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Lapse in regulations fails to keep drivers with medical problems out of the most dangerous vehicles
Sunday, January 16, 2000
By Steve Twedt, Post-Gazette Staff Writer
Every day, hundreds of America's commercial truck and bus drivers climb into their rigs with serious physical or mental problems, power up their 80,000-pound behemoths and head for the highway.
Steve Twedt can be reached by phone at 412-263-1963, or by e-mail at stwedt@post-gazette.com
The drivers' medical problems range from life-threatening heart conditions to unreported epilepsy, from uncontrolled diabetes to undiagnosed but highly dangerous sleep disorders.
It's not that drivers want to be unsafe or, in some cases, even realize they're unsafe. But when the wheels aren't rolling, there's no money coming in. For their families, sometimes for their love of the road, they'll risk their health -- and the safety of other motorists -- to keep driving.
For years, the U.S. Department of Transportation has required commercial drivers to undergo physicals at least every two years to prove they're medically fit to drive massive rigs on interstate highways. A waiver may be granted for a few conditions, such as a missing limb or poor vision in one eye. Individual states also have some leeway with drivers who stay within their borders, and drivers for government agencies are exempt.
But a Pittsburgh Post-Gazette investigation has found critical problems with the regulations, problems that may cost dozens of lives each year and put hundreds more at risk. Among the findings:
A federal database of fatal accidents lists 33 fatal big rig crashes from 1997 through 1998 in which police reported that the driver's medication was a factor, or the driver fell ill and passed out. The federal numbers do not include accidents involving only injuries, and many believe the fatal crashes are underreported because they rely on an investigating officer recognizing and noting those circumstances.
Performing checkups
The majority of truck and bus drivers are excellent drivers. A recent University of Michigan study of more than 8,000 fatal accidents involving trucks and automobiles found that more than 70 percent were the auto driver's fault.
But the carnage is massive: more than 5,000 people die each year in crashes involving trucks, the equivalent of a jetliner crash every two weeks. Nearly 80 percent of those truck crash deaths are in the passenger vehicle, which typically weighs at least two to three times less than a tractor-trailer.
Whoever is at fault in these crashes, it is usually those in the passenger vehicle who pay with their lives.
A truck driver's alertness and reaction speed can make the difference between a near-miss and a fatality. Federal regulations are designed to make sure that alertness is not compromised by health problems.
But those regulations allow "any licensed medical examiner" to perform the physicals, including physician assistants and chiropractors, without requiring specialized training or demonstrated proficiency. While federal regulations say examiners should "be knowledgeable of the specific physical and mental demands" of driving a commercial vehicle, specialists in this area say many are not.
As a result, ill-informed examiners pass drivers who have poor vision in one eye, sky-high blood pressure or active heart problems, among other ailments that should disqualify them.
Some trucking firms -- usually the larger carriers -- require drivers to go to a specific doctor, but that is far from the industry standard.
Too often, the physicals fall far short of comprehensive: One local driver went through 20 years' worth of physicals mandated by the U.S. Department of Transportation before an examiner finally noted that he had an artificial leg.
Reporting the problem
Physicians who find a commercial driver medically unfit are not required to report the driver to federal officials, and have no means to report them if they wanted to. That allows impaired drivers to go from examiner to examiner until they get certified.
"There is nothing to prevent them from shopping around," said Dan Smyser, head of Pennsylvania's Motor Carrier Division in the Department of Transportation.
When asked about the lack of reporting, one former safety board member admitted it was a weakness of the certification process.
"I think you've nailed a loophole in the licensing process. That's definitely a deficiency in the system," said James Kolstad, who served as chairman of the National Transportation Safety Board from 1987 to 1992.
"If somebody is going to be employed in a transportation role in which the lives of other people might be endangered by his performance, that [a failed physical] should be noted."
Dr. George Schmieler, an occupational medicine specialist in Washington, Pa., said he recently failed a truck driver who, less than two years earlier, had gone into complete heart failure.
"He had actually died, and was brought back," Schmieler said.
Later, Schmieler learned the driver had simply gone to another doctor who was less familiar with the regulations. That doctor cleared him to start driving trucks again.
"It's frustrating to know they can be certified by someone else," Schmieler said.
