Thousands of drug tests used by a major US diagnostic company in California prisons last year are suspected to have generated false positive results, an enormous error that has jeopardized the parole requests of some incarcerated people, according to civil rights lawyers and prison medical records.
California prison officials have known about the issue for months, but have failed to clear people’s records or reverse the consequences people have faced from the tests.
The problem originated with tests conducted by Quest Diagnostics, a company used by healthcare professionals across the country, and the sole firm contracted to do clinical drug screening for the California department of corrections and rehabilitation (CDCR).
From mid-April through July of last year, Quest’s urine opiate drug screenings in CDCR prisons used an “alternative” reagent, the chemical meant to detect drug traces, while the company’s lab faced a backorder of its usual reagent.
The switch resulted in “more presumptive positive results” than registered in tests with its usual chemical, and when Quest restored its original reagent, the positivity rate “returned to its historical average”, according to a letter the firm sent to prison healthcare officials.
UnCommon Law, an Oakland-based non-profit that represents people seeking parole, obtained the letter when one of its clients received it from his provider. UnCommon Law also obtained public records and testing data that it shared with the Guardian.
The letter said the alternative reagent “passed all quality-control metrics” and that the change in performance was only “slightly different”.
But state data, obtained by UnCommon Law, showed the spike in positive tests was substantial.
From January through April, when the normal chemical was being used, the monthly positive opiate rate across CDCR prisons ranged from 6.6% to 6.8% each month, according to the records from California Correctional Health Care Services (CCHCS), the state agency that provides prison medical care. The rate then suddenly rose to 17.1% in May, 20.5% in June and 17.1% in July. The positivity rate returned to 6.8% in August, when the company returned to the original reagent, and stayed in that range for the rest of year.
The state acknowledged the issue in January to the Prison Law Office (PLO), a civil rights firm that monitors CDCR’s medical care, which is under a court-appointed oversight due to longstanding violations. Prison healthcare officials told PLO in a letter they had “generated a list of patients that may have received a false positive result” from Quest.
Alison Hardy, a PLO attorney, said officials sent her office a list of roughly 6,000 individual patients who got positive results under the alternative reagent.
A data analysis by UnCommon Law suggests there could have been more than 5,000 false positives, which could include multiple tests for the same person. The figure is a rough estimate based on the total number of tests from April through July and assuming the positivity rate would’ve stayed consistent if the reagent hadn’t changed.
Dr Fred Rottnek, a family medicine professor and addiction expert at Saint Louis University, who reviewed some of the Quest records for UnCommon Law, said the 300% jump in positivity rates rendered the tests “basically worthless”.
“There should be a mandate to go back and review all of the medical records, and whether the lab results had any bearing on parole board decisions,” said Rottnek, who previously served as the St Louis county jail medical director.
Denied freedom
The Quest tests are used in the prisons’ substance use treatment programs. The tests are meant to be a reference point for clinicians tracking a patient’s progress, and not used for disciplinary or punitive purposes, with providers barred from sharing results with correctional officers.
There is, however, a major exception: the Board of Parole Hearings (BPH) can access and rely on the tests as it weighs whether an incarcerated person should be freed.
Attorneys have long criticized that practice, pointing out the results often are not confirmed by additional tests and viewed out of context of treatment journeys. Patients sometimes are not informed of the results until they are cited in formal proceedings, giving them little opportunity to contest them. PLO reported in a court filing that some people impacted by false positives only learned of the results at their parole hearings.
The Quest issue offered a particularly stark example of how the tests are unreliable and should not influence life-altering decisions, advocates said.
One of UnCommon Law’s impacted clients is a man in his 60s who has been incarcerated for decades for a teenage conviction for a violent crime and is now eligible for parole. His lawyers asked to keep his identity anonymous out of fear that publicly speaking about his case could jeopardize his parole process.
The last time BPH denied him parole was in 2023, with commissioners citing a rule violation of drug use several years prior, among other factors.
Last year, BPH conducted a standard review of the denial and weighed whether to give him a parole hearing in the near future. The board decided not to expedite his case, writing that he had tested positive for opiates in May and July of last year while in substance use treatment. “This is of considerable concern as it reflects continued substance abuse … and it demonstrates continuing struggles with criminal thinking,” the board wrote.
The man’s physician had given him the Quest disclosure letter noting both tests took place during the window the alternative reagent was used, and he strongly denied using opioids. His physician agreed, writing in medical records that he believed his patient’s assertions that he had not relapsed.
