Department of Transportation (DOT) regulations direct the medical review officer (MRO) on dealing with a situation where a drug test is negative but the MRO gains knowledge of prescribed medication. This prescribed medicine may or may not present a safety concern and the MRO when applicable will notate this safety concern on a negative drug test result.
Employers should not be asking employees about their medical prescriptions or their medical conditions. It is the employer’s responsibility to make sure the DOT safety-sensitive employee is fit for duty for safely performing the job. When a Safety Concern notation is received from the MRO, the employer should request the employee get a fit for duty exam and clearance to do their job from the prescribing physician or an occupational medicine specialist. The physician should review the job description, review specific employer concerns, and conduct a thorough medical interview and examination of the patient. The physician should provide clearance to perform the job or an explanation of work limitations.
DOT Regulation Summarized for MRO Safety Concerns
Through the course of the drug test verification process, the Medical Review Officer (MRO) may become aware of an employee’s or applicant’s medical information raising concerns about the individual’s ability to safely perform his/her safety-sensitive function. Medical information may include but is not limited to, details regarding an individual’s medical diagnosis, current condition, treatments, side-effects, prescription or over-the-counter medication use or abuse, contraindications, recovery process; or physical, emotional, or cognitive limitations.
If utilizing “reasonable medical judgment” the MRO determines the medical information obtained indicates the employee is likely to be determined medically unqualified to perform safety-sensitive duties under the applicable DOT agency regulation or the employee is likely to pose a significant safety risk if allowed to perform safety-sensitive functions, the MRO is required to report the information to the appropriate third parties without the employee’s consent (§40.327). Authorized third parties are limited to the employer, physician, or other health care provider responsible for determining the medical qualification of the employee under an applicable DOT agency safety regulation, a SAP as part of a return-to-duty evaluation, a DOT agency, or the National Transportation Safety Board as part of an accident investigation.
MROs are not only permitted to report this information, they are also required to report this information. The only exception to this requirement is if the law of a foreign country (e.g. Canada) prohibits the MRO from providing the medical information to the employer.