[Federal Register: October 5, 2000 (Volume 65, Number 194)]
[Rules and Regulations]
[Page 59363-59380]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr05oc00-7]
[[Page 59363]]
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DEPARTMENT OF TRANSPORTATION
Federal Motor Carrier Safety Administration
49 CFR Part 391
[FMCSA Docket No. 98-3542 (formerly FHWA Docket No. 98-3542)]
RIN 2126-AA06 (formerly 2125-AC63)
Physical Qualification of Drivers; Medical Examination;
Certificate
AGENCY: Federal Motor Carrier Safety Administration (FMCSA), DOT.
ACTION: Final rule.
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SUMMARY: This document updates and simplifies the medical examination
form that is currently used to determine the physical qualification of
commercial motor vehicle (CMV) drivers operating in interstate
commerce. The FMCSA takes this action in response to numerous requests
from medical examiners to update and simplify the medical examination
form that is currently used. This action is intended to reduce the
incidence of errors on such forms and to provide more uniform medical
examinations of CMV drivers engaged in interstate commerce. The current
Federal physical qualification standards tested by medical examiners
and recorded on the form will not be revised in this rulemaking.
DATES: November 6, 2000.
FOR FURTHER INFORMATION CONTACT: For information about the rulemaking,
Ms. Sandra Zywokarte, Office of Bus and Truck Standards and Operations,
(202) 366-2987; for information about legal issues related to this
notice, Ms. Judith Rutledge, Office of the Chief Counsel, (202) 366-
2519, FMCSA, Department of Transportation, 400 Seventh Street, SW.,
Washington, DC 20590. Office hours are from 7:45 a.m. to 4:15 p.m.,
e.t., Monday through Friday, except Federal holidays.
SUPPLEMENTARY INFORMATION:
Electronic Access
An electronic copy of this document may be downloaded using a
computer, modem and suitable communications software from the
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512-1661. Internet users may reach the Office of the Federal Register's
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http://frwebgate.access.gpo.gov/cgi-bin/leaving.cgi?from=leavingFR.html&log=linklog&to=http://www.nara.gov/fedreg
and the Government Printing Office's web page at
http://www.access.gpo.gov/nara.
Background
The authority to require medical certification of CMV driver
qualification was originally granted to the Interstate Commerce
Commission (ICC) in the Motor Carrier Act of 1935. The authority was
transferred to the DOT in 1966 and is currently codified at 49 U.S.C.
31502(b). On October 9, 1999, the Secretary of Transportation
transferred the motor carrier safety functions performed by the Federal
Highway Administration (FHWA) to the Office of Motor Carrier Safety, a
new office created in the DOT. This transfer was performed pursuant to
section 338 of the DOT and Related Agencies Appropriations Act, 2000,
Public Law 106-69, 113 Stat. 986, as amended by Public Law 106-73, 113
Stat. 1046. The Motor Carrier Safety Improvement Act of 1999, Public
Law 106-159, 113 Stat. 1748, transferred the functions to the Federal
Motor Carrier Safety Administration (FMCSA). As a result of the
transfer of functions, the FMCSA now administers the driver physical
qualification standards and examinations in 49 CFR Part 391.
The first physical qualification standard for CMV drivers was
published by the ICC in 1939. It required a driver to have the
following minimum qualifications:
Good physical and mental health; good eyesight; adequate
hearing; no addiction to narcotic drugs; and no excessive use of
alcoholic beverages or liquors.
Over the next three decades, other physical qualification
regulations were promulgated by the ICC, but most were not clearly
defined until 1970, after the creation of the DOT. On April 22, 1970
(35 FR 6458), the existing physical qualification requirements were
substantially tightened, based upon discussions with our agency's
medical advisors. This rule required a driver to have a physical
examination every 2 years, included guidelines for evaluation of
persons in high-risk medical categories, and provided that the
examining physician be given full information about the
responsibilities of and the exacting demands made on CMV drivers. There
have been no major changes since then.
Current Medical Examination Form
The current form, at 49 CFR 391.43(f), has remained unchanged since
it was adopted by the DOT in 1970. As a result, our agency has received
numerous requests to make changes to the current medical examination
form. Physicians and other medical providers have indicated that the
format, layout and content of the current form are outdated, difficult
to use, or irrelevant.
Additionally, substantial changes in medical technology and the
technology, operating practices, and economics of the motor carrier
industry have affected the lifestyles of and, therefore, the physical
and mental demands placed on CMV drivers. Having agreed that the
current medical form is outdated and its continued use problematic, we
decided to initiate rulemaking to revise the form.
Medical Examination Form Revision Process
We contracted with the Association for the Advancement of
Automotive Medicine (AAAM) to review and evaluate the current form and
develop a revised form. The process was defined and limited by several
norms. The underlying physical qualification standards tested by
medical providers and recorded on the form would not be revised in this
rulemaking. In addition, the instructions for performing and recording
physical examinations found in 49 CFR 391.43 would be revised only to
the extent necessary to ensure that instructions to medical examiners
are understandable and consistent with the information provided on the
proposed medical examination form and guidance materials established by
us for medical examiners.
To ensure that the revised form reflected the most current medical
concepts and was responsive to the needs of the groups using the forms,
the AAAM convened a working group to serve as reviewers of the draft
form. The review panel members included two occupational health
physicians, a motor carrier, two State motor vehicle administration
officials and our agency representatives. A second draft of the form
was then submitted to a correspondence advisory group, providing a more
comprehensive review process. This larger group of reviewers was made
up of medical providers, motor carriers, State motor vehicle agency
representatives, Canadian motor transport officials, our agency field
staff, and other interested groups.
Revised Medical Examination Form
The revised form, modeled after physical examination forms in use
today, has been organized to (1) gain simplicity and efficiency, (2)
reflect current medical terminology and examination components and (3)
be a self-contained document (i.e., the form will, to the extent
possible, include all relevant information necessary to conduct the
physical examination and certification).
