Shy Bladder Versus Shy Lung: Who Decides?
While doing research for the MRO Assistant course that we are developing we came upon one of the few areas that the DOT regulations for alcohol testing diverge from the DOT regulations for drug testing. For the most part the alcohol testing regulations mimic the drug testing regulations: consequences for rule violations, reasons for test, and refusals to test are very similar. One of the most significant differences between DOT alcohol testing and DOT drug testing is the role of the MRO in drug testing. Laboratory analysis of drug tests are not official until the MRO has reviewed and verified the result and reports to the employer. That is very different from alcohol testing, in which the BAT or STT reports the result directly to the employer. The MRO has no role in reviewing alcohol results for DOT testing.
The subtle difference to which we want to call attention has to do with how shy bladder and shy lung scenarios are resolved. A shy bladder relates to drug testing, in which the donor is not able to provide an adequate urine specimen after three hours. A shy lung relates to alcohol testing, in which the donor is not able to provide an adequate amount of breath to perform a breath alcohol test. In both scenarios, the employer must have the employee examined by a physician to determine if there is a medical explanation for why the employee was not able to provide the adequate urine sample or the adequate breath sample. For the shy bladder scenario, the examining physician must be acceptable to the MRO as well as the employer. In both scenarios the examining doctor must be given instructions about the consequences for refusing to take the drug or alcohol test, so that the doctor is aware of the ramifications of his or her decision.
The difference comes when the examining doctor makes their report. For a shy bladder scenario, if the examining physician is not the MRO, the physician sends their report to the MRO. The MRO reviews the report, but is not required to accept the examining doctor’s conclusions. The MRO makes the final decision as to whether there is a valid medical explanation for the shy bladder and the test will be cancelled, or if there is not a valid medical explanation and the test will be reported as a refusal to test.
On the other hand, for a shy lung scenario, the examining physician sends their report directly to the employer. The DOT regulations give no alternative to the employer other than to accept the examining physician’s findings. The employer then reports the test as cancelled or as a refusal to test. Even though the employer will always rely on the findings of the examining physician, the examining physician has no authority to actually cancel the breath alcohol test or to report the test as a refusal to test. That authority remains with the employer.
We can see an advantage in having the MRO involved in reviewing the medical explanations for shy bladder scenarios. First of all, the MRO has a say in choosing the doctor who will perform the examination. That increases the likelihood that the examining physician has the appropriate expertise. Secondly, an experienced MRO would be familiar with the possible valid medical explanations for shy bladder, and so provides an expert second opinion when reviewing the examining physician’s report.
To recap, then, here’s the distinction between shy bladder and shy lung scenarios: The MRO decides whether a shy bladder test is cancelled or is reported as a refusal. For a shy lung scenario, technically the employer reports the test result.