### # 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
X07/17/200B



# 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.pdfif'CPScreen,HHProduction-[DrugTeslDetail:1056021BllloadingTime:4.181003111/!aEif'.f.le.:i.er'llcesl,.absandSR:iosB.ep<l<tsIookf!l.alrttenOncert""inlnformation-.11_.ss::••DonorName:!RichFavadc·.·.I·.,.....•··•..jNegative.,:!CollectlonDate:;S/26/20084:2l:OOPM_;rrloonat!On\Sili&DateInformationjRestllt&ReportInFormation\l.<lbName:·jAdvancedTlll!icologvNetwOJ!<ol.-·---·-----OJ,-.:Jil!lLabAccount:j4409532992.-·'.,··---"]-o;a;;g;;d:niOUry5/24/20103:'17:00PMp('";!"CPScroen.NETProduction·[DrutlTestDetail:105602188LoadingTh\10:4.2610034]l!lr3£i.,..flo-:!:ostsondehiiveSR......:'Iools-·.,._1\!!ndoW"f!elpI.-M$llnformatton'·.+••r;/·......,l<l.!!Oooorld:-r..toorrypo:t0oof.0Non-DOTIMROCopyj!--·Cer\fledCOpy.!.....!.fjbooorNamef!Ric:hFavacitLabAccoult:_::::,'.c:q!VerfiedResUI::jNegative.::jCollection..OnJgT..tDei...-Donor'Jnfcrmat:Jon----"1.LastNeme:\Favacic..-:II''""11-IIAU<itr••ll........ll-cocllYoew--11''"""""'011-...CommentsinResult(i.e.commentsbOxinthecommentssectionofscreenshot):{4/20/20108:55:18AM}<araetz>KarenLeamancalledinfromtheFAAtoquestionwhyittooksolongforthespedmentobetested.IcalledATNandspoketoMonicatoindicatedtheIaccountnumberwaschangedon07/16-07/17{7/17/20082:15:32PM}Namepopulatedfromdeleteddrugtestid:O{7/17/20082:15:32PM}<nastaskserv1>donornamepopulatedfromMROCopy.{7/17/200812:30:07PM}<cboedecker>COCREQSletterhasbeenfaxed.CPScrean.HUProduction-Time:4.28100341l!S£3·!I'E1leQJstiJmer.Labsaro:1siteS•e!JoiSandRandoins'aiiddtaioesReportsIOO!.o'f!!ailitenance2r5tein,MainInfnnnatinn'Spedmenld:!;osso218_B__Oonorld·i··...TestOOTType:.f0DOTQNon-DOTjMROCopyE2J·,.CertfledCopy.0.DonorNamer.lUchFavadc-labActount:14409532992.::iMiscellaneousDOC0\---,;rCoi!ed:ianoaie;CUstomNeriAJrZCharter\..-l.-1•arne:iDrugTestDetails!Dcnor&.MROInformationc-SitelnfonnationiSite;r•o_cc_H_ealt_h_dba-:C-once--ntr-a-M.,.ed-:-::Cen-_,'··•1CoJiedor. -.'SitePhone;[440-9754185--3lSiteFax:.ISiteId:hzate·Y.r&t&3I. - .l....,•.··'IjCOIIOctfonD.;t,i:··js/28/20083.·.MROCopyAddDate:,i7/17/20062:16:00PM·_.,i··jii4:z!PM3MROCOpyAddUsen.jtgoldner·J,.....II17116/20063Cert.CopyAddDate:!.Ii}...,....ce.t.COpyAddUsen!tjReceiveDate:j7/16/2006iJReceivellme:jt:32!'MIrRepqrtedDatesJI1format1on".....,.Cust.Avail.Date::)7/17/20062:16:00PMVer&lRes,ChgDate:J7/16/200B1::33:00PM:r::--:-:--;MROAvaD.Date:·j?/17/20062:16:00PMCaRMROOOte:JFna!Res:Rptoaie:f7/17/200BZ:I6:00PM.'ACTIVE!Locked:0"'Added:nastasl<serv27/16/2fJOBI::33:00PM··._if>CPScreen.NETProduction-[OrugTestDetail:103602188LoadingTime:4.2310034]!lfaEJ·if'Ei1eQlstomer.2erVItes'!,pbsandahdRandOrris<Q)sts'andCharges·'B.8Poit5,lools;'Mailitenance;·':f\l.indoW!'tfeip'.·.rMainInformationId;[105602188·Donor!d:·----·DonorName:.jRkhFavacicVerifiedResult:LabName:)AdvancedToxicologyNetwotkTestDOTTyPe:l@DOT.QNon-DOTjLabAccount:.;l4409532992Collectl.;,.Date:]5128/20084:21:00PM···l--'Customer[AI_rzCharter.Name:··IDrugTestDetaiisfDonor&.MROInformationfSite&.DateInformationlPonclCode:j50502•••Jr1··-.··;.''--.···!···.1fDrugCode·;..·.!ResultType11PanelDesc:jATNNidaPanel!•lAm•-•·:j!1r,po:"'am:nes!NEG,...1JCocalneiNEGI_j..1jNEGJ..Lab·1!jOplatesiNEGCommentsi.1(PCP)!NEGl!Positivefcomments:r;;:-,eRptAccoUJ)t.!F.x(.l!,.,:·!'"1!.MROCopyCertifiedCopy'-J!SIIlti

### 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.e
11111

g•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 10/08/2002RECORDING 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'.~~--~-;-'-~~~~--** ....... .......:.--"""-

### ~440)**~7S** 

### ..**~l~.5** . Collector**Fa~** No

. ._·
_____ ...__ __________ _

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~K s~·--~~~~~~~~~~~~~--~~~~~~--~~----~~~~~--------~~~----~--**  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.