Consistent with accepted practices regarding the order of the
examination, the first section of the examination form is completed by
the driver. This section requests information on the driver's
[[Page 59364]]
health history, seeking ``yes'' or ``no'' answers to a variety of
medical condition questions. Any ``yes'' response requires further
clarification by the driver. Once this section is completed, the driver
is required to sign the form, affirming that all the information
contained in this section is accurate and complete. An additional
statement indicates that inaccurate, false, or missing information may
invalidate both the examination and any Medical Examiner's Certificate
issued based on it.
The second section of the examination form covers the physical
examination and tests that are performed by the medical examiner. The
medical examiner is provided information on both the relevant Federal
physical qualification standards and the tests required to measure
compliance with those standards. The Federal standards and guidelines
for evaluation of a driver's vision, hearing, and blood pressure are
included in this section of the form, thereby reducing the potential
for errors by the medical examiner.
Unlike the current physical examination form, the revised form
clearly indicates when numerical readings must be recorded. Space is
also provided on the form for recording any optional tests which the
medical examiner considers necessary to evaluate a driver's physical
qualification.
A full page of the revised form is devoted to instruction and
recordation of the medical examiner's findings. The medical certificate
is also provided, and must be completed by the medical examiner if he
or she finds that the driver meets all the Federal physical
qualification requirements.
The third section of the revised form not only sets forth the
Federal physical qualification standards found at 49 CFR 391.41, but
also contains more detailed information for the medical examiner
regarding the driver's role and the types of duties he or she may face
as a result of his or her employment. This section also contains the
agency's guidelines to help medical examiners assess a driver's
physical qualification. These guidelines are strictly advisory and were
established after consultation with physicians, States, and industry
representatives.
In addition to the revisions to 49 CFR 391.43 in the final rule, we
are making technical corrections to paragraphs (d) and (g) of that
section, to paragraphs (b)(1) and (b)(2)(ii) under Sec. 391.41 and
paragraph (d)(2) under Sec. 391.49.
The FMCSA's primary concern is to enhance highway safety, rather
than to unnecessarily limit employment opportunities for individuals
with physical impairments. The intent of the final rule is to
facilitate medical providers' efforts to establish and document the
physical qualification of a driver to operate a CMV by promoting
reliable and understandable determinations of medical qualification.
Comments
On August 5, 1998, we published an NPRM rulemaking (63 FR 41769)
seeking comments on our proposed medical examination form. We invited
individuals, medical providers, motor carriers, and other interested
parties to provide comments on how to improve our proposed examination
form and instructions for performing and recording physical
examinations. Forty-six public comments addressing the notice were
received and have been considered in our final decision to amend
Federal regulations governing the examination to determine the physical
qualification of CMV drivers engaged in interstate commerce.
We received comments from 23 physicians, 8 employers of truck
drivers, 4 State motor vehicle administrations, 1 State enforcement
agency, 1 Canadian motor vehicle agency, 3 trucking associations, 1
motor coach association, 1 trade association, 1 nursing association, 1
medical association and 2 advocacy groups. The majority of the comments
supported the proposed medical examination form with suggestions for
additions and deletions to the form. One comment completely opposed the
proposal. Some comments offered suggestions for additions or deletions
without indicating support for the form. Others suggested changes to
the Federal physical qualification standards tested by medical
examiners and recorded on the form.
Although most comments were generally supportive, a number of
comments strongly opposed providing space on the proposed form for
recording the results of such optional tests as an electrocardiogram
(ECG) and exercise stress test (EST). Still others expressed concerns
that the form has too many pages. These comments and others will be
discussed in detail below by section, and in accordance with the order
of the examination.
Discussion of Comments
Driver's Information
Comments directed to this section of the examination form suggested
format changes for recording and denoting certain information on the
form. The FMCSA has considered these comments and modified the form as
follows: The format for recording the date of birth on the form will
show month, day and year and the area code will be denoted by
parentheses. The agency has also added another category, other, to the
area on the form denoting the class of license held by the driver. This
change is provided to accommodate non-CDL licensed drivers.
Health History
This section of the form received a number of comments suggesting
additions or deletions of information and changes to the format. The
Alabama Power Company, J.B. Hunt Transport, Inc., the Maryland Motor
Vehicle Administration, the Wisconsin Department of Transportation and
the Ministry of Transportation and Highways in British Columbia
expressed support for the inclusion of a driver certification statement
affirming that the information provided by the driver is accurate and
complete. The American Association of Occupational Health Nurses
(AAOHN) and the Maryland Motor Vehicle Administration indicated that
the agency's statement that encourages the medical examiner to discuss
health history information with the driver is not strong enough and the
discussion should be required. Dr. Ellison Wittels commented that ``the
medical examiner needs to comment on any ``yes'' answer and address the
severity of the problem.'' Comments from Dr. Wittles and the AAOHN
indicated that more space should be allotted for the medical examiner's
review of the health history. Dr. John A. Hansen agreed that there is
inadequate space on the proposed form for the medical examiner's
``impression and opinion,'' and indicated that too much space is
allocated to driver's comments and the listing of their medications. In
fact, Dr. Hansen suggests that, in general, the format of the proposed
form is ``excessive.''
The American College of Occupational and Environmental Medicine
(ACOEM) believes that the ``expanded medical history section assists
the [medical] examiner in making a thorough evaluation,'' but questions
whether any of the conditions listed in the health history are likely
to interfere with the driver's ability to safely operate a CMV. The
ACOEM also expressed concerns over the potential for breaching
confidential medical information.
The Owner Operator Independent Drivers Association, Inc., (OOIDA)
an international trade association representing the interests of
independent owner-operators and
[[Page 59365]]
professional truck drivers, supports the overall goals of the proposal.
