United States Department of Transportation
Federal Motor Carrier Safety Administration
Medical Review Board
The Medical Review Board (MRB) of the U.S. Department of Transportation's (DOT) Federal Motor Carrier Safety Administration (FMCSA) was convened on July 26, 2007, at the Crystal City Sheraton, Arlington, VA. The meeting was open to the public.
Board Members Present:
Dr. Kurt Hegmann, Chairperson
Dr. Michael Greenberg, Co-chairperson
Dr. Barbara Phillips
Dr. Matthew Rizzo
Board Member Absent:
Dr. Gunnar Andersson
Medical Expert Panel Representative:
Dr. Alan Krumholz
*Larry W. Minor, Associate Administrator for Policy and Program Development
Dr. Mary D. Gunnels, Director, Medical Programs
Kaye Kirby, Team Leader, Medical Review Board Support
Pearlie Robinson, Co-Leader, Medical Review Board Support
Linda Phillips, Medical Programs Staff
Madeline Boyd, Medical Programs Staff
*Designated Federal Official
State Department of Transportation Staff:
Carol Grubbs, Indiana Department of Transportation
Claudia Mellott-Koerner, Indiana Department of Transportation
Dr. Stephen Tregear, ECRI
Dr. Marie Tiller, ECRI
John Sheridan, MANILA Consulting Group, Inc.
Cyndi Sarner, MANILA Consulting Group, Inc.
Maria Soto, MANILA Consulting Group, Inc.
Cindy Reilly, MANILA Consulting Group, Inc.
Dellaoise Saunders, Wright Solutions
Glenna Tinney, Axiom Resource Management, Inc.
Members of the Public:
Christie Cullinan, American Trucking Association, Inc.
Katie Hathaway, American Diabetes Association
Don Vancil, Road Ready
Joel Whiteman, Road Ready
Julie Perrot, National Transportation Safety Board
Katie Church, United Parcel Service
Bryan Porter, Truck Driver
Larry W. Minor, Associate Administrator for Policy and Program Development, called the fifth public meeting of the MRB to order, in his role as DFO.
Dr. Kurt Hegmann, Chairperson of the MRB, opened the meeting. During final deliberations, the MRB unanimously approved a recommendation to the FMCSA that commercial drivers with diabetes mellitus who are insulin treated be allowed to drive commercial motor vehicles if free of severe hypoglycemic reactions, do not have altered mental status or unawareness of hypoglycemia, and properly manage their diabetes mellitus. It was recommended that drivers be restricted from driving hazardous materials or commercial passenger vehicles (buses and large vans). The MRB also approved a recommendation that all drivers diagnosed with diabetes mellitus, regardless of whether they are insulin treated, be required to obtain annual re-certification by a qualified physician. (See Detailed Summary for recommended changes.) Finally, the MRB approved a recommendation to the FMCSA that the membership of the board be increased from five to seven members.
Dr. Stephen Tregear was charged with developing an evidenced-based research report on Seizure Disorders and Commercial Driving. His literature search was aimed at studies that would develop answers to six key research questions. He presented the highlights of his reports findings:
- Overall risk of crash among individuals with seizure disorders: limited data indicates an increased risk of crash 1.13 to 2.16 times more likely to experience a motor vehicle crash than those who do not have the disorder. The limited data were provided from several low-quality studies. Additional data suggest a significant reduction in risk if a driver has reliable aura (warning of seizure) before onset of seizure.
- Likelihood of seizures among those on anti-epileptic drugs: no valid studies available, but data suggest that risk of seizure is significantly reduced after eight seizure-free years (to about 2 percent).
- Risk of seizures following epilepsy surgery: limited data indicate a steady decline in incidence of seizures. The data suggest that the longer a patient is seizure free, the less likelihood of a future seizure. The risk of seizures was similar to those on anti-epileptic drugs, about 2 percent after eight years.
- Risk of additional seizures among drivers who have had only one lifetime seizure: very limited data suggest that, although there is a high rate of additional seizures in the second year, the seizures significantly decline so that by the fifth year the risk of seizure is about 2 percent.
- Seizure risk and anti-epileptic drug therapy compliance: of five studies, one showed no significant increase in crash rate regardless of whether a driver was consistent in taking anti-epileptic drugs. The other four studies showed conflicting or inconsistent results. No evidence-based conclusion could be drawn.
- The long-term effects of anti-epileptic drug therapy: two small studies suggested a negative effect on driving skills, but the data were limited and neither relied on driving simulators to quantify results. No evidence-based conclusion could be drawn.
Dr. Alan Krumholz, representing the Medical Expert Panel on seizure disorders, reported that the panel was continuing discussion of the issues. Preliminarily, the panel agreed that an individual whose seizure disorder is under control, evidenced by a seizure-free period of time, should be allowed to drive commercial vehicles if certified by a physician annually or every six months. He said the panel would develop specific recommendations on the period of time and other details and present these in a final report. Dr. Krumholz said he thought the number of crashes directly related to a seizure is very small, lower than many other health-related crashes.
During public comment, Katie Hathaway, a representative of the American Diabetes Association (ADA), expressed concern that the restriction on insulin-treated drivers who carry hazardous materials and vehicles with passengers seems to lump them in a category rather than rely on individual assessment of driving capabilities.
Claudia Mellott-Koerner, from the State of Indiana Department of Transportation, recommended the development of a standard for the qualification of a commercial driver transitioning to insulin treatment; the collection of nationwide crash data on a national scale that would allow correlation of the drivers physical condition with the other facts of the crash (such as specific driver error, mechanical failures); and a policy that would assess the number of health conditions an individual driver has. Considering medical conditions individually, a medical examiner might certify the driver, but assessing them all together might suggest the driver is unsafe to drive and should be disqualified.
Christie Cullinan, American Trucking Association, Inc., referring to Ms. Mellott-Koerners recommendation, expressed concern about establishing a certification program based on subjective criteria that might be applied inconsistently to drivers.
A truck driver disqualified because of a seizure disorder diagnosis, said certification should be based on an individual assessment of a drivers condition and ability to drive. He also acknowledged having previously completed DOT examination forms recording he did not have seizures when he actually did.