Let's get started again. This is the MRO session. This is not anything else. Of course, we finish up with the MRO Jeopardy, which should be lots of fun. Don't start cheating and asking your AI to give you the answers. I'm going to start off by just giving a little bit of what's new, what should you think about when it comes to the MRO position. Catherine Russo is going to be speaking about state laws and some other interesting things that are coming down the pike. And then, of course, we will have the MRO Jeopardy. So. All right. I'm Chief Medical Officer of Norfolk Southern Railroad. However, at this meeting, I am speaking on behalf of Acumetics. I do not represent. What did I do? Help. I don't know what I did. I wanted to use that on the space bar. Here we go. Okay. So what are the topics I'm going to try to cover real quickly is the mandatory guidance for federal workplace drug testing. That is DHHS. It is not DOT. What kind of resources do we have through SAMHSA, the Substance Abuse Mental Health Services Administration? What about the current transportation regulations like oral fluid? Not there yet. The most recent DTAB meeting, what was discussed, what do we need to be aware of? And then a little bit of just educational things with the National NPLC comes out with the Drug Testing Matters Newsletter, which is incredibly educational and helpful when you're trying to find out what does this really mean. And then ODAPC, the Office of Drug and Alcohol Policy and Compliance has put out their Back to Basics series. It's kind of for service providers, what does the blank need to know? What does the MRO in this case need to know? And then finally, just a couple of slides on the Medical Examiner Handbook. If you were sitting in this room this morning, you've already seen those two slides, so just click, time out if you want to. If you haven't, it talks about methadone and suboxone and how that now needs to be handled under the new 2024 Medical Examiner Handbook. I didn't mess it up this time. So what's come back in 2023 is SAMHSA's come out with the new guidance, mandatory guidance, which starts their program. Department of Transportation follows with what DHHS approves when they put together their regulations and their criteria. They came out with criteria for urine and oral fluid testing. We've been waiting for oral fluid testing for some time now. The big thing that is really holding things back right now is that they cannot begin oral fluid testing until there are at least two labs that are able to meet the criteria and able to be approved on that list. As of yesterday, there are still zero labs approved to do oral fluid testing. So right now, there's not moving anywhere on there. Now, some of the other significant changes aside from oral fluid testing, that came out through SAMHSA was with the MRO. First of all, the MRO verifies the morphine coding results differently. Right now, no additional decision points for coding and morphine under DHHS testing, Federal Work-Free Drug Place, not under DOT. The cutoff for morphine is now 2,000. It used to be 2,000, it's now 4,000, but we don't worry about is there proven use or not. So that additional requirement for clinical testing no longer exists. So we're not worried about poppy seeds. If they're positive above that 4,000, they're positive under Federal Drug-Free Work-Place, not under DOT. I'm going to keep on saying that so there's no confusion. The other thing is that the MRO is working under Federal Drug-Free Work-Place testing, not under DOT, have to submit semi-annual reports to the agencies. They have to submit the information on what drug was positive by the lab, and then it was verified, including by the negative by the MRO. So it's a couple of different steps in there. And they also have to include the reason for the downgrade on that. So did they have a prescription? Did the individual give some other crazy story that they accept it? They need to document why. It's important to have that information because it's real frustrating to know that some MROs are downgrading for what are really, really shaky reasons of, oh, they have a 20-year-old prescription that says PRN. And I think I was just using the example earlier of somebody who had given me a prescription once for Marinol that they theoretically still had the bottle from a cancer diagnosis 10 years earlier. Certainly not even proximate close to current use. And the refusal to test criteria originally or currently, not currently, in the past, if it was a pre-employment, they didn't have to report it as a refusal. Now it will be reported as a refusal. Drug-free workplace programs, not DOT. These are some really nice resources available for you. It's a nice guidance manual for the MRO. It is not the same as DOT. I'm going to keep on saying that so nobody can say otherwise. There's some case studies, again, not DOT, both for oral fluid and for urine. We can't do oral fluid testing yet. There's not two labs approved to do it. And then there's also some older resources available on that same website. So I think it's real useful to look at. What about the final rule for Department of Transportation when it comes to adding oral fluid? Rule's out there. The chain of custody is out there to use it. The problem is we don't have the labs to have it approved yet. So we're still waiting. At the last DTAB meeting in March, they looked about adding fentanyl to the standard panel. That's a lot of people who are concerned because of the high use of fentanyl in the communities. They're still looking at the research, still making the decision. ACOB did submit a comment on that, which we think is it's probably not a bad idea. You can go look at the detailed comment up there. And then if you're interested in DTAB's meetings, they have really nice presentations that can give you some educational information on the substances that we're testing for. And at the DTAB meeting, you can get all the different presentations that are shown at that meeting. NLPC is the National Library Certification Program, which is really this thing that runs everything down of how does drug testing have to be conducted? What are the verifications? What are the different characteristics? What are the criteria that need to be used? And they have topics on everything that you can imagine, whether it is on screening, on