Longo, of the Federal Motor Carrier Safety Administration, said these issues should be addressed under a proposed program that would have failed exams reported to state motor vehicle administrators. However, details of that program have not been made public yet.
If shopping around doesn't work, some drivers sign their own medical cards, using a phony name.
"We're finding medical certificates signed when they shouldn't have been," said Trooper J.D. Freese of the New Hampshire State Police, echoing a concern expressed by many others during a Post-Gazette survey of the medical waiver programs of all 50 states and Washington, D.C. "You can have your girlfriend, your wife, anyone put their signature on there."
Because almost any licensed health care worker can do the exam, distinguishing between valid and invalid signatures is nearly impossible.
During Kolstad's tenure, the NTSB released an eight-state study of 182 fatal accidents that found 10 percent of fatally injured truck drivers had a health problem that was either a major factor or the probable cause of an accident. Nearly 90 percent of those problems were heart-related.
In one case, a truck driver was found dead of an apparent heart attack after his truck rode the shoulder of the road for 164 feet before striking a small tree. Despite being cleared in three previous physicals as having no cardiovascular disease, the driver had been taking heart medication for years, the driver's wife said later.
In that case, the driver was not forthcoming about his medications and the examining physician had not done the proper tests. In another fatality listed in the report, the driver had forged a doctor's signature on his medical card. In a third, a Greyhound bus driver whose bus went out of control and overturned in Nashville, Tenn., had not told the examiner he had bouts of depression and vision problems.
Focus on tragedy
Beginning Jan. 1, an agency separate from the Federal Highway Administration was established to focus solely on highway safety issues. One of the Federal Motor Carrier Safety Administration's biggest tasks will be tackling the issue of how many hours a commercial driver can safely work, each day and each week.
But the health of truck and bus drivers, and their medical certification, is drawing the spotlight.
An NTSB report released this month on the June 1998 bus crash that killed seven people on the Pennsylvania Turnpike found that driver M. Scott Wisner, 61, had taken an over-the-counter cold and allergy medication that causes sleepiness. The report said the antihistamine "contributed to making the bus driver sleepy and reducing his alertness," citing that finding and the driver's irregular work schedule as causes of the crash.
Last Mother's Day, 22 people died after a tour bus headed to a Mississippi casino from New Orleans went off the highway and overturned. It was the fourth-largest fatal bus crash in U.S. history. Police say the driver, 46-year-old Frank Bedell of New Orleans, had smoked marijuana hours before the trip.
When the NTSB convenes a public hearing on the crash this week, though, Bedell's fitness and the entire commercial driver medical certification process will come under scrutiny.
Bedell -- who survived the May crash but died of a heart attack in August -- had received a full, two-year medical certificate in August 1998, nine months before the fatal crash. A family physician passed him despite a diagnosis of congestive heart failure that should have disqualified him.
On top of that, Bedell had high blood pressure and serious kidney problems. The day before the fateful trip, he'd undergone dialysis and checked back into the clinic that evening, complaining of dizziness and nausea.
"Should he have been qualified for two years? Probably not. Should he have been driving the day he was? Obviously not," said Dr. Natalie Hartenbaum, a Philadelphia physician and author of the definitive guide on Department of Transportation medical certification.
Hartenbaum, who is scheduled to testify at the New Orleans hearing, stopped short of saying the family physician who certified Bedell was wrong. Further tests may have disproved the heart failure diagnosis, she said. But that points to another weakness in the system: drivers who barely qualify on several individual conditions may still be impaired when they go back on the road.
"You have to look at the whole person," Hartenbaum said. Bedell, despite all his ailments, still got his medical card, "But my feeling is, there are a lot of drivers out there who are as bad, or worse, but don't get picked up."
Local physicians who specialize in occupational medicine have seen some of those drivers.
Dr. Pamela Gianni, based in Scottdale, Pa., was chastised by a truck driver a few years ago for not certifying him as fit to drive. The driver had been arrested two months earlier after he held his wife hostage at gunpoint, then threatened suicide, in their Westmoreland County home.
Another driver couldn't understand why Gianni balked when he said he was taking medication to control his bouts of uncontrolled anger, prescribed after a court-ordered examination. The medication could make you sleepy, Gianni told him.
