Highway Safety: Selected Cases of Commercial Drivers with Potentially Disqualifying Impairments
Released: 2012-11-30T00:00:00


Highlights: section_title: Why GAO Did This Study
paragraphs: Commercial vehicles such as tractor trailers and school buses must be operated by skilled drivers who are mentally and physically capable of performing their jobs safely. Prior GAO work has shown weaknesses in DOT’s oversight of CDLs, such as inadequate medical certifications for commercial drivers, potentially putting the public at risk.

GAO was asked to update its work on impaired commercial drivers. This report describes (1) key controls designed to prevent medically unfit or impaired commercial drivers from operating commercial vehicles and (2) examples of commercial drivers with potentially disqualifying impairments related to epilepsy, drugs, or alcohol.

To identify key controls, GAO reviewed FMCSA policies and regulations, and interviewed officials. Cases were identified on the basis of FMCSA roadside-inspection data, DOT’s Commercial Driver License Information System (CDLIS), a national database of all commercial drivers, and SSA disability insurance files. From this analysis, GAO identified commercial drivers who were driving with an epilepsy diagnosis. GAO also randomly selected 100 individuals to determine whether the driver was receiving SSA disability benefits when the state issued or renewed the driver’s CDL. These cases cannot be generalized beyond those presented.

GAO provided a draft of this report to SSA and DOT. SSA did not have any comments. DOT provided technical comments, which have been addressed in the report, as appropriate.

section_title: What GAO Found
paragraphs: The Federal Motor Carrier Safety Administration (FMCSA), part of the Department of Transportation (DOT), has established a number of key controls designed to prevent commercial driver’s license (CDL) holders from operating commercial vehicles while impaired. First, drivers are required to undergo regular medical exams by a certified medical examiner. Second, employers are responsible for drug testing employees at various points of employment. Third, state and federal roadside-inspection programs are in place to identify impaired drivers and perform other safety checks. If these key controls are operating effectively, they will help identify commercial drivers who are not capable of driving safely. However, GAO’s prior work has found that these controls were vulnerable to abuse or manipulation. The Moving Ahead for Progress in the 21st Century Act, enacted in July 2012, will require additional measures to ensure that disqualified drivers do not operate commercial vehicles, and could help address some of these vulnerabilities. For example, the law requires DOT to implement a national clearinghouse of commercial-driver controlled-substance and alcohol test results by July 2014. DOT has also taken some actions, and now requires CDL holders to provide a copy of their medical certificates to the State licensing agency.

Matching CDL holders with Social Security Administration (SSA) disability files produced 204 commercial drivers who drove a commercial vehicle as recently as 2011 despite having epilepsy, a disqualifying medical condition characterized by sudden seizures and unconsciousness. Thirty-one of these drivers were involved in accidents, demonstrating the threat to public safety posed by medically impaired drivers. GAO also identified 23 cases where state licensing agencies issued or renewed CDLs for drivers after they were, according to SSA records, diagnosed with epilepsy or had drug or alcohol dependence noted, which could also disqualify them from driving under DOT regulations.

However, because DOT did not require state licensing agencies to maintain drivers’ medical certifications at the time of GAO’s review, it is unlikely that states knew of the drivers’ conditions. In fact, they were unable to provide medical certifications for any of the 23 individuals. States are now required to electronically store medical certificates for new and renewing CDL applicants and will be required to electronically maintain this information for all CDL holders by January 2014. Doing so could help prevent ineligible drivers from obtaining or renewing CDLs in the future.

section_title: Letter
paragraphs: Millions of Americans hold commercial driver’s licenses (CDL), allowing  them to operate tractor trailers, school buses, cargo vans, or other  commercial vehicles on our nation’s roads and highways. The Federal  Motor Carrier Safety Administration (FMCSA) establishes regulations and  oversees the safe operation of commercial vehicles, including preventing  crashes, injuries, and fatalities. FMCSA partners with states to conduct  roadside inspections and oversee CDLs in adherence to minimum federal  requirements and guidance established by the Motor Carrier Safety  Improvement Act of 1999.

