By Charlie Morasch
The FMCSA Medical Review Board recently recommended commercial drivers be subjected to a “Fitness for Duty” matrix, effectively mandating millions of drivers to schedule annual or twice annual DOT physicals for high blood pressure, diabetes, sleep apnea and a variety of other issues. If approved by FMCSA, the matrix would likely park many other drivers permanently.
In March, Land Line interviewed Kurt Hegmann, MD, chairman of FMCSA’s Medical Review Board, about the matrix. For more on this topic, visit landlinemag.com.
LL: Truck drivers tell us they’re worried about medically based regulations from FMCSA, including many that blame truckers for the estimated 4,000 to 5,000 highway deaths annually that include wrecks with commercial trucks. What led the Medical Review Board to pursue this “Fitness for Duty” matrix?
KH: This has been a problem that the agency has recognized for many years, and to my knowledge has never solved. If you are looking at it from the standpoint of does (driver health) cause crashes, I don’t think there is a material argument about that.
Editor’s note: Following up in a later phone call through an FMCSA spokesman, Hegmann added that FMCSA is working to solve the problem.
LL: You mean you think there is no argument that driver health directly causes accidents?
KH: Yes, and if you have multiple conditions you are more likely to suffer an impairment. Therefore, closer scrutiny is justified.
LL: How long has the board been discussing the “Fitness for Duty” matrix?
KH: We’ve been talking about that thing for the length of the duration of the board – as being one of the justifications for the MRB in the first place.
LL: FMCSA’s stats show that at least 75 percent of fatalities from wrecks involving commercial trucks are not caused by the truck driver. Is that something the board takes into consideration – that so few wrecks are caused by commercial drivers in the first place?
KH: We certainly take into account that there are multiple factors involved in crashes. It is very difficult to apportion what causes what in crashes because, for example, one might say a crash occurred because someone did something with a car, and therefore the truck did something in response.
Someone may say the truck driver may have had no responsibility, while another person might say, ‘Well, that’s not quite correct; at least part of the problem was the driver driving this fast, and they have multiple conditions impairing their ability to react in the appropriate manner.’
Nevertheless, even if you take into account your
statistics – let’s say your stats are true – that 1,200 people per year die due to injuries from a crash that wasn’t the fault of the (automobile driver), that’s a lot of people.”
LL: For the 1,200 fatalities that may not be the four-wheeler driver’s fault, do you have any estimate as to how many of these events could be blamed on the health of the commercial driver?
KH: First of all, we’re not blaming anybody. I’m trying to make clear that these are multifactorial issues, and it’s extremely complex. Regarding the entire issue of data in this area, the MRB has taken repeated positions that more research is needed. I think that’s the best answer – that the amount of data we have today is very limited.
LL: That’s something that OOIDA and truckers have said. How can a board of doctors recommend something that would cost millions or billions in health care, without having the data to back up these claims?
KH: 4,800 (total fatalities tied to all truck-car interactions) is a lot of data. I don’t think it’s appropriate to say there is no data. It is correct to say that the quality of the evidence stating that any one particular intervention has a known degree of impact, that clearly is in some areas questionable. In some areas, it comes down to best judgment of multiple groups of different panels of experts.
LL: Between 4,000 and 5,000 wrecks involving commercial deaths – that number is really small compared to a lot of other death categories in the U.S. Several studies have pointed to between 40,000 and 100,000 deaths that are caused annually by medical professionals at medical facilities. You’re actually far more likely to die because of a medical error in a hospital than you are on the road by hitting a truck driver.
KH: I think that is an inappropriate use of statistics. The issue is in the working age population – what causes death. The statistics you are citing right now are heavily weighted toward the old and the very heavy. Or the old-old. If you just simply deal with the issue of your probability of living to go home to provide for your family tomorrow, this is a major cause of death and disability in the United States.
LL: When the board discusses a recommendation like the matrix, do you all take into consideration the cost incurred by the patient or the commercial driver in this case?
KH: I don’t think it would be accurate to say we weight things totally in terms of financing without regard to practicalities. I think we actually do incorporate practicalities. But the degree of cost involved in this type of intervention I don’t believe is that high, relative to the cost in terms of injuries, disabilities, health care provided for those disabilities, lawsuits and everything else.
LL: Is there ever a question of ethics when you have this group of medical doctors who are essentially creating doctor visits by saying, “We’re going to require you to go to Dr. X for multiple visits, and by the way I’m in a field where I could potentially benefit from that requirement.” Is that ever brought up during the meetings?
KH: I don’t believe that any of the individuals on the Medical Review Board will personally benefit from changes in this system. You’d have to ask other people individually, but I doubt any of them will see any change in income. If anything, considering the time they’re spending on this process to try and improve the health of truckers and the public, they have forgone income.
LL: Board member Dr. Barbara Phillips is on the national Sleep Foundation Board, a group partially funded by sleep study labs, and has many doctors that would benefit from the sleep apnea and BMI recommendation if it were approved by FMCSA. One thing that truckers bring up to us is, is it fair that someone who could directly benefit from this regulation is approving it and advocating it?
KH: Wow. You’d have to actually ask her directly. I can assure you that in this process I will have suffered financial losses for having been involved in this process because it cost so much time, and I suspect that’s true of most or all of the members. It is out of the goodwill of the members that we are trying to work to make a system that works better to prevent these injuries and death.
LL: Earlier you mentioned additional study linking driver health to public safety. Has the MRB proposed such study?
KH: Yes, more than once. We have made recommendations to the agency that additional research is needed in virtually every area we have reviewed. We specifically indicated there ought to be a registry for data both for all truckers, but also separate investigations involving all deaths.
LL: We were struck by how little data there is.
KH: No, there’s almost nothing – even overseas. The quality of what is available is very weak. On the MRB Web page there is research related to recommendations. One after another after another – you’ll see that the amount of evidence is very weak, and it’s really not any better overseas.
Editor’s note: Hegmann later said he believes some data links commercial driver apnea to safety risks.
LL: One provision that offended many at OOIDA is the part where a medical staffer can disqualify someone if they feel verbally or physically threatened, though the MRB included no anecdotal or statistical evidence of any threat from drivers. Was there any discussion on that matter during the meeting?
KH: I don’t remember exactly, but I can tell you that I have been told by more than one person – and this is an extraordinarily rare occurrence – but I have certainly been told that people have been physically threatened. If that happens, in my opinion, that person has demonstrated questionable ability to drive a truck safely. But again, I emphasize, the vast majority – let me emphasize I know and have examined many truckers – and by a rule, one after another they are really nice people. They are fun to work with. They’re cool people; they perform hugely important things. It’s the old problem of a few, and very few, bad apples creating other problems.
LL: If that happened, wouldn’t that be an assault case for police to handle?
KH: It certainly does happen in health care, but it’s rare. Most people don’t cross that line. For some reason there are a few people who do. One has to wonder whether one would want to be driving next to such a driver. And that would be a concern among unfit car drivers, too.
LL: Of the millions of people working in the medical field, out of a few people there, maybe someone’s having a bad day, or are on a power trip and they say, “Well, you know what, that’s a psychological issue you just demonstrated so you’re gone.”
KH: Clearly, if (FMCSA) goes down that road, something would have to be set up to catch and counter that issue too to make it a balanced system.
LL: Have you yourself ever been threatened?
KH: No, not by a trucker. I haven’t ever had a single truck driver who has been anything other than a perfect gentleman or lady. It’s a fun group to deal with actually.
To send comments to the Medical Review Board, visit http://www.fmcsa.dot.gov/about/contact/who-to-contact/contactus.htm.