confirmation, on opioids, on amphetamines. So if you just want to get some more information on how the drug testing works, what it looks for, this would be the place to go. Back to Basics for Service Agents, came out recently with one for the Medical Review Office. So that was actually last year. But just as a highlight, a reminder, the Medical Review Officer acts as an independent and impartial gatekeeper. You are not representing the individual. You're not representing the employer when you're doing this. You are independent and you are impartial. The whole purpose of the Medical Review Officer is to ensure the integrity of the program. You've got to be consistent in how you do it. You can't do it one way for one company and different way for another company. You review the process and that's threatened civility of the entire Department of Transportation program. Role, very simple. Is there a legitimate medical explanation for that laboratory finding? That's your role under this program. Now, if you're looking at under some other organizations, other agencies, you may also be conducting it as a fitness for duty evaluation as well. But the basic Department of Transportation by itself under Part 40, it's just, is there a legitimate medical explanation for the lab finding? It's important you remember to ensure timely results and that you keep the information confidential except for those people who absolutely have a need to know. You do need to directly, and I think Dr. Martin and I have had discussions on this one before, directly supervise the staff that's under your supervision, if any. So if you were a Medical Review Officer and there are MRO assistants or whatever you want to call them who are working for a different company, they need to be under your supervision to actually meet one of these requirements. It's important that copy two is always completed. Your staff may stamp negative results, but the MRO needs to sign all non-negative results, whether it's downgraded or not. It has to be signed by an MRO. It cannot be signed by someone else on your behalf. You need to review all and verify all positive, adulterated, substituted, and or invalid tests, even the non-negatives for a Schedule I substance. So someone comes back positive for marijuana, you can't just say, oh, it's a Schedule I, don't do it. You still need to go through that same review, that same offering of a, is there a legitimate medical explanation for that? When you determine whether or not it's legitimate, what do you do? Take all necessary steps, which does not say, are you taking the medication? Okay, thank you, goodbye. It means you've got to get the, and what's challenging for some people is you can't just accept the label. Labels can be adulterated, labels can be copied, labels can be from decades ago. You have to go ahead and verify that either with the pharmacy or at the healthcare provider. We do not, as MROs, determine refusal to test in all situation, only in certain situations. That is, B, no medical reason for providing that insufficient specimen. If they didn't undergo the medical evaluation as directed, if the laboratory reported a confirmed adulterator or substitute it with no medical reason for that result, and finally, if the individual admits to either tampering or somehow other adulterating his specimen. Those are the only refusals an MRO reports out. An MRO does not report a failure to show up. An MRO does not report it out as a refusal to test if the collector finds foreign samples, if the collector finds bleach, if the collector finds something else that could lead the test to be adulterated. That is a collector-reported, employee-determined refusal to test. And if you cancel a test, don't forget to document why you canceled the test. The MRO, this is also, people come back and say, oh, I need you to, I can't release the results. As an MRO, you do not need to have the employee's written authorization to disclose those drug testing results. If you're verifying the results, if you're discussing it with the treating provider, if you're reporting it to the employer or talking to substance abuse professionals, or if you're reporting it to certain third parties, such as the Department of Transportation or the government agency, as such as the National Transportation Safety Board. In a lot of cases, the pharmacist may not give you the information. In some cases, the healthcare provider will not give you the information. In that case, it is your responsibility to call the donor, the individual, and say, you need to provide authorization, you need to sign the release as needed so I can obtain this information. Not your problem, it's theirs. Reporting explained to the DER, what the DER's responsibility when you're looking at a negative dilute. What you don't do for non-negative results is you have to offer the individual the opportunity to have the split specimen tested. You have to offer the split specimen. You can't assume they're not gonna want it. If you know there's no split specimen available, it doesn't matter. You still need to offer it to the individual. They ask for it, then you have no choice but to cancel the test. You don't hold up the split specimen for the employee to pay for the test. It gets done first. Resolve the payment issues afterwards. And then finally, when they make that request, you must timely request that for the lab, notify the lab immediately to have that split specimen run. Don't forget the following. Employees are entitled to their drug testing records. You can't say the company paid for it, therefore I can't give it to you. Employee request, you give it to them. You can provide, you know, if they request it, you have 10 days to give them the response. And don't make it difficult for the DER to get ahold of you. You have to have that information. The other recommendation is if you haven't spoken to your DERs in a while, reach out to them. Do they want, do they need things done differently? Not that you're going to be doing Program A, Program B, but you want to make sure that they're aware of what you're doing and how you're doing it. Just touch base, make sure you have all the right contact information. Medical Examiner Handbook, two really quick things. As they've redone the regulations, not at all. Regulations have not changed. The medical advisory criteria have changed very