NTSB

NTSB Most Wanted Transportation Safety Improvements

Federal Issues

Highway

Prevent Medically Unqualified Drivers from Operating Commercial Vehicles

Objectives

• Establish a comprehensive medical oversight program for interstate commercial drivers.

• Ensure that examiners are qualified and know what to look for.

• Track all medical certificate applications.

• Enhance oversight and enforcement of invalid certificates.

• Provide mechanisms for reporting medical conditions.

Importance

Based on its investigations of accidents involving drivers with serious medical conditions, the Safety Board has determined that serious flaws exist in the medical certification process for commercial vehicle drivers. Flaws in the certification process can lead to increased highway fatalities and injuries for commercial vehicle drivers, their passengers, and the motoring public.

Many drivers whose occupations and serious medical conditions are known to their employers, health care providers, and others are never reported to the appropriate motor vehicle licensing authorities, thereby potentially endangering the drivers themselves and others.

Enforcement authorities cannot, in most instances, determine the validity of a medical certificate during safety inspections and routine stops because of the absence of procedures or information sources to validate the medical certificate.

The inability to authenticate the information on a medical certificate hampers enforcement authorities in their ability to identify unfit drivers and place them out of service.

In the absence of a mechanism to track all medical certification examinations, a commercial driver with a serious medical condition who is denied a medical certificate by one examiner may be able to obtain a certificate from another examiner, thus subverting the purpose of the medical certification process.

Summary of Action

The FMCSA issued a final rule for updating the medical examination form for commercial drivers in October 2000, prior to the issuance of the Board’s recommendation. Simply updating this form provides no process for ensuring the qualifications and/or training of all potential medical examiners. The FMCSA has also not established a tracking mechanism for reviewing prior applications for medical certification (although the FMCSA has indicated that it will research various approaches), nor updated medical certification regulations that determine whether drivers with common medical conditions should be issued a medical certificate.

While the FMCSA did publish a new medical certification form, it does not come with specific guidance or a readily identifiable source of information for questions on such examinations. Also, the FMCSA has not put into place a medical certification review process that prevents, or identifies and corrects, the inappropriate issuance of a medical certification. The FMCSA has noted an intent to address the ability of enforcement authorities to identify invalid medical certification and to prevent uncertified drivers from driving until an appropriate medical examination takes place. To support this effort, the FMCSA plans to issue a notice of proposed rulemaking in early 2005 that will link the medical certificate of commercial drivers with the commercial driver’s license (CDL) process. When the medical certificate and the CDL are linked, law enforcement officials will be able to access a driver’s medical status at the roadside and take appropriate action.

FMCSA is establishing a nationally recognized Medical Review Board (MRB) to make recommendations for revising medical standards and recommendations for commercial motor vehicle drivers (CMV). The MRB will also research requirements to enable future CMV driver medical standards to be developed. This is important because most of the medical standards currently in effect were adopted in the 1970s. Finally, the MRB will provide the FMCSA with an authoritative resource of medical expertise for making decisions on the medical and physical qualification of individual commercial drivers, including drivers with multiple impairments. In September 2004, the FMCSA awarded two contracts – one to develop a Medical Registry and one to develop a Medical Review Board.

Finally, while the Safety Board agrees with the FMCSA’s efforts to merge medical certification and CDLs, this will most likely not improve awareness of the process for reporting medical conditions between medical certification examinations among drivers, health care providers, and employers.

At meetings between the Safety Board and the FMCSA in October and November 2003, the FMCSA reported that it had established a Medical Division to address issues related to medical certification of commercial drivers. This division is dedicated to overseeing all aspects of the physical qualifications program for CMV drivers.

Action(s) Remaining

Continue efforts to develop medical certification procedures that ensure unfit drivers are not allowed behind the wheel of a commercial vehicle. This activity will prevent unfit commercial drivers from endangering themselves and the motoring public.

Safety Recommendations

H-01-17 (FMCSA)

Issued September 10, 2001