NTSB seeks revamping of medical certification

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The National Transportation Safety Board, finding the medical certification program for truck and bus drivers plagued with loopholes, has urged a thoroughgoing redesign of the system to assure drivers are medically fit before they are hired and get behind the wheel.

In response, the Federal Motor Carrier Safety Administration has promised to consider the recommendation and has pledged to propose new rules later this year to tighten up the system. But it immediately balked at one key NTSB idea: a national registry of medical practitioners qualified to issue medical certificates for truck and bus drivers.

In an investigation of a bus crash in 1999, NTSB found fault with the way virtually all drivers are examined by medical personnel, how their records fail to get to new employers and how drivers can get away with long term drug and alcohol abuse.

New Orleans crash
The recommendations stem from an NTSB investigation of a bus crash in New Orleans on May 9, 1999 that killed 21 passengers and seriously injured the driver and 15 other passengers.
The driver, in a Custom Bus Charters, Inc., bus with 43 passengers going from near New Orleans to a casino 80 miles away in Bay St. Louis, Miss., suddenly slouched, righted himself, and slouched again before zigzagging across I-610 and back and careening off the roadway down a slope and slamming into a dirt embankment.

During the day before, he had spent hours in hospital undergoing kidney dialysis, left early against doctors’ advice, was later transported back to the hospital’s emergency room severely dehydrated, staying there until the early morning hours, and began his driving shift at 5 a.m., according to NTSB investigators. The accident happened at 9 a.m. The driver also had marijuana in his system.

Aside from kidney problems, the 46-year-old driver with nearly 20 years’ experience, also suffered from coronary heart disease and high blood pressure and was overweight. He had a history of drug abuse and was fired from two previous driver jobs for using drugs.

Major loopholes
“The federal regulations for medical certification and for drug testing we found are riddled with loopholes,” Joseph Osterman, directory of NTSB’s Office of Highway Safety, told CCJ.

“Medical certifications are not particularly involved,” Osterman says. “They look very much like a Boy Scout summer camp physical. And drivers are not required to go to their doctor or any doctor who has any particular knowledge of their physical well-being. They can see a doctor right off the street.” Osterman cites other flaws, such as the lack of certification or training for the doctor or medical practitioner and the lack of a requirement that the driver supply medical records.

Osterman also noted that results of pre-employment and random drug tests are not recorded anywhere, leaving a new employer unable to get information on their new hires. And previous employers are reluctant to share information on their drivers for fear of liability.

Recommended changes
NTSB recommended to FMCSA that it develop a medical oversight program that requires:

  • Those performing driver medical examinations to be qualified and educated about driver occupational issues.
  • All positive drug and alcohol test results and refusals under Department of Transportation test requirement be recorded. All carriers would have to query the system before hiring a driver, and all certification personnel would have to query it before issuing a medical certificate.
  • A system to record and track every prior driver application for medical certification.
  • Medical certification regulations to be updated periodically.
  • Examiners to get specific guidance and have an easy source of information for help on their tests.
  • Enforcement authorities to have a way to identify invalid certificates during safety inspections and routine stops, and to be able to stop uncertified drivers from driving until they are certified.
  • Mechanisms for reporting medical conditions to the medical certification and reviewing authorities, with information about this system being available to individuals, medical personnel and employers.

The board also recommended that the National Conference of State Legislators, a central clearinghouse of information about state laws, urge states to pass laws granting immunity to carriers for “good-faith reporting of potentially impaired commercial drivers by all individuals.”

Registry of examiners?
In its report on the accident, the board noted that the Federal Aviation Administration has a registry of qualified medical examiners for pilots and urged consideration of a similar registry for drivers. But FMCSA spokesman David Longo says such a comparison is “unfair,” in view of the large number of motor carriers, drivers and trucks.

“It would not be practical to have a registry of doctors or health practitioners because the list would have to be too big,” Longo says.

Nevertheless, “we are still working on the [medical certification] issue, and we hope to have a Notice of Proposed Rulemaking out later this year to tighten that up.”