significantly for a number of the regulations. One of the key things here is that methadone, which had been a part of the maybe regulation, definitely may be part of the medical advisory criteria, is not listed anywhere in either regulation or medical advisory criteria. It is not a prohibitive substance. It is just like everything else, including suboxone, that the medical examiner, not the medical review officer, because that's a different situation. The medical review officer needs to evaluate whether or not this person is able to operate that commercial motor vehicle safely. It is not a automatic no. And again, a reminder on CBD. CBD very much is a buyer beware situation. Right now, legal CBD, legal products, contain 0.3% by weight of THC are legal under the Hemp Act. They are not regulated by the FDA. There are no controls at all. In a couple of studies that have been done, the amount labeled on the packaging has been incredibly wrong. And there are people who allege that their positive test is purely because of the CBD that they've used. Department of Transportation doesn't really care. So as an examiner, it would behoove you to kind of advise anyone who comes in and says, I use CBD gummies for my back pain and to help me sleep at night, or I love my CBD tea. You better be careful because if you pop a positive, we don't care. And I think I just said all of that already. And that is it. I want to go a little quicker because there's a lot of things happening right now in cannabis. I want to bring Katherine Marusso up and I can try to find your, Doug, do you know where her slides are at? You're going to do that? Okay. And I'll let Katherine introduce herself. And while you're setting up, I'll take a question or two, if anybody has one. If not, I'll grab them after the meeting, but I don't know who it is. So just come up next to me and ask a question. Okay. Hi everyone. I'm Katherine Russo. I'm an attorney. I'm an employment attorney. So everything that I will talk about today is really, I see everything through the lens of advising employers because that's what I do all day long, both DOT regulated employers and non-DOT. So I'm going to talk a little bit about both. So let me go back here. I think I missed one. Okay. Well, let's start with the federal. The federal, as you know, is kind of a mess. Federal law is a big mess when it comes to cannabis and CBD, as Natalie just said. So they just announced last week that marijuana is going to be rescheduled from schedule one down to schedule three. We're not a hundred percent sure how that's going to look. The notice of proposed rulemaking is coming out next week. I haven't seen it yet. I think ideally what it means is that now marijuana will become available on the federal level as medical, you know, as any other medical, you know, medication that people want to use, which has not been the case up until now. I don't know what that's going to look like. Does it mean the FDA is going to regulate it? Do people have to only purchase it from FDA regulated pharmacies? You know, we don't know yet how that's all going to look. And it's very different from how things look at the state level. So I'm not sure that this rescheduling is going to be helpful, especially to employers at all, because it's just going to make things even messier than they already are. So here on this slide, I've got, you know, the federal law about CBD and hemp is that we have the foreign bill that came out in 2018. And now that these CBD products and hemp products are being marketed everywhere, as Natalie said, you don't know how much THC is in them. The problem that I'm seeing with my clients is that many employees and applicants are saying, well, I tested positive because I went to the grocery store and I bought these gummies and I didn't know they had THC in them. And that's creating a huge problem for employers because now, you know, if somebody tests positive, they've got to figure out what am I going to do? Am I going to believe that this person used gummies from the grocery store? Or are they lying? And are they really using marijuana in a state where it's illegal? So it's creating a lot of challenges for employers. And as you can see from this slide, you know, to make this even messier at the federal level, a couple of months ago the Attorneys General of several states plus DC sent a letter to Congress about the reauthorization of the farm bill that legalized hemp with no more than .3% THC. You know, and they kind of painted this picture of which we've just been talking about how now there's just this flood of these products on the market. You know, some of them look like candy, you know, gummies look like, oh, that sounds like a great thing to have, you know. And it's really becoming just this exploding market and nobody's regulating it. And again, you don't know how much THC is in these products and people are using them and then they're testing positive on drug tests at work. Now, here's where I usually say in my presentation that, you know, none of what I'm talking about applies to DOT. And this is still true for the moment, right? So for the moment, any federally mandated drug and alcohol testing under DOT or other federal agencies like the Department of Defense, the Department of Energy, they're still going to require testing for marijuana and it will be disqualifying. But once, at some point in the future, once marijuana is put on Schedule 3, this is all going to change. So, you know, just we all need to keep our eyes on that because I think that at some point DOT and the other federal agencies will have to take marijuana off their list of drugs to be tested. Now, one other thing I always like to talk about is the federal contractors. I get this question from employers probably three or four times a week where people say to me, well, we're a federal contractor so we can never let anybody use marijuana. So if they test positive, we're just going to fire them. And I have to say to you, I think it really depends on what your contract actually says. So if you have a federal contract that mandates the testing, mandates testing for marijuana, and mandates that you don't have anybody using it, then maybe you're okay. But if you don't have that, you can't just rely on the Federal Drug Free Workplace Act. That law is just a law that applies to federal contractors with a