# Description 

AIR Z FLYING SVC,INC. FAA 2010-0974 

Agency Exhibits 

1 Controlled Sustance Test Rpt- dtd 20080717- 1 pp 

2 Sta Rohl - dtd 7/23/08 - 1 pp 

3 Sta Frankel- dtd 20110518- OBJECTION TO PORTIONS -1 pp · 

4 seeR Ex A 

5 seeR ExC 

6 Jan database print screen - 1 pp 

7 Specimen ID- dtd 7/1/10-6 pp 

8 Relevant Admissions by Air Z- 1 pp ADMITIED BY AGMT OF PARTIES 

9 Perception Drug Test- 1 pp 

10 Ltr Rohl dtd 20110510 - 1 pp 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

29 

10 IN 

X X 

X X 

X X 

NA NA 

NA NA 

X X 

X X 

X X 

X X 

X X 

X 

X 

X 

X 

X 

X 

X 

X 

X 

X 

X 

X 

X 
07/17/200B 

I 

Attn: Brad Rohi/Larry Rohl 

1885 Lost Nation Rd. 

Willoughby, OH 44094-

Phone: 888-818-2992 

1111111&1 :::::::::::::::::::::::::::::::::::::::::::: 

CboicePoint Medical Review Services 

480 Quadrangle Drive Suite D 

Bonngbrook, XL 60440 

Tel: 800-939-4782 Fax: 630-679-5635 

Controlled Substance Test Report 

Client Name: Air Z Charter 

I 

Acx:ount Number: 106162-00000 

Donor Name: Ot.her ID: 

DonoriD: "'*"'-*"'-

Test Result : Negative 

Result Description : Negative 

Substances Found : 

MRO Verified Comment : 

Specimen ID: 105602188 

Specitnen Collection Date: 5/28/20084:21:00 PM 

Lab Name: Advanced Toxicology Network 

Testing Panel,: ATN Nfda Panel 

CCF Received: 7/17/2008 

Verification Date: 7/17/2000 

Reported Date: 7/17/2008 

CollectionSite: Concentra Medical Center 

- · ·(Signature.On Flle) ... : . . ..... ::. 

,',;:•:1· 

Emp. Category: DRIVER 

·Test Reason: 

Test Type: 

Lab Account #: 

Test Account#: 

Test Client Name: 

Location ID: 

Cost Center: 

MRO Phone: 

888-794-6574 

Pre-Employment 

DOT 

4409532992-4409532992 

106162~00000 

Air Z Charter 
. . . . . . . . .. . . .. . • ; ''') ~::!. ·' :·,'! 

' '""'·•··•• .. 

I : ~; • ; ; ; • / : ~ ':' • • : • ; 
;•··· 

t; 

' 

( 

. :,· 

.1r z Flying Service Inc.-Case# 2009SW91 0051 

Inspector Statement 

, . 

On July 23, 2008, Connie Ingram, John Wachtel and I inspected Air Z Flying Service Inc. 

During the inspection, it was determined that Air Z hired Ritch Kovacic and allowed Ritch 

Kovacic to perform maintenance/preventative maintenance before receiving a verified 

negative pre-employment drug test result. 

On Wednesday, May 18, 2011, 8:30am, I initiated a phone call to Alternative Safety & 

Testing Solutions (ASTS) and requested to speak with Dr. Weber, Medical Review 

Officer (MRO). I was told that Dr. Weber does not occupy an office at thatlocation and 

was transferred to the Office Manager, Jan Garza. Ms. Garza asked for the specimen 

number that I was calling about and once I gave that to her, she confirmed the name of 

the donor and the company name of Air Z. She also confirmed that Air Z was never 

contacted regarding this test, as they were not a client of ASTS. Ms. Garza confirmed 

that once ASTS received the collection ·and realized that it was for a company that was 

not a client, ASTS called the collection site to get the company information that went 

along with the collection. The collection site never returned the call. Ms. Garza provided 

Dr. Weber's pager number. 

