This guide is specifically referring to DOT requirements for Shy Bladder. Non-DOT employers may elect to use the same process. The term Shy Bladder refers to a situation in which a donor (your employee or applicant) has an inability to provide the urine specimen required, a volume of 45 ml. The shy bladder process starts after the donor makes the initial attempt to provide the specimen required for the DOT drug test. The donor is required to make an initial attempt to provide the specimen even if they believe they cannot void a specimen at this time.
In the shy bladder process, the donor is provided water to consume: a maximum of 40 ounces distributed over a 3-hour period. For example, providing 8 ounces of water every 20 minutes. The donor has up to three hours to provide a specimen of adequate volume and can make as many attempts as needed to provide the specimen. No specimens can be combined to make the adequate quantity of 45 ml; this amount must come from on void. The donor cannot leave the facility until an adequate specimen is provided or the three hours expires.
If the donor leaves the facility prior to providing the 45 ml of specimen for testing or prior to the three-hour time limit without providing an adequate specimen; this is considered a REFUSAL to test. Based on the documentation from the collector, the employer designated employer representative (DER) must make the official determination of the REFUSAL to test.
Urine specimen collectors are encouraged to use a form to document the shy bladder process, this is called the Shy Bladder Log.
Donor Instructions and Forms for Medical Exam
Donor Claims Medical Explanation
If the three hours’ time period expires and the donor has not been able to provide an adequate volume of specimen for testing; DOT regulations allow for the donor to obtain a medical evaluation within five days to determine if there is an acceptable medical reason for not being able to provide a specimen. The physical exam is scheduled after the DER consults with the Medical Review Officer (DER). The physician chosen to complete the evaluation must have expertise in the medical issues raised and be acceptable to the Medical Review Officer. The physician selected should not be the donor’s personal doctor. If it is determined that there is no legitimate physiological or pre-existing psychological reason for not providing a urine specimen, it will be considered a refusal to test. If it is determined there is a medical explanation the MRO will cancel the test.
Note that a negative test is always needed for pre-employment and return to duty. The medical explanation and cancellation of the test does not waive the requirement for a negative test for pre-employment and return to duty.
More Detailed Information on the DOT Shy Bladder and Medical Exam
When a donor has not provided a specimen of at least 45 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.
If another physician will perform the evaluation, the MRO shall provide the other physician with the following information and instructions:
- The donor was required to take a drug test, but was unable to provide a sufficient quantity of urine to complete the test;
- The potential consequences of refusing to take the required drug test; and
- The physician must agree to follow the requirements of paragraphs (c) through (f) of this section.
The physician who conducts this evaluation shall make one of the following determinations:
- A medical condition has, or with a high degree of probability could have, precluded the donor from providing a sufficient amount of urine; or
- 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.
For purposes of the applicable DOT regulations, 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.
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.
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.
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:
- 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;
- 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
- 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.