contract of $100,000 or more. And all it says is don't let your people use illegal drugs at work. It doesn't require any drug testing. It says nothing about marijuana. So don't assume that just because you're a federal contractor, you know, nobody's allowed to use marijuana. So the bottom line is that the status of cannabis and CBD at the federal level is just a gigantic mess right now. Unfortunately. And so I think that what many employers are doing, unless it's clear, and again, for right now the DOT regulations are clear, that's going to change. But I think for right now, what I've been advising employers is, I think you really got to look at state laws. For your non-DOT testing, you got to really look at state laws. You know, and this is because the federal government has really been treating marijuana like it's a legal drug for quite a while now. Or at least they've been conceding that states have the right to regulate it. So even though it's technically on Schedule 1 right now, and it has been forever, since 1970, you know, they've basically allowed the states to regulate it. And the courts have recognized that. And the courts have said, hey, you know what? If an employer comes into court and says, well, federal law says it's illegal, they're not going to buy that argument, and they're going to want to know if you're complying with state laws. So let's talk a little bit about state laws. So there's a huge number of state laws. Every year when I do this slide, there's more and more states that have medical marijuana laws and adult use laws. Then there are these medical CBD laws. Now we have lots and lots of laws that are regulating whether and when you can test for marijuana. Then you have these laws that protect off-duty use, which I think is very, very troubling from a drug testing perspective. So, you know, if the law says all off-duty use of marijuana is protected, then how do you test somebody? Because we don't have a drug test that can distinguish between, you know, I used it on duty versus I used it off-duty. So this is a huge controversy, and it's becoming very, very difficult for employers to do drug testing for marijuana. And I'm going to talk about some of these laws now. So what I still call recreational or adult use laws, there's just a ton of them now, as you can see. And more and more of them, the ones in red here are having employment protections. That means that applicants and employees who use cannabis off-duty are going to be protected. And so employers have to be careful about whether or not they can test and take adverse actions against people who test positive. And unfortunately, the laws are all different. I wish I could give you a simple do this and don't do that, but it really is going to vary by state. And if you're a multi-state employer, you've got to be really familiar with all the laws in your states because it's going to be different in every single state. So I'm just going to talk today about the new ones. So the new ones that came out last year, since last year's conference, that's what I'm going to talk about today. So the big one is California. Like this is all I talk about at work every day. So this law took effect on January 1st of this year. And like many other laws now, it protects all off-duty use, says employers cannot discriminate against people who use marijuana off-duty. And more than that, you can't test for marijuana unless you're certain that you're testing for non-psychoactive cannabis metabolites. And they don't define that. So I'm not even 100% you know, as a lawyer I'm not 100% sure what that means. I'm not a doctor. Most employers have no idea what that means. So it's very confusing. The good news is there is an exemption if you're an employer in the building and construction trade. But for everybody else, most employers have no idea what to do. Now most, many drug testing vendors are telling employers to use oral fluid testing in California. And I do have a lot of clients that are using it. I'm not 100% because I'm an attorney, I'm not 100% convinced that that's the right way to go because I think it depends on how long the look back period is. Right? What I've heard, and I'm not an expert on it, is that oral fluid testing generally has a window of detection of about 24 hours. And I still find that a little troublesome because if an employee comes in and let's say you test them on a post-accident test first thing in the morning, they're going to say, yeah, but I used it last night and I'm legally entitled to do that so you can't fire me. So I have a real concern about whether even oral fluid testing is going to be, you know, satisfy this law. I hope I'm wrong. I hope it does and I'm waiting for the first court case in California to tell us whether oral fluid testing is okay. I'm just not sure, to be very honest with you. There's a similar law in Washington State, but it just applies in the pre-employment context. So you can still test for marijuana on other tests, but for the pre-employment, you can't unless you're, again, testing for the non-psychoactive components. But there is an exception for safety-sensitive jobs. Thank goodness. So that's a little helpful. Minnesota had a new adult use law that took effect last summer. So marijuana is now a lawful, consumable product and employers can't discriminate against people who use those products. Interestingly, though, they left reasonable suspicion testing alone and that includes post-accident testing. But pre-employment testing and routine physical examination testing are prohibited unless the job is safety-sensitive. So it's not so terrible, that one. Ohio also has a new adult use law. I think they're working on the regulations that may come into effect sometime this year. But Ohio has some good language that I see as employer-friendly because employers are still allowed to take adverse actions against people who are using marijuana. And then Delaware also had an adult use law that took effect last year. And there really are no restrictions imposed on employers in terms of drug testing. Okay, so let's go to the medical laws. So as you may recall, I usually divide these laws up into three categories, like the high risk, medium risk, low risk. Honestly, most of them are in the high risk categories now. And by that I mean these laws have either we have case law or we have statutory language