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From: Dr. L
Password: orange
Date: 22 Nov 2006
Time: 07:59:21 -0800
Remote Name: 65.166.170.179
I have a question about a patient on dialysis after failure of a renal transplant. Another facility certified him to be a commercial driver after speaking to his "urologist." (I assume they mean nephrologist.) But, he was unable to produce enough urine to submit a specimen. He says that he will be unable to produce a urine specimen. I have found the 49 CFR 40.195 regulation. I am asking that he be examined for evidence of illicit drug use after I have spoken with his physician to ensure acceptability to me. I then plan to request a hair test, since I don't want to put a needle in a dialysis patient and risk effecting the shunt or infection. If he is randomly selected in the future, then does the exam have to be repeated in the absence of suspicion? or do we just go right to the hair test? As an occupational medicine doctor, I wonder if his DOT certification is appropriate. His employer reports that he feels bad for 24 hours after each dialysis session. Should I just stay out of that determination, or does the public safety concern override the impulse to contact the medical examiner to discuss the case?