Everything You’ve Ever Wanted to Know about
FMCSA Driver Physical Qualifications
ROHC
October 18, 2014
Elaine M. Papp RN MSN
FAAOHN COHN-S CM
Elaine Papp, RN, MSN, COHN-S, FAAOHN
Chief, Medical Programs Division
Agenda





Overview of FMCSA Medical Programs and Medical
Certification Requirements
National Registry of Certified Medical Examiners
Medical Exemptions
Case study discussions
Online tools
2
FMCSA Mission
The Federal Motor
Carrier Safety
Administration is
focused on reducing
crashes, injuries, and
fatalities involving large
trucks and buses.
3
Interstate or Intrastate

Defined by transportation of goods:

Interstate commerce, transports people or goods across a state
line


Example -- Federal Express driver
Intrastate commerce, transports people or goods within the state

Example -- A gravel truck driver -- gravel from a quarry within a state to
businesses in the same state
4
Truck and Bus Driver Statistics

3.5 million active
interstate drivers


3 million CDL holders
Approx. 539,033
active interstate motor
carriers
5
U.S. Department of Transportation (DOT)
Interstate Traffic Crash Statistics 2012
Persons
Fatalities
Injuries
Large
Truck
Crashes
Bus
Crashes
3,464
250
73,000
12,000
Large
Truck
and Bus
Crashes
3,702
All
Vehicle
Crashes
30,800
85,000 1,634,000
6
Medical Program Activities


Rulemaking/Guidance Development
Research





Medical Review Board
Medical Expert Panels
Evidence Reports
Compliance Assistance
Medical Exemptions/Variances



Vision, Diabetes, Hearing, Seizure
Skill Performance Evaluation (SPE)
Agency has requested public comment on exemption
applications for seizure conditions and hearing loss
7
Purpose of the Medical Certification
Examination

Determine a driver's physical
qualification to operate a commercial
motor vehicle (CMV)



Interstate commerce
49 CFR 391.41-49
Med Cert/CDL Rule

Driver must provide MEC to SDLA
to
obtain or maintain commercial
driver’s license
8
Medical Examiner Responsibilities

Knowledgeable about:




Physical and mental demands of CMV driver job duties
FMCSA regulations, including guidance
Use of medical protocols
Make medical determinations based on FMCSA
regulations and advisory criteria
9
National Registry of Certified Medical
Examiners (National Registry)
10
National Registry Background


New regulation - Published April 20, 2012
Requires medical examiners:






Complete training
Pass a test
Periodic training and testing
Maintain licensure
Report completed CMV driver examinations monthly
Compliance Date – May 21, 2014


All CMV drivers must use a ME on the National Registry
Medical certificates issued prior to May 21, 2014 are valid until
the expiration date
11
National Registry Statistics
As of October 14, 2014
 59,553 ME - registered but haven’t taken test




34,953 ME – passed test, not yet certified
34,237 ME – certified on registry
Fail rate – 8.39%
Enforcement actions


5 active OIG inspections of fraudulent Mes
33 sent letters of cease and desist
12
Transition to National Registry

ME certification – reasons for pending certification



Technical difficulties




Not entering National Registry training
Not updating medical license information
Password reset
Difficulty with using MCSA-5850
Correcting errors on driver exam results
ME guidance



Compares to FAA
Want specific guidance
Don’t understand regulations/guidance/MRB recommendations
13
Lessons Learned

Training


Communication



Inconsistent – varies by provider
Difficulties with email
Volume of calls
Fraud



National Registry is accomplishing the objective
Finding fraudulent MEs and drivers
Need to increase enforcement staff
14
Regulations and Advisory Criteria

Regulations


Mandatory
Advisory Criteria

Assist the Medical Examiner in making individual
determination of physical fitness for driving
15
Medical Exemption Programs





Federal Diabetes Exemption Program
Federal Vision Exemption Program
Hearing Exemptions
Seizure Exemptions
Skill Performance Evaluation Certificate Program
16
Federal Diabetes Exemption Program


Exemptions for drivers who have insulin-dependent
diabetes mellitus
Drivers submit application



Medical information showing their diabetes is under control
To maintain exemption, drivers submit quarterly
monitoring reports
Diabetes exemption application can be found at:
https://www.fmcsa.dot.gov/rules-regulations/topics/medical/exemptions.htm or
call (703) 448-3094
17
Sample MEC with Diabetes Exemption
18
Federal Vision Exemption Program



One eye does not meet the minimum vision requirements
Better eye must meet the minimum vision standard
Drivers submit application