that says employers may not discriminate against people who use medical marijuana. And so that's, you know, troubling. If you have somebody who tests positive for marijuana, again, on a non-DOT test, and they say that they're using medical marijuana, you're going to have to have this whole interactive dialogue and direct threat analysis. Those are requirements under the Americans with Disabilities Act so that you can figure out whether it's going to be safe for this person to do their job at work if they only use off-duty. This list is, these are the states where the medical marijuana law doesn't say anything about employment, so I'm not that sure how much legal risk there is in these states. And then these are the states where there's the lowest level of legal risk, either because there have been cases favorable to employers or in a few of these states, there's actually language that protects employers and doesn't allow employees to sue them. So you can see that the states and the laws are really, they're all over the place. This slide, these are just a few states that have helpful language for safety-sensitive employees. So if you have, you know, if you have employees in these states, think about whether or not you can take advantage of these laws. Like, for example, in Arkansas, you would have to designate on your job descriptions whether the job is safety-sensitive in order to be able to take action against somebody using medical marijuana. Now, in all of these, you know, I know I categorize these medical marijuana laws into different categories, but honestly, there is the risk of just a generic disability claim in all of these states. You know, even in the states, like even in Florida, here in Florida there's some good language in the law that says employees can't sue their employers over a decision made with regard to marijuana. But I always have a concern that somebody could just ignore that law and sue under just the generic, good old, disability discrimination claim statute, rather, where they would just argue, I have a medical condition, I need to use marijuana, and you either fired me or refused to hire me. And that's like a valid claim pretty much in any state. I don't know how successful they'll be, but certainly, they could try to get around the medical marijuana laws that way. So, the trend that I'm seeing with medical marijuana, anyway, is that most employers are starting to accept it. Again, this is in the non-DOT context. They're starting to accept it, and they're starting to engage in the whole interactive dialogue, as you would with other medications that create a safety risk. Just as if somebody told you, you know, I have a prescription from Vicodin that I have to use for a couple of weeks, you would have your interactive dialogue and try to assess whether the person can do their job duties safely or not. And that's what most employers are doing for now with medical marijuana. And again, you know, just these are rules under the Americans with Disabilities Act. You can't have blanket rules. And this is true of any medication. So, you could never have a rule that says, we don't let people use Vicodin in our organization, or we don't let people use medical marijuana. That, you know, theoretically violates the ADA. So, it always has to be individualized. And you always have to really look at the person's job duties and have a dialogue with them and their physician about when they use marijuana, how it affects them. Are they going to be able to do the job duties safely? Now, this is an interesting topic because in states where both medical marijuana and adult use marijuana are legal, I almost feel like that makes medical marijuana irrelevant. You know, I live in New York, and we have both. So, sometimes when a New York employer calls me and says, oh, this person is telling us they use medical marijuana. Do I have to see their medical marijuana card? My answer is, well, they can get marijuana anywhere they want to in New York, right? You can get it anywhere in New York. So, I don't know that a medical card really matters in states like that, but I do think you should have your dialogue with the person, make sure they're not going to be using it at work, you know. And that's actually a really good topic also for me to mention here is I think what employers need to do now, now that we live in a world of marijuana acceptance is have a policy that's really, really strong about what's acceptable at work. So, you all should have policies that tell employees you can't use it at work. Don't bring it to work. You can't use it at lunchtime. Don't go out in the parking lot and smoke it in your cars like a lot of people do in New York. You know, don't do that. Can't use it on your rest break. You can't use it in the smoking area where people are smoking cigarettes. It's not like cigarettes. So, you have to have really strong, clear policies to tell employees because everybody thinks, oh, it's okay now. It's legal. I can do it whenever I want to, wherever I want to. And so, it's really important to have very strongly worded clear policies to tell employees you can't use it at work time. You can't be impaired at work time. And if you are, we're going to take disciplinary action up to and including termination. And these, I referenced this earlier. There are some states that also have these medical use CBD laws. And these laws concern me a little bit because, you know, like for example, Texas has this low THC law which allows people to use low THC products if their doctor recommends it. So, you know, you could easily have an employee in Texas test positive for marijuana and tell you, oh, but I'm using this, you know, CBD product that my doctor said is great for my arthritis. You know, and now you kind of have to evaluate that whole situation because again, you don't know if they're telling you the truth. I would recommend that you have the employee bring in their doctor's letter saying they have to use this. And then again, you have to analyze the whole safety issue and whether you think it's going to be safe and appropriate for them to use if they're only using it when they're off duty. And again, you know, my law firm is seeing, you know, a very large uptick in litigation involving CBD and hemp. You know, this is really a huge, huge problem because, you know, there's no way really