FMCSA wants national registry of medical examiners for CDL checkups

The Federal Motor Carrier Safety Administration (FMCSA) is preparing new initiatives for its medical program, including regulations to provide for a federal medical qualification certificate to be made part of the commercial driver license (CDL).

Rose McMurray, FMCSA assistant administrator, discussed the initiatives July 24 before the House Committee on Transportation and Infrastructure, according to FMCSA information. “These initiatives include engaging the diverse medical community that examines drivers for medical fitness for duty, and in carrying out the planning, development, and research necessary to promulgate and enforce these proposed rules and programs,” she said.

Two new initiatives form the cornerstone of FMCSA's medical program redevelopment: the proposed merger of the medical certification and CDL processes and creation of a National Registry. Currently, these two initiatives are under departmental development and review, she said.

She pointed out that drivers must undergo medical examinations at least every two years, and that FMCSA maintains an enforcement program that, in conjunction with state and local partners, conducts compliance reviews and roadside inspections.

In 2007, roadside inspection resulted in more than 145,000 citations issued to drivers who did not possess medical certificates and more than 42,000 citations to drivers with expired medical certificates. Among the 16,000 FMCSA-conducted compliance reviews, 43 acute violations were identified where carriers used physically unqualified drivers and 181 critical violations identified where carriers did not have medical certificates on file, she said.

Among FMCSA's proposals is a requirement that CDL holders provide a copy of their medical certificate to the state driver licensing agency in order to be granted a CDL or to maintain their existing interstate driving privileges.

States would then add the medical certification information to the driver's record. If a driver failed to renew his medical certificate, or if a driver failed the physical examination, the CDL would be downgraded automatically to prohibit operation in interstate commerce.

States would be required to make the medical certification status available electronically to motor carrier safety enforcement personnel, motor carriers, and drivers. FMCSA and the states would be able to monitor whether a driver is medically certified, meaning that interstate CDL drivers would no longer be required to carry the medical certificate (also known as a medical card). Compliance with the medical requirements would be verifiable at the roadside by enforcement officers querying the driver license system.

FMCSA also has a process underway to establish a national registry of certified medical examiners. Current regulations allow driver medical examinations to be conducted by medical doctors, doctors of osteopathy, physician assistants, advanced nurse practitioners, chiropractors, and any other medical professional licensed or certified by individual state laws to perform occupation-specific physical examinations in accordance with the agency's protocols.

In addition, FMCSA would incorporate the initiatives within other agency plans, including the CDL Information System modernization and the Comprehensive Safety Analysis 2010 programs.

In 2005, FMCSA established the Department of Transportation's first Medical Review Board (MRB) to provide advice to the agency about the medical adequacy of existing standards. To date, the board has held eight public meetings. The physicians have made more than 40 science-based recommendations that FMCSA is considering in regard to changes to the medical regulations.

In examining its regulated driver population, FMCSA applies the evidence to analyze how disease and injury or symptoms from medical conditions, such as drowsiness or dizziness, are more likely to result in a large truck or bus crash. Once a study is completed, FMCSA holds a proceeding with physicians and scientific experts to conduct a peer review of this evidence. The evidence report and expert panel recommendations are then reviewed by the medical board.

“Crashes are usually the result of multiple events leading up to an incident,” McMurray said. “Braking, speed, and aggressive driving can be established, but the effect of a person's physical condition is extremely hard to establish as a direct causal factor for a crash, with the exception of several obvious causes, such as a cardiac event that can be verified by an autopsy.”

To date, FMCSA has completed 12 evidence reports on a wide range of topics, from medications and diabetes mellitus to vision and cardiovascular disease.

FMCSA is considering proposed changes to the driver physical qualification requirements to ensure that evidence-based standards are used to determine medical fitness for duty, she said.

McMurray's testimony is online at fmcsa.dot.gov. See the news section.

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