However, the OOIDA raised concerns regarding the amount and relevancy
of information solicited under the health history section and the
confidentiality of medical information of drivers. The OOIDA believes
that vague terminology and a lack of understanding of medical terms and
conditions on the part of drivers will unjustly result in a driver
being determined medically unqualified. Therefore, the OOIDA suggests
that the medical examiner complete the health history section. The
OOIDA also expressed concern that information in this section which it
views as ``unnecessary and irrelevant'' would be used by employers for
purposes other than the intended medical certification. Finally, the
OOIDA opposes the requirement for a driver certification statement
suggesting that such a requirement will not prevent drivers from
falsifying or omitting information if a ``yes'' response would result
in the driver being found medically unqualified.
The AHAS commented that the ``FHWA could significantly improve
highway safety by promoting increased definitive diagnoses and
treatment of apnea'' and noted that ``many preliminary diagnoses of
apnea are made on the basis of selfreport.'' The FMCSA believes the
information on sleep disorders in this section will help elicit
information from the driver regarding any history of sleep disorders
and thereby, facilitate the identification and treatment of such
disorders.
The FMCSA has considered the comments to this section and modified
the form as follows: The two questions regarding hospitalization and
serious illness in the last 5 years have been combined into one
question that reads: ``any illness or injury in the last 5 years.'' A
box has been added to indicate when medications are taken for nervous
or psychiatric disorders. The section on sleep disorders was modified
to include ``pauses in breathing while asleep'' and to substitute
``loud snoring'' for severe snoring. The term ``severe'' has been
dropped from the health history because it is too subjective. Under the
section on diabetes, the term ``pills'' was substituted for
``medication.'' The condition ``pleurisy'' has been deleted from the
form because it is non-specific and non-discriminating.
The format for this section has been modified to increase the space
allotted for the medical examiner's comments. As a result, the space
allocated for the driver's comments has been reduced. The statement
encouraging the medical examiner to discuss the health history with the
driver has been modified and expanded to address the use of
prescription and over-the-counter medications. The statement now reads:
the medical examiner must review and discuss with the driver any
``yes'' answers and potential hazards of medications, including over-
the-counter medications, while driving.
The FMCSA's modification of the information in the health history
is limited because this information has previously been subject to
several levels of review and subsequent changes by the medical
community and other interested groups.
Although the health history section has been expanded, the FMCSA
believes that this information is necessary and relevant. Having this
information will assist the medical examiner in conducting a thorough
evaluation and facilitate the determination as to the likelihood that
an individual has a condition that would interfere with the safe
operation of a CMV.
The FMCSA agrees with the comments that the confidentiality of
medical information is an important issue and takes the position that
medical information is best maintained by the medical examiner. In
fact, the Medical Examiner's Certificate at 49 CFR 391.43(h) carries a
statement indicating that the completed medical examination is on file
in the office of the medical examiner. Although the FMCSRs do not
require that the completed medical examination form be provided to the
employer, the FMCSA does not prohibit employers from obtaining copies
of the form. The FMCSA does not believe this is a problem since
employers must comply with applicable State and Federal laws regarding
the privacy and maintenance of employee medical information.
The agency maintains that the driver certification statement
requirement would discourage an individual from omitting or falsifying
information as someone is likely to pause and consider his/her action
before signing such a statement. This is especially so since the
deliberate omission or falsification of information may invalidate the
examination and any Medical Examiner's Certificate issued based on it.
The agency did not adopt the suggestion of one comment to allow
medical examiners to complete the health history since this is not the
usual process for completion of a health history. However, to ensure
involvement by the medical examiner, the FMCSA has made the review and
discussion of any ``yes'' responses with the driver mandatory.
Testing: Vision and Hearing
The majority of comments to this section were suggestions for
amending the actual vision and hearing standards which is beyond the
scope of this rulemaking. The FMCSA will consider these comments in its
ongoing review of physical qualification requirements and in any future
rulemakings to amend the standards under Sec. 391.41. The agency is
considering, under a separate notice, a rule change regarding field of
vision, an area of concern raised in several of the comments. This
proposed change is based on a recent review and the recommendations
from an expert panel of ophthalmologists. (See Frank C. Berson, M.D.,
Mark C. Kuperwaser, M.D., Lloyd Paul Aiello, M.D., and James W.
Rosenberg, M.D., ``Visual Requirements and Commercial Drivers,''
October 16, 1998, filed in the docket.)
The FMCSA has considered the comments to these sections and
modified the form as follows: A single box designating ``corrective
lens'' has been added to the form. The four boxes designating
``glasses'', ``contact lenses'', ``right lens'' and ``left lens'' on
the proposed form have been deleted. Several comments indicated
confusion over which box to check if an individual wore both glasses
and contact lenses. The word ``individual'' has been substituted for
the word ``patient'' under the section for recording numerical readings
for hearing testing.
Testing: Blood Pressure/Pulse Rate
There were relatively few comments on this section and the majority
of them focused on the need for additional space on the form. Several
comments suggested the need for additional space on the form to record
both the pulse rate and the quality of the pulse. Other comments
suggested space for recording the second reading of the blood pressure
since the instructions indicate that the medical examiner should take
at least two readings to confirm an individual's blood pressure.
Finally, two comments suggested changes to the recommended thresholds
for acceptable blood pressures.
The FMCSA has considered the comments to this section and modified
the form as follows: The space allocated for the pulse rate has been
enlarged to accommodate the recording of both the pulse rate and the
quality of the pulse. The recommendation for space for recording a
second blood pressure reading was not adopted because the medical
examiner is not limited to just two readings and the possibility exists
[[Page 59366]]
that several readings may be necessary to establish a fixed blood
pressure. Only the fixed blood pressure should be recorded on the form.
