The Collection Scenario
As the donor was removing his sweat shirt he uncovered a pop bottle filled with urine. Before the collector could say anything, the donor said “I can’t do this!” and threw the bottle away into a garbage can. The donor was very upset, saying “I never smoke but I’m going through a break up and I’m depressed and I went out Saturday and drank and smoked, and I’m going to fail this test.” Since the donor threw the bottle out on his own and did not give the collector a substituted specimen, the collector proceeded as a normal collection. The donor went into restroom and gave an acceptable specimen, and the collector processed the specimen as a normal collection.
Our analysis and advice
Unfortunately, the collection was not handled properly. If someone brings something to the collection site that was meant to potentially tamper with the process or substitute the specimen, the collection should be done under direct observation. It doesn’t really matter that the donor admitted to having the substituted specimen and voluntarily threw it away before the collector could say anything; the point is that the donor did bring something to the collection site to tamper with the process. So, as soon as the donor pulled out the bottle of substituted urine, the collector should have informed him that the collection will be conducted under direct observation procedures due to bringing a potential substituted specimen to the collection site.
The collector should also retrieve the substituted specimen that was thrown away and write a memorandum of record to fully describe the substituted specimen and send copies to the MRO and the employer.
Collection Scenario Continued: The collector attempts to correct the mistake…
Immediately after the collection was processed collection site personnel began questioning if perhaps the collection should have been done under direct observation, and that perhaps the substituted specimen should have been processed. The staff decided to leave the discarded substituted specimen in the trash and to perform another collection using direct observation procedures.
The donor could not produce an adequate specimen under direct observation so the shy bladder process was started. After giving the donor 40 oz. of water he was then able to give an adequate specimen under direct observation. Staff realized that they would need to document a reason for performing a shy bladder procedure with a direct observation, so the collector made a note in the remarks that “Observation was done due to suspicious behavior.”
Our analysis and advice
Whenever someone in the collection process determines that a direct observation collection should have been conducted and wasn’t, the donor should be directed to immediately re-do the collection under direct observation. The decision to conduct a second collection using direct observation procedures, and then to also follow the shy bladder procedures, was the correct course of action for the scenario.