A KINNECT Doctor has recommended the examinee undergo a Medical Review Officer (MRO) Assessment. What is it and why is it necessary?
What is an MRO?
KINNECT’s MRO’s are medical practitioners who have:
Independently certified competence in the field of interpreting drug and alcohol test results;
Knowledge of substance use disorders;
Knowledge of the relevant legal standards and regulations that apply in our society; and
Practical knowledge of the specific regulations that apply to your workplace.
If specifically requested (and when informed by your drug and alcohol policy and procedures), KINNECT’s MRO’s can apply their specialised knowledge of managing alcohol and drug related issues in the workplace to assisting your management requirements.
Where do these specialists fit in KINNECT’s processes?
You have engaged KINNECT to perform a drug screen for a specific list of drugs that are commonly abused. You want to know if there is an unacceptable workplace safety risk posed by either (i) the drug/class of drugs and/or the associated behaviours, or (ii) the medical reason which the examinee suffers, being treated with the substance detected
The initial step is to detect the presence of illicit drugs or substances of potential concern. At times prescription or over the counter medications may also trigger a non-negative test result at the point of collection. The testing used to get a rapid result are not as specific as laboratory tests which is why further laboratory testing (GCMS/LCMS) and interpretation of the results is required.
A laboratory equipped with the advice completed by the donor’s declaration, can only indicate if (i) the laboratory findings are above or below a critical level for the specific compounds tested (ie. a POSITIVE or NEGATIVE test); and (ii) whether the finding appears consistent with the declared medication. The laboratory report cannot tell you about:
‘the reason’ the medication was prescribed
whether ‘the reason’ poses a workplace safety risk if it was untreated
whether ‘the reason’ poses a residual workplace safety risk when treated with the substance detected
whether the nature of the medication poses a workplace safety risk that is greater than the risk of not treating the reason for which the medication was prescribed
whether the medication was lawfully prescribed
whether the medication was legally dispensed
whether the medication was being used in accordance with the prescriber’s recommendations
whether the declaration was being used to mask illicit use
whether other treatment options are reasonably available to the examinee so they can work safely and avoid inappropriate detection as part of your ongoing drug and alcohol management procedures and processes
When assessing the examinee’s medication declarations, KINNECT’s doctors ask: “Has the examinee told me sufficient information to inform a robust assessment? Is the list of medications provided consistent with the other information provided during the medical? Did the examinee declare the reason for the medication before or after the test result was known? What does the rest of the medical information reveal about the associated condition? Do I need further information to know if the finding represents (i) legitimate therapeutic use, (ii) innocuous source, or (iii) some other explanation?”
The consequences of a less than robust assessment, for all parties can be far reaching (i.e. not employing an otherwise suitable candidate, inappropriate standing down a valued employee, disciplinary action, termination, legal action), so it is important the process is completed with the highest integrity. If insufficient information is available to form a robust and defendable assessment, further information is required. This may require: further information from the employer, clarifying the role, tasks or environmental demands that may affect the safety of the worker, others or plant and equipment; further information from the examinee, clarifying the information provided by the examinee; further information from their doctor assessing the reasons and implications of declared medication; and/or further information from an independent specialist: an MRO, or IME from for example, a pain specialist, psychiatrist, or addiction medicine specialist.
What question does a base level MRO referral address?
A referral for MRO Assessment is to answer the fundamental question: “Does the test result represent either legitimate therapeutic use or an innocuous source?” The equates a finding: “MRO verified negative”, or “MRO confirmed positive”.
What if the MRO finding is “MRO confirmed Positive”?
If the result is an MRO confirmed positive, the situation is best managed in accordance with your drug and alcohol policy and procedures. We facilitate the MRO finding being conveyed directly to you. Without your specific authority, we do NOT expend any further activity that might generate additional costs to you.
What if the MRO finding is “MRO verifed Negative”?
If the result is MRO verified as negative, this information is also shared directly with you, but triggers continuing the activity for which you have engaged KINNECT. Our review doctor incorporates the findings of the MRO review into their assessment. At this stage, we have neither asked nor authorised, on your behalf, the MRO to apply their specialist expertise to assess the workplace safety risk issues. We limit the cost of the MRO service to only the question of legitimate therapeutic use, or innocuous source. Often you do not need the added expertise (and hence cost) over and above what you have already engaged KINNECT to evaluate.
Depending on the case requirements, at the initial review KINNECT’s doctor may have already sought additional information from either the workplace, the examinee, or their treating doctors. Alternatively, they have decided to wait for outcome of the MRO assessment before generating unnecessary activity. The need for additional information to interpret the overall health risk profile of the examinee is indicated on the initial KINNECT doctor certification. For example, the reviewing doctor may indicate “Fit with restriction”, with the restriction being “requires advice from an MRO” if the only issue is the need to know if the result is due to legitimate use, AND the reason for the use, AND all the other information collated and medications declared, have no impact on their ability to safely meet the requirements of the role.
Sometimes, as the additional information is collated, it may be recommended for a second referral back to the MRO so they can apply their expertise evaluating all that is known about the individual. This will only happen with your authority as additional costs will be incurred. For these cases, KINNECT engages two levels of MROs accredited by the Australian Medical Review Officers Association (AMROA). Most cases can be handled by a general practitioner who has the additional qualifications of an MRO. For more complex cases, we may recommend the services of a Consultant Physician in Occupational and Environmental Medicine who also hold the MRO credential.
Our MROs are contracted service providers who strictly adhere to the privacy, confidentiality and record keeping standards in accordance with the nature of their investigations and the relevant legislation. KINNECT is not entitled to the information collated by an MRO without explicit consent of the examinee. KINNECT’s general consent, provided by all examinees, does not entitle either KINNECT or KINNECT’s clients, with a right to access the record of an MRO. Without the individual’s explicit consent, this information is only accessible if conflict results in formal legal proceedings.