Advisory panel to modify FMCSA Medical Examiner Handbook

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a concerned doctor looks as an elderly man points to his abdomen in a doctors office
5 Oct 2017

A team of medical advisors will review The Federal Motor Carrier Safety Administration's Medical Examiner Handbook for language and accuracy so agency physicians can again use it as a guideline to assess commercial driver health.

The handbook was used as an informational reference point for FMCSA medical examiners when performing physicals to determine if commercial operators were medically fit for work. However, the handbook itself and the FMCSA received criticism because the guidelines were often mistaken for actual FMCSA regulations. As a result, it has been prohibited from official use by agency medical examiners since 2015.

According to Land Line Magazine, the five-panel medical review board met on Sept. 26 and 27 to discuss amending the 260-page handbook to make it appear less regulatory and more suggestive in nature.

Jay Grimes, manager of Federal Affairs for the Owner-Operator Independent Drivers Association, was one of many representatives at the meeting who hoped the new changes would improve the guideline's clarity.

"We make the case overall that as they address the handbook that they really make it clear the difference between regulation and guidance," Grimes told Land Line Magazine. "The formatting throughout the handbook can be very confusing, because it provides different notes and reminders that can certainly be interpreted as regulation, but they're not."

Unclear regulatory distinctions create confusion for operators and examiners

According to a statement from the medical review board, the handbook was originally published to the FMCSA website in 2008. Stakeholders and some of the 50,000 certified medical examiners eventually began treating the advice featured within it as law. As a result, it affected the way operators approached receiving physicals and led to many endangering themselves and others by being on the road when they potentially should not have been.

Albert Osbahr, medical director and board member for Occupational Health Services at Catawba Valley Medical Center in North Carolina, told Transport Topics that he has given around 10,000 physicals to operators, and many valued their job security over their safety on the road.

"Because of the need to have a job [and] the hubris that is out there, and the lack of insight that continues to push people out on the road when they do have health problems, really is a huge concern for me," Osbahr said. "I'll be honest with you, the safety risk is the last thing most of the truckers that I see face to face are concerned about. They're concerned about their jobs."

The disconnect between drivers, medical examiners and the guidelines the FMCSA physicians use to evaluate operators caused the administration to remove the Medical Examiner Handbook from their website in 2015.

The new handbook will aim to help physicians determine the health of drivers in accordance with existing FMCSA regulation and proven medical best practices.

Grimes also wanted the updated handbook to contain information regarding the rights of operators, even pushing for the advisors to create a separate document acting as a drivers' bill of rights.

Drivers have the ability to get second opinions from outside professionals, but many thought there were regulations preventing such action. Grimes also noted examiners have overruled the judgment and instruction of some drivers' personal doctors in determining their own evaluations and that notice of this should made in the upcoming revisions.

"We also wanted to make the point that throughout the book there should be some references that CMEs [certified medical examiners] shouldn't be overruling personal physicians of drivers," Grimes said, according to Land Line Magazine. "They should stress the importance that a CME should accept the medical judgment of a driver's personal physician. Too often we're seeing CMEs ignoring the physician's judgment and denying medical cards to drivers."