Why a Medical Review Officer (MRO) may not be beneficial to the employer.

By: Dan R. Berkabile

Nevada law requires any laboratory that tests human biological specimens to be regulated by the State as a medical laboratory. As such, the laboratory is required to report the results of its testing in a prescribed manner. For drug testing, the report must list the drugs screened for and their cutoff levels. Drugs reported positive or negative must refer to this list on the report. If the prescribed medication accounts for a drug reported positive, it can be noted on the report as, “the drug identified is consistent with prescribed medication, or language similar to this. Additional information may be given.

MRO’s are mandatory in federal drug testing. They are optional in private drug testing. I suppose private employers pay the additional const for a MRO thinking it will reduce their liability, not believing that following state guidelines is as sage. However, it must be remembered that the State is regulating their testing anyway.

In using the MRO, if an applicant was taking prescribed medication equal to a positive finding, the MRO would report the results to the employer as negative. The applicant would be hired without any knowledge to the employer about the prescription. The employer would have to depend entirely upon the applicant to reveal any possible interference the prescription medication may have on job performance and safety.

However, without the MRO, the laboratory report goes directly to the employer and none of this would be a concern. The notation on the report already shows that the laboratory conducted a medical review under its laboratory director a pathologist. The report would also be received sooner by the employer.

It is true that prescription medications are confidential. The American Disabilities Act (ADA) stresses this. However, I believe the intent of ADA is not directed so much toward abused drugs typical in pre-employment drug screening. If a person has a prescription for one of the abused drugs, I believe the employer should know about it. The possibilities are codeine, amphetamine, methamphetamine (speed), morphine (metabolite of heroin), and more recently, marijuana. (A good question would be: would a MRO exclude a positive finding for marijuana if the person showed that a doctor prescribed it?)

In the latest Nevada legislative session, a representative of a large labor union testified before a senate subcommittee concerning the passage of a proposed drug testing bill. I was presenting during this meeting. The following is a word by word transcription from public records of the portion of this individual’s testimony concerning medical review officers:

“We believe that in using a lab such as (the lab was named), thy have qualified people on staff including medical officer (I believe the meaning here is medical doctor or pathologist), and when we get the test results back from the lab, they have done their primary test, they have done their confirming test, they have looked at that, and any test that we have ever had challenged by an employee, and they have that option to challenge a test, not to retest, but to challenge it, have always come back in the positive. My concern would be if we were to interpret that MRO must be used one hundred percent of the time, we’re going to add an expense for that MRO testing. As an example, in one case lab charges an addition al $6.00 to have every test result review by an MRO. Additionally, if it’s post testing, now we’re adding time on that we’re going to have somebody out of a job until we get the test results back. Whatever that time may be, hours or days, it’s additional exposure to injury.” (The last sentence refers to a person remaining on the job.) The individual further mentioned the delay that MRO review brings about in hiring new workers.

In Nevada, a laboratory that performs drug testing must be licensed as a clinical laboratory. As such, the laboratory is directed by a licensed pathologist who is responsible for all results reported by the laboratory. Under these regulations another doctor in the system going over results is not necessary, and is only a waste of time and money, as the labor representative above explained.

Dan R. Berkabile

Forensic Chemist