FMCSA Medical Board to Discuss Driver Seizure Policy
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A Federal Motor Carrier Safety Administration medical advisory board is planning to discuss possible changes to the agency’s strict requirement for truck drivers with a history of seizures to be granted special exemptions before getting behind the wheel.
An FMCSA spokesman confirmed April 15 that the agency’s medical review board, which has not met since last summer, will convene April 27-28 in a virtual session.
The board also is scheduled to discuss progress on the agency’s revision of its 350-page certified medical examiners handbook, which has been in the rewriting stage for the past several years. Another issue the board is set to discuss concerns a required refresher course every five years for medical examiners, one that has yet to be made ready by the agency.
Morris
The examiners handbook is used as a reference for physicians performing medical exams for truck and bus drivers, but its suggestions are not regulatory in nature. Nonetheless, the outdated handbook still is being used by many physicians for best procedures guidance, according to medical review board member Brian Morris, corporate director of medical surveillance for Boston-based OccMed Consulting & Injury Care.
In a 2017 meeting, the board declined to alter the seizure policy after discussing a 2007 study that outlined the pitfalls of ensuring that drivers with a history of seizures are qualified to drive.
Addressing the seizure requirement, Morris said current regulations automatically disqualify a driver with a seizure diagnosis and require the driver to submit to a sometimes lengthy waiver process while seeking an exemption from FMCSA.
“Tagging that diagnosis on somebody can be a career-ender, even if you’re doing a great job with your medications and not having seizures,” Morris said. “It’s a throwback to years ago when the treatment for seizures was not that great.
“It was a good rule at the time. But times have changed, and there’s a whole segment of people out there that drive passenger cars and have been seizure-free for years.”
Morris added, “To be granted a seizure waiver is next to impossible. So there’s a move afoot to find a way to clear those individuals to drive.
Hartenbaum
“We’re tying to figure out a way that we could have the regular medical examiners out there in the community clear individuals with seizures. If we can get proper documentation from a treating doctor that an individual is seizure-free on medication, I think the board would go along with it.”
But Natalie Hartenbaum, a medical doctor who is widely recognized as an expert in occupational fitness, said although the handbook is outdated, some examiners still appear to be using it in making medical decisions. Hartenbaum, CEO of OccuMedix Inc., is the author of “The DOT Medical Examination: An Unofficial Guide to Commercial Drivers’ Medical Certification.”
Hartenbaum, who attends all medical review board meetings, often is asked questions by board members during their meetings. She said she hopes the board does not tinker with the current exemption process for drivers with a history of seizures.
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“The board has gone against removing the exemption process for vision, which I think makes sense,” she said. “I really would have concerns about removing the seizure determinations over to the certifying provider.”
She added, “They moved insulin over, but I think there are still some concerns that we really haven’t seen how that works, or may not work. I think seizures are a more complicated area even than diabetes. The problem with seizures is that they are a very sudden event, even when they’re well-controlled.”
While she said she believes the old handbook needed to be updated, she was concerned with the first draft of the rewrite.
“I think too many examiners look at the handbook as a black-and-white certify-don’t certify, where in the handbook it clearly says ‘recommended guidance.’ But too many examiners don’t use medical judgment,” she said.
Potter
Meanwhile, physicians certified to give medical exams to truck and bus drivers still are waiting for the mandatory refresher course to be made available by FMCSA.
“There currently is no process to recertify,” said Abigail Potter, manager of safety and occupational health policy for American Trucking Associations. “They [FMCSA] have kind of delayed that process.”
The medical review board is composed of five physicians.
“These physicians were chosen from a field of many qualified candidates who possess a wide variety of expertise and experience,” FMCSA said. “MRB members specialize in the areas most relevant to the bus and truck driver population.”
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