By John McElligott, MD
with Jeffrey Heinrich, Ed.D., PA-C
Just when you thought the worst was over when it comes to regulations, guess what? Now start thinking about finding a psychiatrist!
The Department of Transportation, Federal Motor Carrier Safety Administration, and the Medical Review Board held a quarterly public meeting in July in Washington, DC. These meetings are designed to provide the public with an opportunity to observe the deliberations about medical standards and provide a forum for comments.
Mental health was one of the major topics reviewed by the MRB at this meeting, and four groups were identified by the experts.
1. Psychotic disorders – schizophrenia, delusional disorder, shared psychotic disorder, substance-induced psychotic disorder and psychotic disorder due to a medical condition;
2. Mood disorders – depression and bipolar disorder (outdated term manic-depressive illness);
3. Anxiety disorders – anxiety itself, panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder, phobias and generalized anxiety disorder; and
4. Personality disorders – hostile, detached, needy, antisocial or obsessive.
Each one of these disorders was reviewed by a Medical Expert Panel (MEP). They looked at 10,000 medical abstracts covering these four disorders. Only 130 abstracts were found to be related to CMV drivers. The MEP’s final recommendation to the MRB was that all drivers with these disorders should be cleared for work by a psychiatrist.
Most of the “general public” attending this meeting were floored when they heard that the MEP recommended all drivers with these disorders should be cleared by a psychiatrist. It was pointed out during the public forum that there simply are not enough psychiatrists in the world to begin to clear every driver who has ever been diagnosed with one of these problems.
Major psychiatric disorders – such as, schizophrenia, delusional disorders and other psychotic disorders – clearly need to be evaluated by a psychiatrist. On the other hand, mood disorders, anxiety disorders and personality disorders are all part of the regular business of life. Most are treated by a family doctor, physician assistant or nurse practitioner. And referral is made to a mental health professional or psychiatrist when the need is identified. The number of drivers with one of these disorders is in the millions.
The MRB agreed that there are not enough psychiatrists to handle the large number of psychiatric disorder cases as recommended by the MEP. It was suggested by the board that only a licensed mental health professional with a master’s degree or higher be considered qualified to complete the examination for psychotic disorders, mood disorders, anxiety disorders and personality disorders.
Since there was a huge volume of data to be analyzed concerning the psychiatric disorders, the MRB recommended sending the MEP report to a subcommittee for a more detailed review. The subcommittee will report back to the MRB.
One other major concern raised by the MEP report related to the drugs being used to treat some of these disorders and to drugs that may be self-prescribed by drivers. At the top of the list were benzodiazepines. The basic thinking of the MRB was that there should be no driving until a medication was cleared from the patient’s system. Now this may potentially be the straw that breaks the camel’s back.
On the list:
- Benzodiazepines include Xanax, Valium, muscle relaxants, Librium and sleeping aids such as Ambien.
- Antidepressants commonly used are Prozac, Celexa, Elavil and many others.
- Over-the-counter soft drinks that contain lithium or lithiated drinks.
The safety issues are important because medicines that make someone drowsy or make someone sleep will certainly need to get a more in-depth review by the MRB. This is a legitimate concern relative to the safety of CMV drivers and the public in general.
In closing, one of the most interesting comments came from an OOIDA staff member after the meeting. “You know, for many truck drivers, the solitude and quiet of the road is therapeutic. They just want to be left alone to drive.”
The authors agree. However, a balanced approach, using data and common sense, clearly needs to drive outcomes for the sake of everyone’s safety. LL
Editor’s note: John McElligott is an M.D. and Fellow of the American College of Physicians. Jeff Heinrich, who serves as the column’s medical editor, has a Doctor of Education degree and PA-C, which means Physician Assistant, Certified.