At approximately 9:00am on May 18, 20011, Dr. Weber returned my page. I asked him 

his procedures for reporting a negative test. Dr. Weber stated that he does not handle 

negative results; he leaves these to his MRO assistant. I asked Dr. Weber to describe 

his assistants' procedures for reporting negatives and he told me that she either faxes or 

send the results to the DER. I asked if there would ever be a reason for his assistant to 

call a company with a negative result and Dr. Weber stated that he believe that if a client 

is set'-UP in their system stating phone calls are the preferred method of notification, his 

assistant would call with the results. I asked Dr. Weber if he remembered phoning Air Z 

in June of 2008 with the negative test result from donor Ritch.Kovacic. Dr. Weber 

replied that he did not remember making. any such phone calL Dr. Weber continued to 

state that he does not remember ever making a phone call to any company to report a 

negative test result. Dr. Weber reiterated that he does not handle negative results, 

except for the 5% review he conducts yearly. 

~ 

At approximately 1:15 pm on May. 18, 20011 I contacted ASTS back to speak with Dr. 

Weber's MRO assistant. It was at that time I discovered that Jan Garza, the Office 

Manager I had spoken previously to is also Dr. Weber's MRO assistant. During this 

conversation, Ms. Garza confirmed again that no contact with Air Z was ever made. Ms. 

Garza also explained that the computer program ASTS utilizes documents when and 

how a result is released (phone, fax, e-mail, etc.). No release was ever documented. 
LexisNexis& 

July 1, 2010 

Karen Leamon 

Manager, Special Investigations Branch 

Drug Abatement Division 

Office of Aerospace Medicine 

Re: Specimen ID 105602188 

Dear Ms. Leamon: 

The following is the information you requested in your email inquiry of June 30,2010: 

Request: 

Answer: 

Request: 

Answer: 

Request: 

Answer: 

Request: 

Answer: 

Request: 

Answer: 

Request: 

Answer: 

Request: 

Answer: 

Request: 

Answer: 

Request: 

Answer: 

Request: 

Answer: 

Date first received a copy of the federal drug testing custody and control form with the 

employee's name on it. 

July 17, 2008 

Date first received laboratory test result. 

July 16, 2008 

Who received the test result? 

ChoicePoint (now LexisNexis) received the drug test result from Advanced Toxicology 

Network. 

How was the test result received? 

Electronically (through electronic download set up with ATN). 

What happened with the test result after it was received? 

Before reporting the result to the client, an attempt was made to obtain the MRO copy of 

the CCF from the collection site. Once received, the result reported to Air Z Charter via their 

normal reporting method (AutoFax). 

Were there any conversations between Concentra and Chokepoint regarding this particular 

test? If yes, what was the content of that conversation? 

There were no conversations with Concentra that are recorded in the result. A fax request 

was sent to Concentra-to obtain the MRO copy of the CCF on July 17, 2008. 

Was the test result communicated to Air Z Charters? If so, when, how and to whom? Was it 

communicated with anyone else besides Air Z Charters? 

Yes. By fax to Brad Rohl at Air Z Charters. It was not communicated with anyone else. 

Did Choicepoint receive any information regarding this test and its test result prior to July 

17, 2008? If yes, was the test result communicated with the company prior to Choice point 

receiving it officially? 

The result was re.ported to ChokePoint on July 16, 2008. That is the first record of the result 

in our database. The test result was communicated with company on July 17, 2008. 

Has LexisNexis maintained the records that were kept by Choice point? 

Yes. 

What is the relationship between LexisNexis and Chokepoint? 

LexisNexis purchased ChoicePoint in 2008. 

LexisNexis® Risk Solutions • LexisNexis Occupatipnal Health Solutions Inc. 

480 Quadrangle Drive, Suite A • Bolingbrook, IL 60440 • lexisnexis.com/risk 
•! 

Re: Specimen 10 105602188 

Page2 

The following is a brief timeline of the result. 

05/28/2008 

07/16/2008 

07/17/2008 

07/17/2008 

07/17/2008 

04/20/2010 

Collection Date 

1:32 pm, CST. Result received by ChokePoint. Result was electronically reported to 

ChokePoint by Advanced Toxicology Network (ATN). 

12:30 pm, CST. Request for MRO copy of the CCF faxed to collection site. 

2:16pm, CST. Custody and Control Form processed. 

2:16pm, CST. Negative result reported to Brad Rohl at Air Z Charter, by AutoFax, to the 

fax# on file, (216) 261-2993. 

8:55 am, CST. Karen Leamon from the FAA called the lexisNexis MRO office with questions 

regarding the drug' test and why it took so long for the result to report. MRO 

representative, Ashley, called ATN and spoke with Monica in customer 

service, who indicated that the account number was changed at the laboratory on 

7/16/2008. TheMRO representative also updated the name of the donor from last name Rideh to Rich. 