for the drug test to distinguish. That's the problem with drug tests, right? They don't tell you whether the person used on duty or off duty, whether they're using CBD, hemp, or something else. And so the employer really just makes their decision based on positive or negative. And it's a big problem because then employees will come back. If they lose their job, they'll come back and say, yeah, but I was using this lawful product. I bought this in the grocery store or my doctor suggested I use this for my medical condition. And it's really becoming a problem and we're starting to see, you know, more and more lawsuits on this. And this slide really is, you know, I just want to sort of echo what Natalie said before, which is I always recommend that employers and their MROs be on the same page. You know, very often, you know, an employer will say to me, well, isn't the MRO supposed to check and find out if this person has a medical marijuana card? And I'll say to them, I really think you're supposed to do it. It's really your job as the employer to assess all of that because in general, the medical review officers don't. I mean, my experience, the medical review officers will just tell the employer this person claims to have a medical marijuana card and then the employer, you know, has to do their own investigation. And that really brings me to the end. We do have a drug testing blog. So I always post about any new laws that come out. I'm sure when this new notice of proposed rulemaking comes out next week, I'll be blogging about that, and I'm happy to take any questions. Thank you. All right, folks. you know what it's time for, right? The 2024 version of MRO Jeopardy. So we have three podiums down here in front. We call for volunteers. Yes, there are prizes for everybody, so don't be shy. If you'd like to come down and participate in MRO Jeopardy, step down here to the three thing or I'll have to have Dr. Harden-Palm come out in the audience and cajole you into participating. Voluntold, that's exactly right. My boss sent me up here. Excellent, look at this. My boss sent me up here. This is fantastic. So that's like the quickest three volunteers we've had in like forever. Okay, so could you introduce yourselves now just for audience informational purposes. The contestant that is to my far left or your right is designated as player number one. Would you introduce yourself please? I'm Dr. Robin McMillan, I work at Acuity International as an MRO and medical review officer. Great. Contestant number two. Hi, I'm Dr. Brent Kale. I'm the medical director and lead MRO at Ohio Health in Columbus, Ohio. Thank you. And last but not least, contestant number three. My name is Nikki Patino. I'm the chief medical director for public safety for the City of Chicago. Okay, very good. Welcome. Okay, so a few rules about MRO Jeopardy. We have one round that you see in front of you with the categories being by the numbers, collectors front and center, problem drug tests, acronyms in Orlando. So information by the numbers, the response will be a number. Acronyms, we will show you the acronym and you must respond what that acronym actually stands for. Okay, there is one daily double in this round. Of course, I'm not going to tell you where it is. We do have a final Jeopardy category, so when we're cleared with this board, we will do the final Jeopardy. Now, a few more bits of information. Please do not kill your buzzers. This is a wireless buzzer system and all you have to do is forcefully press down, but don't slam on it or you might break it, which would be embarrassing. And the other thing is, is that I have control of when the buzzers are active. Okay, so how do you know when it's okay to chime in? So if you've watched the TV show game, right, you notice that you can't buzz in early. It won't allow you to do that. So I have to read the entire question first, or the answer first, if you will, and then I have to hit my spacebar, which makes it active, and if you look at the upper right-hand corner, you'll see when that happens. It'll say buzzers on. Okay, so please do not buzz in until you see that buzzers on. Are there any questions? No questions. Based upon a random drawing that occurred shortly before this session, contestant number three gets to choose the first category and amount. I will choose Orlando for 400. Orlando for 400. The answer is the singular remaining original ride at Universal Theme Park is dedicated to this alien. Player number three. E.T. Could you please say that in form of a question, please? Who is E.T.? E.T. is correct. You still have control of the board. Orlando for 500. Orlando for 500. This boy band originated in Orlando in 1993, first performing at SeaWorld. What is NSYNC? NSYNC? I'm sorry, that's incorrect. You don't have to buzz in if you don't want to. She's thinking really hard. Yes, player number three. Who are the Beastie Boys? I'm sorry, that is incorrect. There's no way, right? Now, anybody in the audience? Backstreet Boys. Okay, contestant number three, you still have control. By the numbers for 400. By the numbers for 400, the answer is number of states where the federal drug testing of THC is prohibited. Hit that buzzer again. Player number two. Zero. Could you put that in the form of a question? Oh, what is zero? That is correct. Somewhat of a trick question. Sorry. Contestant number two, you have control. Problem drug test for 100. Problem drug test for 100. The answer is a specimen ID mismatch or no collector signature with no printed name are examples of this. Who got it? Hit it harder. Player number one. I thought it was a fatal flaw. Who is a fatal flaw? That is correct. Contestant one, you have control. He's consulting the crowd. No, she's my boss. Oh, he's consulting the boss. Even better. That's good strategy. Yes, I agree. Category and number, please. Player number one. Oh, by the numbers for 500. By the numbers for 500. The answer is proposed initial federal cutoff level for oral fluid testing for codeine and morphine. What is four? Hang on. You have to chime in at the buzz in. Yes, player number one. What is four? I'm sorry, that's incorrect. That's a shot. I have no idea. No guesses. Anybody in the audience? The audience guessed 10. Answer is 30. Oh, well, that wasn't that far off. Oral fluid, folks. Read the question. Okay, player number one. You still have control of the board. Okay, we'll take problem drug test for 500 problem drug test for 500. The answer is an invalid urine test result is reported when this adulterant level is tested, and both the initial and second tests on two aliquots show a level equal to or greater than 50 micrograms per milliliter. Player number two. What are nitrites? I'm sorry, that's incorrect. 