Commercial Drivers: Certification Process for Drivers with Serious Medical Conditions
Published: 2008-06-30T00:00:00

Fast Facts:

Highlights:
section_title: Why GAO Did This Study
paragraphs: Millions of drivers hold commercial driver licenses (CDL), allowing them to operate commercial vehicles. The Department of Transportation (DOT) established regulations requiring medical examiners to certify that these drivers are medically fit to operate their vehicles and provides oversight of their implementation. Little is known on the extent to which individuals with serious medical conditions hold CDLs. GAO was asked to (1) examine the extent to which individuals holding a current CDL have serious medical conditions and (2) provide examples of commercial drivers with medical conditions that should disqualify them from receiving a CDL. To examine the extent to which individuals holding CDLs have serious medical conditions, GAO identified those who were in both DOT's CDL database and selected federal disability databases of the Social Security Administration, Office of Personnel Management, and Departments of Veterans Affairs and Labor and have been identified as 100 percent disabled according to the program's criteria. Because DOT's data also include inactive licenses, GAO obtained current CDL data from 12 selected states based primarily on the size of CDL population. To provide case study examples, GAO focused on four states--Florida, Maryland, Minnesota, and Virginia. For 15 drivers identified from data mining, GAO interviewed, as appropriate, the driver, driver's employer, and driver's physician. GAO is not making any recommendations.
section_title: What GAO Found
paragraphs: Commercial drivers with serious medical conditions can still meet DOT medical fitness requirements to safely operate a commercial vehicle and thus hold CDLs. However, there is general agreement that careful medical evaluations are necessary to ensure that serious medical conditions do not preclude the safe operation of a commercial vehicle. Because medical determinations rely in large part on subjective factors that are not captured in databases, it is impossible to determine from data matching and mining alone the extent to which commercial drivers have medical conditions that preclude them from safely driving a commercial vehicle and therefore if the certification process is effective. GAO's analysis provides a starting point for exploring the effectiveness of the current CDL medical certification process. Our analysis of commercial license data from DOT and medical disability data from the Social Security Administration, Office of Personnel Management, and Departments of Veterans Affairs and Labor found that about 563,000 of such individuals had commercial driver licenses and were determined by the federal government to be eligible for full disability benefits. This represented over 4 percent of all commercial driver licenses in the DOT database. Our analysis of 12 selected states indicates that most of these commercial drivers still have active licenses. Specifically, for these 12 selected states, about 85 percent had a current CDL even though they had a medical condition from which they received full federal disability benefits. The majority of these drivers were issued a CDL after the driver was approved for full federal disability benefit. Our investigations detail examples of 15 cases where careful medical evaluations did not occur on commercial drivers who were receiving full disability benefits for serious medical conditions.

section_title: Letter
paragraphs: Millions of American drivers hold commercial driver licenses (CDL),  Millions of American drivers hold commercial driver licenses (CDL),  allowing them to operate a variety of commercial vehicles such as school  allowing them to operate a variety of commercial vehicles such as school  buses, cargo vans, and tractor trailers. To help prevent accidents resulting  buses, cargo vans, and tractor trailers. To help prevent accidents resulting  from commercial drivers with medical conditions, federal law requires  from commercial drivers with medical conditions, federal law requires  medical examiners to certify that commercial drivers are medically fit to  medical examiners to certify that commercial drivers are medically fit to  operate their vehicles. Specifically, the Department of Transportation  operate their vehicles. Specifically, the Department of Transportation  (DOT) requires commercial drivers to undergo a medical physical  (DOT) requires commercial drivers to undergo a medical physical  examination at least every 2 years. As part of this medical physical, DOT  examination at least every 2 years. As part of this medical physical, DOT  regulations establish standards that the medical examiner must follow to  regulations establish standards that the medical examiner must follow to  determine a driver’s fitness including reviewing the driver’s medical  determine a driver’s fitness including reviewing the driver’s medical  history, performing key medical tests (such as vision and hearing tests),  history, performing key medical tests (such as vision and hearing tests),  and conducting a physical examination of the commercial driver.  and conducting a physical examination of the commercial driver.  Notwithstanding these written regulations, medical examiners must still  Notwithstanding these written regulations, medical examiners must still  exercise judgment in determining whether individuals are medically fit to  exercise judgment in determining whether individuals are medically fit to  drive commercial vehicles, such as people whose serious medical  drive commercial vehicles, such as people whose serious medical  conditions make them eligible for federal disability benefits.  conditions make them eligible for federal disability benefits.
