Medical Review Officer

QUESTION:

What actions must the Medical Review Officer (MRO) take when a positive test result is received from the laboratory?

ANSWER:

49 Code of Federal Regulations Part 40 states that the MRO, or the MRO staff, must make reasonable efforts to reach the employee at the day and evening telephone numbers listed on the Custody & Control Form (CCF). Reasonable efforts include, as a minimum, three attempts, spaced reasonably over a 24 hour period, to reach the employee at the day and evening telephone numbers listed on the CCF.

[Editor's Note: It is critically important for employers to be aware, and track, drug testing results for all employees. This includes questioning lengthy-over 3 days-delays in receiving test results from MROs. The MRO has a responsibility to report test results in a timely manner. This is especially important when a test is determined to be positive since it is the employer's responsibility to "immediately remove" an individual who has received a positive test result from his/her covered position. If the MRO staff can't locate the individual, they are required to request the assistance of the company Designated Employer Representative (DER). Recent DOT audits have found situations where the MRO failed to notify the employer and the employer had not tracked the test to ensure it had been reported resulting in significant delays in reporting a positive test result. A delay of this nature is considered a "serious" violation of the Federal Rule and can result in a "Civil Penalty" against the employer.]

QUESTION:

Must a test result be cancelled by the MRO when it is discovered the employee did not have a full three hours to provide a sufficient amount of urine?

ANSWER:

*    Not affording the employee a full three hours to provide a specimen is not automatically a basis for the MRO to cancel a test.
*    The three hour time period is a maximum rather a minimum. But, to avoid potential issues about the fairness of the collection, collectors are advised to provide the full three hours.
*    In each of the following examples, the collector could stop the collection process, thoroughly document the details and times on Copy 2 of the CCF, and inform the DER of the employee's inability to provide a sufficient amount of urine:

    *    After 2 hours and 50 minutes, the employee informs the collector there is no reason to try again because he or she will not be able to provide a specimen. The collector terminates the collection.
    *    After 2 hours and 50 minutes, the employee requests to try again but provides another insufficient amount of urine. The collector terminates the collection because there is no practical possibility that the employee will provide the requisite amount in the next 10 minutes.

*    In each of these two examples, the employee has had a fair opportunity to provide 45 mL of urine, and the test should not be cancelled because the full three-hour period was not used.
*    The medical evaluation should be conducted to determine if there is a legitimate physiological condition or psychological disorder explanation for the employee's inability to provide the requisite amount of urine.
*    In situations where it appears the employee was not provided a fair opportunity to provide the requisite amount of urine, the MRO could cancel the test.

    *    For example, the collector terminates a collection after two hours because the collection site is closing and all collectors are leaving.

*    Please note that it remains a refusal to test if the employee leaves the collection site without permission.

QUESTION:

How does 49 CFR Part 40 differ from the DOT Agency specific regulations? 49

ANSWER:

1.    CFR Part 40 (commonly referred to as "Part 40") states:

    *    How drug and alcohol testing is conducted,
    *    Who is authorized to participate in the drug and alcohol testing program, and
    *    What employees must do before they may return-to-duty following a drug and/or alcohol violation

2.    The DOT Agency and the USCG specific regulations state:

    *    The agency's prohibitions on drug and alcohol use,
    *    Who is subject to the regulations,
    *    What testing is authorized,
    *    When testing is authorized, and
    *    The consequences of non-compliance.

The DOT Agencies and the USCG incorporate Part 40 into their regulations and enforce compliance of all their respective regulations.