Applicants for jobs with Maryland hospitals, including physicians, would have to pass drug and alcohol tests to gain employment or credentials under guidelines being developed by the hospital industry.

Pre-employment testing, including the screening of physicians, represents an escalation in the effort among the state's 69 hospitals to create drug-free work environments. At the same time, the proposal has raised new concerns that it would be a first step toward random testing of all health care workers.

A substance abuse task force of industry representatives also is considering requiring agencies that provide temporary hospital workers to certify that their employees are drug-free or risk losing their contracts.

The policy recommendations being considered by the Maryland Hospital Association come during a period of heated debate among health care professionals. Proponents argue that the policies are needed to ensure public confidence in the health system. Critics contend that testing would violate employees' privacy rights.

Though several major hospitals throughout the Washington region have begun some form of drug screening of prospective employees, the Maryland Hospital Association's proposed guidelines represent the area's first industry-wide attempt at a uniform approach to testing workers.

Other hospital groups may follow suit. At its annual meeting this week, the Virginia Hospital Association will hear lawyer John G. Kruchko, one of the area's leading advocates of drug testing, press for similar guidelines.

The District hospital association has not discussed the issue, but some hospitals in the city have implemented policies on their own, according to area administrators.

Hospital administrators said they do not think there is a greater problem of drug abuse among health care workers than others. But they acknowledge that the access that hospital employees have to some controlled substances creates a special concern.

"It's not going after anybody. It's not to develop a 'gotcha' " atmosphere, said Steven J. Summer, senior vice president of the Maryland Hospital Association. "The community looks to hospitals for the wisdom. By hospitals taking the initiative, it will help set the stage for other employers to establish substance-free environments."

The association is planning to vote on the recommendations and other guidelines by January. Hospitals in the state are not required to follow the association's recommendations. But several already have implemented drug-testing policies, from pre-employment screening to annual testing of employees. Many other hospitals are considering similar policies.

In Maryland, the debate over testing was sparked partly by Johns Hopkins University Medical Center's controversial decision this year to begin mandatory alcohol and drug testing of its 1,500 staff physicians and about 5,000 other hospital employees.

Johns Hopkins administrators unveiled the random drug test program in February and planned to have the testing in place for all employees by the end of the year. But in the face of some physician opposition, the administrators have postponed implementation once and said last week they are unsure when the program will go into effect.

Also this year, Dimensions Health Corp., which operates several hospitals and nursing homes in Prince George's County, including Prince George's Hospital Center, began mandatory pre-employment drug and alcohol screening.

In October, Shady Grove Adventist Hospital began testing all new employees, including staff physicians, during the first three months on the job. Those employees will be tested again each year.

"Because we are a health-care provider, there should be an example set," said Jeffrey A. Austin, senior vice president for human resources at Dimensions. "Our employees feel a need to convey that."

As for doctors, Austin said, "I think the medical profession is on record saying . . . they want to make sure the general public has the highest level of comfort {with} the medical field."

Angelo J. Troisi, executive director of the Medical and Chirugical Faculty of Maryland, the state's medical association, said his organization has not taken a position on drug testing of physicians.

"The physicians of Med-Chi are dedicated to accomplishing whatever is necessary in this war against drugs," Troisi said.

However, other doctors expressed concern about where drug testing might lead. Kenneth Johnson, who is chairman of the Johns Hopkins Medical School Council's substance abuse committee, said the organization is polling its membership to develop a response to the testing plan.

"My own opinion is there is a kind of hysteria surrounding this and one ought to proceed very carefully in dealing with people when you start drug testing without cause," Johnson said.