Based on its investigations of accidents involving drivers with serious medical conditions, the NTSB 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.
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 Regulations (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 vision and hearing, prescription medications, renal disease, and psychiatric disorders, among others. The FMCSA is currently considering more than 60 recommendations from the MRB to determine whether the agency will initiate rulemakings to revise any of its medical standards.
In addition to its work through the MRB, the FMCSA continues to develop a National Registry of Certified Medical Examiners (NRCME), an action also required by the SAFETEA-LU legislation. The FMCSA published a notice of proposed rulemaking (NPRM) on the NRCME in November 2008. The NPRM proposes to amend the FMCSR to establish and maintain an NRCME and to require that all medical examiners who conduct medical examinations of interstate commercial motor vehicle drivers complete certain training on physical qualification standards, pass a test to verify an understanding of those standards, and maintain competence by periodic training and testing. In its comments on the NPRM, the NTSB noted a number of continuing deficiencies in the FMCSA's approach, including the continuing potential for insufficiently qualified examiners, the lack of a process to review or track medical certification examinations or decisions, a lack of reporting mechanisms between required exams, and a lack of coordination between data collection processes in this NPRM and in the final rule (further discussed below) merging the medical certificate with the CDL. Assuming that these issues can be appropriately addressed as this rule moves forward, the rule will likely help to ensure that the individuals performing examinations are qualified to do so.
On December 1, 2008, the FMCSA issued a final rule amending the FMCSRs to require interstate commercial driver's license (CDL) holders subject to the physical qualification requirements of the FMCSRs to provide a current original or copy of their medical examiner's certificates to their state driver licensing agency. The rule addresses the ability of enforcement authorities to identify invalid medical certification and to prevent uncertified drivers from driving until an appropriate medical examination takes place. Although many of the NTSB's comments on deficiencies identified in the NPRM preceding this rule were not addressed, including the lack of a process to establish the validity of a medical certificate, the lack of a process for a state to downgrade a medical certification between required exams, and the lack of a requirement or even permission for a state to maintain the complete examination forms, the NTSB believes that the rule is an important achievement because, at the roadside, law enforcement officials will be able to determine whether a driver possesses a current medical certificate and will be able to take appropriate action if the driver does not.
A decade after the New Orleans, Louisiana, accident that precipitated the issuance of these recommendations, the pace of progress to establish an overall system of driver medical certification remains slow. Nevertheless, the MRB continues to meet regularly to discuss certification standards surrounding various important medical conditions and to make recommendations to the FMCSA about medical standards, and rulemaking is underway to establish the NRCME. The merging of the CDL and the medical certificate should help to improve driver oversight by the enforcement community. Although the initiatives completed at this time will not create the comprehensive medical oversight program for interstate commercial drivers that was envisioned in the NTSB's recommendations nearly 9 years ago, the FMCSA has made some progress toward improving safety.
Of note, the FMCSA has filled its newly created Medical Officer position to provide a high level of medical expertise in transportation issues as the agency moves forward in its efforts to address these recommendations. Although the NTSB did not recommend that such a position be created, the hiring of a qualified individual to lead the FMCSA medical program places the FMCSA in a better position to address the development of the comprehensive medical oversight program recommended by the NTSB.
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.
H-01-17 (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: 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, New Orleans, Louisiana, 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, New Orleans, Louisiana, 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, New Orleans, Louisiana, May 9, 1999. [NTSB/HAR-01/01])
H-01-20 (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: 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, New Orleans, Louisiana, 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, New Orleans, Louisiana, 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, New Orleans, Louisiana, May 9, 1999.[NTSB/HAR-01/01])
