Committee hears bill to loosen mandatory reporting, testing for prenatal substance exposure

Senate Bill 22-32, which would change North Dakota’s mandatory reporting and newborn testing rules for prenatal exposure to controlled substances and alcohol, was the subject of a House Human Services Committee hearing where medical groups and clinicians urged the panel to give the bill a “do pass.”

Proponents told the committee the bill would preserve the physician–patient relationship and reduce deterrents that keep pregnant people from seeking prenatal care and addiction treatment. They said the current law requires reporting and, in some cases, automatic testing of newborns when any substance use occurred at any time during pregnancy.

Dr. Anna Tobias, an obstetrician and maternal–fetal medicine physician and North Dakota section chair for the American College of Obstetricians and Gynecologists, said substance use disorder is a medical condition and that compulsory reporting drives patients away from prenatal care. “Being mandated to report women with substance use disorders to child protective services is a barrier in maintaining a safe physician patient relationship,” Tobias said. She said that prenatal care and access to treatment improve maternal and neonatal outcomes and that changing reporting from “shall” to “may” would allow clinicians to use discretion when testing or reporting.

Dr. Danielle Thirdle, a pediatric hospitalist who oversees a maternal–infant dyad program for mothers with substance use disorders, testified that North Dakota is among three states that require compulsory newborn testing for substance use based on any use during pregnancy. She told the committee that routine drug screens produce false positives linked to prescribed medications, and mandatory testing can lead to unnecessary CPS referrals even when a patient is compliant with treatment. “In women who are currently prescribed a medication for their substance use disorder and enrolled in a treatment program, I have only ever felt the required drug testing of infants dissolves trust with the medical system,” Thirdle said.

Committee members asked presenters about the timing and relative harms of different substances during pregnancy and how the bill would affect clinical practice. Tobias and Thirdle said effects vary by substance and trimester and that the bill would retain clinician ability to test and report when clinical concerns exist but would remove automatic testing and reporting in cases where a patient is engaged in treatment.

No opposition testimonies were recorded during the hearing; the committee closed the hearing on SB 22-32 after the proponents’ presentations.

The bill’s text and any implementing administrative rules will determine how reporting waivers and clinician discretion are applied in practice.