugs would fail, the corresponding patient sample would still be reported.”
In her court testimony, Riley also said that she brought concerns to her bosses in Averhealth’s senior management, but they declined to fix the problems. “Their reaction was … ‘We have contractual time agreements to get this data out, and we just want to get this data out,’” she testified.
Averhealth told VICE News that Riley’s allegations were “baseless” and noted that the independent investigation commissioned by Michigan found “no issues noted with the testing process, the validity of the results, or the qualifications of the lab and personnel.”
Riley ended up quitting Averhealth seven weeks after she started in September 2020. Before she left, however, she filed a complaint with the College of American Pathologists, a private group that monitors and certifies drug testing companies, including Averhealth. Michigan’s DHHS told VICE News that Averhealth has to this day not shared any results from the College of American Pathologists investigation.
Averhealth told VICE News that reports from the College of American Pathologists are confidential and that the company can’t produce or disclose them. The College of American Pathologists declined to comment on the investigation but said in a statement that Averhealth remained an accredited laboratory, and that its last on-site inspection was April 11, 2022.
In an internal email obtained by VICE News, Averhealth refused to acknowledge the problems Riley pointed out before leaving the company—in fact, it blamed her for them.
“We believe Mrs. Riley was disgruntled for reasons unknown to Averhealth,” Averhealth’s CEO wrote to his contacts at Michigan DHHS in November 2020. In another memo a few weeks later, he wrote that Riley hadn’t raised her concerns internally and that she was “directly responsible” for every one of the errors she later reported to judges.
Riley now works as an associate professor of pathology and lab director at Saint Louis University. She declined to comment for this article.
Averhealth has admitted to some mistakes, according to emails the company sent to the state and obtained by VICE News. In September 2019, a lab technician placed a sample in the wrong slot, which caused 13 results to be attributed to the wrong people. The problem was discovered a month later, and Averhealth promised the state it would never happen again. About a year later, in October 2020, 139 people tested negative for substances when they had in fact used drugs, due to a software bug. The company said it fixed the issue.
But there were other complaints, too, that Averhealth said were unrelated to software or human error. In October 2020, one caseworker emailed superiors about two separate parents whose results didn’t match external tests. “These contradicting results are hindering permanency,” the caseworker wrote, referring to kids in the foster care system finding permanent homes, according to an internal email. But Averhealth argued that the discrepant results were due to different testing technologies.
While Michigan was investigating Averhealth, Hodor was trying to find alternative tests. In her frequent TikTok updates to other parents with child protective services cases, she compared the process of fighting Averhealth results to a “full-time job.” “I left 41 voicemails to CPS supervisors,” she vented in one video from August 2021.
Hodor estimates she sought out 140 independent urine tests—including a month's worth of daily tests—and also spent money on three hair follicle tests and two patches that tested her sweat continuously for two weeks. All of them were clean, she says. (VICE News reviewed 13 and confirmed they were negative for illicit drugs.)
But the judge in Hodor’s case wouldn’t admit them as evidence, at least at first. That’s because Averhealth’s official tests are mouth swabs, which show more-recent drug use than other forms of testing. As Averhealth put it in a training document, comparing urine or hair results to spit is an “apples to oranges” situation. But just how different the testing methods are remains unclear.
“One of the issues with oral fluid testing—it's kind of an Achilles heel—is the really short detection window,” said Paul Cary, a forensic toxicologist who authored many of the drug testing policies and procedures used by drug treatment courts. Averhealth promises in training materials reviewed by VICE News that drugs linger in spit for 48 hours. But in reality, Cary said, “the average detection window is about 24 hours.” This leads companies to lower their cutoff limits, or the minimum amount of a drug that constitutes a positive test. They do this to catch drugs over a longer span of time.
Averhealth doesn’t set its cutoff levels—the state of Michigan does. In fact, its contract with the company specifies that Averhealth must continually lower cutoff levels as testing technology improves.
But when cutoff limits are too low, according to Cary, tests are so sensitive that it’s easier to mistake trace amounts of drugs—for instance, ones left on instruments from previous samples—for actual drug use. That would result in a false positive.
“This practice of ignoring failures was commonplace.”
Despite these flaws, oral fluid as a testing mechanism is gaining popularity all around the country. It’s cheap and easy to swab someone’s mouth; no one has to take their pants off or awkwardly pee in front of an observer. In February, the Department of Transportation, a huge player that sets standards for drug testing millions of employees in aviation, trucking, railroads, mass transit, pipelines, and other industries, announced it would soon allow agencies to test using oral fluid instead of urine, which has long been the gold standard.
Urine has clear cutoff levels, established over decades. Swabbing oral fluid, because it’s a newer test, is less settled, according to Cary. Michigan has often debated changing cutoff levels, in part because of the accusations of false positives, according to internal emails obtained by VICE News.
In 2020, Michigan raised cutoff levels after a recommendation from Averhealth. In April 2021, the state’s independent investigators recommended raising them once again for benzodiazepines, opiates, and THC. That’s because a test “with cutoffs inappropriately low for its intended application may be subject to false positives by environmental contamination,” the investigators wrote. But the state declined to raise the levels.
A nationwide problem
Although oral testing has its problems, other types of tests produced by Averhealth are also being scrutinized. In Missouri, two parents who were hair-tested by Averhealth filed a class-action suit against the company, arguing that their positive results for meth were wrong and that shoddy quality controls were, once again, at fault. In February, the plaintiffs voluntarily pulled their suit, but their lawyer, Rick Cornfeld, told VICE News he plans to refile the case with different plaintiffs. Averhealth said it tested each specimen appropriately.
In Pennsylvania, Jessica Mack is the lead plaintiff in another class action suing Averhealth over allegedly false urine test results. In 2017, Mack was jailed for a week based on the results of an initial screening that came back positive for alcohol, then later turned out to be negative. Mack had been on probation for driving under the influence of alcohol, and one of the conditions of her sentence was abstinence. Mack lost her job temporarily during her time in jail. Averhealth, once again, said it tested Mack’s sample appropriately. The lawsuit is pending.
In Michigan, the state pays for court-ordered drug testing on behalf of parents like Hodor. But in Pennsylvania, individuals like Mack who are on probation or parole are responsible for footing the cost of the company’s tests—even when the results are wrong.
After she was released from jail, Mack continued to test with Averhealth. According to her lawsuit, the company produced another 10 false positive results for alcohol. Averhealth allegedly told Mack that she was free to pay extra for additional tests that were more accurate. Mack did, and each time, Averhealth’s more expensive follow-up tests disproved its original results, according to her suit.
Hodor, too, wants to sue Averhealth. But for now, she’s focused on getting her kids back. So far in 2022, she says she hasn’t had a positive test, and her final court date is in July. If everything goes well, all of her kids will come home for good later this summer.
Because the state evaluates each child’s placement individually, one of Hodor’s sons already came home this spring. Hodor decked out the house he grew up in with Spiderman balloons for the occasion. “Are you sure this isn’t a dream?” Hodor asked him in a TikTok. “I’m 100 percent sure,” he replied, beaming.
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