50. A lot of deep thought looks. Question here. Going once, going twice. Player number one. I just picked, what is glutaraldehyde? I'm sorry, that's incorrect. Okay, took a shot. Player three. No, she has this concerned look on her face. She doesn't know. Once, twice. She's reaching. She's not reaching. She's okay. Okay, audience. Correct answer is chromium. Ammonia. Chromium. Chromium. Contestant number one. You still have control. Well, we get the answer for 400. Problem drug test for 400. Problem drug test for 400. The answer is the MRO should consider elapsed time and increased temperature effects when an invalid test is reported with the pH level between these two values. Player number two. What is between 9 and 9.5? That is correct. Very good. And player number two, you now have control. Problem drug test 200. Problem drug test for 200. The answer is laboratories typically verify oral fluid specimens, emphasis oral fluid specimens, actually are human by testing this. Player number two. What are epithelial cells? Could you be more specific? What are epithelial cells? No, I cannot. Okay. Player number one or three. Anyone in the audience? Oh, she's going to chime in. Okay, player number three. What are mucosal epithelial cells? No, sorry, that's incorrect. Audience. No takers. What are mucosal epithelial cells? No, sorry, that's incorrect. Audience. No takers. IGG. Player number two. You still have control, sir. Well, let's finish it out. Problem drug test for 300. Problem drug test for 300. The answer is an invalid urine result occurs when the specific gravity is greater than 1.0010 but less than 1.0200 and the creatinine is less than this. What is two? What is two? Let's see. Is that right? Problem drug test. Yes, that is correct. I had to check myself there. Sorry. Okay, good job. You have control of the board. I'll try. What are acronyms for 100? Acronyms for 100. The answer is SAMHSA. Player number three. Substance abuse, mental health, and wait, sorry, substance abuse and mental health. I'm sorry, time is up. Sorry. Player number one or two. Substance abuse and mental health. Please, please buzz in. Oh, what? Please buzz in with your buzzer first. Thank you. Player number two. Substance abuse and mental health safety administration. I'm sorry, that's incorrect. Yes, sir. Hit that again. Player number one. There you go. Taking another shot here which has not been successful so far, I'm going to say substance abuse and mental health services administration. That is correct. Player number one, you have control. Substance abuse and mental health. That's what I heard. Did you hear something different? We could go to the judges. I'm just kidding. Player number one. Well, collectors front and center for 100. Collectors front and center for 100. The answer is general term used for the type of testing done where the collector is both the collector, administrator, and interpreter of a drug test done at the same time. What is point of care testing? Yes, sir. That is correct. Point of care or point of collection, either one is acceptable. Player number two. Collectors front and center for 200. Collectors for 200. That's the daily double. So you have 1,200. You can wager any amount up to and including that amount. He's going to go for it. I'll bottom out. Sure. I'll risk 800. 800. The answer is the number of error-free mock collections that a collector needs to complete after qualification training in order to be initially qualified. Player number two is the only one that can answer. His daily double. Sorry. Oh, man. What is 20? I'm sorry. That's incorrect. The answer is five. I was going to say that. Oh, I don't get to go on you? Okay. Player number two, you still have control of the board. By the numbers by 100. I'm sorry. By the numbers for 100? Yes. Is that what you said? There's this huge echo up here. By the numbers? By the numbers by 100. Thank you. The answer is the federal confirmatory test urine testing cutoff for PCP. Can anybody go? Player number one. What is 10? I'm sorry. That's incorrect. Player two or player three? Player number two. What is 50? I'm sorry. That's incorrect. Player three. She's again halfway reaching for the buzzer. Struggling. Going once. Going twice. Audience? 25. Player number two. Please choose a category and an amount. By the numbers for 200. By the numbers for 200. The answer is the FMCSA 2024 random drug testing rate. Player number three. What is five percent? Sorry. That's incorrect. Players one or two? Player number one. What is 25 percent? I'm sorry. That's incorrect. Okay. But it's a good guess. I might as well guess. What is 10 percent? Sorry. That's incorrect. Audience? 50 is the correct answer. We had a bad year last year. Player number two. Still in control. Oh, geez. Let's finish out by the numbers for 300. By the numbers for 300. He wants to finish. The answer is confirmatory test cutoff concentration for THC and federal urine testing. Player number three. What is 50? Say that again. What is 50? I'm sorry. That's incorrect. Player number two. What is 15? That is correct. Next choice, please. What are, give me acronyms for 200. Acronyms for 200. The answer is ODEPSEA. Player number one. Office of Drug and Alcohol Policy Certification. Sorry. Very close. Consultation. What is Office of Drug and Alcohol Committee? Sorry. That's incorrect. Player three. She's very confused. Audience. Compliance is the word. Compliance. Yes. Player number two. You still have control, believe it or not. Okay. Let's go collectors front and center for 300. Collectors for 300. The answer is the number of days a collector has in order to complete error correction training after being so notified. Player number two. What is five days? Sorry. That's incorrect. Hit those buzzers again. What is five days? Player number two. What is five days? Sorry. That's incorrect. Hit those buzzers again. Player number three. What is 30 days? That is correct. Very good. Player number three. You now have control. Acronyms