Any change to the threshold value for an acceptable blood pressure is
outside the scope of this rulemaking. The FMCSA is considering a review
and update of its recommendations regarding blood pressure.
Testing: Laboratory and Other Test Findings
This was clearly one of the most commented on sections in the
proposal. The majority of the comments were opposed to including space
on the form for recording the optional tests, ECG and EST. Those
opposing or having serious concerns over this issue include: the ATA,
the OOIDA, the National Automobile Dealers Association, the Georgia
Motor Trucking Association, DSI Transport, Inc., Houston Industries,
Inc., the Illinois State Police, Dr. Russell J. Green, Medical Director
for Hillcrest Health Works, and Dr. Ellison H. Wittels. The OOIDA,
Houston Industries, Inc., and Dr. Wittels also recommended that the
Echocardiogram and chest x-ray be deleted from the form. Their
opposition was based on the following concerns: (1) The efficacy of
these tests to detect coronary artery disease (CAD) and predict future
coronary events in asymptomatic individuals is unsupported, (2)
optional tests would increase the costs for all parties, and (3) the
appearance of the optional tests on the form will be misinterpreted as
mandatory requirements.
The FMCSA believes that the concerns of the ATA, the OOIDA and
others regarding the recommendations for and recordation of the
optional tests, ECG and EST, on the examination form have merit.
According to the information (See part A.l. on ``Screening for
Asymptomatic Coronary Artery Disease,'' by the U.S. Preventive Services
Task Force's ``Guide to Clinical Preventive Services,'' 2nd ed.,
Baltimore: Williams & Wilkins, December 1995, in the docket as appendix
1 to the ATA's comment) submitted by Dr. Donald Whorton (on behalf of
the ATA) and Dr. Richard Moore, it seems that the benefits of screening
to identify asymptomatic CAD are unproven. The evidence summarized in
the Guide indicated that the use of a resting ECG for screening for
asymptomatic CAD showed limited sensitivity and specificity. Relative
to the first quality, it was reported that 29 percent of patients with
clinically proven CAD had a normal resting ECG (a sensitivity of 71
percent). The evidence presented also indicated that one-third to one-
half of patients with normal coronary arteries had positive findings
(poor specificity in the 50 to 67 percent range). Moreover, the Guide
gave evidence that the predictive value of the resting ECG was low.
Prospective studies found that symptomatic CAD develops in 3 to 15
percent of persons with abnormal ECG findings and that most coronary
events occur in persons without resting ECG abnormalities. Based on
these findings, routine ECG testing is not an efficient approach for
detecting CAD or predicting future events.
While exercise ECG is more accurate than resting ECG in detecting
CAD and predicting future coronary events, the Guide reported that its
sensitivity and predictive values do not promote comprehensive
endorsement as a screening test. For example, most patients with
asymptomatic CAD do not have positive exercise results (poor
sensitivity). Relative to prediction, although asymptomatic persons
with a positive result on an exercise ECG are more likely to experience
an event than those with a negative result, long-term studies have
shown that only one to eleven percent will suffer an acute myocardial
infarction or sudden death. The majority of events will occur with a
negative test result. Thus, the less than desirable qualities of
exercise ECG do not allow it to enjoy a broad endorsement as a
screening tool and, in addition, it is more expensive than the resting
ECG.
Notwithstanding this lack of evidence to support screening for
asymptomatic CAD, the FMCSA believes that screening individuals in
certain occupations, such as truck and bus drivers, may be justified
because of possible benefits to public safety. However, since the FMCSA
is not aware of any studies which have addressed the efficacy of
screening these individuals to detect asymptomatic CAD, it proposes to
establish a panel of medical experts to review and make recommendations
for amending the agency's standards and guidelines for qualifying
commercial drivers with cardiac conditions, and for screening drivers
for cardiac risk factors.
The FMCSA has considered the comments to this section and modified
the form as follows: Space will be provided for describing and
recording any optional tests which the medical examiner considers
necessary to assess a driver's physical qualification. However,
references to specific tests (ECG, EST, echocardiogram, and chest x-
ray) in this section have been removed. This will eliminate the
potential for such optional tests to be misinterpreted as mandatory
requirements and allow more space for the medical examiner to describe,
record and comment on any optional test conducted as part of the
examination.
Although the FMCSA has not adopted the recommendations of the
Parents Against Tired Truckers (P.A.T.T.) to require the eight question
Epworth Sleep Disorder Test as part of the physical examination, the
agency recognizes and shares P.A.T.T.'s concerns that excessive day-
time sleepiness as a result of untreated sleep apnea can affect a
driver's ability to perform safely. The FMCSA has ongoing research to
evaluate the prevalence and performance of a population of CMV drivers
with sleep apnea. An extension of this research involves the
development and evaluation of a screening tool for identifying drivers
with sleep apnea. Moreover, the FMCSA's 1991 report, ``Pulmonary/
Respiratory Conditions and Commercial Drivers,'' provides specific
recommendations for qualifying CMV drivers with sleep apnea. This
report may be obtained from the National Technical Information Service,
by calling 1-800-553-6847 and identifying the report by title and
``PB'' number (PB91-236455), or by going to:
http://frwebgate.access.gpo.gov/cgi-bin/leaving.cgi?from=leavingFR.html&log=linklog&
to=http://www.fmcsa.dot.gov/facts_research/research_technology/publications/medreports.htm.
