What happens when an individual is unable to provide a sufficient amount of specimen for a pre-employment, follow-up, or return-to-duty test because of a permanent or long-term medical condition? (§ 40.195)

This section explains procedures when an employee has a permanent or long-term medical condition that prevents them from giving enough urine for a pre-employment, follow-up, or return-to-duty drug test. These test reasons require the employee to receive a negative result. Other test reasons do not. Refer to § 40.61(e) for urine collection or § 40.72 for oral fluid collection.

Medical Review Officer (MRO) Responsibilities:

  1. Determine Drug Use Evidence: The MRO checks if there is clinical evidence of illicit drug use. The MRO conducts or arranges a medical evaluation and consults appropriate physicians.
  2. Ensure Medical Evaluation: If the MRO does not perform the evaluation personally, a licensed physician acceptable to the MRO must complete it.
  3. Alternative Testing: If needed, the evaluation can include an alternative test (e.g., blood) to identify drug use.

Reporting Results:

  • If No Drug Use Evidence: The MRO reports a negative result to the employer. The MRO documents the condition and findings. The MRO must mark “Negative” on the Custody and Control Form (CCF), sign it, and date it.
  • If Drug Use Evidence is Found: The MRO reports the test as cancelled. The MRO documents the condition and the drug use signs. A cancelled test prevents the employee from starting or resuming safety-sensitive duties.

Definition of Permanent or Long-Term Medical Conditions:

  • These conditions involve physiological, anatomic, or psychological issues. They existed before the attempted test and are unlikely to improve.
  • Examples include renal failure, urinary tract damage, or severe psychiatric disorders that affect urination.
  • Temporary conditions, like cystitis, urethritis, or prostatitis, do not qualify.