Prescription for Safety

June 2012

FMCSA's medical certificate program is evolving to bring greater safety to the nation's roadways.

When a charter bus carrying 55 passengers crashed in New Orleans on May 9, 1999, it not only resulted in 22 fatalities, it put a spotlight on the glaring need to evolve the medical certificate program.

While inclement weather and poor road conditions often play a part in such deadly accidents, neither was to blame for this one. Simply put, the driver—employed by Custom Bus Charters—should not have been behind the wheel. Despite suffering from potentially incapacitating medical conditions, the driver obtained a medical certificate by falsifying and omitting crucial health history information from the examination form. And although the medical practitioner was concerned about the driver's heart disease and possible kidney disease, she still issued a medical certificate.

"The horrific nature of the incident not only prompted an NTSB investigation, it ultimately prompted Congress to pass a series of laws (in 1999 and 2004) including the implementation of a national registry for certified medical examiners," says Bill Quade, Associate Administrator for Enforcement and Program Delivery at the Federal Motor Carrier Safety Administration (FMCSA).

In response to the laws, FMCSA developed and unveiled a phased approach in 2010 to rectify the medical certification issue. While FMCSA's program is a national program, each state accepts certificates through differing methods (in person, mail, fax and email) and each has its own set of restrictions, punishments and recertification processes if a certified driver's license holder doesn't comply.

Phase One

The first and current phase is a rule requiring drivers to submit their medical certificates to their issuing state for inclusion on their Commerical Driver License (CDL). The goal of this phase is to put the framework in place to merge the medical certificate with the CDL. This merge is significant because it is a crucial step toward consistently certifying that the CDL holder is medically fit to drive.

Maryland, for example, has made several modifications to its licensing application system, driver record system and Commercial Driver License Information System (CDLIS) communication process in order to comply with the requirements of CDLIS 5 and medical certification.

"We have also established an automated workflow system to aid with the management of medical certification data and to coordinate communications with commercial license holders," says Maryland Motor Vehicle Administration Director of Driver Programs Thomas Liberatore. "Additional modifications have been made to allow for the presentation of medical certification information on driving records (accessed in person or electronically) as permitted under the Driver Privacy Protection Act (DDPA) and FMCSA requirements."

 In addition to the technology changes put in place, Liberatore's team has also instituted a public information campaign to communicate medical certification requirements to the CDL community, established a web page containing information on the certification process, and updated Maryland's interfaces to allow local law enforcement agencies access to medical certification information.

Like many other states, the challenges are the quantity of resources needed and the effort required to complete the changes for CDLIS 5 and medical certification compliance, explains Liberatore. "This also involves the coordination and interfacing of legacy systems to meet medical certification mandates," he adds. "Outreach to CDL holders was a major challenge, and there continues to be a great deal of uncertainty and confusion regarding the changes to the medical certification process. For instance, how long does the licensee retain the DOT card? When do you need to update your information with the licensing authority? What does it mean to self-certify? And how will this impact employers and CDL holders as we progress to the 2014 deadline?"

Phase Two

The next phase, which is currently under development, involves publishing the national registry. This phase will allow FMCSA to train practitioners according to its rules and regulations before listing them as one of the DOT's authorized providers—a number estimated to top 50,000. FMCSA is currently in the process of compiling the names of approved providers to include on the registry to be unveiled before the end of 2012.

Getting phase two live as soon as possible is crucial, explains Quade. "This step addresses one of the biggest concerns—whether or not the examiner knows our rules and expectations," he says. "Just because a practitioner knows medicine does not mean they know DOT requirements. For instance, the practitioner may see 20/100 vision in one eye as acceptable, but we don't see it that way. We just want ... consistency in the standards and minimum requirements."

Success requires significant outreach to the physician community, explains Liberatore. "As state DLAs are taking a more active role in monitoring DOT card information, it is becoming clear that some physicians are not fully aware of FMCSA requirements," he says. "While we address these issues when the card is presented, it would save a significant amount of time and effort if medical professionals and customers are educated regarding the requirements and medical documentation. This also relates to the need for the national medical directory proposed by FMCSA and the ability for electronic submission and verification of DOT card information."

Phase Three

The final phase is to have the medical practitioners electronically transmit the information directly to the states. "We ultimately want to eliminate asking the driver to provide the certificate to the state. The goal is to eliminate any opportunity for drivers to provide the state with fraudulent documents, while also eliminating the burden on both the driver and the state," says Liberatore. "When the examiner electronically transmits information, drivers no longer have to go to the DMV and no one needs to do data entry. The biggest thing is to make sure the quality of the information is as high as can be."

To enact the final phase, FMCSA needs to build a robust IT infrastructure capable of supporting accurate submittal—a process that will undoubtedly take a few years to accomplish and will require an additional FMCSA rule. "The vision is that eventually it goes to each individual jurisdiction since the state is where the driver's record resides. We believe that is where the medical certificate should reside as well," he says.

However, FMCSA understands simply putting the procedures in place is not enough. "Between now and the end goal, our inspectors are going to work with the state roadside inspectors to conduct random checks of medical certificates drivers are carrying," says Quade. "We need to make sure the doctors did the exams, cut down on fraud and increase the quality of information the states collect and maintain. This is a means of addressing state concerns."