Regulatory compliance is not a chore any fleet looks forward to, but the costs of non-compliance – even if unintentional, committed solely by mistake – can leave a motor carrier facing monetary fines and unwanted extra scrutiny by any number of federal agencies.

Driver medical exams required by the Department of Transportation (DOT) offer one such example as they can “create nightmares” for fleets as they combine the complexities of Federal Motor Carrier Safety Administration (FMCSA) regulations that can at times contradict medical guidance given to the examiners in charge of administering said exams and even stand athwart best medical practices.

On top of that, trying to understand the medical terminology involved with those exams can be extremely confusing to those outside the medical field.

Fleet Owner touched base with two experts to get some advice on the thorny subject of driver medical exams: Bob Stanton and John Glenn.

Stanton is an over-the-road driver who also serves as a “driver liaison” with Dedicated Sleep Health and Wellness, a firm providing sleep apnea testing and treatment. As a driver afflicted with sleep apnea, he has been an active advocate on a number of driver-health related issues.

Glenn, a physician’s assistant since 1989, is experienced both family practice and emergency medical care and for the last 14 years has focused on sleep-related medical issues. 

Start with the basics: What are the critical items fleets need to know about when it comes to driver medical exams?

First of all, fleet managers need to be aware of the National Registry of Certified Medical Examiners (NRCME) and to make sure staff in charge of dealing with driver qualification files understand that examiners being used for driver medical exams are in that registry (a registry established four years ago that officially went “live” in 2014) and that they are documenting this.

On top of that, know that in April of this year the MCSA-5875 – a.k.a. the DOT “long form” – and MCSA-5876, the DOT Medical Certificate, both went through revisions.

What are some things fleets should NOT do when it comes to managing driver medical exams?

For starters, DON’T have existing drivers take a DOT physical while over the road away from home unless absolutely necessary and you are sure they will not get a disqualified or “DQ” result.

A driver taking a DOT medical exam that results in a DQ is out of service, even if they had time remaining on their old medical card. Something as simple as blood pressure being too high during a DOT exam can leave you with the logistical nightmare of a truck, driver and load stranded on the side of the road.

Another area of caution is when a new hire gets a DQ or “short term” medical card pending additional testing or treatment and is sent home from orientation.

The Americans with Disabilities Act (ADA) will apply with many of the medical conditions involved and know that the Equal Employment Opportunity Commission (EEOC) has been more active in ADA enforcement in trucking.

Bringing new hires back after going home for treatment or getting testing done while still in orientation might be needed: Keep that in mind.

What are some of the top “to do list” items for fleets when it comes to driver medical exams?

It’s critical to start reminding drivers about upcoming medical card expirations at least 30 days in advance.

The new MCSA-5875 – that DOT “long form” again – now features more questions about a driver’s long-term medical history. It now asks “have you ever had” versus asking “do you currently have” as one example. This often requires a driver to get medical history, test results and contact information from previous treating physicians. A new optional CMV Driver Medication Questionnaire can be used by an NRCME examiner to gather more information on medications from the prescribing health care provider.

NRCME examiners also have a new certification option with the exam. They can complete the entire exam and issue a 45-day temporary card pending further information, along with possible 30-, 60-, or 90-day cards. Information can be submitted by e-mail or fax without the driver needing to redo the entire exam.

Also realize drivers can get a second medical opinion about their medical exam results.

FMCSA allows drivers to seek a second medical opinion from a different NRCME certified examiner, but the caveat is that the driver MUST provide the second examiner all information provided the first examiner. Having options for drivers to seek a second medical opinion from an examiner suitable to the motor carrier should be included in your medical policies.

Why do you stress that fleets need to use “good” medical examiners? And what using third party firms to audit a fleet’s medical tests?

A minimum for any DOT medical examiner is that they are currently listed in the NRCME registry. This can be easily confirmed on the FMCSA’s NRCME website.

A fleet wants an examiner who ensures drivers meet the medical requirements without creating undue administrative issues. In the event of a major accident, medical documentation may be critical in litigation. Fleets may have their own medical standards more restrictive than FMCSA. Developing a network of examiners that works with your geographic operations is important.

Also, you should consider using a third party medical auditing firm for DOT exam reviews.

These firms are often part of drug and alcohol testing programs and they can provide a variety of services ranging from reminder systems and administrative auditing of exams to full medical expert review of exam and getting copies of the MCSA-5875 (again, the DOT long form) to access driver personal health and medical information.

This story originally appeared at Fleet Owner