Your email also requests any notes on the result. Attached with this letter are screenshots ofthe result in 

our database. The screenshots demonstrate the dates listed in this letter, and any notes in the result. 

Should you have any additional questions, please feel free to email me at maryann.peltier@lexisnexis.com. 

Sincerely, 

Mary Ann Peltier 

Manager, MRO Services 

lexisNexis 

Attachment: Screenshots- spec ID 105602188.pdf 
if' CPScreen,HH Production -[Drug Tesl Detail: 1056021 Bllloading Time :4.18100311 1/!aE

f'.f.le .:i.er'llces l,.absandSR:ios B.ep<l<ts Iook f!l.alrttenOnce 

rt""inlnformation-. 

1

1

_.ss:: •• 

Donor Name: !Rich Favadc ·. · . I ·. , . . ... •· ·• .. 

jNegative . ,:! CollectlonDate: ;S/26/20084:2l:OOPM_; 

rrloonat!On \Sili &Date Information j Restllt &Report InFormation\ 

l.<lb Name: ·jAdvanced Tlll!icologv NetwOJ!< 

ol 

.-·- --·-- --- OJ,-

.:Jil!l 

Lab Account: j4409532992 

. -·'. ,·· 

---"]-o;a;;g;;d:niOUry 5/24/2010 3:'17:00PM 

p 

('" 
;!" CPScroen.NET Production· [Drutl Test Detail: 105602188 Loading Th\10 :4.2610034] l!lr3£i 

.,.. flo -: !:ostsondehiiveS R ...... :'Iools -· .,._ 1\!!ndoW"f!elp 

I.-M$llnformatton ' ·. + • •r ; / · .. ...., l<l.! ! Oooorld:- r..toorrypo: t 0 oof. 0 Non-DOT I MROCopy j 

! - -· Cer\fledCOpy.!.. .. .!.f j booorNamef!Ric:hFavacit LabAccoult: _::::,' . c:q ! VerfiedResUI:: jNegative .::j Collection . . 

OnJgT..tDei ... 

- Donor'Jnfcrmat:Jon ----"1. 

LastNeme: \Favacic . . 

- :I 

I ''"" 11-IIAU<itr••ll ........ ll-cocll Yoew--11''"""""'011-

... 

Comments in Result (i.e. comments bOx in the comments 

section of screenshot): 

{4/20/2010 8:55:18 AM}<araetz> Karen Leaman called in 

the FAA to question why it took so long for the spedmen to 

tested. I called ATN and spoke to Monica to indicated the I account number was changed on 07/16-07/17 

{7/17/2008 2:15:32 PM}Name populated from deleted dru

id:O 

{7/17/2008 2:15:32 PM}<nastaskserv1> donor name popu

from MRO Copy. 

{7/17/2008 12:30:07 PM}<cboedecker> COCREQS letter 

been faxed. 
CPScrean.HU Production- Time :4.28100341 

·!I' E1le QJstiJmer. Labs aro:1 siteS• e!JoiS and Randoins' aiid dtaioes Reports IOO!.o ' f!!ailitenance 2r5tein 

, Main Infnnnatinn ' 

Spedmenld:!;osso218_B__ 

Oonorld·i·· . . . TestOOTType:.f0 DOT Q Non-DOT j MROCopy E2J · , . Certfled Copy . 0 

. Donor Namer. lUch Favadc - lab Actount: 14409532992 .::i Miscellaneous DOC 0 

\ ---,;r Coi!ed:ianoaie; CUstomN er iAJrZCharter \ .. -l . - 1 • arne: i 

Drug Test Details! Dcnor&.MRO Information 

c-Sitelnfonnation i Site ;r•o_cc_H_ealt_h_dba-:C-once--ntr-a-M.,.ed-:-::Cen-_,'··• 

1 CoJiedor . - . 

' 

Site Phone; [440-9754185- -3 l SiteFax: .I 

Site Id: hzate · Y.r&t &3 I 

. - . l 

. ... , •. ·· ' I 

j COIIOctfonD.;t,i:· ·js/28/2008 3 . · . MROCopyAddDate:, i7/17/20062:16:00PM · _ . , 

i ··jii4:z!PM 3 MROCOpyAddUsen.jtgoldner · J 

, . . . . . I I 17116/2006 3 Cert. CopyAddDate: ! . I 

i} .. . , .. .. ce.t.COpyAddUsen! t 

j Receive Date: j7/16/2006 iJ Receivellme: jt:32!'M I 

rRepqrted Dates JI1format1on" . . . . . , 

. Cust. Avail. Date: :)7/17/20062:16:00 PM Ver&l Res, Chg Date: J7/16/200B 1::33:00 PM: r::--:-:--; 

MRO AvaD. Date:·j?/17/2006 2:16:00 PM CaRMROOOte:J 

Fna!Res: Rptoaie: f7/17/200BZ:I6:00PM . 

