Document ID: USCG-2018-0041-0001
Agency: uscg
Document Type: Proposed Rule
Title: Draft Merchant Mariner Medical Manual
Posted Date: 2018-11-13T05:00Z

[Federal Register Volume 83, Number 219 (Tuesday, November 13, 2018)]
[Proposed Rules]
[Pages 56272-56273]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2018-24502]

 ========================================================================
 Proposed Rules
                                                 Federal Register
 ________________________________________________________________________
 
 This section of the FEDERAL REGISTER contains notices to the public of 
 the proposed issuance of rules and regulations. The purpose of these 
 notices is to give interested persons an opportunity to participate in 
 the rule making prior to the adoption of the final rules.
 
 ========================================================================
 

  Federal Register / Vol. 83, No. 219 / Tuesday, November 13, 2018 / 
Proposed Rules  

[[Page 56272]]

DEPARTMENT OF HOMELAND SECURITY

Coast Guard

46 CFR Part 10

[Docket No. USCG-2018-0041]

Draft Merchant Mariner Medical Manual

AGENCY: Coast Guard, DHS.

ACTION: Notification of availability and request for comments.

-----------------------------------------------------------------------

SUMMARY: The Coast Guard is seeking public comment regarding the draft 
Merchant Mariner Medical Manual. The guidance in this Manual should 
assist medical practitioners, the maritime industry, individual 
mariners, and Coast Guard personnel in evaluating a mariner applicant's 
physical and medical status to meet the requirements of the merchant 
mariner medical certificate. This draft Commandant Instruction Manual 
incorporates and consolidates prior guidance on the medical evaluation 
of merchant mariners contained in several Coast Guard documents. The 
Manual includes guidance on the medical certificate and related 
processes, including procedures for application, issuance, and 
cancellation of the medical certificate.

DATES: Comments must be submitted to the online docket, via http://www.regulations.gov, on or before January 14, 2019.

ADDRESSES: You may submit comments identified by docket number USCG-
2018-0041 using the Federal eRulemaking Portal at http://www.regulations.gov. See the ``Public Participation and Request for 
Comments'' portion of the SUPPLEMENTARY INFORMATION section for further 
instructions on submitting comments.

FOR FURTHER INFORMATION CONTACT: For information about this document 
call or email Adrienne Buggs, M.D., United States Coast Guard, Office 
of Merchant Mariner Credentialing; telephone: 202-372-2357, email: 
[email protected].

SUPPLEMENTARY INFORMATION:

Public Participation and Comments

    We encourage you to submit comments (or related material) on the 
draft Merchant Mariner Medical Manual. We will consider all submissions 
and may adjust our final action based on your comments. If you submit a 
comment, please include the docket number for this document, indicate 
the specific section of this document to which each comment applies, 
and provide a reason for each suggestion or recommendation.
    We encourage you to submit comments through the Federal eRulemaking 
Portal at http://www.regulations.gov. If your material cannot be 
submitted using http://www.regulations.gov, contact the person in the 
FOR FURTHER INFORMATION CONTACT section of this document for alternate 
instructions. Documents mentioned in this notification, and all public 
comments, will be posted in our online docket at http://www.regulations.gov and can be viewed by following that website's 
instructions. Additionally, if you go to the online docket and sign up 
for email alerts, you will be notified when comments are posted or the 
Coast Guard publishes any additional documents related to this 
notification of availability.
    We accept anonymous comments. All comments received will be posted 
without change to http://www.regulations.gov and will include any 
personal information you have provided. For more about privacy and the 
docket, visit https://www.regulations.gov/privacyNotice.

Background and Discussion of Draft Manual

    The Coast Guard provided guidance on the medical and physical 
requirements for merchant mariners in the Medical and Physical 
Evaluation Guidelines for Merchant Mariner Credentials, Navigation and 
Inspection Circular (NVIC) 04-08, Commandant Publication (COMDTPUB) 
16700.4; and in Part A of the Marine Safety Manual, Volume III, Marine 
Industry Personnel, COMDTINST M16000.8 (Series) [MSM]. In the years 
since publication of NVIC 04-08, information received from public 
comment, medical appeals, and federal advisory committee 
recommendations highlighted the need for additional specificity and 
clarity in the medical guidance document. It also underscored the 
potential for confusion caused by having medical evaluation guidance 
contained in multiple guidance documents. For example, Part A of the 
MSM, Volume III, which has not been updated since 1999, may contain 
some information that conflicts with the guidance in NVIC 04-08. In 
response to these concerns, the Coast Guard began a series of revisions 
to the medical evaluation guidelines, published as Change 1 to NVIC 04-
08, in June 2013, and Change 2 to NVIC 04-08, in April 2016.
    In addition to the revisions needed for improved clarity and 
specificity, the medical guidance also required new policy following 
publication of the Coast Guard's final rule on the Implementation of 
the Amendments to the International Convention on Standards for 
Training, Certification and Watchkeeping for Seafarers, 1978, and 
Changes to National Endorsements (78 FR 77795, Dec. 24, 2013). 
Specifically, the Coast Guard needed to develop new guidance to address 
the medical certificate and related processes required by these 
regulations. The Coast Guard provided this new guidance through a 
separate document, titled NVIC 01-14, Guidance on the Issuance of 
Medical Certificates. With the experience gained since the publication 
of NVIC 01-14, the Coast Guard has identified areas of the medical 
certificate policy that are in need of clarification, particularly with 
respect to some entry-level mariners, and procedures related to 
mariners who become unfit while in possession of a valid medical 
certificate. Rather than issuing a change to NVIC 01-14, the Coast 
Guard will include the revised medical certificate guidance with the 
medical evaluation guidance in a new policy document called the 
Merchant Mariner Medical Manual, also known as Commandant Instruction 
M16721.48.
    The draft Merchant Mariner Medical Manual revises, updates and 
combines the medical evaluation guidance previously published in NVIC 
04-08, Part A of the MSM, Volume III, and NVIC 01-14. The Coast Guard 
developed the draft Manual in consultation with experienced maritime 
community medical practitioners and industry stakeholders serving on 
the Merchant Mariner Medical Advisory Committee (MEDMAC) and the

