About The Medical Examiner Registry
The medical examiner registry rules apply to all healthcare professionals, regardless of their experience or credentials: • whose scope of practice authorizes them to perform physical examinations, as defined by their state of licensure • who intend to perform physical examinations and issue medical certificates for CMV drivers in compliance with Medical Advisory Criteria for Evaluation Under the Requirements of 49 CFR 391.41 of the FMCSRs
Examiners are expected to follow advisory criteria (guidelines) contained in the FMCSA’s Medical Examiner Handbook. The guidelines are based on medical literature and reflect best practice. They are intended to help an examiner determine whether a driver is medically qualified in accordance with 49 CFR 391.41. Examiners who deviate from the guidelines must document their reasoning.
Employers also are given some discretion in the matter. Section 390 of the FMCSRs describes general applicability and enforcement. A subpart, Section 390.3(d), allows employers to adopt additional medical requirements, stating: “Nothing in subchapter B of this chapter shall be construed to prohibit an employer from requiring and enforcing more stringent requirements relating to safety of operation and employee safety and health.” However, in applying this section, employers are advised to ensure they remain in compliance with provisions that protect employees under the Americans with Disabilities Act and amendments to the act.
The FMSCA does not provide the required training or administer the exam, nor does it directly operate or endorse training organizations. Medical examiner training organizations must be accredited to provide continuing education units. Training may be provided through traditional classroom methods, self-paced learning, or a combination of modalities. Applicants may take the exam in person at designated test locations or online in accordance with specific security and privacy requirements. Examinees who fail the test are allowed to re-take the examination once every 30 days. Training organizations and test vendors are listed on the NRCME website.
Other requirements: • registry candidates must take the test within three years of completing the training • examiners who qualify for the registry are required to take refresher training every five years (offered at no cost through the FMCSA) • approved examiners are required to undergo recertification every 10 years • training and testing are required for each examiner in a clinic or office There is no requirement for training ancillary or support staff or any prohibition against allowing allied professionals to acquire specialized training.
Medical Examiner Responsibilities
The examiner’s job is to ensure that commercial drivers can safely perform both driving and non-driving work-related tasks. The driver’s medical certificate, once signed by the examiner, is not limited to the current employer. In conducting the examination and completing the related certification, the examiner must follow mandated medical standards, consider all available guidance and best practices, and review each driver’s specific role and responsibilities.
Examiners are required to submit the name of each examinee and related information through the national registry system on a monthly basis, regardless of whether the applicant passes the medical examination. Examiners also are required to provide copies of requested medical examination reports and certificates to the FMCSA or to authorized federal, state, and local enforcement agencies within 48 hours of a request.
Under these rules, the FMCSA estimates 40,000 certified medical examiners are needed to perform exams, submit monthly reports, and file examiner’s certificates on 4,623,000 drivers a year. According to the agency, the transmission of CMV driver examination data will require approximately 46,525 hours of medical examiner administrative time on a yearly basis. The agency estimates that half of the nation’s motor carriers will request a copy of the medical examiner’s certificate at one minute per transaction. To help providers effectively manage their time, the FMCSA will allow administrative assistants and approved third parties such as software vendors to submit batch reports to the agency on behalf of examining providers.
In addition, some industry groups and other stakeholders have urged adoption of a provision to allow medical examiners to transmit required information directly to state licensing agencies for inclusion in the national Commercial Driver’s License Information System (CDLIS).
The intent is to reduce the likelihood of fraud and processing errors. In a related notice of proposed rulemaking issued May 10, 2013, the FMCSA introduced a proposal in response to requests to expedite reporting to state agencies. Proponents say these requirements would allow state and federal enforcement officials to view the most current, accurate information on the status of a CMV driver, including medical variance information.
“Transportation companies are learning that innovative health promotion and wellness programs help reduce health risks in the driver population.”
Legislative Background
The FMCSA has jurisdiction over drivers on public highways. It oversees the formulation of national transportation policy and promotes intermodal transportation. During loading and unloading of trucks and passengers, Occupational Safety and Health Administration regulations apply.
In August 2005, Congress enacted the Safe, Accountable, Flexible, Efficient Transportation Equity Act: A Legacy for Users (SAFETEA-LU), authorizing the FMCSA to create the National Registry of Certified Medical Examiners (49 U.S. Code 31149). On Dec. 1, 2008, the FMCSA published a notice of proposed rulemaking to establish the national registry (73 FR 73129). The public comment period closed on January 30, 2009, and the registry was published in the Federal Register on April 20, 2012.