Not all serious medical conditions interfere with the safe operation of a  Not all serious medical conditions interfere with the safe operation of a  commercial vehicle. However, some serious medical conditions can and  commercial vehicle. However, some serious medical conditions can and  should disqualify a driver from being medically certified according to DOT  should disqualify a driver from being medically certified according to DOT  regulations.  regulations.
It is unknown to what extent individuals with serious medical conditions  It is unknown to what extent individuals with serious medical conditions  hold CDLs and whether there are situations of medically unfit individuals  hold CDLs and whether there are situations of medically unfit individuals  who hold a CDL. In this context, you asked us to (1) determine to the  who hold a CDL. In this context, you asked us to (1) determine to the  extent possible the number of individuals holding a current CDL who have  extent possible the number of individuals holding a current CDL who have  serious medical conditions, and (2) provide case-study examples of  serious medical conditions, and (2) provide case-study examples of  commercial drivers who hold an active CDL despite having a medical  condition that should disqualify them from obtaining a CDL.
To explore the overlap between CDL holders and people with serious  medical conditions, we identified individuals who were in both DOT’s  Commercial Driver License Information System (CDLIS) database and  selected federal disability databases. We presumed that individuals  receiving full federal disability benefits were eligible for these benefits  because of the seriousness of their medical conditions.  DOT’s CDLIS  database contains an archive of all CDLs reported to DOT by the states.  We obtained this database and compared the CDL holders from CDLIS  with the disability recipients of selected federal programs administered by  the Social Security Administration (SSA), Department of Veterans Affairs  (VA), Office of Personnel Management (OPM), and Department of Labor  (DOL). Specifically, we identified CDL holders that are both currently  receiving disability benefits and have been identified as 100 percent  disabled according to the program’s criteria. We further analyzed the  recipient files to extract those medical conditions that would likely  disqualify a driver from a CDL, such as deafness and epilepsy. Because  CDLIS contains inactive CDLs in its population, we obtained data of active  CDLs from a nonrepresentative selection of 12 states to identify those CDL  holders in CDLIS that have an active CDL. Further, because commercial  drivers may contract a serious medical condition after the issuance of the  CDL, we determined the number of individuals that received their CDL  subsequent to the federal agencies determination that the individual is  eligible for full benefits due to their medical condition. In addition, our  estimate does not include drivers with severe medical conditions that are  not in the selected federal programs we analyzed.
To provide case-study examples of commercial drivers who hold active  CDLs and also receive full federal benefits due to a CDL disqualifying  medical condition, we focused on four states as agreed to with your  staff—Florida, Maryland, Minnesota, and Virginia. From these four states,  we selected, for detailed investigation, 15 commercial drivers that we  identified based on our data analysis and mining. For each case, we  interviewed, as appropriate, the commercial driver, the driver’s employer,  and the driver’s physician to determine whether, under current DOT  regulations and guidelines, the medical condition should have precluded  the driver from holding a valid CDL. For these 15 cases, we also reviewed  relevant state department of motor vehicle reports, police reports, and  other public records.
We performed our investigative work from May 2007 to June 2008 in  accordance with standards prescribed by the President’s Council on  Integrity and Efficiency. A detailed discussion of our scope and  methodology is presented in appendix I.
subsections: section_title: Background
paragraphs: The loss of lives and property resulting from commercial motor vehicle  accidents has been a focus of public concern for several years. In 2006,  about 5,300 people died as a result of crashes involving large commercial  trucks or buses, and about 126,000 more were injured. A recent study  performed by DOT showed that a significant number of commercial driver  crashes were due to a physical impairment of the driver. Specifically, DOT  found that about 12 percent of the crashes where the crash cause could be  identified were due to drivers falling asleep, being disabled by a heart  attack or seizure, or other physical impairments.
The Federal Motor Carrier Safety Administration (FMCSA) within DOT  shoulders the primary federal responsibility for reducing crashes, injuries,  and fatalities involving large trucks and buses. FMCSA’s primary means of  preventing these crashes is to develop and enforce regulations to help  ensure that drivers and motor carriers are operating in a safe manner.  FMCSA’s regulations, among other things, require that drivers of  commercial motor vehicles are 21 years old, can read and speak the  English language, have a current and valid commercial motor vehicle  operator’s license, have successfully completed a driver’s road test, and  are physically qualified to drive. As part of these regulations, FMCSA  established standards for the physical qualifications of commercial  drivers, including the requirement of a medical certification from a  medical examiner stating that the commercial driver is physically qualified  to operate a commercial motor vehicle. See appendix II for a description  of the federal medical requirements.
