What is a Shy Bladder Event?

A shy bladder event is when a person fails to provide a sufficient amount of urine (45 mL) that is within acceptable temperature range during the 3-hour time limit set by the DOT for regulated drug tests. There is a specific procedure which now must be followed.

What if the collection was not really a Shy Bladder?

You must base this determination on information received from the collector. Any claims made by the donor about the collection procedure should be explored with the collection site. Documentation should be gathered and kept on file to ensure that your decisions are defensible in the event of an audit or legal hearing. If this was not a Shy Bladder Event, then you should check whether the event qualifies as a Refusal to Test or if there was some collector error that overstepped the donor’s right to a fair and accurate test. Please call the MRO to inform him of these discoveries, as he will need to update his records and his course of action appropriately as well. You may also wish to draw upon the MRO’s experience and advice in handling an unusual circumstance.

What do I do now? / What am I responsible for now?

You must consult with the Medical Review Office, then instruct the donor to submit for a Shy Bladder Evaluation. You must advise the donor that he/she has only five business days to obtain this evaluation. You must provide “reasonable assistance” in locating a qualified physician to perform the evaluation. You can review the federal regulations governing this process at Rule 49 CFR Part 40.193. The Q&A section also has some helpful details. We recommend that you, as the employer, schedule the evaluation yourself and instruct the donor when and where to go for the evaluation. Taking control of the situation in this way will prevent delays and reduce noncompliance risks.

What is a Shy Bladder Evaluation?

This is an examination by a qualified physician (see next question) to identify and establish proof of a medical condition that could explain the Shy Bladder Event.

Who can perform the evaluation?

Per DOT regulations, this evaluation must be performed by a Medical Doctor (M.D.) or Doctor of Osteopathy (D.O.). To prevent a conflict of interest, this evaluation should NOT be performed by the patient's Primary Care Physician (PCP). We recommend checking with the occupational clinics and the physicians who regularly conduct Fitness for Duty evaluations. Unfortunately, the DOT does not permit Doctors of Chiropracty (D.C.), Nurse Practitioners (N.P. or A.P.R.N.), or Physician Assistants (P.A.) to perform this evaluation.

What if the employee/applicant no longer works for us or is no longer under consideration for the job?

The requirement for this evaluation is separate from the decision to employ. The DOT requires that the donor be instructed to submit to this evaluation, regardless of his/her employment status or prospects.

What if the employee/applicant tells me a reason for not being able to provide a specimen?

It is not your role to determine whether any explanation is acceptable. Once a Shy Bladder Event has occurred, only a physician in consultation with the MRO can make the decision that impacts the result of the test. You should document communication with the donor and ensure the MRO is kept informed. You should advise the donor that federal law says the medical evaluation is required.

What if the employee/applicant claims the collection was performed incorrectly?

Such claims should be explored (and either established or refuted) by confirming details and obtaining written statements of fact from the collector and, if relevant, other staff at the collection site. Please contact the MRO to inform him of these circumstances.

What if the employee/applicant refuses to be evaluated?

You should ensure the donor is aware of the consequences of refusing to be evaluated. This will be considered a refusal to test. The donor would be disallowed from performing Safety Sensitive tasks for any employer, not just the one for whom this test was conducted. A refusal to test requires evaluation by a qualified substance abuse professional and completion of a return-to-duty test and must be entered into a follow-up testing program.

Who pays for this evaluation?

The federal regulations are deliberately silent on this, leaving it as a matter to be decided by the employer/employee relationship. It is recommended to have a policy in place regarding payment of the evaluation.

What if the employee/applicant offers to take another test or offers to take a test with an alternative specimen (hair, oral fluid, etc.)?

This is not an option. The DOT requires the Shy Bladder Evaluation take place.

What if no medical condition is found or supported by medical evidence?

If no medical condition can be shown, the MRO will determine that the DOT drug test was refused on the date it was assigned. This carries the same consequences are refusing to test in other ways or having a positive test.

What if a medical condition is found?

One of two things will happen.

  • In the case of a Random, Reasonable-Suspicion/Cause, or Post-Accident test, there will be no further action required. The test will be Cancelled. If the test was Random, it will not count toward the total number of Random tests performed for the employer or consortium.
  • In the case of a Pre-Employment, Return-to-Duty, or Follow-Up test, there will be a separate evaluation required, called a Signs of Illicit Drug Use Evaluation. The details of this are addressed under the Signs of Illicit Drug Use Evaluation section.

What if I cannot reach the employee/applicant?

Exhaustive efforts should be undertaken to ensure there can be no accusation of failing to inform the donor of this requirement and his/her rights and options. Guidance from the Office of Drug and Alcohol Policy and Compliance (ODAPC) has been received instructing employers to go so far as to send a certified letter, requiring signature for delivery, to the donor’s last known address with instructions that make it clear that the donor is required by Federal law to contact the employer to receive detailed instructions on how to maintain their clearance to work in their field. The letter’s contents should make it plain that failure to contact the employer may result in the Federal DOT agency revoking the donor’s clearance to work for ANY employer in their field.