Cover story: Medically Certified
Currently there is no centralized listing of who is performing DOT physicals, estimated by the FMCSA at more than 400,000 medical practitioners who could perform the examinations. Clinton Smith, a chiropractor who has performed DOT exams since 1994, says anyone can conduct a physical as long as they have a state license and follow the DOT exam form.
The proposal would require that medical professionals undergo training and pass a test before they could be listed in the registry, similar to what’s required for Federal Aviation Administration examiners. Potential medical examiners would include doctors of medicine and osteopathy, chiropractors, advanced practice nurses and physician assistants.
After several delays, the FMCSA will flip the registry switch on Dec. 9, and give it about a year to get organized. Within two years of the start, any carrier with 50 or more drivers will have to use an NRCME examiner. Within three years, all carriers and owner-operators will have to use an NRCME examiner for a physical.
The FMCSA wants medical examiners to be familiar with DOT medical standards and the physical demands of being a commercial truck or bus driver. That’s the expectation now, but there’s no way to determine if the examiner understands the trucker’s job. “That’s been the Achilles heel of the DOT medical exam process up until now,” says Michael Megehee, a chiropractor who’s worked with teams on DOT exam requirements and a medical examiner training course.
For example, Dr. Brent Tidwell, a chiropractor who conducts DOT physicals at his practice in Tuscaloosa, Ala., says he gave a trucker taking medicine for high blood pressure a one-year card. His previous doctor had given him a two-year card. “It plainly states in the regs that if they’re on blood pressure medicine, it’s a yearly checkup,” he says. “He’ll go back to that doctor and I’ll never see him again.”
In 2005 the FMCSA found in California that of 66,000 medical exam reports, 10 percent of commercial drivers were issued certificates as being physically qualified even though the report said the driver shouldn’t have been qualified or should have received a shorter-term medical certificate. In the same year in Indiana, 28 percent of CDL medical exams contained mistakes.
The National Transportation Safety Board doesn’t believe the registry process goes far enough. For one, the NTSB contends the proposal doesn’t completely address medical examiner qualifications. “An example is chiropractors, who don’t have the authority in any state to prescribe medications,” says Dr. Mitch Garber, NTSB chief medical officer. “They nonetheless would be put in the position where they’re having to evaluate the effect of prescribed medications on vehicle drivers.”
Megehee says the planned training will focus on how to evaluate the exam’s results and whether that driver is safe to operate a commercial vehicle. “Over 40 percent of [commercial] drivers have to have a yearly exam because of some kind of medical condition,” he says. “In the past many drivers who had a two-year certificate should have had only one year — or maybe not driving at all.”
Megehee, who heads Team CME, a company that performs DOT exams and alcohol and drug testing, says the registry proposal may help some drivers who would have been taken off the road in the past because of their medical condition.
Dr. Garber isn’t so sure the proposed system will properly identify and treat truckers with serious medical conditions. He says the proposal falls short of being the comprehensive medical oversight program NTSB recommends. “Drivers ought to be medically fit,” he says. “The current system does not assure that. Even with these changes, because there are still fairly significant gaps in the process itself, that outcome is not assured.”
No More Medical Cards in 2012
By Todd Dills
By Jan. 31, 2012, drivers will be required to “submit their medical cards to the state licensing agency,” says FMCSA’s Larry Minor, to comply with the Medical CDL rule, which will turn the current medical-card program into an electronic system tied directly to drivers’ CDLs.