The National Transportation Safety Board (NTSB), an independent  federal agency that investigates transportation accidents, considers the  medical fitness of commercial drivers a major concern. Over the past  several years, NTSB has reported on serious flaws in the medical  certification process of commercial drivers. NTSB stated that these flaws  can lead to increased highway fatalities and injuries for commercial  vehicle drivers, their passengers, and the motoring public.
In 2001 NTSB recommended eight safety actions to improve the oversight  of the medical certification process, in response to a bus crash that killed  22 people in Louisiana. According to NTSB, currently all eight of the  recommendations remain open. In response to FMCSA’s failure to  adequately address NTSB’s recommendations, NTSB placed the oversight  of medical fitness on its “Most Wanted” list in 2003. Table 1 details each of  NTSB’s recommendations.
Several fatality crashes highlight the need for and the importance of  having an effective medical certificate process. For example,  In July 2000, a truck collided with a Tennessee Highway Patrol vehicle  protecting a highway work zone. The patrol car exploded at impact,  killing the state trooper. The driver of the truck had previously been  diagnosed with sleep apnea and hypothyroidism, and had a similar  crash in 1997, when he struck the rear of a patrol car in Utah. NTSB  stated that it believes that if a comprehensive medical oversight  program been in place at the time of the accident, this driver, with  known and potentially incapacitating medical conditions, would have  been less likely to have been operating a commercial vehicle. This  accident, the NTSB said, “demonstrates how easily unfit drivers are  able to take advantage of the inadequacies of the current medical  system, resulting in potentially fatal consequences.”
In May 2005, a truck collided with a sports utility vehicle in Kansas  killing a mother and her 10-month-old baby. Prior to the accident, a  physician diagnosed the truck driver with a severe form of sleep apnea.  The truck driver subsequently went to another physician who issued  the medical certificate because the driver did not disclose this illness.  The truck driver was found guilty of two counts of vehicular  manslaughter.
In August 2005 in New York, a truck collided with a motor vehicle,  killing the occupants. The truck driver admitted to forging a medical  certificate required to get his CDL license because he had been  diagnosed with a seizure disorder. The truck driver recently pled guilty  of two counts of manslaughter.
section_title: Serious Medical Conditions and Commercial Driver Licenses
paragraphs: Commercial drivers with serious medical conditions can still meet DOT  medical fitness requirements to safely operate a commercial vehicle and  thus hold CDLs. However, there is general agreement that careful medical  evaluations are necessary to ensure that serious medical conditions do not  preclude the safe operation of a commercial vehicle. It is impossible to  determine from data analysis which commercial drivers receiving  disability benefits have a medical condition that precludes them from  safely driving a commercial vehicle because medical determinations are  largely based on subjective factors that are not captured in databases. As  such our analysis provides a starting point for exploring the effectiveness  of the current CDL medical certification process.
Our analysis of DOT data and disability data from the four selected federal  agencies, SSA, VA, OPM, and DOL, found that about 563,000 individuals  had been issued CDLs and were receiving full medical disability benefits.  This represented over 4 percent of all CDLs in the DOT database.  However, because DOT’s database does include drivers that had  suspended, revoked, or lapsed licenses, the actual number of active  commercial drivers that receive full federal disability benefits cannot be  determined. Also, our analysis does not include drivers with severe  medical conditions that are not in the specific disability programs we  selected.
The majority of the individuals with serious medical conditions from our  12 selected states had an active CDL. Specifically, as shown in figure 1, of  the 563,000 CDL holders receiving full disability benefits, about 135,000 of  those individuals were from our 12 selected states. About 114,000 of these  135,000 individuals, or about 85 percent, had an active CDL according to  CDL data provided by the 12 selected states.
