Synonym: inadequate breath procedure
Differential diagnosis of the "shy lung":
(1) underlying lung disease that prevents the subject from providing an adequate sample
(2) subterfuge to avoid drug testing
(3) subterfuge to delay return to work
If the patient has been unable to produce an adequate breath specimen, then:
(1) the patient should be given the opportunity to try again.
(2) if the test is for screening and if the collector is qualified for saliva testing, then a saliva test can be performed.
(3) if none of the above, then the person must be evaluated by a physician acceptable to the MRO who is able to determine if there is a medical condition that may explain the inability to produce a specimen.
Conditions that may explain "shy lung" include:
(1) advanced emphysema
(2) asthma provided that there is reasonable evidence that it could have interfered with testing
If no reasonable explanation can be found then the person is presumed to have refused testing.
Refusal to test for breath alcohol includes:
(1) failure to appear for testing within a reasonable time (exception: pre-employment test)
(2) leaving the collection site before the collection process is complete (exception: leaving the site before testing has started AND if pre-employment)
(3) refusal (not inability) to provide an adequate sample (exception: leaving the site before testing has started AND if pre-employment)
(4) absence of an adequate explanation (medical or psychological condition) for the inability to produce an adequate breath specimen.
(5) refusal to be examined by a physician if indicated for insufficient breath
(6) refusal to sign the alcohol testing form (ATF)
(7) failure to cooperate during testing