Lilli Paratore, the man’s attorney with UnCommon Law, said she believed that before the test results, her client had a strong chance at getting granted parole: “It felt within reach. These drug tests, if they remain uncorrected, hugely alter the picture.”
Paratore wrote to the board that Quest’s disclosure “conclusively demonstrates that [his] two positive tests were false”. Moreover, Paratore argued in the letter, the results should already have been treated as inconclusive, because they were not followed by confirmatory testing, nor interpreted by a doctor.
BPH responded that there was evidence he had used other illicit drugs besides the opiates identified in the Quest tests.
Paratore told the Guardian that one of the other tests was related to his prescribed anti-depressant and another was for an authorized pain medication.
The man told the Guardian, in comments shared by his lawyer, that he was “floored and shocked” when he learned of the positive opiate tests and that the parole board “never gave me a chance to defend myself”.
Paratore said the development has made her client consider stopping his drug treatment: “He’s in a program that’s helping him achieve sobriety. His doctors say he’s doing well. But to him, it feels like, ‘What’s more important – my participation in this program or my freedom?’”
His next parole hearing is in 2026.
Kyle Buis, a spokesperson for CCHCS, the prison healthcare agency, declined to comment on the number of patients affected by the alternative reagent. He said in an email that CCHCS identified an “unexpected increase” in positive results last year: “Upon recognizing the abnormal trend, CCHCS escalated the concern to the laboratory, which identified a change in testing methods resulting in an increase in positive urine test results.”
“CCHCS is in the process of directly notifying patients who may have been impacted by a falsely positive test due to the change in testing method, via a letter, which will also be placed in their electronic health record,” he said. “CCHCS is actively reviewing its protocols to ensure the accuracy of results and reiterating that these tests are intended for clinical use only.”
Jennifer Petrella, a Quest spokesperson, said the alternative reagent was “cleared” for use by the US Food and Drug Administration, but acknowledged the company believed it “led to a higher presumptive positivity rate”.
“It is not uncommon, nor clinically inappropriate, for some variation to occur when different reagents are used,” she said in an email. She declined to answer questions about the number of suspected false positives generated last year.
She emphasized that the tests come with disclaimers: “It is well-known that presumptive screening can, in some cases, generate positive results that, with subsequent confirmatory testing, would be identified as negative. We make clear on our test reports that presumptive results have not been confirmed with definitive testing. In addition, the reports state that drug testing results should be used for clinical purposes only.”
Quest offers “powerful confirmatory testing” to evaluate initial results, Petrella continued, but those follow-ups must be requested by physicians.
“In most cases, CCHCS does not order confirmatory testing,” she said.
Calls for reforms
Natasha Baker, an UnCommon Law attorney, argued CDCR and BPH should proactively wipe the positive results from people’s records, and that people who have already suffered parole consequences should be given a clear pathway to remedy those harms.
Rottnek argued that the parole board more broadly should not have access to individual clinical drug tests, but rather treatment summaries from doctors.
CCHCS said in a court filing last month it would “educate” BPH that when it is considering patients’ addiction recovery, “attention should be on the provider’s documentation and interpretation of the urine drug screening results, rather than on the … results alone”.
Terri Hardy, a CDCR spokesperson, said in an email: “The Board of Parole Hearing officers base their suitability findings on a number of factors, including treatment summaries and notes. They are trained to determine the weight and credibility of evidence in the record.”
Keith Wattley, UnCommon Law’s executive director, said concerns about false tests were not limited to last year. One of his clients, a 50-year-old woman, was denied parole last year with commissioners citing in part the fact that she allegedly tested positive for opiates in August 2023 while in treatment. Her own provider’s notes from the tests, however, said the “results are as expected unchanged and no provider follow-up is required”, and when she was seen two months later, the provider wrote the patient “has not used any drugs”.
“It’s demoralizing and disrespectful to someone who has fought addiction for their entire lives and finally see years or decades of sobriety only to have the board recklessly mischaracterize their journey in a way that means many more years in prison,” said Wattley, noting that the allegations of drug use and dishonesty remain in their records and can impede his clients through years of subsequent hearings.
BPH should not rely on substance use treatment medical records, he added, because it discourages people from getting the help they need to overcome their addiction.
“The board’s behavior here is lazy, reckless and irresponsible with devastating consequences for incarcerated people and their families.”
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