Most Wanted

Transportation Safety

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Highway

Prevent Medically Unqualified Drivers from Operating Commercial Vehicles

Objectives

Establish a comprehensive medical oversight program for interstate commercial drivers.
Ensure that examiners are qualified and know what to look for.
Track all medical certificate applications.
Enhance oversight and enforcement of invalid certificates.
Provide mechanisms for reporting medical conditions.

Importance

Based on its investigations of accidents involving drivers with serious medical conditions, the Safety Board has determined that serious flaws exist in the medical certification process for commercial vehicle drivers. Flaws in the certification process can lead to increased highway fatalities and injuries for commercial vehicle drivers, their passengers, and the motoring public.

Many commercial vehicle drivers whose serious medical conditions are known to their employers, health care providers, and others are never reported to the appropriate motor vehicle licensing authorities, thereby potentially endangering both the drivers and others.

Enforcement authorities cannot, in most instances, determine the validity of a medical certificate during safety inspections and routine stops because of the absence of procedures or information sources to validate the medical certificate. The inability to authenticate the information on a medical certificate hampers enforcement authorities in their ability to identify unfit drivers and place them out of service.

In the absence of a mechanism to track all medical certification examinations, a commercial driver with a serious medical condition who is denied a medical certificate by one examiner may be able to obtain a medical certificate from another examiner, thus subverting the purpose of the medical certification process.

Summary of Action
On October 3, 2005, the Federal Motor Carrier Safety Administration (FMCSA) announced the establishment of a Medical Review Board (MRB) as required by the Safe, Accountable, Flexible, and Efficient Transportation Equity Act; A Legacy for Users (SAFETEA-LU). The five members of the MRB held their first public meeting on August 31, 2006, to begin reviewing all current Federal Motor Carrier Safety Regulation (FMCSR) medical standards, in accordance with the Federal Advisory Committee Act. The MRB holds quarterly public meetings; the members also work with research panels to examine medical issues affecting commercial motor vehicle (CMV) drivers for the development of new science-based standards and guidelines to ensure the physical qualification requirements for CMV operators. Current topics being reviewed by the MRB include cardiovascular, diabetes, sleep disorders, and kidney disease, among others.

In addition to the MRB, the FMCSA is developing a National Registry of Certified Medical Examiners (NRCME), an action also required by the SAFETEA-LU legislation. FMCSA staff indicated at an October 12, 2007, briefing that the FMCSA has completed a Role Delineation Study (RDS), the results of which should provide a blueprint for the medical examiner certification test and be used by subject matter experts to assist in the development of core curriculum specifications for medical examiner training. To complete the RDS, a variety of methods were used, including a literature review, direct observations of CMV driver physical examinations and medical examiner expert meetings, to draft a tentative list of all tasks required when performing a CMV driver physical examination. To validate the task list, the FMCSA performed a national survey of 5,000 medical examiners currently certified to perform medical examinations (doctors of medicine, doctors of osteopathy, physician assistants, advanced practice nurses, and doctors of chiropractic). The survey gathered data on the role of medical examiners and provided medical examiners who perform FMCSA physical examinations of CMV drivers a means of participating in an assessment of the knowledge, skills, and abilities necessary to effectively determine whether a CMV driver’s health meets Federal physical qualification standards. The medical experts are also tasked with the development of a blueprint for the medical examiner certification test and core curriculum specifications for medical examiner training. The FMCSA has completed an online medical examiner’s handbook that it expects to make available on the NRCME Web site by the end of 2007 and it anticipates publishing an NPRM on the NRCME in February 2008.

Although the FMCSA has made progress towards the development of a comprehensive oversight system, several areas still need attention. The Safety Board has urged the FMCSA to address the issues of failed and denied medical forms and a tracking system to document driver status for verification by subsequent examiners. SAFETEA-LU Section 4116 contains provisions on medical certification requiring the FMCSA to periodically review a sampling of applications.

On November 16, 2006, the FMCSA issued an NPRM to merge information from the medical certificate of commercial drivers into the commercial driver’s license (CDL) process. If adopted, the proposed rule will, to a certain extent, address the ability of enforcement authorities to identify invalid medical certification and to prevent uncertified drivers from driving until an appropriate medical examination takes place. The Safety Board continues to believe that this is an important milestone to achieve, because when the medical certificate and the CDL are linked, law enforcement officials should be able to access a driver’s medical status at the roadside and take appropriate action. The Board has commented on a number of deficiencies in the NPRM; the FMCSA indicates that they anticipate publishing a final rule on this issue in April 2008.

