Why Hospital Blood Alcohol Tests Lack Forensic Reliability in DUI Cases

When facing a DUI charge, the evidence often hinges on blood alcohol concentration (BAC) test results. However, it's important to understand that not all BAC tests are created equal—particularly those conducted in hospital laboratories. While essential for medical treatment, hospital laboratory testing for alcohol levels lacks the forensic reliability necessary to stand up in court under the Daubert standard. Here’s why:

1. Purpose of Hospital Blood Tests

Hospital blood tests are primarily designed for diagnostic purposes to inform medical treatment decisions, not for legal proceedings. These tests prioritize rapid results to address the patient’s immediate health needs rather than producing precise, legally admissible BAC levels (Garriott, 1996).

2. Differences in Measurement Techniques

Hospital laboratories commonly use Enzymatic Immunoassays (EIA) to measure BAC. Although effective for quick medical assessments, EIA tests are not selective for ethanol (the type of alcohol consumed) and can react with other substances, such as isopropyl alcohol and other similarly structured molecules, leading to inaccurate readings (Garriott, 1983);(Hunsaker 2016). Elevated lactate and lactate dehydrogenase can theoretically cause false positive results of enzymatic ethanol assay (EIA) and there are multiple potential causes of lactic acidosis such as bleeding, shivering, shock, genetic disorders, medicines like metformin, liver disease, exercise. (Albano, 2019; Foucher 2024 & Kraut 2014).   Analysis of alcohol levels in blood serum using an EIA is a sensitive and accurate index of low to moderate increases in blood ethanol appropriate to emergency department, but not legal, interpretation. (Keim, 1999).   Additionally , EIA tests are considered indirect measurements of alcohol concentration, introducing another potential source of error  Enzymatic immunoassays are preliminary tests and should be considered presumptive. (Citron, J. 2009).

In contrast, forensic laboratories use Gas Chromatography (GC), which is recognized as the gold standard for BAC testing. GC precisely separates and quantifies ethanol, ensuring accurate and reliable results that are critical in legal contexts (Jain, 1971).

3. Serum vs. Whole Blood Testing

Hospital labs frequently test serum, the liquid portion of blood, instead of whole blood. Since alcohol is more concentrated in serum, these tests can report higher alcohol concentrations (Charlebois, 1996). However, legal BAC limits are based on whole blood measurements, and there is no universally accepted formula to accurately convert serum BAC to whole blood BAC. This discrepancy further undermines the forensic reliability of hospital BAC tests (Penetar, 2008; Citron, J. 2009).

4. Lack of Forensic Protocols

For a BAC test to be admissible in court, it must follow strict forensic protocols, including a documented chain of custody and proper specimen handling procedures. Hospital labs are primarily focused on patient care and may not adhere to these forensic protocols, making the results susceptible to challenges in court.

5. Manufacturer Disclaimers

Even the manufacturers of hospital lab equipment acknowledge the limitations of their products in legal contexts. For example, Roche Diagnostics, a major manufacturer of blood analysis machines, explicitly states that their equipment is not intended for forensic use (Citron, 2009). This disclaimer clearly indicates that results from such machines should not be relied upon in DUI cases.

6. Potential for Contamination

Hospital BAC tests are prone to contamination, such as from alcohol-based skin cleansers used during blood draws, which can artificially elevate the reported alcohol level (Ialongo C, 2023). While forensic labs take precautions to avoid such contamination, hospital settings may not, leading to unreliable results.

Hospital blood alcohol tests are vital for medical treatment but fall short of meeting the stringent requirements of forensic reliability in DUI cases. The use of Enzymatic Immunoassays, testing of serum instead of whole blood, and the lack of adherence to forensic protocols all contribute to the inadmissibility of these results under the Daubert standard. For anyone facing DUI charges, it’s crucial to understand these limitations and ensure that only valid, reliable evidence is used in court.