Further, our analysis of the state CDL data indicates that most of the  licenses were issued after the commercial driver was found to be eligible  for full disability benefits. Specifically, about 85,000 of the 135,000  individuals, or about 63 percent, had their CDL issued after the federal  agency determined that the individual met the federal requirements for full  disability benefits according to data from our four selected federal  agencies. See appendix III for details for each selected state for the  number of (1) commercial drivers with active CDLs, (2) commercial  drivers with an active CDL even though they had a medical condition from  which they received full federal disability benefits, and (3) commercial  drivers that were issued a CDL after the driver was approved for full  federal disability benefit payments.
Because much of the determination of the medical fitness of commercial  drivers relies on subjective factors, and because there are ways to  circumvent the process (as shown below), it is impossible to determine  the extent to which these commercial drivers have a medical condition  that would preclude them from safely driving a commercial vehicle. As  such our analysis provides a starting point for exploring the effectiveness  of the current CDL medical certification process. However, because these  individuals are receiving full disability benefits, it is likely that these  medical conditions are severe. Further, our analysis also showed that over  1,000 of these drivers are diagnosed with vision, hearing, or seizure  disorders, which are medical conditions that would routinely deny the  granting of a CDL.
section_title: Examples of Commercial Drivers with Serious Medical Conditions
paragraphs: Our investigations detail examples of 15 cases where careful medical  evaluations did not occur on commercial drivers who were receiving full  medical disability benefits. The case studies were selected from  approximately 30,000 individuals from Florida, Maryland, Minnesota, and  Virginia that had their CDL issued after the federal agency determined that  the individual met the federal requirements for full medical disability  benefits. For all 15 cases, we found that the states renewed the drivers’  CDLs after the drivers were found by the federal government to be eligible  for full disability benefits. For more detailed information on criteria for  selection of the 15 cases, see appendix I.
On the basis of our investigation of these 15 cases, we identified instances  where careful medical examinations did not occur. Most states do not  require commercial drivers to provide medical certifications to be issued a  CDL. Instead, many states only require individuals to self-certify that a  medical examiner granted them a medical certification allowing them to  operate commercial vehicles, thus meeting the minimum federal  requirements. As a result, we found several commercial drivers who  made false assertions on their self-certification that they received a  medical certification when in fact no certification was made. For more  information on state requirements for medical certifications, see appendix  IV.
In addition, our investigations found that commercial drivers produced  fraudulent documentation regarding their medical certification.  Specifically, we found instances where commercial drivers forged a  medical examiner’s signature on a medical certification form. In addition,  we also found a driver who failed to disclose to the medical examiner that  another doctor had prescribed him morphine for his back pain.
Finally, our investigations found certain medical examiners did not follow  the federal requirements in the determination of medical fitness of  commercial drivers. For example, one medical examiner represented to  GAO that she did not know that a driver’s deafness would disqualify the  individual from receiving a medical certification.
Table 2 highlights 5 of the 15 drivers we investigated. For all cases we  investigated, the CDL was issued after the driver’s disability benefits  started. Appendix V provides details on the other 10 cases we examined.  We are referring all 15 cases to the respective state driver license agency  for further investigation.
The following provides illustrative detailed information on three of the  cases we examined.
Case 1: A bus driver in Maryland has been receiving Social Security  disability benefits since March 2006 due to his heart conditions.  Specifically, the driver had open heart surgery in 2003 to repair a ruptured  aorta, had a stroke in 2005, and shortly thereafter had another surgery to  replace a heart valve. In June 2006, approximately 3 months after Social  Security determined the driver was fully disabled; the Maryland driver  license agency renewed his CDL for 5 years with a “Passenger”  endorsement. The bus driver provided our investigator a forged medical  certificate. Specifically, we found that  the medical certificate did not have the required medical license  number,  the physician did not have any record that the bus driver underwent a  medical examination for a CDL, and  the physician denied conducting a CDL medical exam or signing the  medical certificate.
Surprisingly, the medical practice also had a copy of the forged medical  certificate in its files. The medical practice’s staff stated, however, that it is  not uncommon for a patient to bring documents to the office and ask that  they be stored in their medical records. The driver’s CDL does not expire  until 2011.
Case 2: A Virginia truck driver has received SSA disability benefits for  over 10 years. The driver’s disability records indicate that that driver had  multiple medical conditions, including complications due to an  amputation, and that the driver is “also essentially illiterate.” The truck  driver has a prosthetic right leg resulting from a farm accident. Although  the driver possesses a current medical certificate, the medical examiner  did not specify on the medical certificate that it is only valid when  accompanied with a Skills Performance Evaluation (SPE) certificate. To  test his prosthetic leg, the truck driver stated that he was asked to push  the medical examiner across the room in a rolling chair with the prosthetic  leg. In our investigation, we attempted to contact the medical examiner  but discovered that he is no longer employed by that clinic. The state  revoked his medical license due to illegally distributing controlled  substances.