' ACTIVE !Locked: 

0"' 

Added:nastasl<serv2 7/16/2fJOB I ::33:00 PM 

··._ 
if> CPScreen.NET Production- [Orug Test Detail: 103602188 Loading Time :4.2310034] 

·if' Ei1e Qlstomer . 2erVItes' !,pbs and ahd RandOrris < Q)sts 'and Charges · 'B.8Poit5, lools ;' Mailitenance ;· ':f\l.indoW!'tfeip '.·. 

rMain Information 

Id; [105602188 · 

Donor!d:·----· 

Donor Name: .jRkh Favacic 

Verified Result: 

LabName: )AdvancedToxicologyNetwotk 

TestDOTTyPe:l@ DOT . Q Non-DOT j 

Lab Account:.;l4409532992 

Collectl.;,. Date: ]5128/20084:21 :00 PM 

···l --' 

Customer [AI_r z Charter . Name: ··I 

Drug Test Detaiisf Donor&.MRO Information f Site &.Date Information l Poncl Code: j50502 •••J r 1 · · - . ·· ; . ''--. · · · ! · · · . 1 fDrug Code ·; . . · . !Result Type 

1 1 Panel Desc: jATN Nida Panel !•lAm •-• · : j ! 1r, po:"'am:nes !NEG 

, .. . 1 JCocalne iNEG I _j .. 1 jNEG J 

. . Lab ·1 ! jOplates iNEG 

Commentsi . 1 (PCP) !NEG 

l ! 

Positive f comments: 

r;;:-

,eRptAccoUJ)t . !F.x( 

. l 

! ,. ,:· !'" 

1 ! 

. 

MROCopy 

Certified Copy 
RELEVANT ADMISSIONS BY RESPONDENT AIR Z FLYING SERVICE, INC. 

1. Respondent sent Ritch Kovacic for a pre-employment drug test on May 28, 2008, so that 

he could perform safety-sensitive functions on Respondent's aircraft. (Resp't Mot. to 

Dismiss 1.) 

2. Mr. Kovacic performed a safety-sensitive function on one of Respondent's aircraft, 

N94EW, on June 6, 2008. (Resp't Mot. to Dismiss 2.) 

3. N94EW was on Respondent's part 135 operations specifications in June 2008. (Resp't 

Response to FAA Disc.) 

4. Section I of the Complaint, to wit: 

Respondent Air Z Flying Service, Inc. (Respondent or Air Z) was advised through a 

Notice of Proposed Civil Penalty dated February 26, 2010, and by a Final Notice of 

Proposed Civil Penalty dated September 8, 2010, that the FAA proposed to assess a civil 

penalty in the amount of$7,700. By a letter dated September 20,2010, Respondent 

requested a hearing. The Enforcement Division, FAA Office of the Chief Counsel 

received Respondent's written request for a hearing by Certified Mail- return receipt 

requested on September 28, 2010. 

5. Section II, ~ 1 of the Complaint, to wit: 

Air Z is now, and at all times.mentioned in this document was, the holder of Air Carrier 

Certificate No. ZFDA222T, issued under 14 C.P.R. part 119 and authorized to conduct 

operations under 14 C.P.R. part 135 ofthe Federal Aviation Regulations. 
I 

. 

. 

). 

1 

C/t\ 
May 10,2011 

EXPLANATION OF LETTER 

I wrote a letter to the inspection team on July 23, 2008 in a hurried manner because they 

wanted a brief letter of correction on the Ritch Kovacic matter. They wanted the letter faxed to 

there room since they were leaving soon. They did not seem very concerned, since all of my 

other records were in order. I did not hear back from them so I thought the matter was 

rectified. 

The dates are off by my mistake, probably because I was rushed due to my other many duties 

with the FBO. I actually sent Ritch Kovacic on 5-28-08 and received a verbal negative within the 

next couple days. The MRO also would let me know at that time that I would be getting a fax. 

Since it was an unsecure fax I let the secretary know a fax would be coming in and to put it in 

my mail box. I went back to my FBO duties. 