[[Page 56273]]

Merchant Marine Personnel Advisory Committee (MERPAC). The draft Manual 
reflects a synthesis of their recommendations and the medical 
requirements of Title 46 Code of Federal Regulations (CFR) part 10, 
subpart C. Members of the public participated in the development of 
medical policy by providing comment and serving on working groups at 
the public meetings of MEDMAC and MERPAC. Additionally, the public had 
the opportunity to comment on drafts of policies contained in this 
Manual, and its predecessor, NVIC 04-08. See requests for comment on 
proposed policies regarding: Diabetes, cardiomyopathy, and sleep 
disorders (80 FR 8586, Feb. 18, 2015); Medications (80 FR 4582, Jan. 
28, 2015); Seizures (78 FR 17917, Mar. 25, 2013); and Implantable 
cardioverter defibrillators (77 FR 55174, Sep. 7, 2012). The Coast 
Guard considered these public comments when developing this draft 
Manual.
    Changes made in this draft Manual seek to improve ease of use, 
clarify and update prior guidance, and provide more transparency to the 
regulated community. Major changes include (1) use of a single manual 
format; (2) clarification of medical certificate requirements for 
certain entry-level mariners; and (3) the proposed medical certificate 
cancellation policy.
    Manual Format: The Coast Guard reorganized the material into a 
manual format instead of a NVIC to improve utility and ease of use for 
the regulated community and others who reference the document. 
Additionally, in issuing a Commandant Instruction Manual, the name and 
number of the document will not change with every future issuance of 
the document, reducing the risk of confusion.
    Entry-level Mariners: This draft adds provisions that clarify 
confusion between 46 CFR 15.401(c), which requires a medical 
certificate in order to serve in a position requiring a merchant 
mariner credential (MMC), and other provisions in 46 CFR part 10 that 
indicate entry-level mariners do not require a medical examination 
except in certain circumstances (see, e.g., Table 1 to 46 CFR 10.239, 
which marks entry-level ratings ``N/A'' as to medical and physical exam 
requirements, and Table 1 to 46 CFR 10.302(a), which is silent as to 
medical requirements for certain entry-level mariners). The draft 
Manual will clarify that the Coast Guard does not require medical 
certificates for entry-level mariners on vessels not subject to the 
International Convention on Standards of Training, Certification and 
Watchkeeping for Seafarers, 1978, as amended, who do not serve as food 
handlers.
    Medical Certificate Cancellation Policy: The guidance now includes 
the process to be followed when the Coast Guard receives information 
indicating that a medical certificate holder has developed a medical 
condition that poses significant risk of sudden incapacitation, or is 
taking medication that poses significant risk of impairment. This 
process includes procedures for cancelling medical certificates, rather 
than merchant mariner credentials (MMCs), for mariners who no longer 
meet medical certification criteria.
    The Coast Guard began issuing medical certificates in January 2014. 
The medical certificate is a certificate issued by the Coast Guard 
under 46 CFR part 10, subpart C, that serves as proof that the seafarer 
meets the medical and physical standards for merchant mariners. The 
medical certificate is not a credential (see definitions of medical 
certificate and credential in 46 CFR 10.107). Prior to the 
establishment of the medical certificate, a merchant mariner's 
certification of medical and physical fitness was embedded in the MMC. 
Under that system, if the Coast Guard received credible information 
that a mariner no longer met the medical and physical standards, the 
Coast Guard's only option was to declare the mariner medically 
incompetent and take suspension and revocation action against the MMC, 
the mariner's professional credential.
    However, not all medical concerns require revocation of the 
professional credential. In most cases, once it is determined that a 
medical certificate holder no longer meets the standards for medical 
certification, it is more appropriate for the agency to take action 
against the certificate that serves as proof of the mariner's medical 
fitness. The proposed medical certificate cancellation policy describes 
the procedures that the Coast Guard would use to cancel a medical 
certificate if it receives credible information that a medical 
certificate holder no longer meets the standards for medical fitness. 
The process involves providing notice to the involved mariner about the 
information received, and allowing them the opportunity to respond and 
provide additional information. The proposed policy preserves the 
mariner's right to reconsideration and appeal under 46 CFR 1.03-15, 
and, allows the involved mariner to continue to work until final agency 
action, except in cases where there is evidence of compelling and 
substantial risk of imminent harm. Furthermore, the policy allows the 
mariner to retain their MMC, simplifying their return to work when 
their medical condition improves and allowing them to continue to work 
in the industry in positions that do not require a medical certificate.

Questions for Public Comment

    The Coast Guard requests public comment on the draft Medical 
Manual, with emphasis on its readability, clarity, and ease of use. We 
welcome suggestions on how the Manual can be improved.
    We are particularly interested in whether the draft Manual 
adequately addresses safety concerns in situations where the Coast 
Guard receives information indicating that a medical certificate holder 
has developed a medical condition that poses a significant risk of 
sudden incapacitation, or is taking a medication that poses a 
significant risk of impairment.
    This document is issued under the authority of 5 U.S.C. 552(a), 46 
U.S.C. 7101, and 46 U.S.C. 7302.

    Dated: November 5, 2018.
J.G. Lantz,
Director, Commercial Regulations and Standards, U.S. Coast Guard.
[FR Doc. 2018-24502 Filed 11-9-18; 8:45 am]
BILLING CODE 9110-04-P