Revision recommended for commercial drivers’ medical exam process
Revision recommended for commercial drivers’ medical exam process
The American College of Occupational and Environmental Medicine (ACOEM) is recommending to the National Transportation Safety Board (NTSB) that revisions be made to the current medical examination process to ensure that commercial drivers are medically fit to operate trucks and buses.
Robert McCunney, president of the Arlington Heights, IL-based ACOEM, says the current system is inadequate for ensuring the physical health of commercial drivers, partly because it allows too much flexibility in choosing a physician to test the driver. Safety would be better assured by requiring that only qualified physicians, including occupational health physicians, conduct the assessments, he says.
System is failing
"With more than 5,000 individuals killed in accidents involving large trucks in the past year, it is obvious that the current commercial driver’s license system is failing," McCunney says. "The unnecessary loss of life last year in the New Orleans bus crash, as a result of a driver who was not medically fit to drive, is a tragedy that could have been avoided had the system been stronger."
In a letter sent to Jim Hall, chairman of the NTSB, McCunney noted that "Current regulations permit the required medical examination to be performed by any licensed health care provider authorized through state licensure to perform medical examinations. While the quality of most of these examinations is excellent, there are many examiners who are unaware of either the regulations or of the regulatory criteria that explain them."
McCunney points to a recent Federal Highway Administration study showing that examiners often do not understand what is required to satisfy the federal motor carrier safety regulations concerning fitness to drive.
Evidence of this was found in missing and inconsistent information on the examination forms and inaccurate interpretations of the medical standards. These deficiencies in the examination process could result in commercial drivers on the road who do not meet the federal regulations.
"Physicians and other health care providers, through their professional training, know how to conduct physical examinations in general," he says. "Occupational physicians who have the clinical and administrative knowledge and skills to perform Department of Transportation exams are specifically trained to assess safe worker capacities and make determinations of proper work placements."
National program would be better
McCunney says the current system does not ensure that examiners are keeping up with new information. A national program that trains and certifies medical examiners would provide overall uniformity in the conduct of the examination, interpretation of the regulations, and reporting procedures. Such a program also would raise the level of performance of the examination process, he says.
In addition, current regulations do not require medical examiners to report the results of examinations to state licensing agencies. Since medical examiners are not required to report to the state any results of examinations, which might preclude a driver from obtaining a license, he says there exists an incentive for drivers to "doctor shop."
For example, a driver who fails an examination provided by one physician may be able to find another physician or health care provider who would report (or omit) examination results in a manner that could be interpreted as a recommendation to issue a license, he adds. By requiring medical examiners to report to the state all adverse examination results, drivers who have an impairment would not be able to "game the system."
McCunney says the ACOEM position is prompted, in part, by recent accidents suggesting that too many commercial drivers get behind the wheel with physical impairments that could make them dangerous to passengers and other drivers. In the May 1999 crash of a Custom Bus Charters tour bus in New Orleans, which killed 22 passengers, the NTSB reports that the driver’s medical condition may have caused the accident.
Man treated for kidney failure was drug user
At the time of the accident, the driver was under treatment for kidney failure and congestive heart failure, the NTSB reports. He was undergoing hemodialysis three times a week. The board also reports that marijuana was detected in the following levels:
r tetrahydrocannabinol (THC), 0.008 µg/ml in the blood;
r THC carboxylic acid, 0.048 µg/ml in the blood;
r THC carboxylic acid, 0.193 µg/ml in urine.
In addition, 0.017 µg/ml of diphenhydramine (an over-the-counter antihistamine) was detected in the blood. He had received the medication during his dialysis treatment the day before the accident. In addition, diphenhydramine and phenylpropanolamine (an over-the-counter decongestant) were detected in his urine.
Another accident occurred in Burnt Cabins, PA, about 4 a.m. in June 1998 on the Pennsylvania Turnpike. A Greyhound bus drifted off the right side of the roadway into an emergency parking area and struck the back of a parked tractor-trailer. Twenty-three people were on board the bus; the driver and six passengers were killed, and the other 16 passengers were injured.
The safety board found that the bus driver’s alertness had been reduced because he had taken an over-the-counter sedating antihistamine and the bus company’s scheduling practices had caused him to be fatigued.
The board also found that the severity of the accident was increased because the Pennsylvania Turnpike Commission routinely permitted non-emergency parking in pull-off areas within the highway clear zone.
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