Upon receiving a verbal It negative" from the MRO, I let Ritch Kovacic know that he was in the 

random drug program and that he was able to work on Air Z Flying Service aircraft. I only "OK" 

a person for Air Z work if I have a confirmed negative result, verbal or written. 

The reason for writing, "Don't remember what happened after that." Was that I did not 

remember what happened to the original faxed result sheet. 

When I did an audit on my own records, I noticed that I was missing Ritch Kovacic's drug result 

sheet. I called Con centra to get an additional copy of the drug res·ult. They told me to contact 

the MRO for the results. I called the MRO, Choice Point, for an additional copy of the test 

results. I received that copy on 7-17-08. I then put it in his records. 

C-1{) 
# Description 

A DOT result- dtd 20080528 - 1 pp 

B Ltr dtd 20110209 ASTS to Rohl- 3 pp 

Air Z Flying Svc. FAA 2010- 0974 

Respondent's Exhibit List 

C Ltr dtd 20100630 ASTS to Leamon - 3 pp 

D Descript of lnsp 5/1/08-6/6/08 - 1 pp 

E 

F 

G 

H 

I 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

ID IN 

X X 

X X 

X X 

X X 
- --------------------------------------

II 

CORPORATION 

, ... ~ Alternative Safety & Testing Solutions 

DOT Result II 

Customer ID: 36746 

AirZ 

1885 Lost Nation Rd Loc Code: 4409532992-D 

Lab Account: CMC/OH-Cieveland-Willoughby 

I Donor lnfo:--j 

jrest Info: 

Willoughby, OH 44094 

Donor Name: Kovack, Ritch 

SSN/10:-

Specimen ID: 105602188 

Collected: 05/28/2008 

Reason: Pre-Employment 

Industry: FMCSA 

Lab: Advanced Toxicology Network 

Coli Site Name: Concentra Willoughby 

co:~~nts: I.___, ______ __;_ ______ __. 

Lab I 

Comments:'------------------' 

Overall Result: I._ ___ N.e11111g•a.ti.ve ___ .. l Test Performed: I HHS/DOT DRUG SCREEN 

Substance Tested 

Marijuana 

Result 

Negative 

Negative 

Negative 

Negative 

Negative 

Screen Level Confihn Level Quant Level 

Cocaine 

Amphetamines 

Opiates 

PCP 

Norman Weber, DO Date Verified:· 

MRO Certified AAMRO 

Through: 

06/06/2008 

50 15 

300 150 

1000 500 

2000 2000 

25 25 

Date MRO CCF Recejved: 05/28/2008 

Report Sent By: 

Report Released: 02/09/2011 

Cert Num: 001008335 Date Certified: 

Corporate Office: 

ll 

1853 R W Berends Dr SW *Wyoming, Ml 49519 *Phone: 800-477-3177 *Fax: 616-53 i 

10/08/2002 
RECORDING TODAYS 

TACH FLIGHT 

TIME 

TOTAL 

TJMEIH 

SERVICE 

Description of Jnspeotions, Tests, Repairs and Alterations 

Entries must he endorsed with Name, Rating and Certificate Number ot 

: Technician or Repair Faclllly. (See back pages for other specific entries.) 

,. __,_ __ .~__ ___ ..t._ __ ....L_~_J_ ___ ___, ______________ · _. _· __ __:.__;.__'··· it 
## Description 

Air Z Flying Svc FAA 2010- 0974 

Court's Exhibit List 

1 Sanctions Guidance Table 2150.038 

2 49 CFR Subpart G, 40.167 

10 IN 

X JN 

X JN 
(\ ( (! .f=l !? 

AlTERNATiVE JAfETY & TfJTING JOU.Jl~ONJ 

<I<>W U JJ 

February 9, 2011 

Laurence E. Rohl 

FAA 

355 Richmond Rd. Hanger 5 

Richmond Hts, OH 44143 

Mr. Rohl, 

This is in response to your subpoena DUCESTECUM, Docket No. CPlOSWOOlO, case 

number 2009-SW -910051. 

I apologize for the delay in the response as I was out of the office on a surgical leave. 

As requested, I have provided copies of the following documents; 

1. The MRO copy of the CCF 

2. A copy of a letter that I Wrote to Karen L. Leamon, from the FAA Drug 

Abatement Division of the FAA in response to an e-mail in reference to the 

receipt of the test result from ATN, the efforts of ASTS to report this specimen, 

and ultimately the reporting of the test result to Air Z. I have added my signature 

to this document today, to verify that this letter accurately reflects the steps taken, 

and the dates these steps were performed, in our effort to report this specimen 

absent any contact information for the DER or the company. 

