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MPA (Medical Psychological Assessment)

Assessment criteria 3rd edition under the magnifying glass

With the amendment of the Driving Licence Ordinance dated 1.5.2014, the legislator has created legal conditions that allow the use of alternative methods instead of the conventional visual inspection with regards to the collection of urine samples within the framework of medical-psychological examinations (MPA) and abstinence checks.

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"Evaluation criteria under the magnifying glass”

Necessary modification of the manual

"Judgment formation in the driving aptitude assessment/assessment criteria, 3rd edition, September 2013"

With the amendment of the Driving Licence Ordinance of 1.5.2014, the legislator has created the legal prerequisites that allow the use of alternative methods instead of the conventional visual inspection with regards to the collection of urine samples within the framework of medical-psychological examinations (MPA) and abstinence checks:

“Driving Licence Ordinance (FeV)
Annexes to the Driving Licence Ordinance
Annex 4a (to § 11 para. 5)
Principles for the conduct of investigations and for the preparation of the
expert report
A basis for assessment of fitness to drive motor vehicles are the assessment guidelines for motor fitness of 27.1.2014
(VkBl. p. 110).
.
.
(3) When urine is delivered, procedures corresponding to the state of the art in science and technology may also be used as an alternative to visual inspection to unambiguously classify the urine of the person to be examined.”
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.

The Ruma Marker System is one such method. The manuals published by Kirschbaum Verlag in connection with the subject of "Urine Control" contain information on the Ruma Marker procedure, namely in the manual "Urteilsbildung in der Fahreignungsbegutachtung Beurteilungskriterien" on page 250 and in the "Handbuch des Fahreignungsrechts" on page 187.
Unfortunately, these remarks are inadequate and inaccurate and therefore need to be revised.

The publishers still deny the applicability of the Ruma Marker system without a valid reason (more on this below), although the Driving Licence Ordinance, which has legal force as mentioned above, now expressly permits such a procedure in addition to visual inspection.

The lack of supervision of urine delivery is criticised, although this is the special feature of the Ruma Marker System, which makes it possible, in contrast to visual inspection and as an alternative to visual inspection intended by the legislator, to proceed comfortably and humanely for all parties involved in urine inspection.

We assume that insufficient knowledge of the Ruma Marker System has led to the assessment to be found in the manuals and comment on this in the following:

The authors of the "Assessment Criteria", 3rd edition, criticize that when using the Ruma Marker system in an abstinence program, all manipulation possibilities beyond the delivery of foreign urine would have to be excluded.

This approach is initially surprising in that, according to the authors, the alternative to the Ruma Marker system, the delivery of urine under visual control, is admitted a few lines earlier on page 250 of the "assessment criteria" as susceptible to manipulation because it says:

“In practice, certain techniques both during and after (in vitro external) and before (in vivo internal) sampling are observed as attempts to falsify samples. A frequently occurring, sometimes difficult to detect an attempt at deception, is the release of foreign urine or other aqueous substances. External additives to urine are also used, such as vinegar, soap, lemon juice, enzymes, reactive chemicals, yellow chromates, water-clear bleaching agents, nitrites, glutaraldehyde and powders for chemical manipulation of urine.”

The further statement

“Such attempts at deception must be ruled out by urination under the visual control of an authorised, suitably trained and reliable person.”

incorrectly suggests that manipulation can be safely prevented under visual control.

The opposite is the case.

Studies already carried out in 2010 and 2011 showed already back then that a dramatic increase in positive findings has taken place using the Ruma Marker system, namely

  • in drug substitution in Munich-Schwabing from 3.6% to 33% for men, from 27% to 40% for women
  • in the prison in Cologne from less than 1% to 15%.
  • in the prison in Geldern from 17% to 24
  • In the psychiatric centre in Rickling with approx. 1500 tests a clear increase of positive findings from 0% to 16% of all patients showed up in comparison with the conventional visual control.

Reference is made to the report on the use of the Ruma Marker System in urine tests for illegal drugs, prepared by Prof. D. Bönsch (Bönsch 2011 in the download area). In summary 3 of the report Bönsch once again states that the proportion of positively tested subjects using the Ruma Marker System has increased in all studies and this allows an indication that there is a high number of unreported cases of deception in the visual checks carried out so far.

In the "Assessment Criteria", after a - but not possible - exclusion of attempts at deception under visual control has been suggested, the following is explained about the Ruma procedure on page 250:

“A method that is being used more and more, in which clients take up polyethylene-based marker substances orally prior to urine delivery, which are then identified in the urine and should thus identify the autosampler (Ruma markers; for further information see www.marker-test.de), in order to ultimately be able to dispense with visual contact when taking a urine sample, is not suitable for the approach of sample collection for analyses as part of driving aptitude diagnostics. If Ruma markers are used, urine delivery remains complete and the urine sample initially unattended; it can therefore be manipulated without any problems. After notification by the manufacturer, such manipulations (addition of interfering substances) are usually noticed (so-called check mix in immunochemical testing) and the sample is then marked as unusable or not evaluated. However, there are no other published scientific empirical values available, which is why it cannot be proven that all possibilities of manipulation have really been tested.”

However, the following applies here:

In order to uncover sample manipulations, further tests are carried out in the laboratory in addition to marker analysis:

  • Dilution control over the creatinine value
  • Sample integrity test for trouble-free analysis including pH value measurement
  • Test for oxidants
  • Glucose and sucrose determination.