Physical Examination
This section of the form received a number of comments suggesting
additions or deletions of information and changes to the format. There
was unanimous agreement among those commenting that the recording of
height and weight in centimeters and kilograms may be problematic and a
source of errors and, therefore, should be recorded in inches and
pounds. Other comments indicated that the ``yes'' and ``no'' columns
which answer the question, ``Is driver's ability to safely operate a
commercial motor vehicle affected?'' may be confusing as the usual
procedure is to check ``yes'' if there are underlying abnormalities and
then comment on whether they present a safety risk. A number of
comments indicated that routine rectal and pelvic examinations are not
appropriate or relevant to driver safety and should be eliminated. The
AAOHN indicated that more space should be allotted for the medical
examiners comments to ``yes'' answers under this section and
recommended expanding the section on certification status to include
the status of individuals who meet the standard and qualify for a 2-
year medical
[[Page 59367]]
certificate. The proposed form indicated that this section should be
completed only if the driver does not qualify for a 2-year certificate.
The FMCSA has considered the comments to this section and modified
the form as follows: The directions for completing this section appear
in one location on the form and now read: Check ``yes'' if there are
any abnormalities. Check ``no'' if the body system is normal. Discuss
any ``yes'' answers in detail in the space below, and indicate whether
it would affect the driver's ability to operate a commercial motor
vehicle safely. Enter applicable item number before each comment. If
organic disease is present, note that it has been compensated for.
Height and weight will be recorded on the form in inches and pounds as
the medical community has indicated that it is more comfortable with
these units of measurement. References to both the pelvic or rectal
examination have been dropped from the form, and as a result, the
reference to hemorrhoids was dropped too. The term ``abnormal'' has
been dropped because it is too subjective and the term ``weakness'' has
been substituted for semi-paralysis. Several comments were not adopted
as they addressed areas extensively discussed by medical providers and
other interested parties during the development of this rule.
The instructions for completing the section on the certification
status has been modified and reads: Note Certification Status Here.
Additional boxes have been added to indicate (1) when a driver meets
the standards in 49 CFR 391.41 and qualifies for a 2-year medical
certificate, and (2) when the certification is conditionally met under
the FMCSRs (e.g., when wearing corrective lenses, a hearing aid or when
accompanied by a waiver/exemption/skill performance evaluation (SPE)
certificate). The handicapped driver waiver form has been replaced by a
skill performance evaluation certificate. See 65 FR 25285 (May 1, 2000)
for more detailed information.
Medical Examiner's Certificate
The replica of the Medical Examiner's Certificate that appeared on
the proposed form under item number 7 ``Physical Examination'' has been
removed to allow more space on the form. This will accommodate the
information added to the section on Certification Status and provide
significantly more space for the medical examiner's comments under this
section.
The box on the Medical Examiner's Certificate titled, ``Name
(Print)'' has been changed and reads: Medical Examiner's Name (Print).
This was done to clarify whose name is to be entered in the box.
Another box on the Certificate which indicates that a driver is
qualified only when accompanied by a waiver has been modified and
reads: accompanied by a ________________ waiver/exemption. The term
``exemption'' has been added to be consistent with the terminology in
49 U.S.C. 31315 and 31136(e) regarding the granting of waivers and
exemptions. A box has been added to indicate that a driver is qualified
only when carrying an SPE certificate.
Instructions to the Medical Examiner
The majority of the comments directed to this section of the form
were favorable and support the concept of a self-contained form which
ensures the medical examiner access to the applicable medical
standards, guidelines and other useful information including the role
and duties of both the medical examiner and driver. For example, not
all medical examiners, as suggested in one comment, are aware of
existing guidance which allows medical examiners to issue medical
certificates for periods less than 2 years in cases where drivers are
qualified, but may have conditions which require more frequent
monitoring.
A number of comments opposed the inclusion in this section of the
recommendations to conduct optional ECG and EST tests. They cited the
lack of evidence to support such screening, costs versus benefits, and
the potential for the optional tests to be misinterpreted as mandatory.
The FMCSA has considered the comments to this section of the form
and made the following modifications. The recommendations for
evaluating cardiac risk factors and conducting the optional baseline
ECG and EST tests have been removed from the Instructions to the
Medical Examiner (Advisory Criteria) on the form and from the
Instructions for Performing and Recording Physical Examinations, Heart,
at 49 CFR 391.43 (f). However, these recommendations have been and are
currently available to assist medical examiners in making physical
qualification determinations, and are found in the FMCSA's conference
report, ``Cardiac Conditions and Commercial Drivers.'' This report may
be obtained from the National Technical Information Service, by calling
1-800-553-6847, and identifying the report by title and ``PB'' number
(PB88-233960), or by going to:
http://frwebgate.access.gpo.gov/cgi-bin/leaving.cgi?from=leavingFR.html&log=linklog&
to=http://www.fmcsa.dot.gov/rulesregs/medreports.htm.
Moreover, as previously indicated, the FMCSA plans to
establish a medical panel to review its cardiac standards and
guidelines for qualifying commercial drivers. As part of the review,
the panel will be asked to address the issue of screening CMV drivers
for CAD. Other modifications to this section were either editorial in
nature or changes to update information to be consistent with current
FMCSA guidelines.
Several comments recommended designating or certifying medical
examiners to ensure more uniform evaluations for fitness to operate
CMVs. This issue is being addressed under a separate rulemaking which
proposes to link the driver physical qualification determinations with
the CDL process.
Format of the Examination Form
In general, comments on the format were favorable. J.B. Hunt
Transport, Inc. stated, ``placing applicable FHWA guidance directly on
the proposed form * * * is an effective way to insure the medical
examiner is aware of the specific regulation.'' The ATA stated,
``FHWA's revised medical examination form, coupled with the above
discussed ATA recommendations, will help serve as an adequate means to
provide consistency and completeness.'' The ATA recommended that the
FHWA permit motor carriers the flexibility to reformat the form to
fewer pages, provided that the content of the form remains the same,
and allow the form to be maintained electronically. The AHAS commented,
``Advocates believes that, taken as a whole, both the form itself and
the supplementary guidance that the agency wants to provide in order to
guide health care providers will be substantial improvements over the
present form. We agree with FHWA that the use of this form with its
added guidance to practitioners could have a positive economic impact
by resulting in more careful screening of commercial drivers to detect
health conditions that could prove to be a safety risk both for drivers
and for the occupants of other vehicles sharing the road with large
trucks and buses.''
