FMCSA Panel Takes Steps to Revise Obsolete Medical Examiners Handbook

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ARLINGTON, Va. — The Federal Motor Carrier Safety Administration’s update to its Medical Examiners Handbook is a step closer to completion. The handbook serves as a guideline for physicians who use it to assess truck driver health.

FMCSA’s Medical Review Board spent two days reviewing a rewrite of the agency’s handbook that is ultimately aimed at keeping unhealthy commercial motor vehicle drivers off the road and ensuring that drivers who mind their health remain behind the wheel.

The rewrite offers the agency’s suggested “best medical practices” for the more than 50,000 certified medical examiners who evaluate such complex medical conditions as diabetes, sleep apnea and cardiovascular disease.

It also offers the examiners, who give truck drivers physical exams at least once every two years, information on regulatory requirements for such problems as high blood pressure, inadequate vision and poor hearing, as well as when to disqualify a driver or limit the length of a driver’s medical certification period.

The five-member medical board’s review of the handbook was July 15-16. The last version of the handbook was deemed out of date in 2015, but board members said that some examiners still use it.

Morris

“We started working on the handbook last year and we got bogged down very quickly because we didn’t think we could make changes to it,” Brian Morris, a Boston occupational medical doctor who serves on the medical board, told Transport Topics. “Changes would require publishing in the Federal Register and getting opinions on it. So if we wanted to make any major changes it would become a very complicated process.”

Since then, the agency assigned its recently named chief medical officer, Joseph Sentef, to trim the previous handbook and update changes or improvements in diagnosing driver medical health. Sentef cut the length of the revised draft handbook from 260 pages to less than 80 pages.

Now, the recommendations of the medical review board will be sent back to FMCSA to produce a final draft version of the handbook and then gain final approval by the board in a subsequent meeting.

During its two-day review the board tweaked (and left unchanged) a number of medical best practices, including:

• The board decided to give examiners broad authority to assess diabetes conditions, but suggested a diabetes study be conducted that could possibly lead to establishing a firm A1C test result number to diagnose drivers with serious diabetes risk. The A1C test is a blood test that reflects an individual’s average blood glucose levels over the past three months.
• Although some prominent health groups have recommended tougher blood pressure standards, the board kept in place a requirement that a driver’s systolic blood pressure be lower than 140 mm Hg and diastolic blood pressure lower than 90 mm Hg to avoid being evaluated as having stage 1 hypertension. Changing the standard would require FMCSA to submit a change to the lengthy regulatory process, board members agreed. “Plus, we’d lose a lot of drivers if we adopted the lower standard,” Morris said.
• While the board discussed the proliferation of marijuana decriminalization in a number of states, it decided that it should not burden medical examiners with the job of enforcing the outright ban of marijuana use by truck drivers. However, it did caution truck drivers about the use of CBD oils derived from legal hemp. “But if you’re a medical examiner, the drug stream is not really part of the examination,” said board member Michael Kelley, senior medical director of Ambulatory Services for OhioHealth Neighborhood Care in Columbus, Ohio. The problem with CBD oils, according to Larry Minor, the agency’s associate administrator for policy, is that mislabeling of the THC content in hemp could cause a driver to fail a drug test. “You use CBD products at your own risk,” Minor said.
• The board decided to leave the current policy in place that permits a driver to have 20/40 vision in both eyes.
• The board agreed to leave examiners wide latitude in determining whether a driver needed to be referred to a costly sleep study for sleep apnea. The revised handbook, which is now headed for review by the agency, refers examiners to 2016 medical review board criteria that drivers not be referred to a sleep study unless the driver has multiple risk factors ranging from hypertension and high body mass index to diabetes, a neck greater than 17 inches, a history of stroke or coronary artery disease and loud snoring.

“I’m very pleased to see the medical review board taking big strides in trying to advise medical examiners,” said Abigail Potter, manager of safety and occupational policy for American Trucking Associations. “Major steps have occurred in giving more clarification for medical examiners.”