Public employers do not have as much freedom in drug testing as do private employers. This is because as local government entities, public hospital districts are subject to the constitution under the Fourteenth Amendment, whereas private entities are not. The constitution raises privacy issues that directly relate to drug testing.

The Fourth Amendment prohibits unreasonable searches and seizures by any state, local, or federal government official, agent, or agency. The United States Supreme Court has held that a urinalysis test constitutes a search and seizure and thus is subject to the Fourth Amendment.

A drug test administered by a public employer does not violate the Fourth Amendment if it is reasonable. Factors considered by the courts include: how intrusive it is, the manner in which it was conducted, the justification for initiating it, and the nature of the job. [O'Connor v. Ortega, 480 U.S. 709, 725-726 (1987)] For example, if the job involves the direct handling of drugs, then a drug test for job applicants is more likely to be viewed by the courts as reasonable.

However, absent public safety concerns, the courts generally require that drug tests be administered on an individual level based on that individual's suspicious behavior. Where there is a reasonable suspicion of drug use then an individual drug test is easier to justify legally than an across-the-board or random drug testing program.

In individual drug testing, the courts look at whether the decision was based on a reasonable individualized suspicion. That is, the question is whether an individual's activities and behavior created a "reasonable" suspicion of drug use. Reasonable suspicion can be based solely on off-duty activities, although standards vary from court to court. For example, the Ninth Circuit Court of Appeals has held that the Department of Labor can test employees in certain designated sensitive positions, including nurses, based on reasonable suspicion of off-duty drug use.

As public entities, public hospital districts have a duty to make their procedures available to the public for inspection and copying, including descriptions of their organization, where to obtain the information, and the general procedural operations. [RCW 42.17.250] In addition, public records and indexes of records must be made available. [RCW 42.17.260] New statutes put a cap on the amount that can be charged for copying at the actual cost, or if uncomputed then at 15 cents a page, and also require that sales tax be charged. [RCWs 42.17.260 and 42.17.300 ; see also Chapter 5, Section D, Records]

Specific exceptions to the public records disclosure requirement are listed under RCW 42.17.310 . For example, personal information in files for employees, appointees, or elected officials do not have to be disclosed to the public if the disclosure would violate their right to privacy. [RCW 42.17.310 (1)(b)] This includes any personal information which would be highly offensive to a reasonable person and not of legitimate concern to the public. [RCW 42.17.255] Residential addresses and phone numbers of employees and application materials submitted to the employer are also among the exceptions to public disclosure. [RCW 42.17.310 (1)(t),(u)]

One area of potential interest to the public is the salaries of public employees. Since salaries are not an exception listed in RCW 42.17 , they are records that must be made available to the public. Salary information is most likely to be of interest to the public with higher ranking supervisors and administrators.

As a governmental entity that provides services to developmentally disabled persons, vulnerable adults (adults who cannot care for themselves), or children under sixteen, a public hospital district must ask each applicant to disclose whether he or she has been convicted of certain abuse or child related crimes. [RCW 43.43.834] The PHD can submit an inquiry to the Washington state patrol after notifying the applicant that an inquiry may be made. The information can be used only in making the initial employment decision. There is no civil liability for failure to request a background check unless it is grossly negligent to fail to do so, but in any case the background check is a good business practice.