No problem, the driver replied, "I don't take it when I'm going to be driving." She learned later that another doctor cleared him to drive again.
Dangers lurking
Once they're on the road, there's no predicting when a driver's medical problems will lead to tragedy. For example:
Trucking groups, such as the American Trucking Association, say the rate of fatalities is actually decreasing because more trucks are driving more miles. However, a U.S. inspector general report issued last spring slammed that argument, calling it a rationalization for not acting to slow the ever-mounting death toll.
Little action
Truckers' fitness has attracted federal interest before. In 1996, the Federal Highway Administration formed a committee with representatives from 28 organizations to look at proposals such as pairing the state-issued commercial driver's license with the federal medical card, to improve the quality of drivers' physicals and to find a way to report failed physicals to a central agency.
Hartenbaum, one of the committee members, said the group met six to eight times through November 1997. "It was meant to be a consensus committee, and we did not reach full consensus," she said. Drivers and medical professionals were concerned about maintaining confidentiality of medical records, and trucking firms worried they might lose their ability to monitor testing. Others stalled on whether any plan was feasible, some asked who would be responsible and others questioned who would pay for the added demands on states.
"There were so many varying interests and so many varying concerns," Hartenbaum recalled.
Today, nearly four years after the committee formed -- and more than two years after its final meeting -- members are still waiting for the proposed rules to be published in the Federal Register.
One of the proposals, to have designated examiners do the physicals along the lines of the Federal Aviation Administration's system of Aviation Medical Examiners, has been watered down to a plan to have examiners voluntarily get special training. The linking of the license and medical card should give states more influence over the drivers' physicals but, because it is still in the rule-making process, federal officials cannot discuss specifics, spokesman Longo said.
While some believe implementing a smaller version of the FAA system for 9 million commercial drivers is impractical, at least one well-placed federal official thinks otherwise.
"That's absurd," said National Transportation Safety Board Chairman James Hall. "It's only impractical if you're not the person who's life is at risk."
Key medical requirements for a Commercial License NTSB chief concerned about safety of commercial road rigs Ex-trucker wishes he had hidden heart problems that took license Driver scouted to find doctors he could fool People with little or no expertise in federal guidelines for commercial driver medical requirements are clearing truckers to take to the road. Federal Motor Carrier Safety Administration spokesman David Longo said regulations call for examiners to be knowledgeable of requirements, but truckers and physicians alike say many are not.There is no central reporting process for truckers who fail physicals, allowing them to find other examiners who will let them get back on the road. Some truckers have been known to sign the physician's authorization form themselves. In Pennsylvania, there are one or two crashes each year in which a truck or bus driver had a heart attack, and up to six crashes per year in which a truck or bus driver blacked out. While these problems aren't unknown to federal highway officials, attempts to tighten up the system have been bogged down by the special interests of affected groups.Five years ago, Somerset County truck driver Raymond G. Holsopple fell asleep at the wheel of his truck on a Maryland highway and plowed into the back of a van, killing four teen-agers. Holsopple was cleared of criminal charges after doctors diagnosed him with sleep apnea, a condition in which breathing problems at night disrupt sleep, leaving the person tired and sleepy all of the time. Despite the risk that creates, routine physicals for commercial drivers do not screen for the sleep disorder.In 1998, a Harrisburg trucking firm and its owner each were fined $25,000 for allowing Allen Jacobs to drive despite being an insulin-treated diabetic. The violation was found after Jacobs died in a March 1997 single-vehicle truck accident.Edward R. Bachmann, 58, of Lakeland, Fla., was driving a tractor-trailer on U.S. 17 in Green Cove Springs, Fla., in 1997, despite a history of heart problems. Bachmann lost consciousness, veered across a lane of traffic and crashed into a concrete power pole. Bachmann's doctor knew of his condition; just before he passed out, the driver told police, he had taken nitroglycerin, which is available only by prescription.Another Florida truck driver, Todd Guarino, 21, was able to get a job driving a gasoline tanker even though he was epileptic. After having an apparent seizure in April 1993, Guarino lost control of his truck, which was loaded with 8,800 gallons of gasoline. The truck went off the road, hit some trees and burst into flames, killing Guarino. His employer said Guarino had not told the company that he had epilepsy.