In 2006, the truck driver was involved in a single vehicle accident when the  load in his truck shifted when making a turn and the truck overturned.  Prior to October 2007, the truck driver had a CDL with both “Tanker” and  “Hazmat” endorsements. In October 2007, the state driver license agency  renewed his CDL with a “Tanker” endorsement, which will not expire until  2012.
Case 3: A bus driver has been receiving Social Security disability benefits  since 1994 for chronic obstructive pulmonary disorder (COPD). The bus  driver currently uses three daily inhalers to control his breathing and has a  breathing test conducted every 6 months. The bus driver stated that he  “gets winded” when he walks to his mailbox and he “occasionally blacks  out and forgets things.” However, the driver stated that he has no problem  driving a bus, however, he cannot handle luggage or perform any other  strenuous duties.
Despite not possessing a valid medical certificate, companies continue to  hire him as a bus driver on an ad hoc basis. For example, the driver drove  a passenger bus as recently as 1 month prior to the time of our interview.  The driver stated that the companies have not asked to see his medical  certificate. He further stated that because most companies are “hurting for  drivers,” they “don’t ask a lot of questions” and pay many of their drivers in  cash. The driver’s CDL expires in 2010.
section_title: Agency Comments and Our Evaluation
paragraphs: We provided a draft of our report to DOT for review and comment. We  received e-mail comments on the draft on June 16, 2008, from FMCSA’s  Office of Medical Programs. In FMCSA’s response, FMCSA stated that our  first objective implies that individuals who are fully disabled have severe  medical conditions that may also prevent safe driving. FMCSA stated the  following:    Disability, even full disability associated with a diagnosis, does not  necessarily mean that an individual is medically unfit to operate a  commercial vehicle.
Disability is not related necessarily to when a medical condition  occurred or recurs. The onset of a disease or disabling medical  condition is more relevant to medical fitness than when the disability  benefits and payments began.  As an example, a fully disabled  individual may have accommodated to the disability and may improve  with treatment while receiving lifelong disability payments.
In general, a medical diagnosis alone is not adequate to determine  medical fitness to operate a commercial vehicle safely.  As an example,  multiple sclerosis, while disabling, has several progressive phases, and  is not necessarily disqualifying.
In addition, FMCSA did not believe that we accurately characterized the 15  cases where careful medical evaluations did not occur. FMCSA stated that  this implies these drivers were evaluated by someone for medical fitness  for duty, but in 9 cases, the driver was not certified or not evaluated by a  medical examiner.
We believe our report clearly acknowledges that it is impossible to  determine the extent to which these commercial drivers have medical  conditions that would preclude them from safely driving a commercial  vehicle. In the report, we state that commercial drivers with serious  medical conditions can still meet DOT medical fitness requirements to  safely operate a commercial vehicle and thus hold CDLs. Further, our  report acknowledged that because medical determinations rely in large  part on subjective factors that are not captured in databases, it is  impossible to determine from data mining and matching the extent to  which commercial drivers have a medical condition that precludes them  from safely driving a commercial vehicle and therefore if the certification  process is effective. Thus, our analysis provides a starting point for  exploring the effectiveness of the current CDL medical certification  process.
We also believe that we fairly characterize that all 15 cases did not have a  careful medical evaluation. For all 15 cases that we reviewed, we found  that the medical evaluation was not adequate or did not occur. Thus, we  conclude that a careful medical evaluation did not occur for all 15 drivers  in our case studies.
FMCSA also provided us a technical comment which we incorporated in  the report.
As agreed with your offices, unless you publicly release its contents earlier  we plan no further distribution of this report until 30 days from its date. At  that time, we will send copies of this report to the Secretary of  Transportation. We will make copies available to others upon request. In  addition, the report will be available at no charge on the GAO Web site at  http://www.gao.gov.