3. Attachment A is a copy of our data screen that pertains to the specimen in 

question which shows that while the lab and CCF indicate that the ·company name 

was Air Z, the upper right Customer field is blank which indicates that at the time 

of the test, there was no contact information on Air z. This document also 

verifies the date of receipt at ASTS (5/30/08), date collected (5/28/08), date ASTS 

received the MRO copy of the CCF (5/28/08) and the name of the collection site. 

In the box labeled MRO Unpublished Notes, the first line indicates that we need a 

set up sheet from the collection site to allow us to report the result. This then 

triggers a fax request from the collection site to provide this information repeated 

on a daily basis until it is received. This site, Concentra Willoughby, typically 

responds rather quickly to our request as they realize their client will not receive a J) rt 

test result until we receive this critical information. :.; 

The second entry indicates that on June 6, 2008 we have yet to receive the ;) 

company information in spite of daily requests. We also indicate that the result," ~ 1-uJ I l <:::::. 

while verified by the MRO has not been reported. t/ 

ASTS Inc. 1853 R.W. Berends Dr. Wyoming, MI 49519 

Phone: 616-531-6661 FAX: 616-534-5545 

~D, 

? ,, 
4. Attachment B is the data screen indicating that we finally received the set up sheet 

from the collection site and entered the company as a client on 7/15/2008 which 

allowed us to report the test result for the first time. 

5. The fmal document is the MRO report which indicates today' s date as the date 

certified. That is somewhat misleading, as our system does not allow us to 

manipulate dates, which was a safety feature that I insisted be part of our design 

to prove that we do not "back date" results at the request of employers. The 

remainder of the data is the same as reported to Air Z on 7/15/2008. 

I hope this information is helpful. 

Sin~ereJI 

?/1~~ V em J oties- President 

ASTS, Inc. 

ASTS Inc. 1853 R.W. Berends Dr. Wyoming, MI 49519 

Phone: 6.16-531-6661 FAX: 616-534-5545 
>5/28/08 15:35 To: Norman Weber 6165345545 Pg 00: 

. .· . sPECIMEN 10 No. •a s~o. e Hnl . AOVANCED TOXICO.LOGY NETWORK 

STEtl1: COMPL!!TED BY COLLECTOR OR EMPLOYER REPRESENTATIV!!!! 3!560 Air Canter'Oova, Memphis, TN 3'6118· (008)222"489 

D. ·R~ason forT ·Pre-employrnl1nt~ ... O A<tnd<>m 

. , O~etu_w,.t!YOuty 0 F'onow-up 

E. Drug Test$ to be PerforflWt:J~ rHO, COO,' PCP, OPt, AMP : 

F. conectlon. Sit$ Addras$:. . co~Emtra Med1cal.·centers 

JIJIOQ lHtn ·I-tuc ~venue .. Will~UQhbYt OM 44~94 

(440). Sr?S-4165 · Ool!eotQr Phone No'.~~--~-;-'-~~~~--....... .......:.--"""-

. Collector Fa~ No . ._· _____ ~440) ...__ ~7S __________ .. ~l~.5 _ 

F!ead spaeimen terriperatur within 4 minutes. Is temr>erature )e(eolmen Collect19n: · . . g' 

between 90° and 100° F ' Yas 0 N.o, !Znter Remark · 'C) Split . ·CJ Single CJ None .Provided (Enter:Remark) b Observed (entet Reni.art ~ 

] ~R~E~M~A~R~Ks~·--~~~~~~~~~~~~~--~~~~~~--~~----~~~~~--------~~~----~-- g ST!P·3: CoUecto)lafflxea bottle ssal($) to bottla(s). Collector d.ates se(:ll(s) .. qon'or lnlllals seal(s). Donor comj)letas sr·~p 5 on Copy 2 (MRO Copy} g STEP 4! CHAIN·OF CUSTODY ·INITtATEO BV COLLECTOR AND COMPLeTED BY LABOAATORV . . · · · · § 

x· . Primary Specimen SPSCIMIN SOTTLE(S) RG . SED TO; 

13ottl& Seal Intact · , . 

..... 

