This article will discuss the shy bladder drug test when the 3 hours expires, and the donor has not provided a specimen. We will cover for both DOT testing and NON-DOT testing.
For both DOT and NON-DOT testing the initial process is the same and starts at the collection site. The donor is always required to make an attempt to void a urine specimen. If they say they cannot go right now, they are required to try anyway. Once an unsuccessful attempt is made this starts the shy bladder process. A Shy Bladder Log should be used to document the shy bladder process.
The donor can be provided up to 40 ounces of water over a 3-hour period. After three hours the event is over. The collector should document the event and call the company Designated Employer Representative (DER) to inform the DER of the situation. What we see as an error is that collectors are not calling the DER when there is a shy bladder that goes the three hours.
Collectors should always use a shy bladder log to document the shy bladder process.
Now here is the difference between the next steps for DOT and NON-DOT testing. For DOT testing the Medical Review Officer (MRO) gets involved working with the employer DER to now get a medical examination for the Donor to determine if there is a medical explanation for the shy bladder. If there is no medical explanation or the donor refuses to go for the medical examination, this goes back to the MRO and it is reported as a Refusal. If there is a medical explanation documented by a licensed physician, this goes back to the MRO and it is reported as a cancelled test. Additional information on the DOT process is provided below. Note that if the final outcome is a refusal, this now requires the MRO to report this violation to the FMCSA Clearinghouse.
For NON-DOT the employer, the process is very similar with the difference being there is no regulatory requirement or MRO involvement. The MRO’s at National Drug Screening (NDS) leave the physician referral process up to the DER with no MRO involvement. The DER reports back to the MRO the physician referral results or report of Refusal. If the employer wants full MRO involvement like the DOT process the NDS MRO’s have a fee of $220.00 for this service.
We have provided a form to provide to the evaluating physician for both DOT testing and NON-DOT testing:
Shy Bladder Physician Referral DOT
Shy Bladder Physician Referral Non-DOT
We also provide short video for the Shy Bladder process at the collection site:
DOT Shy Bladder Situations: A few things Collectors and Employers Need to Know
If you are a client of National Drug Screening, please call for assistance when you have a shy bladder event which goes the 3 hours without a specimen to test.
More on DOT Shy Bladder Medical Exam
(a) When a donor has not provided a specimen of at least 30 mL within the 3 hours permitted for urine collection, an employer shall direct the donor to obtain, within 5 business days, an evaluation from a licensed physician who is acceptable to the MRO and has expertise in the medical issues raised by the donor’s failure to provide a sufficient specimen. The MRO may perform this evaluation if the MRO has the appropriate expertise and available in the local area, same as the donor.
(b) If another physician will perform the evaluation, the MRO shall provide the other physician with the following information and instructions:
(1) The donor was required to take a drug test, but was unable to provide a sufficient quantity of urine to complete the test;
(2) The potential consequences of refusing to take the required drug test; and
(3) The physician must agree to follow the requirements of paragraphs (c) through (f) of this section.
(c) The physician who conducts this evaluation shall make one of the following determinations:
(1) A medical condition has, or with a high degree of probability could have, precluded the donor from providing a sufficient amount of urine; or
(2) There is an inadequate basis for determining that a medical condition has, or with a high degree of probability could have, precluded the donor from providing a sufficient quantity of urine.
(d) For purposes of this section, a medical condition includes an ascertainable physiological condition (e.g., a urinary system dysfunction) or a medically documented pre-existing psychological disorder but does not include unsupported assertions of “situational anxiety” or dehydration.
(e) The physician who conducts this evaluation shall provide a written statement of his or her determination and the basis for it to the MRO. This statement may not include detailed information on the donor’s medical condition beyond what is necessary to explain the determination.
(f) If the physician who conducts this evaluation determines that the donor’s medical condition is a serious and permanent or long-term disability that is highly likely to prevent the donor from providing a sufficient amount of urine for a very long or indefinite period of time, the physician shall set forth this determination and the reasons for it in the written statement to the MRO.
(g) The MRO shall seriously consider and assess the information provided by the physician in deciding whether the donor has a medical condition that has, or with a high degree of probability could have, precluded the donor from providing a sufficient amount of urine, as follows:
(1) If the MRO concurs with the physician’s determination, then the MRO shall declare that the donor has not violated the employer policy or DOT regulation and shall take no further action with respect to the donor, the test is cancelled;
(2) If the MRO determines that the medical condition has not, or with a high degree of probability could not have, precluded the donor from providing a sufficient amount of urine, then the MRO shall declare that there has been a refusal to test; or
(3) If the MRO determines that the medical condition is highly likely to prevent the donor from providing a sufficient amount of urine for a very long or indefinite period of time, then the MRO shall authorize an alternative evaluation process, tailored to the individual case, for drug testing.