Please contact me at (202) 512-6722 or kutzg@gao.gov if you have any  questions concerning this report. Contact points for our Offices of  Congressional Relations and Public Affairs may be found on the last page  of this report. GAO staff who made key contributions to this report are  listed in appendix VI.
section_title: Appendix I: Scope and Methodology
paragraphs: To determine to the extent possible the number of individuals holding a  current commercial driver license (CDL) who have serious medical  conditions, we presumed that individuals receiving full federal disability  benefits were eligible for these benefits because of the seriousness of their  medical conditions.  As such, we obtained and analyzed the Department of  Transportation’s (DOT) Commercial Driver License Information System  (CDLIS) database as of May 2007. For the Social Security Administration  (SSA) and the Department of Veterans Affairs (VA) we provided the CDLIS  commercial driver information to those agencies. SSA and VA then  matched the commercial drivers to the individuals receiving benefits for  their disability programs and provided us those results. We also obtained  and analyzed the recipient files for four additional federal disability  programs. These include the Office of Personnel Management’s (OPM)  civil service retirement program and the three programs administered by  the Department of Labor: Black Lung, Federal Employee Compensation  Act, and the Energy Employees Occupational Illness Compensation  Program. We matched the CDL holders from CDLIS to the four federal  disability recipient files based on social security number, name, and date  of birth. We further analyzed the CDL and disability data to ensure that the  commercial drivers met the following criteria:  the individual must be currently receiving disability benefits, and  the individual must be identified as 100 percent disabled according to  the program’s criteria.
Because CDLIS is an archival database, the CDLIS data contain  information on expired CDLs. To identify the active drivers within CDLIS,  we obtained CDL data from a nonrepresentative selection of 12 states. The  12 selected states, representing about 42 percent of all CDLs contained in  CDLIS, are: California, Florida, Illinois, Kentucky, Maryland, Michigan,  Minnesota, Montana, Tennessee, Texas, Virginia, and Wisconsin. The 12  states were selected primarily based on the size of the CDL population.  Because commercial drivers may contract a serious medical condition  after the issuance of the CDL, we also determined the number of  individuals that received their CDL subsequent to when the federal  agencies determined the individual to be eligible for full disability benefits.  Our estimate does not include drivers with severe medical conditions that  are not in the selected programs we analyzed.
We matched the 12 state CDL files to the six CDLIS-disability match files  based on driver license number, and identified those CDLs that were  current based on license status.
To provide case-study examples of commercial drivers who hold active  CDLs while also receiving federal disability payments for a disqualifying  medical condition, we focused on four states—Florida, Maryland,  Minnesota, and Virginia. From these four states, we selected, in a  nonrepresentative fashion, 15 commercial drivers for detailed  investigation. We identified these driver cases based on our data analysis  and mining. For each case, we interviewed, as appropriate, the  commercial driver, the driver’s employer, and the driver’s physician to  determine whether the medical condition should have precluded the driver  from holding a valid CDL. For these 15 cases, we also reviewed state  department of motor vehicle reports, police reports, and other public  records.
subsections: section_title: Data Reliability
paragraphs: To determine the reliability of DOT’s CDLIS data, we used SSA’s  Enumeration and Verification System to verify key data elements in the  database that were used to perform our work.
For the federal disability databases, we assessed the reliability of the data  from SSA and VA, which comprise 99 percent of the CDLIS-disability  matches. To verify its reliability, we reviewed program logic used by the  agencies to match the CDLIS data with their federal disability recipients.  We also reviewed the current Performance and Accountability Reports for  the agencies to verify that their systems had successfully undergone the  required stewardship reviews.
For the 12 selected states’ CDL databases, we performed electronic testing  of the specific data elements in the database that were used to perform  our work. In addition, for 5 of the 12 states we verified the query logic  used to create the CDL extract files. For the other 7 states we were unable  to obtain the query logic.
We performed our investigative work from May 2007 to June 2008 in  accordance with standards prescribed by the President’s Council on  Integrity and Efficiency.
section_title: Appendix II: Medical Certificate Requirements
paragraphs: Federal regulations require that commercial drivers be examined and  certified by a licensed medical examiner, such as licensed physician,  physician’s assistant, and nurse practitioner, to ensure they meet minimum  physical qualifications prior to driving. It is the responsibility of both  drivers and motor carriers employing drivers to ensure that drivers’  medical certificates are current. According to federal regulations, the  medical examiner must be knowledgeable about the regulatory physical  qualifications and guidelines as well as the driver’s responsibilities and  work environment. In general, the medical certification procedures  include the following steps:    The driver completes and certifies a medical certification form that  includes information about the driver’s health history. The form is  provided to the medical examiner as part of the examination.