"' 

~ adulterated it in any mann~r; each 11peolm~n bo_ttfe used was liet11ed w1lh a tamper- ~. 

atrd 01'1 the label affb<t!ld to ~S¢/'rspecfme(l bottle Is corr~t. · . .· . · 11: 

1 oert/ly'that J,p;ovldud my UJine ·BPevlmen 'to tho oa/laOtor; that I have 

evid~ e In mm~ sence; aM that th$ /nf()rmatfon provld~d on 

. .· ::f'j)..Pjoy.: ~- Slgn~~tuta or Donor , · . . -~ P 

· Daytlm~ PhonE! No.'~. i!-Zf .. J.I!?'".ft. . Evening Phone No: Date of 8111~ ~ Should ihe resulle of the ,hilioratoty tests for the epeolm~n lqentllled by thl~ fqrm ba conflrmad· positive, the Medical Ra'lllaw Officer will contact you. to ~&k · g 

about prescrlptlone .and over-tha·coun\er fl)&dioations you may have.taken. Thetefore, you f1'1ay want .to meke Ei IIBt of those n\edioationa for your own tf!ICOr<ls § 

·.THIS. LIST IS NOT. NECESSARY. If you choose to mak$ a ll$t, do so ellh&r on .a ~;~ep~rate place· of p~;~.per or c;>n th~ baok of your copy (Copy 5).-DO NOT ~-

PROVIDE T~!S INFORMATION ON THE BA'CK OF ANY O'fHERCOPY (?F THe FORM. TAKI:. yOPY 5 WITH YOU. . . . . . ~ 

STEP $; COMPLETED BY MEDICA!. REVIEW OFFICER • PRIMARY SPECIMiiN · · · 

In acoordance with applica_ble Federel re(julri1m$nts, my determlnatlon/V9rf,flc(J.tlon Fs: . a NEGATIVE · a POSITIVE: !!l Ti:!ST CANCELLE!D CJ BEF.USAL 'f.O T~ST·5ECAUSC:: . 

' 0 D!LUTI; IJ ADU!.IERATE.D 0 \?UBSi\TUTEO 

REMARKS----~--------------~------~~~~~--------------~------------------------------~ 

. (PRINT) Medical Flevl&W Offl~t~r'a Name (Firat, Ml, Larrt) 

I. ·( 

Date (MoJDay/Yr,) 

ST!P T: OOMPLI!rf!D BY MEDICAL REVIE~ OFFICER ·SPLIT SPECIMEN 

In acoordence wlth spplice.b/e Fede~al requirements, my determination/verification for the split specimen (If tested) is; 

0 RECONFIRMED o FAILeD TO ReCONFrB.M ·• RI::ASON __________________ __. __ ~_,_~-

I / 

(PAINT) M6dltal A6VIew Ottlc•r~ NUI'It {Fit$t. 1,11,, ~S.t) 
SlO/liO!lJ 

(\ f!l?r? 

L\lTERNAliVE fAFETY &. TEJTING /OlUTIONf 

(/(>\)}_) u cU 

June 30,2010 

Karen L. Leamon 

Manager, Spec.ia.l Investiptions Branch 

Drug Abatement Di"i.sion · 

Office of Aerospace Medicine 

Ms. Leamon, 

This is a response to your ~~.leSt regarding a test result for Air Z provided by Ritch 

Kovack on 5128/08, reported by Advanced Toxicology Netvvork 

(A. TN) fi spec 02188. 

I will respond to your q~ons in the sequence provided in your e-mail dated 6/29/1 0~ 

With a brief introduction to the relationship between Concentra Medical Center 

(Concentra) and ASTS Inc. 

ASTS provides MRO and random selection services to approximately 15,000 client 

oompanies for Concentra in approximately 30 Coneentra Medical Centers. Many of 

these are small companies that send an employee to Concenua. on rare occasions. When 

the Concentra Center (In this case the Concmttain Willoughby, OH) obtains a. new 

client. they complete a set-up fomt and forward the infonnation (company name. 

location, con*t person. method of result delivery~ ete) to both A TN and ASTS. ASTS 

then creates a new client in our data base and awaits a test result. 

In many instances, particularly with. smaller companies, the first indication that the 

c()mpany is a new client to the Concenna Center is tbe arrival of a donor attempting to 

Pfovide a specimen fora drug screen collection, with no advance notice. 

If this company is subject to DOT testing regulations. tbe.Conccnn Center will collect 

the specimen and list ASTS as the MRO fur that c9llection. The staff at Concentra is the:n 

instructed to complete the "new client information fonn and forward toASTS and A lN. 