Other comments indicated that the form has too many pages and
questioned whether medical examiners would read them. The ACOEM
commented, ``It is unlikely that expanding explanations from one side
of a page to four sides will drastically increase the quality.'' The
Federal Express Corporation believes ``the proposed three page form
unnecessarily adds to the paperwork burden of medical examiners and
motor carriers.'' Schneider National did not comment specifically on
the proposed form, but
[[Page 59368]]
included a copy of its physical exam form which Schneider considers
both ``comprehensive'' and ``helpful'' in determining driver fitness.
The Schneider form includes a 3-page physical exam form, 1-page
driver's job description and 2 pages of instructional/informational
materials, for a total of 6 pages.
The FMCSA believes the format of its examination form achieves the
agency's overall objectives of accuracy and efficiency, and to be a
self-contained document. Although the FMCSA has concluded that the new
form would not increase cost and time burdens, it has adopted the ATA's
recommendation to allow motor carriers and others to reformat the form,
including an electronic version, so long as it remains a self-contained
form and incorporates all of the information in 49 CFR 391.43(f), as
amended in this rulemaking.
In addition to the revisions to 49 CFR 391.43 in this final rule,
the FMCSA has made technical corrections to paragraphs (c)(1), (d) and
(g) of that section. We are also making technical corrections to 49 CFR
391.41, paragraphs (b)(1) and (b)(2)(ii) and finally, to 49 CFR 391.49,
paragraph (d)(2).
The FMCSA's primary concern is to enhance highway safety, not to
unnecessarily limit employment opportunities for individuals with
physical impairments. Consistent with its safety mandate and
regulations, the FMCSA is interested in promoting individual
determinations of medical qualification to operate a CMV. The revised
medical examination form is intended to facilitate medical examiners'
efforts to establish and document the physical qualifications of a
driver to operate a CMV by promoting reliable and understandable
determinations of physical qualification.
Executive Order 12866 (Regulatory Planning and Review) and DOT
Regulatory Policies and Procedures
The FMCSA has determined that this action is not a significant
regulatory action under Executive Order 12866 or significant under the
regulatory policies and procedures of the DOT. It is anticipated that
the economic impact of this final rule will be minimal because the use
of existing printed supplies of the forms addressed in this action will
be allowed until the forms are depleted, or until 12 months after the
effective date of this rulemaking, whichever occurs first. Allowing the
use of existing forms will avert substantial monetary loss by motor
carriers, medical providers, and vendors of forms that might otherwise
result from this rulemaking. Moreover, users of the examination form
have the flexibility to reformat the form to fewer pages, including an
electronic version so long as it remains a self-contained form and
incorporates all of the information in 49 CFR 391.43(f), as amended in
this rulemaking. According such flexibility will have the potential to
reduce costs. This action will facilitate regulatory uniformity and
result in easier compliance with and enforcement of the driver
qualification requirements of the FMCSRs. This form will, to the extent
possible, include all relevant information necessary to establish and
record the physical qualification of a driver to operate a CMV. As a
result, the FMCSA believes that this rulemaking will have a positive
economic impact. Therefore, a full regulatory evaluation is not
required.
Regulatory Flexibility Act
In compliance with the Regulatory Flexibility Act, 5 U.S.C. 601-
612, the FMCSA has evaluated the effects of this final rule on small
entities. The FMCSA believes that this action will not have a
significant economic impact on a substantial number of small entities
or the nation's economy because it would allow individual small
carriers, medical examiners and vendors of the form to use the forms
they now have on hand until those supplies have been depleted, or until
12 months after the effective date of this rulemaking. Additionally,
users of the forms will have the flexibility to reformat the forms to
less pages, including an electronic version, so long as it remains a
self-contained form and incorporates all of the information in 49 CFR
391.43(f), as amended in this rulemaking. To the extent that this final
rule will facilitate compliance with driver qualification requirements,
the projected positive economic impact is not expected to be
sufficiently significant to warrant a full regulatory evaluation.
Accordingly, the FMCSA certifies that this action will not have a
significant economic impact on a substantial number of small entities.
Unfunded Mandates Reform Act of 1995
The FMCSA has determined that this rulemaking will not result in
the expenditure by State, local and tribal governments, or by the
private sector, in the aggregate of $100 million or more in any one
year, as required by the Unfunded Mandates Reform Act of 1995 (2 U.S.C.
15e32).
Executive Order 13132 (Federalism)
This action has been analyzed in accordance with the principles and
criteria contained in Executive Order 13132 dated August 4, 1999, and
it has been determined this action does not have a substantial direct
effect or sufficient federalism implications on States that would limit
the policymaking discretion of the States. Nothing in this document
directly prempts any State law or regulation.
Executive Order 12372 (Intergovernmental Review)
Catalog of Federal Domestic Assistance Program Number 20.217, Motor
Carrier Safety. The regulations implementing Executive Order 12372
regarding intergovernmental consultation on Federal programs and
activities do not apply to this program.
National Environmental Policy Act
The agency has analyzed this action for the purposes of the
National Environmental Policy Act of 1969, as amended (42 U.S.C. 4321
et seq.), and has determined that this action will not have any effect
on the quality of the environment.
