Insufficient urine, positive hair

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BFit

Insufficient urine, positive hair

Post by BFit » Thu Jun 17, 2010 9:12 am

I have a company who ordered a non-DOT observed urine drug screen on an employee (his father is the DER and doesn't trust his son) for reasonable suspicion.

My nurse collected urine and hair samples from this unwilling employee. He came into the office, threw his jacket on the floor, and said let's go. She advised him that it was to be an observed sample. (Remember: his father works for company and is the DER.) He reluctantly submitted to an observed specimen collection but produced an insufficient amount. He stated he wasn't interested in producing another specimen so he left for 2 minutes - walked out the door and then returned stating he would do the hair specimen. This was collected. She took the urine sample and left it on the desk with another MA. Then my nurse asked if he was willing to give another urine sample. He only agreed to the first insufficient specimen to send. The nurse had him sign one sealed specimen and had it analyzed because the employee insisted and the DER was aware since he came by. The urine specimen came back positive for morphine but the hair sample was negative for morphine and positive for marijuana metabolites.

She made a mistake by agreeing to send the first insufficient sample. She should have marked it as refusal to test and notified the DER. Doesn't this invalidate the urine test? Please advise. Thank you for input.

HM



DrSteve

Re: Insufficient urine, positive hair

Post by DrSteve » Thu Jun 17, 2010 3:08 pm

Similar to question as posted to Karl Auerbach's MRO email list.

(1) You posted that the urine test, was a DOT/Federally regulated test. The donor produced a quantity not sufficient (QNS) specimen, and refused to give another specimen. This is a clear REFUSAL TO TEST. The problem is that there is now a problem, since you sent it into the lab and did not inform the donor about the rules and regulations of a QNS, i.e., that he can produce another specimen but if he walks out or refuses to produce another specimen it will be a refusal. Without this documentation, you would have a problem if and when it is legally challenged. Or perhaps if it comes up in an audit.

(2) The hair test is a simple POSITIVE test for THC. Hair and urine have different windows of detection. (Hair can go back 90 days).

(3) Not sure of the relevance, but why was there morphine in the urine? What levels? Were all drugs tested?

BFit

Re: Insufficient urine, positive hair

Post by BFit » Thu Jun 17, 2010 4:56 pm

I apologize I didn't know my question to Karl Auerbach was posted on another MRO site. I had two positive morphine urine drug screens simultaneously, one DOT and the other non-DOT. I inadvertently reported it as a DOT collection to Karl. I proposed the question to this forum for several reasons. FIrst, would the MRO decision be affected if this was a DOT versus non-DOT collection. (My nurse said "I wouldn't have sent it if it was a DOT collection.") Second, I haven't had a consensus as to the final MRO decision. Third, I thought this was an interesting case to present for discussion. I agree it was a refusal to test. She did explain the QNS procedure but he still refused. He also left the unsealed collected urine sample unattended until he completed the hair sample. The DER was there during the entire collection process and was only interested in sending a sample.

It was a 10 panel non-DOT urine sample (+morphine only no quantitative available). Later, the employee admitted to using several drugs to his father.

DrSteve

Re: Insufficient urine, positive hair

Post by DrSteve » Thu Jun 17, 2010 6:04 pm

The post you made for Karl is often viewed by the readers and contributors here.

You still did not tell us the morphine quants and any MRO review of the morphine positive(s). The results MIGHT be different if a non-DOT vs. a DOT test, but for the most part, most MROs try to follow the DOT guidelines as close as possible. The morphine level must be reported to the MRO for a variety of reasons (i.e. poppy seeds, etc.). Did you use a Federally certified lab for the testing?

Your big problem is that you sent in the specimen to the lab for review, and it appears that the lab has a sufficient quantity to perform all screening and confirmation tests (I think).

Steven Herbets, M.D.

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