Medical Review Officers: What They Do, And Why They’re Integral To Your Workforce

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5 September 2023

Medical Review Officers: What They Do, And Why They’re Integral To Your Workforce

The Medical Review Officer (MRO) is arguably one of the most important additions to your drug testing program. An MRO is mandatory for all Department of Transportation (DOT) governed employers, but are also highly recommended for all other employers with a drug testing program. Utilizing an MRO will help protect both you and your employees by providing a non-biased professional assessment of results. On a more practical level, employing an MRO can provide critical protection when liabilities are assessed.

The MRO serves as the gatekeeper of your program, ensuring both the accuracy and integrity of your results.

Although they are part of your staff, the MRO is to be independent and impartial. Their purpose is to ensure the fairness of results.

What An MRO Does

The MRO can offer critical oversight of the entire drug test process and supervises much of the drug testing process from receipt of results to follow up on those results. They are also responsible for maintaining records of their interactions with employees and test results. Responsibility for the drug testing program still rests with the employer and the Designated Employer Representative (DER), but the MRO fulfils several crucial oversight functions.

Review Results

The MRO reviews all positive, adulterated, rejected, invalid or substituted test results. They will also review specimen results reported for negative and negative/dilute and report these to the designated employer representative. MROs working for DOT covered employers must review at least 5% of all negative results reported by staff to ensure the proper handling of the review process. The MRO will further review all specimens requiring corrective action.

Investigate Results

The MRO will discuss invalid tests results with laboratory personnel and may, at their discretion, request further testing at another laboratory. They may also interview the donor for an explanation of the results. Most commonly, this is to determine if prescription drugs played a role in the test results. The MRO will often be called upon to make a determination regarding whether prescription drugs are being used appropriately and can request additional information from the prescribing physician and the donor’s pharmacist.

Recommend Action

MROs may conduct medical examinations of donors or review the findings of the examining physician in specific cases. They are also the ones who make a determination of “refusal to test” or “cancelled test” when a collector reports that the donor was unable or unwilling to provide a urine specimen.

Responsibility for Chain of Custody and donor privacy is an essential part of the MRO’s job as part of their oversight of the entire testing process. They will review that process regularly to ensure that both privacy and integrity are preserved, with respect to results. They will also ensure the integrity of the testing process, including quality assurance reviews of specimen collections and external lab certification and reliability. If performance issues, or an excessive number of errors, are identified at any point in the process, the MRO is required to report these concerns to the appropriate party, whether that is the employer, collection site or laboratory.

Records Maintenance

Following the determination of a result, MROs working for DOT employers must report the verified result to the appropriate federal agency. They are also required to maintain all records related to drug testing for at least two years and ensure the confidentiality of those results is protected while those records are in their possession.

What an MRO Can’t Do

While the MRO has far-reaching responsibilities when it comes to your drug testing program, there are a few things they cannot do. Most of these prohibitions ensure that MROs stick to medical facts and remain uninfluenced by personality or politics.

For example, by federal law MROs are prohibited from:

  • Considering any drug, alcohol or even DNA tests performed outside of your drug testing program
  • Make decisions about factual disputes between the employee and the collector
  • Make determinations about whether a test should be ordered other than ordering confirmation (second) tests

With an MRO involved, the drug testing process will become even less subjective, particularly when it comes to examining and accepting results. For this reason, MROs cannot accept non-medical explanations for questionable drug test results. This includes accepting:

  • Explanations of test results that are not a legitimate medical explanation (for example if an employee claimed that someone slipped something into his drink)
  • The use of hemp or physician prescription to verify a cannabis test as negative
  • A proffered medical explanation for the presence of PCP, 6-am, MDMA, MDA or MDEA
  • Soap, bleach or other glutaraldehyde as a legitimate medical explanation for an adulterated specimen
  • That an employee can produce urine with no detectable creatinine

Adding an MRO to your team, whether you are a DOT or a non-DOT employer, helps ensure you maintain a reliable and robust drug-testing program. As independent overseers, they can also help mitigate any concerns regarding the integrity of results and help reduce or eliminate liability concerns.