The medical examiner discusses the driver’s health history and the side  effects of prescribed medication and common over-the-counter  medications.
The medical examiner tests the driver’s vision, hearing, blood pressure,  pulse rate, and urine specimen (for testing sugar and protein levels).
The medical examiner conducts a physical examination and makes a  determination on driver fitness.
If the medical examiner determines the driver is fit to drive, he/she  signs the medical certificate, which the driver must carry with his/her  license. The certificate must be dated. The medical examiner keeps a  copy in his/her records, and provides a copy to the driver’s employer.
When the medical examiner finds medical conditions that prevent  certification of the physical condition of the driver and this finding is in  conflict with the findings of another medical examiner or the driver’s  personal physician, the driver can apply to the Federal Motor Carrier  Safety Administration (FMCSA) for a determination.
Federal regulations and the accompanying medical guidance provide  criteria to the medical examiners for determining the physical condition of  commercial drivers. Although the medical examiner makes the  determination as to whether the driver is medically fit to operate a  commercial vehicle, the following provides a general overview of the  nature of the physical qualifications:    no loss of physical limbs, including a foot, a leg, a hand, or an arm;   no impairment of limbs that would interfere with grasping or their  ability to perform normal tasks;    no established medical history or clinical diagnosis of diabetes  currently requiring insulin for control, respiratory dysfunction, or high  blood pressure that would affect their ability to control or drive a  commercial motor vehicle;    no current diagnosis of a variety of coronary conditions and  cardiovascular disease including congestive heart failure;    no mental disease or psychiatric disorder that would interfere with  their ability to drive a commercial vehicle safely;    has distant visual acuity and hearing ability that meets stated    does not use a controlled substance or habit-forming drug; and   has no current clinical diagnosis of alcoholism.
When operating a commercial motor vehicle, drivers must have a copy of  the medical examiner’s certificate in their possession. Motor carriers, in  turn, are required to maintain a copy of the certificate in their files. When  drivers are stopped for a roadside inspection, state inspectors can review  the medical examiner’s certificate. During compliance reviews of motor  carriers, FMCSA investigators may also verify the validity of medical  certifications on file with the motor carrier.
section_title: Appendix III: Information on Commercial Drivers for the 12 Selected States
paragraphs: In the main portion of the report, we state that from the 12 selected states  114,000 commercial drivers had a current commercial driver license (CDL)  even though they had a medical condition from which they received full  federal disability benefits. Further, approximately 85,000, or about 63  percent of the active commercial drivers, were issued a CDL after the  driver was approved for full federal disability benefit payments. Table 3  below provides details by each selected state on the number of   (1) commercial drivers with active CDLs, (2) commercial drivers with an  active CDL even though they had a medical condition from which they  received full federal disability benefits, and (3) commercial drivers that  were issued a CDL after the driver was approved for full federal disability  benefit payments.
section_title: Appendix IV: Methods Used by States to Verify Commercial Driver Medical Certification
paragraphs: The states have adopted different levels of control to verify that  commercial driver license applicants meet the Department of  Transportation (DOT) medical certification requirements. As shown in  figure 2, 25 states, or 50 percent, allow drivers to self-certify that they meet  the requirements. The self-certification is often simply a check-box on the  application. Eighteen states, or 36 percent, require that the commercial  driver show the DOT medical certificate to the driver licensing agency at  the time of application. Further, 6 states, or 12 percent, not only require  that the driver show the DOT medical certificate at the time of application  but also maintain a copy of the certificate in the driving records of the  applicant. Finally, 1 state did not respond to the inquiries.
section_title: Appendix V: Commercial Drivers with Serious Medical Conditions
paragraphs: Table 2 in the main portion of the report provides information on five  detailed case studies. Table 4 shows the remaining case studies that we  investigated. As with the five cases discussed in the body of this testimony,  we found drivers with a valid commercial driver license (CDL) who also  had serious medical conditions.
section_title: Appendix VI: Staff Acknowledgments
paragraphs: GAO staff who made major contributions to this report include Matthew  Valenta, Assistant Director; Sunny Chang; Paul DeSaulniers; Craig Fischer;  John V. Kelly; Jeffrey McDermott; Andrew McIntosh; Andrew O’Connell;  Philip Reiff; Nathaniel Taylor; and Lindsay Welter.