Paperwork Reduction Act of 1995
Under the Paperwork Reduction Act of 1995 (PRA) (44 U.S.C. 3501, et
seq.), Federal agencies must obtain approval from the Office of
Management and Budget (OMB) for each collection of information they
conduct, sponsor, or require through regulations. The FMCSA has
determined that this final rule will affect collection of information
requirements for the purposes of the PRA because it revises a form
associated with a currently-approved information collection covered by
OMB Approval No. 2126-0006, entitled Medical Qualification
Requirements. Interested parties were invited to provide comments
regarding the form revision in an NPRM which was issued on August 5,
1998. Comments which were received are discussed above in Discussion of
Comments. Because the current information collection is due to expire
on September 30, 2000, it has been submitted to OMB for a three-year
renewal. The renewal request, which includes a revised estimate of 20
minutes to complete and document the medical examination, is more
accurate. The FMCSA is not making any additional revisions to the
information collection as a result of this final rule.
Regulation Identification Number
A regulation identification number (RIN) is assigned to each
regulatory action listed in the Unified Agenda of
[[Page 59369]]
Federal Regulations. The Regulatory Information Service Center
publishes the Unified Agenda in April and October of each year. The RIN
contained in the heading of this document can be used to cross
reference this action with the Unified Agenda.
List of Subjects in 49 CFR Part 391
Driver qualifications-physical examinations, Highway safety, Motor
carriers, Reporting and recordkeeping requirements, Safety,
Transportation.
Issued on: September 19, 2000.
Clyde J. Hart, Jr.,
Acting Deputy Administrator, Federal Motor Carrier Safety
Administration.
In consideration of the foregoing, the FMCSA amends title 49, CFR,
chapter III, part 391 as set forth below:
PART 391--QUALIFICATIONS OF DRIVERS [AMENDED]
1. The authority citation for part 391 continues to read as
follows:
Authority: 49 U.S.C. 322, 504, 31133, 31136, and 31502; and 49
CFR 1.73.
2. Section 391.41 is amended by revising paragraphs (b)(1) and
(b)(2)(ii) to read as follows:
Sec. 391.41 Physical qualifications for drivers.
* * * * *
(b) * * *
(1) Has no loss of a foot, a leg, a hand, or an arm, or has been
granted a skill performance evaluation certificate pursuant to
Sec. 391.49;
(2) * * *
(ii) An arm, foot, or leg which interferes with the ability to
perform normal tasks associated with operating a commercial motor
vehicle; or any other significant limb defect or limitation which
interferes with the ability to perform normal tasks associated with
operating a commercial motor vehicle; or has been granted a skill
performance evaluation certificate pursuant to Sec. 391.49.
* * * * *
3. Section 391.43 is amended by revising paragraphs (c)(1), (d),
(f), (g) and (h) to read as follows:
Sec. 391.43 Medical examination; certificate of physical
qualification.
* * * * *
(c) * * *
(1) Be knowledgeable of the specific physical and mental demands
associated with operating a commercial motor vehicle and the
requirements of this subpart, including the medical advisory criteria
prepared by the FHWA as guidelines to aid the medical examiner in
making the qualification determination; and
* * * * *
(d) Any driver authorized to operate a commercial motor vehicle
within an exempt intracity zone pursuant to Sec. 391.62 of this part
shall furnish the examining medical examiner with a copy of the medical
findings that led to the issuance of the first certificate of medical
examination which allowed the driver to operate a commercial motor
vehicle wholly within an exempt intracity zone.
* * * * *
(f) The medical examination shall be performed, and its results
shall be recorded, substantially in accordance with the following
instructions and examination form. Existing forms may be used until
current printed supplies are depleted or until November 6, 2001,
whichever occurs first.
Instructions for Performing and Recording Physical Examinations
The medical examiner must be familiar with 49 CFR 391.41,
Physical qualifications for drivers, and should review these
instructions before performing the physical examination. Answer each
question ``yes'' or ``no'' and record numerical readings where
indicated on the physical examination form.
The medical examiner must be aware of the rigorous physical,
mental, and emotional demands placed on the driver of a commercial
motor vehicle. In the interest of public safety, the medical
examiner is required to certify that the driver does not have any
physical, mental, or organic condition that might affect the
driver's ability to operate a commercial motor vehicle safely.
General information. The purpose of this history and physical
examination is to detect the presence of physical, mental, or
organic conditions of such a character and extent as to affect the
driver's ability to operate a commercial motor vehicle safely. The
examination should be conducted carefully and should at least
include all of the information requested in the following form.
History of certain conditions may be cause for rejection. Indicate
the need for further testing and/or require evaluation by a
specialist. Conditions may be recorded which do not, because of
their character or degree, indicate that certification of physical
fitness should be denied. However, these conditions should be
discussed with the driver and he/she should be advised to take the
necessary steps to insure correction, particularly of those
conditions which, if neglected, might affect the driver's ability to
drive safely.
General appearance and development. Note marked overweight. Note
any postural defect, perceptible limp, tremor, or other conditions
that might be caused by alcoholism, thyroid intoxication or other
illnesses.
Head-eyes. When other than the Snellen chart is used, the
results of such test must be expressed in values comparable to the
standard Snellen test. If the driver wears corrective lenses for
driving, these should be worn while driver's visual acuity is being
tested. If contact lenses are worn, there should be sufficient
evidence of good tolerance of and adaptation to their use. Indicate
the driver's need to wear corrective lenses to meet the vision
standard on the Medical Examiner's Certificate by checking the box,
``Qualified only when wearing corrective lenses.'' In recording
distance vision use 20 feet as normal. Report all vision as a
fraction with 20 as the numerator and the smallest type read at 20
feet as the denominator. Monocular drivers are not qualified to
operate commercial motor vehicles in interstate commerce.
Ears. Note evidence of any ear disease, symptoms of aural
vertigo, or Meniere's Syndrome. When recording hearing, record
distance from patient at which a forced whispered voice can first be
heard. For the whispered voice test, the individual should be
stationed at least 5 feet from the examiner with the ear being
tested turned toward the examiner. The other ear is covered. Using
the breath which remains after a normal expiration, the examiner
whispers words or random numbers such as 66, 18, 23, etc. The
examiner should not use only sibilants (s-sounding test materials).