Analyses on this scale are not normally carried out within the scope of the conventional visual method.

Dilution with water or foreign urine up to the limit of the marker detection is therefore recognised contrary to the other view.

Although, as explained above, external manipulations can be detected using the Ruma Marker System, the visual control for manipulations is demonstrably more susceptible than the Ruma Marker System and a higher number of positive findings is made in the latter procedure due to the more difficult manipulation, the use of the Ruma Marker System is rejected by the publishers on the grounds, that "it cannot be proven comprehensibly that all possibilities of manipulation would be tested" and thus the visual control taken over is wrongly favoured.

While for the execution of the visual inspection any standards are missing and the possibility of unnoticed and successful manipulations of urine tests under visual inspection is generally known and accepted, the Ruma Marker-System, which is superior to the visual inspection, is required for incomprehensible reasons to be 100% secure in the detection of manipulations.

There is no apparent reason why the Ruma Marker system should be subject to different, stricter standards than the visual inspection, and the "Assessment Criteria" on page 250 also reads:

“...a non-evaluation of a urine sample can hardly be regarded as an abort criterion since the burden of proof would then lie with the laboratory, i.e. the manipulation or proof of an artifact, which could not be achieved with the necessary certainty. This makes it possible for every client who has to fear a positive sample to repeat urine delivery by manipulation. This contradicts the idea of an abstinence test...”

Apart from the fact that the Ruma Marker system, contrary to the authors' doubts, enables to detect the manipulations described in the literature and those that interfere with the detection of drugs, the argument that the burden of proof for an actual conscious manipulation lies with the laboratory is wrong.

In the field of MPA testing, this is a legally untenable view, simply assuming, without any justification, that the laboratory must provide proof of manipulation. Manipulation itself is detected and proven when the Ruma Marker system is used, as shown above.

As far as the question of the laboratory's alleged burden of proof is concerned, reference is first made to the relevant legal explanations in the "Handbuch des Fahreignungsrechts" published by Kirschbaum Verlag, including the subject's duty to cooperate. In the grant procedure, the applicant has to submit an application in accordance with §§ 2 section 6 S. 1 No. 2 and section 2 S. 1 No. 3 StVG, to prove its suitability, so that it is demonstrably due in the case of refusal (compare “Handbuch des Fahreignungsrechts”, p. 215). If the subject has manipulated the urine sample, he cannot prove his suitability.

The doctor taking the sample is therefore not responsible for any manipulation of the urine delivered as part of the Ruma Marker test. He only owes the application of the Ruma Marker system according to the principles of medical art (lex artis).

Under these circumstances, the statement made both in the "Assessment Criteria" on page 250 and in the "Manual of Driving Fitness Law" on page 187 that the examining laboratory must provide evidence of manipulation is false.

The argument that persons can avoid another appointment by repeating a sample by manipulating a urine sample is also irrelevant, as the "Handbuch des Fahreignungsrechts" on page 269 also refers to the time limits for the submission of the evidence in (see §§ 11 (6), 11 (8) FeV).

It is interesting to note that on page 264 of the "Assessment Criteria" in a passage which does not specifically deal with the Ruma Marker System, the release of foreign urine is expressly listed as a termination criterion for an abstinence control procedure but it is not explained how it should be detected.

We would like to point out that the Ruma Marker procedure rejected by the publishers is the only procedure worldwide by which such manipulation can be uncovered.

The discussion about the Ruma Marker system also omits the fact that not the question of the discovery of manipulations should be in the foreground, but rather the procedure itself, which, in contrast to the visual inspection susceptible to manipulation, enables a reliable and humane procedure for all participants, samplers as well as test persons.

Monika Wetzke (CEO Ruma GmbH)

Responsible for content:
Rechtsanwalt Herbert Kern

Hiedemann Rechtsanwälte

Hohenstaufenring 48-54 | 50674 Köln

T +49 (0)221 93 12 09-36 

F +49 (0)221 93 12 09-72

herbert.kern@hiedemann.de

www.hiedemann.de

Analytically verified results instead of simple visual control

The various forms of manipulation in urine control have long been known. Especially the use of foreign or fake urine - be it by means of external aids such as the Whizzinator or even by an application into one's own bladder - is problematic and often extremely sophisticated. The conventional visual inspection quickly reaches its limits here*.

The Ruma Marker System offers a unique, analytically proven solution to this problem. The test persons drink a marker solution which, as a "chemical fingerprint", clearly allocates the urine sample to the urine donor. Uncomplicated to use, harmless for the patient and forensically accredited in the analysis.

Certified samplers instead of "just taking a look".

A urine sample is only legally usable if every step from the identification of the test person to the transmission of the results is transparent and comprehensible. Against this background, the legislator requires not only the laboratories but also the samplers to have a clearly defined, documented quality assurance system and corresponding training and qualification certificates. For this reason, the users of the Ruma Marker System are certified according to a uniform and transparent quality standard in the area of MPA/abstinence control. They do not have to "reinvent the wheel". In line with our overarching quality standards, we guarantee legal compliance in all matters relating to urine control.

You want to use the Ruma quality standard for yourself and your patients? Enlist here for further training courses.

The Ruma Marker System is available for MPA/abstinence control in almost all federal states. For further information please contact us at MPU@marker-test.de

* see also G. Skopp, L. Pötsch, J. Becker, J. Röhrich, R. Mattern: On the preanalytical phase of chemical-toxicological investigations, forensic medicine (1998) 8:163 - 167; Springer-Verlag