Shy bladder

Scope

This regulation applies to drivers of commercial motor vehicles (CMVs) subject to drug testing under the Federal Motor Carrier Safety Regulations (FMCSRs).

Regulatory citations

• 49 CFR 40.193 — What happens when an employee does not provide a sufficient amount of specimen for a drug test?  

Key definitions

• Designated employer representative (DER): An individual identified by an employer as able to receive communications and test results from service agents.

• Medical review officer (MRO): A licensed physician who is responsible for receiving and reviewing laboratory results generated by an employer's drug testing program and evaluating medical explanations for certain drug results.

• Shy bladder: Unable to provide a sufficient amount of urine to permit a drug test.

Summary of requirements

Insufficient sample. If a driver does not provide a sufficient amount of urine to permit a drug test (at least 45 mL), the collector must:

• Discard the specimen (unless it shows signs of adulteration or tampering); and
• Urge the driver to drink up to 40 ounces of fluid, distributed reasonably through a period of up to three hours, or until the individual has provided a sufficient specimen, whichever occurs first.
• If the driver has not provided a sufficient specimen within three hours of the first unsuccessful attempt, the collector must discontinue the collection, note this on the custody and control form (CCF), and notify the DER.

Refusal to test. If the driver refuses to make the attempt to provide a new urine specimen, or leaves the collection site before the collection process is complete, the collection must be discontinued and the collector must immediately notify the designated employer representative (DER). This is considered a refusal to test.

When to discard. The collector must discard any specimen the driver previously provided to include any specimen that is “out of temperature range” or shows signs of tampering. In the remarks section of the CCF that the collector will distribute to the medical review officer (MRO) and DER, the collector must note the fact that the driver provided an “out of temperature range specimen” or “specimen that shows signs of tampering” and that it was discarded because the employee did not provide a second sufficient specimen.

Evaluation. After consulting with the MRO, the DER will direct the driver to obtain an evaluation from a licensed physician. The physician must be acceptable to the MRO and must have expertise in medical issues raised by the driver’s failure to provide a sufficient specimen.

An MRO with the appropriate expertise may perform the evaluation. The evaluation must take place within five days.

The physician conducting the evaluation will recommend that the MRO make one of the following determinations:

1. A medical condition could have prevented the driver from providing a sufficient amount of urine. If this is the case, the test must be cancelled.
2. There isn’t enough information to prove that a medical condition could have prevented the driver from providing a sufficient amount of urine for testing. If this is the case, this is a refusal to test.

After completing the evaluation, the physician must provide a written statement of recommendations and the basis for them to the MRO. The physician may not include detailed information on the driver’s medical condition beyond what is necessary to explain the conclusion and recommendations. The MRO must seriously consider and assess the physician’s recommendations in making a determination about whether the driver has, or with a high degree of probability could have, prevented the driver from providing a sufficient amount of urine. The MRO must report the determination to the DER in writing as soon as possible.

Cancelled test. If the test is cancelled, no further action may be taken against the driver and the driver remains in the testing pool.