for 500. Acronyms for 500. The answer is STT. They all look confused. Audience? You have to think. I'll call testing, screening test technician. Player number 3, you still have control. Acronyms for 400. Acronyms for 400. The answer is THCV. Player number 2. Tetrahydrocannabinoid V. The sudden realization that there's an extra letter. Oh, no. He's given up. Yeah, I give up. Player number 1. I'm going to go for tetrahydrocannabinoid V. You know, that's so creative, I'm going to give you credit for that. There are certain times during the course of this that I just can't resist giving people credit for things like that. So, congratulations, you now have control of the board. I have control? Yes, you do. Well, let's clear out acronyms for 300. Acronyms for 300. The answer is PIE. 3.1415926535897. Nice try. It's not going to work twice. And I'm not going to accept blueberry, cherry, apple. Sorry. It's not going to work. It's not in context, like in a sentence. I understand. Oh, you do? Okay. Okay, audience? Public interest exclusion. Okay. Player number 1, you still have control. Well, I don't know anything about Orlando. So I'm going to take collectors front and center for 400. Collectors for 400. The answer is the urine volume necessary to be provided by the donor for an acceptable split specimen test. Player number 2. Oh, what is 45? That is correct. You're welcome. You've got to be quick. Back in your control, player number 2. Let's finish that out. Collectors front and center for 500. Collectors for 500. The answer is copy 4 of the chain of custody form goes to this person. Player number 3. The donor? Sorry, that's incorrect. Player number 1. Yes, sir. Who is the DER? That is correct. Despite the fact you know nothing about Orlando, you are now forced to choose one. I'll take Orlando for 300. Orlando for 300. The answer is the obligatory Nebraska football question. Congratulations. The 2014 Gator Bowl, which I attended, played in Orlando, featured the Nebraska Cornhuskers, who defeated this team, contributing to the Huskers' historical 17-8-1 regular season record and 13-7 bowl record versus SEC teams. Player number 2. Who is the Alabama Crimson Tide? I'm sorry, that's incorrect. But a really good guess. Player number 3. Who are the LSU Tigers? Another good guess, but incorrect. Player number 1. It would help if you knew who was in the Southeastern Conference, wouldn't it? My wife works for the Patriots. I only know about them. Who? My wife works for the Patriots. I only know about them. Audience? Georgia Bulldogs. In this game, by the way, Tommy Armstrong threw a 99-yard pass to Quincy Inunua, which is currently the all-time longest-passing touchdown record for Nebraska. It was Grant, let me tell you. Yes, sir. You've got one or two things to pick here. Well, we might as well take Orlando for 200. Going for 200. The answer is this Orlando Magic player was the first rookie to be voted an all-star starter since Michael Jordan. Did they work for the Celtics? I'm from Boston. What do you want? I do believe that this individual did play for the Celtics at one point in his later career. You do? Giving you a hint. Player number two. Who is Shaquille O'Neal? That is correct. Oh, I was just going to say that. Last but not least, Orlando for 100. The answer is the first theme park in Orlando, which opened in 1949, featured a 15-foot-long variety of this animal. Player number three. What is SeaWorld? SeaWorld is an animal? I don't know. No? Sorry. Player number one or two. It's got to have the word gator in its name. Hit your buzzer, John. Yes, sir. It's got to have the word gator in its name. Yes. Alligators. Okay. All right. So let's review. Good job. Nice. Before we move into Final Jeopardy. You're not done yet. Sorry. Oh, you thought you were done. Surely you just. Okay. You should have two pieces of paper in front of you with hopefully a writing instrument of some sort. One of those pieces of paper you are going to write down your wager, but only after I show you the Final Jeopardy category. You will then have 30 seconds to write down your answer. Please make sure you write it down in the form of a question. Many people like to write a question mark at this point in time so they don't forget that. Just a little hint. Like in Spanish? So the Final Jeopardy category is HHS certified laboratories. Please write down the amount that you would like to wager. You all have your wages written? Okay. The Final Jeopardy answer is the number of Canadian HHS certified laboratories for urine drug testing. Also, its square root was the first known irrational number. What? What? I'm trying to remember irrational numbers from imaginary numbers. Pi is an irrational number, but pi squared is still true. It must be pi squared. That's why you write it. That's why you write it. I'll never steal again. So please would you put down your wager. I'll never steal again. So please would you put down your writing utensils. Let's see. Now I can't remember whose totals were what, but let's go to player number one who is now trying to break his buzzer. Could you please tell me what your Final Jeopardy answer is, sir? Eleven. Eleven? I'm sorry, that's incorrect. Stay tuned. Player number two. What is three? What is three? I'm sorry, is also incorrect. Player number three. What is one? What is one is also incorrect, but the last two were very close. The correct answer is two. So player number one, what did you wager? Four hundred. And player number two? Three hundred. And finally player number three. Five hundred. So did I do that right? So we have prizes, like I told you. So in third place, with a score of 200, we have player number three. What's that? Oh sure, yeah. So for third place, we have a Captain America keychain, because all MROs are superheroes. In second place, which is really player one, but that's okay, we have... I want my keychain! Van is fired. No, that's okay. In second place, if you open that up, what you'll find is you'll see a shot glass and a golf ball in there, which might be two things you might want to consider other than doing MRO work. And our MRO Jeopardy! 2024 champion, who now gets his own Universal Studios ball cap. Congratulations sir, you are the champion for this year. Thank you all for your attendance, have a good rest of the conference.

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