Could you give some additional information about your "clinical environment"? What is the purpose of the DOA testing in your case? Are these tests performed in an emergency situation?

It can be in the emergency department as well as in hospital detox units or outpatient units without legal purposes, only clinical attention.

I do not think that a confirmatory method is required in most cases - only if the immunoassay result is in conflict with the clinical diagnosis or if any legal issues are involved. In emergency situations, the confirmation would be too slow. The most frequent "errors" with immunoassays are false positives due to their extreme sensitivity and some cross-reactivity to related drugs. Confirmatory methods are quite expensive and hence, it might cause problems with your financial department or the health insurance, if they are performed without a clear indication. From an analytical and scientific point of view, a confirmation method is always desirable to increase the reliability ("validity") of the result.

Mr. Izquierdo,

Your question is associated with philosophy, because of the Health System does not represent Institution from the Institutions of Justice.

A reason is that 'medicine', in general, cannot be associated with the physico-chemical sciences. It is rather associated with 'biology'. Because of the foundations of the former group sciences are universally valid physical laws, so that any experimentally observed phenomena have their physical explanation and an explicit mathematical expression.

On the contrary, the biology operates with observable facts, however, very frequently there is a lack of relationships between them and/or physical explanation. Same is valid to some areas of medicine, for instance, psychiatry, endocrinology, etc.

Largest part of biological experiments are carried out under variation of the chemical content of the matrix. Or there is unknown the physical background of the observable response of the examined system. There is operated with a statistically representative quantity of experimental data over a range of biological objects (including tissue). But all these data are irreproducible in the context of the analytical chemistry. There is lack of mathematical expression or a significant non-representativeness of the data in statistical terms. This means that, the equations (when they are) are not universally valid. And thus these data cannot be independently repeated in order to be verified.

When sets of data cannot be verified independently over the time, they cannot serve as property of evidence.

That is why, any experimental datasets from the latter areas, are (should obligatory be!) checked by specialized independent laboratories to the Institutions of Justice, when these experiments involve chemicals under control. Explicitly there is highlighted 'independent', in order to be ensured reliability of the results from the measurements. The latter is associated with an area called 'analytical science', which tackles the analytical problem of 'the reliability of the meaning of the experimentally measurable quantities' (Or what means given measurable quantity; what exactly this quantity reflects; is this the true one quantity; etc.?). When the quantities are from chemical experiments this area is included as a sub-area of the analytical chemistry and the corresponding statistical analysis is called 'chemometrics'. So, a part of the research in the analytical science (including the chemometrics) involves as well as mathematics and statistics, by they are also based on strict systems of equations.

Within the framework of an experiment very frequently the corresponding analytical procedures could not elicit exact to the chemical content and structure of the matter analytical information, furthermore in quantitative terms. The potential sources of errors leading to discrepancy of the data are large number and have with different characters.

In order to obtain "confirmation" you should send the samples to the corresponding specialized laboratories. Most closely disposed, and safety for the samples, are the laboratories of the Police Departments in your City.

The control over cases of DOAs in tissues cannot be concentrated in your System, due to reasons mentioned above, and thus it has not controlling functions. DOAs, however, as substances under control.

In this context, even if you have own analytical MS-protocols for DOAs in tissue, and even if these protocols are reliable, the results are under juridical obstruction in cases of lawsuits. But the latter are, because of "for clinical purposes in DOA testing" could include illegal distribution/consumption of DOAs by your System; and etc.

Due to reasons of the latter characters, such as results can be generated by any laboratory. Your clinical laboratory is one of many others. And all citizens have right to use the services of all existing laboratories, only on the base of own personal (to the individual) choice (Furthermore not only in your Country). In this context the Law fully protects the citizens against possible illegal activities, due to lack of the competence of the population in medicine and public health.