A 1N then proc;eues the spc:cimcn and reports the result to ASTS. 

Irt the specimen in question, the new client information form was not forwarded to ASTS. 

The specimen was collected, ASTS was named the MRO, and the specimen was 

forwarded to A rn and reponed toASTS. · v'w)\~ ,, 

In the event that ASTS receives a result from A 1N without a matching client company in 

O\at database, it is our procedure to ~mail the Concen.tra Center that collected the II '7 

ASTS Inc. 1!53 R.W. Bem1ds Dr. Wyoming. Ml 49Sl? 

Phone: 616--531-6661 FAX: 616-S34-SS4S ~ 

swo .. --------- \{\1-1 
~LO/l!O/i!J 

. -

. . . .ilit': .• 1 A .. 

specimen and request a set-op form to allow us to report me test result. TypicaUy. the 

request receives immecfult(: resp<mse and ASTS is able to report the result in a. timely 

manner. On very rare occasions. the request does not receive a response, which results in 

repeated requests to the Concentra CeDter. These requ.ests are sent <>n a daily basis listing 

every COD1pany and specimen that requires information to report. ASTS undent.mds the 

importance of timeliness in. the reporting of specimens. which requires us to moJtitor test 

results not reponed on a daily basis. 

:--·. . Questions: · 

·· ··· ~ ASTS contacted Concentra MedicaJ Center in Willoughby requesting infoJlDation on.~ 

client company chat would allow us to report !:he test result via e-mail or fax on numeJ'O~ 

occasions. Our audit trail on our new system originated on the ~te our new syStem was ) install~ in 2009, therefore we 3tt unable to report the number and ~e of each n:q~ 

---~ .. -· ... . .~ 

Th.e conversations between AS-=ffi-aOO...concentta were via e-mail and :.fux and penained 

only to the requested inf.onnation that wou.ld allow us to report the result to Air Z. No 

information was exchanged regarding the actual result -~· ··- ·- __ .. .. 

( .. -..... ASTS ~~n~.the Center Administra.t~r at the ~~oughby Co~tra Medical c~tei:~ '·.... We are not certain of the name of the Center Administrator back m May of2008. ~ 

--------- ·--.......... _._ -····~ .. - .. -··---... -------- ASTS was l.Ul.able to contact A.iJ: Z as we did not have the address, phone number, or 1he 

name of the DER for this company. The only information we bad at that time was derived 

from the test result reported by ATN and the CCF. 

Air Z did not conract ASTS dwing the time that the result was received from A TN and 

the time that ASTS n:ported the result. 

As ASTS did not have any company infonnatio~ and since the regulations prohibit the 

MRO from .reporting to anyone except the DER for Air Z, we were unable to report the · 

test result. 

ASTS received all of the information (the testresult and the CCF) to verify 'the test teSUlt~ 

however, we did not have any information regarding the company. The verification 

process is not initiat.ed until we have infonnati.on that allows us to i-eport the result. Until 

tba1 time; the result remains ill .. limbo'~ while every reasonable effort is made to obtain 

the appropriate company information. When ASTS ~ived company contact 

infonnation., we verified the result and immediately contacted the DER from· Air Z of the 

test result 

As A.STS MRO services are a client of Con«:ntra Medical Centers, a charge i3 generated 

at the end of every month for each specimen ~ived from .A 1N collected at each 

Concenrra. Medical C~oter. At the end of May, the Willoughby Concentra was invoiced 

for the speeim.en received listing the date of collection, donor's name, and SSN. · /j 

'7/,? 

swo ;. 

ASTS 1~. IBS3.1L W. Berends Dr. WyomiPg. M1 49S 19 

Phone: 6l6-S31-'66l FAX: 616-534-5545 

" c: '· 
~LO/CtO~ 

At no point did ASTS report the result to Air z; Concentra or any other party, verbally or 

writt~ until me set-up sheet was received via Fax transmission on July l S. 2008.. ASTS 

then verified the result and forwarded th.e result to the DER at Air z. 

I hope this information is useful and please contact us if we may be of further ~ce. 

Si"ki( c{?/!t 

V em Jon~resident 

SI'IO + 

ASTS lnc. 18'3 .R.W. B~n::ods Dr- Wyoming, M1 49519 

Ph011C: 616-SJI-6661 FAX: 616-5.34-5545 

\ C.