Common FMCSA Compliance Problems: Medical Examiner's Certificates & Reports

The FMCSA requires commercial drivers to be physically qualified to operate a commercial vehicle and have valid medical examiner’s certificates and reports, but motor carriers and drivers are commonly found to be non-compliant with these regulations.

This is the second post in my four-part series on common FMCSA compliance problems: Part 1, Hours of Service; Part 3, Alcohol & Drug Screens; Part 4, Non-English Speaking Drivers.

The U.S. Department of Transportation, through the FMCSA, has set forth the physical qualifications for persons to be permitted to operate a commercial vehicle. Generally (barring certain variances and exceptions), a person is physically qualified to drive a commercial motor vehicle if he or she meets all the criteria set forth in 49 C.F.R. § 391.41, which requires the following:

No loss or impairment of limb;
Has not been diagnosed with diabetes mellitus, certain vascular or cardiovascular diseases, certain respiratory dysfunctions, high blood pressure, epilepsy or conditions likely to cause loss of consciousness, and/or mental or psychiatric disorders likely to interfere with an ability to safely operate a commercial vehicle;
Meets certain sight and hearing parameters;
Does not use any Schedule I drug under 21 C.F.R § 1308.11;
Does not use any non-Schedule I drug apart from having a prescription from a licensed medical practitioner; and
Has no current clinical diagnosis of alcoholism.

Medical Examinations

In order to ensure that a person meets the physical qualifications for driving a commercial vehicle, drivers are required (unless otherwise excepted) to undergo a medical examination every two years. Only a medical examiner who is listed on the National Registry of Certified Medical Examiners may perform a medical examination for these purposes. Medical examiners are not limited to physicians or medical doctors, but may also include chiropractors and certified registered nurse practitioners (CRNP). Medical professionals on the National Registry of Certified Medical Examiners will have completed a training course and passed a test pertaining to FMCSA physical qualification standards for drivers.

The guidelines and instructions for the performance of a medical examination by a medical examiner are set forth in 49 C.F.R. § 391.43, with the results of the examination recorded in a Medical Examination Report (commonly referred to as a “long form”). The Medical Examination Report contains, in part, a health history and the results of certain tests and examinations performed on the driver.

Medical Examiners

If the medical examiner finds that the driver is physically qualified to drive a commercial vehicle pursuant to the guidelines of 49 C.F.R. § 391.43, the examiner is to furnish the driver with a Medical Examiner’s Certificate (commonly called a “medical card”). Once the driver has been issued a Medical Examiner’s Certificate, the driver should maintain a copy in his possession, provide a copy to the motor carrier, and register a copy with the appropriate state agency (i.e., Alabama Department of Transportation).

Medical Examiner’s Certificates and Reports

A motor carrier must maintain as a part of its driver qualification file a copy of the Medical Examiner’s Certificate, but is not required to maintain a copy of the Medical Examination Report. In fact, while it is not prohibited from obtaining a copy, the motor carrier is not entitled to receive a copy of the Medical Examination Report, nor can it attempt to require the driver to produce to the motor carrier a copy. In order to obtain the Medical Examination Report, a motor carrier must obtain a release form signed by the driver.

No instruction is given by the FMCSA to medical examiners in 49 C.F.R. § 391.43 regarding the sharing of medical information, and medical examiners are referred to HIPAA regulations for guidance. The FMCSA has advised only that what information can or must be turned over to the employer is a legal question, subject to HIPAA, and that medical examiners should obtain a legal opinion to resolve any doubts.[1]

Under the definitions of the Privacy Rule set forth in 45 C.F.R § 160.103, a Medical Examination Report is considered protected health information, since it contains individually identifiable health information. Specifically, the information contained in the long form relates to the driver’s health history and the results of certain tests and examinations performed on the driver, and is information that identifies the driver or for which there is a reasonable basis to believe it can be used to identify the driver. In contrast, the Medical Examiner’s Certificate contains no such protected health information and only identifies the driver as being permitted to operate a commercial vehicle because he is in compliance with the Federal Motor Carrier Safety Regulations governing the driver’s physical qualifications.

In short, the FMCSA does not instruct motor carriers to take any measures to verify that accuracy or merits of a DOT medical certification. Moreover, the FMCSR do not require a motor carrier to obtain a diver’s medical records.[2] Even if the motor carrier wanted to make such an inquiry, it may not be permitted access to its driver’s medical records, secondary to the HIPAA Privacy Rule.

For more on this topic, read about systematic problems and scams within the FMCSR/DOT medical examination framework.

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