On February 28, 2007, the Secretary of Transportation established the CDL Advisory Committee to study and address current impediments and foreseeable challenges to the CDL program’s effectiveness and measures needed to realize the full safety potential of the CDL program. Members of the advisory committee include State motor vehicle administrators, organizations representing government agencies or officials, members of the Judicial Conference, representatives of the trucking industry, representatives of labor organizations, safety advocates, and other significant stakeholders. The committee members discussed the issue of medical oversight of commercial drivers at length in their meetings and included, in the Committee’s report to Congress, a recommendation that the FMCSA implement the Safety Board’s eight safety recommendations on medical oversight.

The FMCSA appears to be working consistently, although slowly, to complete some of the tasks specifically assigned to it by Congress; the MRB continues to meet regularly and discuss certification standards surrounding various important medical conditions, an NPRM regarding the inclusion of medical certification information as part of the commercial driver’s license has been published, and some progress has been made on establishing a national registry of certified medical examiners. However, many issues remain unaddressed, and the overall system of driver medical certification is no more effective this year than last.

Action Remaining
Continue efforts to develop medical certification procedures that ensure unfit drivers are not allowed behind the wheel of a commercial vehicle. Once complete, these efforts will prevent unfit commercial drivers from endangering themselves and the motoring public.

Safety Recommendations

H-01-17 (FMCSA)
Issued September 10, 2001
Added to the Most Wanted List: 2003
Status: Open—Unacceptable Response
Develop a comprehensive medical oversight program for interstate commercial drivers that contains the following program elements: individuals performing medical examinations for drivers are qualified to do so and are educated about occupational issues for drivers. (Source: Investigation of the motorcoach run-off-the-road accident at New Orleans, Louisiana, on May 9, 1999 [NTSB/HAR-01/01])

H-01-18 (FMCSA)
Issued September 10, 2001
Added to the Most Wanted List: 2003
Status: Open—Unacceptable Response
Develop a comprehensive medical oversight program for interstate commercial drivers that contains the following program elements: a tracking mechanism is established that ensures that every prior application by an individual for medical certification is recorded and reviewed. (Source: Investigation of the motorcoach run-off-the-road accident at New Orleans, Louisiana, on May 9, 1999 [NTSB/HAR-01/01])

H-01-19 (FMCSA)
Issued September 10, 2001
Added to the Most Wanted List: 2003
Status: Open—Acceptable Response
Develop a comprehensive medical oversight program for interstate commercial drivers that contains the following program elements: medical certification regulations are updated periodically to permit trained examiners to clearly determine whether drivers with common medical conditions should be issued a medical certificate. (Source: Investigation of the motorcoach run-off-the-road accident at New Orleans, Louisiana, on May 9, 1999 [NTSB/HAR-01/01])

H-01-20 (FMCSA)
Issued September 10, 2001
Added to the Most Wanted List: 2003
Status: Open—Unacceptable Response
Develop a comprehensive medical oversight program for interstate commercial drivers that contains the following program elements: individuals performing examinations have specific guidance and a readily identifiable source of information for questions on such examinations. (Source: Investigation of the motorcoach run-off-the-road accident at New Orleans, Louisiana, on May 9, 1999 [NTSB/HAR-01/01])

H-01-21 (FMCSA)
Issued September 10, 2001
Added to the Most Wanted List: 2003
Status: Open—Unacceptable Response
Develop a comprehensive medical oversight program for interstate commercial drivers that contains the following program elements: the review process prevents, or identifies and corrects, the inappropriate issuance of medical certification. (Source: Investigation of the motorcoach run-off-the-road accident at New Orleans, Louisiana, on May 9, 1999 [NTSB/HAR-01/01])

H-01-22 (FMCSA)
Issued September 10, 2001
Added to the Most Wanted List: 2003
Status: Open— Acceptable Response
Develop a comprehensive medical oversight program for interstate commercial drivers that contains the following program elements: enforcement authorities can identify invalid medical certification during safety inspections and routine stops. (Source: Investigation of the motorcoach run-off-the-road accident at New Orleans, Louisiana, on May 9, 1999 [NTSB/HAR-01/01])

H-01-23 (FMCSA)
Issued September 10, 2001
Added to the Most Wanted List: 2003
Status: Open—Acceptable Response
Develop a comprehensive medical oversight program for interstate commercial drivers that contains the following program elements: enforcement authorities can prevent an uncertified driver from driving until an appropriate medical examination takes place. (Source: Investigation of the motorcoach run-off-the-road accident at New Orleans, Louisiana, on May 9, 1999 [NTSB/HAR-01/01])

H-01-24 (FMCSA)
Issued September 10, 2001
Added to the Most Wanted List: 2003
Status: Open—Unacceptable Response
Develop a comprehensive medical oversight program for interstate commercial drivers that contains the following program elements: mechanisms for reporting medical conditions to the medical certification and reviewing authority and for evaluating these conditions between medical certification exams are in place; individuals, health care providers, and employers are aware of these mechanisms. (Source: Investigation of the motorcoach run-off-the-road accident at New Orleans, Louisiana, on May 9, 1999 [NTSB/HAR-01/01])

November 2007

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