Medical information showing driver is able to meet all other
physical requirements
Experience driving with vision deficiency
Crash/violation history
Vision exemption application can be found at
https://www.fmcsa.dot.gov/rules-regulations/topics/medical/exemptions.htm
or call (703) 448-3094
19
Sample MEC with Vision Exemption
20
Federal Hearing Exemption Program


Driver must perceive forced whisper in better ear at not
less than 5 feet with or without hearing aid or no
hearing loss in better in greater than 40 decibels at 500,
1,000 and 2,000 Hz with or without hearing aid
Driver may apply for an exemption by contacting the
Medical Programs Division at FMCSA (202) 366-4001
21
Sample MEC with Hearing Exemption
22
Federal Seizure Exemption Program



Disqualified from operating in interstate commerce
49 CFR 391.41(b)(8)
May be considered for exemption based on number of
years:



Since last seizure, stable on anti-seizure medication, medical
history
Exemption determinations are based on a case-by-case
review
Driver may apply for an exemption by contacting the
Medical Programs Division at FMCSA (202) 366-4001
23
Sample MEC with Seizure Exemption
24
Skill Performance Evaluation (SPE)



Driver with loss or fixed limb impairment
Evaluation of driving skills
Driver completes application process including


Assessment and evaluation by an Orthopedic Surgeon or
Physiatrist
Medical examination certification that designates he is
otherwise qualified except for completion of the SPE
25
Sample MEC with SPE
26
OSA

Congressional action

Public Law 113-45
■

■
Signed into law October 2013
Requires Agency to develop regulation on OSA before issuing
new guidance
What does the Agency say about OSA?
OSA


Included in respiratory dysfunction regulation 49 CFR
391.41(b)(5)
Advisory criteria


Respiratory dysfunction
MRB/MCSAC Recommendations to Agency

Two-pronged approach



Interim - guidance
Long-term - rulemaking
Agency has not taken action on MRB/MCSC
recommendations
OSA
■ Focus for ME

Use medical protocols/standards of clinical care to determine
physical qualification
■


Consider the actual risk of sudden or gradual incapacitation
Undiagnosed OSA with risk factors
■

Like all other medical conditions
Consider issuing short-term medical card for testing and treatment
Driver diagnosed and successfully treated
■
Demonstrated compliance with treatment
 Letter from treating clinician
 CPAP recorder printout
 Dental device tracking printout or other
Interstate or Intrastate regulatory guidancewhich one applies?
Does the driver cross state lines?
Is the salary paid by a municipality?
Does the cargo cross state lines?
Does the employer require out of state
driving assignments?
Case 1



55 year old package driver of large truck subject to
DOT medical standards
Present history of Type II insulin treated diabetes and
other co-morbid conditions
Essential Job Function: “Meet DOT requirements,
safely drive a CMV, bend, stoop, squat, crouch,
crawl”
Case 1
Is this driver able to continue to drive a CMV? No
unless accompanied by an FMCSA issued exemption.
The driver operates in interstate commerce
Driver has insulin treated diabetes
Driver may apply for an exemption through
the Federal Diabetes Exemption program
Driver still must meet all other Physical
Qualification Standards
Case 2


42 year old semi-truck driver seeking to drive in
interstate commerce
Diagnosed with OSA and treated



Using CPAP with recording device
Seeing Pulmonologist regularly
Has letter from treating clinician stating compliant with
treatment
Case 2
Is this driver able to continue to drive a CMV? Yes. No
need for further sleep study.
The driver operates in interstate commerce
Diagnosed with OSA and compliant with
treatment
Treating clinician attests to driver’s
compliance
Driver must meet all other Physical
Qualification Standards
Case 3


56 year old male package driver
History




Epilepsy
Depressed mood
Agitation
Anxiety
Case 3
Is this driver able to continue to drive a CMV? No unless
accompanied by an FMCSA issued exemption.
The driver operates in interstate commerce
Driver does not meet the Epilepsy
standard and has co-morbidities
Driver may apply for a Epilepsy
exemption
Driver may need further clearance by
a specialist
Online Tools

You may access the following on the the FMCSA
website:




Evidence Reports
Medical Expert Panel Reports
Medical Review Board (MRB) Recommendations
Medical Examiner’s Handbook (pdf version)
37
Contact Information
Federal Motor Carrier Safety
Administration, Medical Programs Division
U.S. Department of Transportation
Washington, D.C.
E-mail: [email protected]
Phone: (202) 366-4001
Fax: (202) 366-8842
Medical Programs
www.fmcsa.dot.gov/rulesregulations/topics/medical/medical.htm
National Registry Website
www.nationalregistry.fmcsa.dot.gov
38