What Is the DOT Shy Bladder Procedure?

"Shy bladder" is the informal name for an employee who cannot provide enough specimen at a DOT drug test collection. Section 49 CFR 40.193 sets the procedure for urine and oral fluid collections across DOT agencies. Basic collection steps are covered in DOT collection protocols.

The starting point. A urine collection needs at least 45 mL. An oral fluid collection needs at least 2 mL. If the employee provides less, the collector gives the employee another attempt. Following the employer's instructions, that attempt can use the same specimen type or the alternate type, with a collector qualified for it (49 CFR 40.193(a)). For a continued urine collection, the collector discards the insufficient specimen, except one that was out of temperature range or showed evidence of tampering.

The urine timeline. The collector urges the employee to drink up to 40 ounces of fluid, distributed reasonably over up to three hours, or until a sufficient specimen is provided. Declining to drink is not a refusal. If the employee refuses to make the attempt or leaves before the process is complete, the collector stops and notifies the DER, and the employer decides whether it is a refusal. If no sufficient specimen comes within three hours of the first unsuccessful attempt, the collector stops the collection and immediately notifies the DER (49 CFR 40.193(b)(1)).

The oral fluid timeline. For oral fluid, an employee who cannot provide a specimen after 15 minutes may be urged to drink up to 8 ounces. A wait of up to one hour is allowed, and the employee stays in a monitored area. After one hour without a sufficient specimen, the collector stops and notifies the DER (49 CFR 40.193(b)(2)).

The medical evaluation. After consulting the MRO, the DER directs the employee to obtain an evaluation from a licensed physician acceptable to the MRO, with expertise in the medical issues raised. The evaluation takes place within five days (49 CFR 40.193(c)).

The outcome.

• Medical condition found. If the referral physician recommends, and the MRO accepts, that a medical condition has, or with a high degree of probability could have, precluded a sufficient specimen, the MRO cancels the test (49 CFR 40.193(d)(1)).
• No medical condition found. Otherwise the MRO reports a refusal to test (49 CFR 40.193(d)(2)). Unsupported assertions of situational anxiety or dehydration do not count as a medical condition (49 CFR 40.193(e)). A refusal has the consequences described in DOT drug test refusal.
• Permanent conditions. For a pre-employment, return-to-duty or follow-up test, a physician who finds a serious and permanent or long-term disability says so in writing, and the MRO follows 49 CFR 40.195 (49 CFR 40.193(g)).

Random tests that are cancelled. When the MRO cancels the test, the employer takes no further action. If the test was random, the employee stays in the random pool (49 CFR 40.193(i)).