If you’re dealing with a DUI charge and hospital blood test results are being used against you, it’s essential to consult with an experienced DUI attorney who understands the nuances of forensic testing and can challenge unreliable evidence

References

1. Garriott, J. (1996). Medicolegal Aspects of Alcohol. Lawyers & Judges Publishing, Tucson, Arizona 1996
2. Garriott, J. C. (1983). **Forensic Toxicology**. *Clinical Chemistry, 29*(3), 477-484.
3. Charlebois RC, Corbett MR, Wigmore JG. Comparison of ethanol concentrations in blood, serum, and blood cells for forensic application. J Anal Toxicol. 1996 May-Jun;20(3):171-8. doi: 10.1093/jat/20.3.171. PMID: 8735198.
4. Citron, J. DUI/DWI: Hospital Laboratory Testing Lacks Forensic Reliability, Journal of Legal Nurse Consulting, Vol.20 No.1 (Winter 2009).
5. Penetar DM, McNeil JF, Ryan ET, Lukas SE. Comparison among plasma, serum, and whole blood ethanol concentrations: impact of storage conditions and collection tubes. J Anal Toxicol. 2008 Sep;32(7):505-10. doi: 10.1093/jat/32.7.505. PMID: 18713519; PMCID: PMC4450647.
6. J.C. Hunsaker, L.B.E. Shields, B.E. Frost, G.D. Dukes, Alcohol: Blood and Body Fluid Analysis, Editor(s): Jason Payne-James, Roger W. Byard, Encyclopedia of Forensic and Legal Medicine (Second Edition),Elsevier,2016,Pages 108-118,ISBN 9780128000557,
7. Albano J, Patarroyo-Aponte GD, Mahmood E. Case of acute hepatic injury and elevated ethanol levels in a non-alcoholic adult. BMJ Case Rep. 2019 Nov 10;12(11):e229814. doi: 10.1136/bcr-2019-229814. PMID: 31712226; PMCID: PMC6855907.
8. Foucher, C & Tubben, R., StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): January, 2024. Bacterial Sepsis. [NIH]
9.  Kraut, J. A., & Madias, N. E. (2014). "Lactic acidosis." New England Journal of Medicine, 371(24), 2309-2319. doi:10.1056/NEJMra1309483
10. Keim ME, Bartfield JM, Raccio-Robak N, Abhyankar VV, Salluzzo RF. Accuracy of an enzymatic assay device for serum ethanol measurement. J Toxicol Clin Toxicol. 1999;37(1):75-81. doi: 10.1081/clt-100102411. PMID: 10078163.
11. Citron, J. DUI/DWI: Hospital Laboratory Testing Lacks Forensic Reliability, Journal of Legal Nurse Consulting, Vol.20 No.1 (Winter 2009).
12. Jain, N. C. (1971). **Gas Chromatography in Blood Alcohol Testing**. *Journal of Clinical Pathology, 24*(2), 139-146.
13. Charlebois RC, Corbett MR, Wigmore JG. Comparison of ethanol concentrations in blood, serum, and blood cells for forensic application. J Anal Toxicol. 1996 May-Jun;20(3):171-8. doi: 10.1093/jat/20.3.171. PMID: 8735198.
14. Penetar DM, McNeil JF, Ryan ET, Lukas SE. Comparison among plasma, serum, and whole blood ethanol concentrations: impact of storage conditions and collection tubes. J Anal Toxicol. 2008 Sep;32(7):505-10. doi: 10.1093/jat/32.7.505. PMID: 18713519; PMCID: PMC4450647.
15. Citron, J. DUI/DWI: Hospital Laboratory Testing Lacks Forensic Reliability, Journal of Legal Nurse Consulting, Vol.20 No.1 (Winter 2009).
16. Ialongo C. Blood alcohol concentration in the clinical laboratory: a narrative review of the preanalytical phase in diagnostic and forensic testing. Biochem Med (Zagreb). 2024 Feb 15;34(1):010501. doi: 10.11613/BM.2024.010501. Epub 2023 Dec 15. PMID: 38107001; PMCID: PMC10564119.

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Disclaimer

The information in this blog post is for general informational purposes only and should not be construed as legal advice. Please consult with an attorney to discuss your specific legal situation.