FMCSA Medical Advisors Re-Examine Driver Seizure Regulations

Changes may be coming soon for regulations regarding truck drivers with a history of seizures.

Currently, the Federal Motor Carrier Safety Administration’s medical advisory board is working on implementing updates to its requirements for these drivers, and announced last month that it would be meeting at the end of April (in a virtual session) to discuss the potential of granting special exemptions for seizure-prone truckers.

The agency also planned to review its revision of the certified medical examiner’s handbook, a resource for physicians conducting exams on truckers and bus drivers, which has been in a stage of rewriting for years. The handbook is considered outdated, but is still widely used by physicians for procedure guidance.

According to Brian Morris, a medical review board member and director of surveillance for OccMed Consulting and Injury Care, today’s regulations disqualify a driver with a history of seizures automatically, and require a driver with this diagnosis to submit a complicated waiver to the FMCSA for the possibility of exemption.

“Tagging that diagnosis on somebody can be a career-ender, even if you’re doing a great job with your medications and not having seizures,” Morris explained. “It’s a throwback to years ago when the treatment for seizures was not that great. It was a good rule at the time, but times have changed, and there’s a whole segment of people out there that drive passenger cars and have been seizure-free for years.”

Morris said opening doors to the industry for these drivers is now a priority. “To be granted a seizure waiver is next to impossible. So, there’s a move afoot to find a way to clear those individuals to drive. We’re trying to figure out a way that we could have the regular medical examiners out there in the community clear individuals with seizures. If we can get proper documentation from a treating doctor that an individual is seizure-free on medication, I think the board would go along with it.”

At the recent medical review board meeting, the agency agreed that it would begin to review recurrence-related literature for truckers who have had at least one seizure, according to FMCSA’s medical programs decision chief, Christine Hydock. This fall, the agency will also bring in outside research on the issue of seizure-related disqualifications, as seeking an exemption can currently take months for approval.

Hydock said only around 300 drivers have been granted exemptions for their seizures.

“While the research is being conducted, the exemption program stays in place,” Hydock said. “Once it is finalized, we’ll make the determination whether or not the information supports moving forward, and how we would update the standard.”

Seizure exemption regulations currently require analysis of a trucker’s medical history, medications, and driving history from the past three years. FMCSA’s associate administrator for policy, Larry Minor, said the agency will continue its studies on the issue so that it can determine the possibility of going “forward with a rulemaking at some point in the future so we can update the seizure standard and get out of the seizure exemption program.”

Following future research, FMCSA also wants to review state driving criteria around seizure disorders for intrastate U.S. commercial vehicle drivers, review commercial vehicle regulatory and medical advisory criteria in relation to seizures in other countries, and conduct interviews with board-certified neurologists regarding overall medical information on seizures.

Additionally, the agency is contemplating whether it should eliminate the exemption requirement just as it did for the diabetes requirements in February of 2019.

In regards to the medical handbook revisions, Minor said changes will be released for public review. In the past, handbook revisions have been difficult, as board members often fail to present information as formal guidance when offering help to examiners.

“This is a constant struggle for the medical review board and medical examiners,” said manager of safety and occupational health policy for American Trucking Associations, Abigail Potter. “Federal regulations require a lot of medical examiners in that they have a lot of authority to interpret medical conditions on a very individual basis.”

One critic of a revised handbook is Natalie Hartenbaum, a doctor and occupational fitness expert who attends all medical board meetings.

“I think we’ve kind of lost our way because many of the [examiner] training programs teach only what was in the medical examiner handbook–that’s fortunately only taught as ‘this is the requirement,’” Hartenbaum said. “We got here because the clear delineation between this is regulation, this is official guidance, this is literature, this is current best practice all merged together. It really has not been pushed apart to make examiners really understand that. I really worry about the safety of the general public on the highways.”

As of now, the FMCSA plans to send the medical review board a report by September 2021 for consideration of these policy updates.