Medical examiners must understand their role in relationship to other medical providers. Even if the medical examiner is a primary care provider for many patients, the medical examiner must recognize the unique requirements of the medical examiner role when performing DOT medical examinations. That role requires that medical examiners serve as the expert who determines whether a driver has met FMCSA requirements, which means the medical examiner may be in a position to disagree with or countermand recommendations made by specialists. The medical examiner is required to make the fitness for duty decision as to whether a driver may be cleared, and that decision may not be ceded to any other medical provider.
For example, the medical examiner may refer a driver with congestive heart failure (CHF) to a cardiologist. The cardiologist might recommend clearance to drive, even though the driver has a left ventricular ejection fraction (LVEF) of 32%. FMCSA guidelines suggest that driver’s with CHF (or any other cardiac condition) should not be cleared with a LVEF of less than 40%. The medical examiner should serve as the final arbiter of the clearance decision, and unless there are compelling reasons to consider certifying the driver, should follow FMCSA guidance recommendations.
Simple forms can be used for most consulting provider requests. Such forms may include a space to note the specific medical conditions and/or concerns and contain a statement to be signed by the consulting provider. The NRCME Training Institute includes such sample forms in the Extra Questions & Materials section of our training program. Specific FMCSA requirements or guidelines should be referenced, such as in the example above noting that FMCSA guidance recommends a minimum LVEF of 40%. In obtaining recommendations from other treatment providers, medical examiners are required to make sure that other medical providers are aware of the job requirements for commercial motor vehicle (CMV) drivers. This requirement is most easily met by including a copy of the FMCSA description of CMV driver duties with a referral request, and by including a statement on such requests that the consulting medical provider is familiar with a CMV driver’s duties.
If consulted medical providers are unwilling to clear a driver, the medical examiner should ascertain the reasons for this and make a decision as to whether the position of the consulted medical provider is consistent with FMCSA requirements and guidelines. If not, the medical examiner may consider recommending that the driver obtain the opinion of a different consulting provider; if this occurs, the medical examiner should document clearly in the Medical Examination Report the reasons for making this recommendation.
Often, a medical examiner should consider obtaining actual medical records from a consulting provider, rather than a simple statement from the consulting driver regarding the driver’s fitness for duty. Such records may reveal details of the driver’s condition that relate to medical certification, details the driver may have hidden from the medical examiner in the driver’s medical history. To obtain such records, the medical examiner must have the driver complete a HIPAA consent form for the records and dates requested.
Embrace the medical examiner role. Advise consulting providers of the CMV driver’s role and of specific FMCSA requirements and guidance. Obtain detailed records when questions persist or as otherwise warranted. Medical examiners who follow these rules will make appropriate certification decisions and will document the necessary support for such decisions.
Steven St. Clair, MD, MPH
Dr. St. Clair is a medical consultant to the NRCME Training Institute, LLC. The NRCME Training Institute, LLC provides an affordable 100% online DOT medical examiner training program which meets and exceeds FMCSA requirements.