The opposite ear should be tested in the same manner. If the
individual fails the whispered voice test, the audiometric test
should be administered. For the audiometric test, record decibel
loss at 500 Hz, 1,000 Hz, and 2,000 Hz. Average the decibel loss at
500 Hz, 1,000 Hz and 2,000 Hz and record as described on the form.
If the individual fails the audiometric test and the whispered voice
test has not been administered, the whispered voice test should be
performed to determine if the standard applicable to that test can
be met.
Throat. Note any irremediable deformities likely to interfere
with breathing or swallowing.
Heart. Note murmurs and arrhythmias, and any history of an
enlarged heart, congestive heart failure, or cardiovascular disease
that is accompanied by syncope, dyspnea, or collapse. Indicate onset
date, diagnosis, medication, and any current limitation. An
electrocardiogram is required when findings so indicate.
Blood pressure (BP). If a driver has hypertension and/or is
being medicated for hypertension, he or she should be recertified
more frequently. An individual diagnosed with mild hypertension
(initial BP is greater than 160/90 but below 181/105) should be
certified for one 3-month period and should be recertified on an
annual basis thereafter if his or her BP is reduced. An individual
diagnosed with moderate to severe hypertension (initial BP is
greater than 180/104) should not be certified until the BP has been
reduced to the mild range (below 181/105). At that time, a 3-month
certification can be issued. Once the driver has reduced his or her
BP to below 161/91, he or she should be recertified every 6 months
thereafter.
Lungs. Note abnormal chest wall expansion, respiratory rate,
breath sounds including wheezes or alveolar rales, impaired
respiratory function, dyspnea, or cyanosis. Abnormal finds on
physical exam may require further testing such as pulmonary tests
and/or x-ray of chest.
[[Page 59370]]
Abdomen and Viscera. Note enlarged liver, enlarged spleen,
abnormal masses, bruits, hernia, and significant abdominal wall
muscle weakness and tenderness. If the diagnosis suggests that the
condition might interfere with the control and safe operation of a
commercial motor vehicle, further testing and evaluation is
required.
Genital-urinary and rectal examination. A urinalysis is
required. Protein, blood or sugar in the urine may be an indication
for further testing to rule out any underlying medical problems.
Note hernias. A condition causing discomfort should be evaluated to
determine the extent to which the condition might interfere with the
control and safe operation of a commercial motor vehicle.
Neurological. Note impaired equilibrium, coordination, or speech
pattern; paresthesia; asymmetric deep tendon reflexes; sensory or
positional abnormalities; abnormal patellar and Babinski's reflexes;
ataxia. Abnormal neurological responses may be an indication for
further testing to rule out an underlying medical condition. Any
neurological condition should be evaluated for the nature and
severity of the condition, the degree of limitation present, the
likelihood of progressive limitation, and the potential for sudden
incapacitation. In instances where the medical examiner has
determined that more frequent monitoring of a condition is
appropriate, a certificate for a shorter period should be issued.
Spine, musculoskeletal. Previous surgery, deformities,
limitation of motion, and tenderness should be noted. Findings may
indicate additional testing and evaluation should be conducted.
Extremities. Carefully examine upper and lower extremities and
note any loss or impairment of leg, foot, toe, arm, hand, or finger.
Note any deformities, atrophy, paralysis, partial paralysis,
clubbing, edema, or hypotonia. If a hand or finger deformity exists,
determine whether prehension and power grasp are sufficient to
enable the driver to maintain steering wheel grip and to control
other vehicle equipment during routine and emergency driving
operations. If a foot or leg deformity exists, determine whether
sufficient mobility and strength exist to enable the driver to
operate pedals properly. In the case of any loss or impairment to an
extremity which may interfere with the driver's ability to operate a
commercial motor vehicle safely, the medical examiner should state
on the medical certificate ``medically unqualified unless
accompanied by a Skill Performance Evaluation Certificate.'' The
driver must then apply to the Field Service Center of the FMCSA, for
the State in which the driver has legal residence, for a Skill
Performance Evaluation Certificate under Sec. 391.49.
Laboratory and Other Testing. Other test(s) may be indicated
based upon the medical history or findings of the physical
examination.
Diabetes. If insulin is necessary to control a diabetic driver's
condition, the driver is not qualified to operate a commercial motor
vehicle in interstate commerce. If mild diabetes is present and it
is controlled by use of an oral hypoglycemic drug and/or diet and
exercise, it should not be considered disqualifying. However, the
driver must remain under adequate medical supervision.
Upon completion of the examination, the medical examiner must
date and sign the form, provide his/her full name, office address
and telephone number. The completed medical examination form shall
be retained on file at the office of the medical examiner.
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(g) If the medical examiner finds that the person he/she examined
is physically qualified to drive a commercial motor vehicle in
accordance with Sec. 391.41(b), the medical examiner shall complete a
certificate in the form prescribed in paragraph (h) of this section and
furnish one copy to the person who was examined and one copy to the
motor carrier that employs him/her.
(h) The medical examiner's certificate shall be substantially in
accordance with the following form. Existing forms may be used until
current printed supplies are depleted or until November 6, 2001,
whichever occurs first.
BILLING CODE 4910-22-P
[GRAPHIC] [TIFF OMITTED] TR05OC00.021
[[Page 59380]]
Sec. 391.49 [Amended]
4. Section 391.49 is amended in paragraph (d)(2) by revising the
erroneous reference ``Sec. 391.43(e)'' to read ``Sec. 391.43(h)''.
[FR Doc. 00-25337 Filed 10-4-00; 8:45 am]
BILLING CODE 4910-22-C
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