The primary legal basis for the medical examiner program comes from 49 U.S.C. 31149, enacted by section 4116(a) of SAFETEA-LU. Subsection 31149(d) provides that the Secretary of Transportation, acting through the FMCSA, shall: • establish and maintain a current national registry of medical examiners who are qualified to perform examinations and issue medical certificates • remove from the registry the name of any medical examiner that fails to meet or maintain the qualifications established by the secretary for being listed in the registry or otherwise does not meet the requirements of this section or regulation issued under this section • accept as valid only medical certificates issued by persons on the national registry of medical examiners
Effective January 30, 2014, all CDL holders must provide information to the licensing agency in their state about the type of commercial motor vehicle they operate. Under a related rule, in many cases drivers are required to submit a current medical examiner’s certificate to their state agency, which becomes part of their driving record. CDL holders who fail to provide a current medical examiner’s certificate are “not certified” and potentially at risk of losing their license.
Specific to sleep apnea, President Obama recently signed a bill (HR 3095) to “ensure that any new or revised requirement providing for the screening, testing, or treatment of individuals operating commercial motor vehicles for sleep disorders is adopted pursuant to a rulemaking proceeding.” The bill does not require that a regulation or standard be promulgated nor does it prohibit guidance; it only mandates that any requirement be adopted through rulemaking.
Currently, an applicant for a commercial driver’s medical certificate must be found to have “no established medical history or clinical diagnosis of a respiratory dysfunction likely to interfere with his/her ability to control and drive a commercial motor vehicle safely.” All else, including what is in the FMCSA’s Medical Examiner Handbook, is guidance, according to Dr. Natalie Hartenbaum, a transportation medicine expert and former president of the American College of Occupational and Environmental Medicine (ACOEM). Dr. Hartenbaum said the agency indicated in a letter to ACOEM that it would use a notice and comment process regardless of whether it pursued guidance or rulemaking.
Conclusion
Transportation companies are learning that innovative health promotion and wellness programs help reduce health risks in the driver population along with treatment, insurance, and accident/injury-related costs. Effective use of technology to support health and safety management and driver education is a critical component of these efforts.
Examples of preventive interventions and health management strategies being implemented by occupational health professionals around the country include:
• outreach at truck stops, fleet terminals, and other areas where drivers congregate
• dedicated clinics and regionally dispersed provider networks where qualified examiners specialize in commercial driver physicals • online and telephonic disease management coaching
• nutritional counseling and weight loss programs for drivers and family members
• sleep education
• mobile apps and health kiosks
• on-the-road fitness programs
• incentives such as insurance discounts
• free biometric screening
• pharmacy benefit management
• smoking cessation
• employee assistance/counseling programs
Drive Safely Work Week tool kits developed by the Network of Employers for Traffic Safety (NETS) contain a number of useful resources. These resources are useful year-round.
Prevention, careful medical evaluation, and education about the importance of complying with treatment recommendations are three key ways to improve driver fitness. It is incumbent on the medical examiner to perform a driver physical in accordance with regulations. The examiner also has to be willing to encourage CDL applicants to seek personal medical attention from high-quality caregivers for further evaluation and treatment, as necessary. While it is essential for employers to help their employees adopt healthy behaviors to obtain desired outcomes, it is up to drivers themselves to take appropriate preventive steps, obtain the care they need, and adhere to treatment recommendations.
Note – RYAN Associates will sponsor a three-week webinar series on this topic. To learn more, go to www.naohp.com/menu/education/upcoming-events/webinar2014driver_examination.pdf beginning April 23, 2014. Dr. Hartenbaum will be the featured speaker in session one.
Endnote
This article is excerpted from a white paper with permission from UL Workplace Health and Safety: www.ulworkplace.com. The author, Karen P. O’Hara, is managing editor and communications specialist at UL Workplace Health and Safety and former senior vice president and editor-in-chief at RYAN Associates and the NAOHP. Ms. O’Hara wishes to thank Natalie Hartenbaum, M.D., president and chief medical officer, OccuMedix, Dresher, Penn., for her assistance.
Citations
- Medical Advisory Criteria for Evaluation Under the Requirements, Federal Motor Carrier Safety Regulations, 49 CFR Part 391.41; Web, www.fmcsa.dot.gov/rules-regulations/administration/medical.htm
- National Registry of Certified Medical Examiners, medical examiner resources, FMCSA. Web, http://nrcme.fmcsa.dot.gov/medical_examiners.aspx
- The Commercial Motor Vehicle Driver Medical Examination: Practical Issues, N. Hartenbaum, OccuMedix, Inc., Am Fam Physician, Apr 15, 2010; 81(8):975-980.
- Final rule, op cit. (see No. 1).
- Commercial Driver’s License Information System, FMCSA. Web, www.fmcsa.dot.gov/registration-licensing/cdl/cdl.htm
- Medical examiner’s certification integration project, Docket ID FMCSA-2012-0178, FMCSA. Web, /www.regulations.gov/#!docketDetail;D=FMCSA-2012-0178
- New Medical Certification Requirements: A Guide for Commercial Driver’s License (CDL) Holders. Web, http://fmcsa.dot.gov/registration-licensing/cdl/cdl-general-info.aspx
- Network of Employers for Traffic Safety. Web, www.trafficsafety.org
