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'Back to Basics' for Medical Review Officers

As an MRO you have an important and indispensable role in the DOT drug testing process.  You act as an independent and impartial 'gatekeeper' and you advocate for the accuracy and integrity of the drug testing process. Your quality assurance reviews of the drug testing process strengthen the validity of the DOT drug testing program and are key to its continued acceptance by regulated employers and their safety-sensitive employees. Your role in determining if there is a legitimate medical explanation for laboratory confirmed positive, adulterated, substituted and/or invalid drug test results is essential. You ensure the timely flow of drug test results and other information to employers and, when required to employees, as you safeguard and protect the confidentiality of all DOT drug testing information in your possession. 

Back to Basics is a reminder that each and every action you take is important to the continued success of DOT drug testing.  Do it Right the First Time and Every Time!

The following are important points to remember as the 'gatekeeper':

  • Directly supervise your staff, if any, to ensure they know the specific and limited Part 40 tasks they are allowed to perform.
  • Copy 2 of the CCF must always be completed.  While your staff may stamp/date negative results on copy 2 of the CCF, only you can sign/date all non-negative test results.
  • Review and verify all positive, adulterated, substituted, and/or invalid test results, even if the non-negative result is a Schedule I drug.
  • When determining whether a medical explanation is legitimate, review and take reasonable and necessary steps to verify the authenticity of all medical records the employee provides:
    • Do not accept photos of the label of the medication as the sole authentication of a prescription.
    • Call the pharmacy to verify the legitimacy of any prescription(s) the employee offers you that may provide a reasonable medical explanation.
    • Call the donor’s prescribing physician if you have suspicions or questions about any information the employee provides you.
  • Determine whether it is a refusal to test ONLY in the following circumstances
    • There was no medical reason for providing an insufficient amount of specimen.
    • The employee did not undergo a medical evaluation or did not permit it to occur.
    • The laboratory reported a confirmed adulterated or substituted specimen and you determined there is no medical reason for the result.
    • During a medical review the employee admitted to having tampered with their specimen.
  • Do Not report ‘refusal to test’ decisions for refusals that occur at the collection site or that pertain to alcohol tests (e.g. ‘shy lung’). These are not MRO functions.
  • If you report a canceled test, don’t forget to provide the reason for the cancelation on the CCF.
  • Remember, as an MRO, you do not need an employee’s written authorization to disclose drug testing information when: 
    • verifying drug test results,
    • discussing alternative medical explanations with prescribing physicians and issuing pharmacists,
    • reporting results to employers,
    • conferring with Substance Abuse Professionals (SAPs) and evaluating physicians; or 
    • reporting other medical information to certain third parties (see § 40.327).
  • It is important to remember the Health Insurance Portability Accountability Act (HIPAA) may apply to pharmacies and prescribing physicians. If they insist on the employee providing a release, advise the employee to act immediately on that request. 
  • Provide all verified drug test results to the employer without unnecessary delay. 
  • When reporting a negative dilute result, remember to explain to the DER the employer’s responsibilities and choices under § 40.197
  • For verified non-negative results (other than invalid), you must offer the employee the option of having their split specimen tested.  
    • Do not tell the employee to call the employer about testing the split specimen.  
    • Do not hold up the split specimen testing based on payment issues.  
    • Resolve payment issues, if any, after the fact.
  • When the employee makes a timely request to test their split specimen, you must immediately notify and direct the laboratory that tested the primary specimen to send the second specimen bottle to a second HHS-certified laboratory.  Do not wait to process split specimen test requests (e.g., process requests once a week).

Do not forget the following:

  • Employees are entitled to their drug testing records.  If an employee requests his/her drug testing records, provide the records within 10 days of the employee’s written request.  
  • Don’t make it difficult for the employee or DER to contact you.  The employee or DER should not have to make several ‘directory’ selections when calling the MRO number on the CCF.
  • Whether you have your own business or work for a C/PTA, if you haven’t spoken with the DER in some time, make a point to contact the DER and see if there are any questions/concerns.

[return to 'Back-to-Basics']