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Monday, January 17, 2000
By Steve Twedt, Post-Gazette Staff Writer
Dr. Pamela Gianni started questioning the effectiveness of Department of Transportation physicals about three years ago while she was working at a clinic in Westmoreland County.
Because many truck and bus drivers lived nearby, she and her colleagues saw them throughout the year and knew their medical histories. Yet after drivers filled out the physical form, with its boxes to check if they had high blood pressure or diabetes, it was as though that history had vanished.
"They just would not check anything off, yet I had a chart on them that was an inch thick," Gianni said. "Sometimes, it was because just the right question was not being asked. Other times, it was, 'Oh, I don't have high blood pressure anymore because I take medication for it.' "
Because she is an occupational medicine specialist, Gianni's work requires expertise in work-related physicals. Yet she and other specialists, such as Dr. George Schmieler in Washington, Pa., and Dr. Eugene Ginchereau at St. Francis Medical Center in Lawrenceville, have seen how porous the system can be.
One weakness, they say, is other examiners' ignorance of department requirements. The physicals are supposed to be done by a licensed physical examiner, but there is no special training or demonstrated expertise required.
Ginchereau once examined a commercial driver in his late 50s who had a glass eye. The Department of Transportation requires 20/40 vision in each eye to ensure adequate depth perception and peripheral vision. "He had been passed for every single exam for over 30 years, then I had to give him the bad news," Ginchereau said.
Schmieler said he recently had to turn down a driver who'd been passed by his family physician six weeks after having a heart attack. Federal guidelines say drivers should wait three months before driving a commercial vehicle again. The driver's disability payments had ended by the time he learned he couldn't drive again for more than a month.
"The problem is that most family physicians don't understand what the rules are, and there's pressure on the family doctor to let him get back to work," Schmieler said. Then there's the pressure from drivers and trucking firms to pass unqualified drivers.
"I've been threatened. People yell at me," Gianni said. "Generally, they say, 'I've been passed all these years. Are you telling me all those doctors were wrong?' "
Gianni once failed a driver who'd been arrested a few months earlier for holding his wife hostage at gunpoint, then threatening suicide. When she called the employer, "They were about as happy as the driver to get that information. They made it clear they were going to help the driver. I have lost big customers because of cases like that."
Schmieler has lost customers, too.
Once, after Schmieler failed a driver with heart problems, the company sent the driver to its own internist, who passed him. "I ran into the physician later and he said, 'I really did not know what the rules were, but the guy needs to get back to work. He seems stable.' "
Then there is the lack of accountability when a driver fails the physical. Gianni said some failed drivers have told her quite openly they would go somewhere else if she failed them. She called a Department of Transportation official once to ask what to do and was told, "We all know that man can go down the street, and probably will."
"Why do I even bother," Gianni said. "It just goes up in smoke when they leave here."
Ginchereau agreed. "They can go until they find someone who doesn't know the regs, and get certified. That's the weakest link in this thing."
Dr. Pamela Gianni says she has been threatened after telling truckers they were medically unfit to drive. (Steve Mellon, Post-Gazette)