Commercial vehicles—large, and sometimes transporting hazardous  materials—must be operated by skilled drivers who are mentally and  physically capable of performing their jobs safely—any impairment can  pose significant dangers to the public. Therefore, FMCSA regulations  require that commercial drivers be tested for drug and alcohol use and  undergo medical fitness certifications. Drug and alcohol testing is required  before employment, randomly while employed, and after an accident  where the CDL driver was at fault. Physical examinations, including vision  and hearing tests and a review of the driver’s medical history, must be  conducted by a medical examiner at least every 2 years.

Over the past decade, the National Transportation Safety Board (NTSB)  and others have reported gaps in enforcing drug and alcohol testing and  medical fitness of commercial drivers. For example, the NTSB reported  that commercial drivers could job-hop from one employer to another to  hide their positive drug tests and that self-reporting positive drug test  results would not effectively identify problem drivers. To address some of  these gaps, in July 2012 the Moving Ahead for Progress in the 21st  Century Act (MAP-21) was enacted into law,implementation of additional measures to ensure that the highest-risk  drivers do not operate commercial vehicles. For example, the law  requires the Department of Transportation (DOT) to implement a national  clearinghouse of commercial driver controlled-substance and alcohol test  results by July 2014 and a national registry of medical examiners qualified  to certify commercial driver fitness by July 2013.

Given that new requirements are not due to be implemented until 2013,  you asked us to describe (1) current key controls designed to prevent  medically unfit or impaired commercial drivers from operating commercial  vehicles and (2) examples of commercial drivers with potentially  disqualifying impairments related to epilepsy, drugs, or alcohol.

To describe key controls, we reviewed FMCSA’s policies and regulations  as well as legislation related to medical requirements and drug and  alcohol testing for commercial drivers. We also reviewed prior GAO  reports and other studies concerning the enforcement of drug and alcohol  testing and medical fitness of commercial drivers. Further, we interviewed  FMCSA officials about agency plans to improve the identification of these  drivers. To examine cases of commercial drivers with potentially  disqualifying impairments related to epilepsy, drugs, or alcohol, we  matched data from the Social Security Administration’s (SSA) disability  insurance database as of December 2010 to the Commercial Driver  License Information System (CDLIS) as of 2011inspection data from the FMCSA’s Motor Carrier Management Inspection  System (MCMIS). Because the number of cases examined was not  drawn from a statistical sample, none of our case selections provide  information that can be generalized beyond the specific cases provided.

To identify commercial drivers who had been involved in a crash or  roadside inspection involving a commercial motor vehicle who had an  impairment based on the severity of their epilepsy, we matched crash and  inspection data from MCMIS with individuals who were receiving SSA  disability benefits on the basis of an epilepsy impairment. We randomly  selected nine of these drivers for more in-depth review.CDLIS and SSA data to identify examples of individuals who renewed or  obtained a new CDL with medical impairments related to epilepsy, drugs,  or alcohol. We matched the Social Security number of CDL holders from  CDLIS to individuals in the Social Security Administration (SSA) disability  insurance files who were eligible for disability benefits. From this match,  we extracted 13,281 individuals who had a primary or secondary  impairment for epilepsy or where drug or alcohol dependence was noted  in SSA’s electronic file. However, CDLIS includes drivers who have  inactive CDLs, so we randomly made a nongeneralizable selection of 100  individuals to identify drivers who had an active CDL at the time SSA  determined their disability began. For these 100 cases, we obtained and  reviewed individuals’ state driving records and SSA disability records, and  requested CDL medical-examination reports and certificates from the  respective states.

We assessed the reliability of the data file that FMCSA and SSA provided  by performing electronic data testing for errors in accuracy and  completeness, reviewing existing information about the data and the  system that produced the data, and interviewing agency officials  knowledgeable about the data. We determined that the data were  sufficiently reliable for the purposes of this report.

We conducted this performance audit from December 2010 to November  2012 in accordance with generally accepted government auditing  standards. Those standards require that we plan and perform the audit to  obtain sufficient, appropriate evidence to provide a reasonable basis for  our findings and conclusions based on the audit objectives. We believe  that the evidence obtained provides a reasonable basis for our findings  and conclusions based on our audit objectives.
subsections: section_title: Background
paragraphs: FMCSA establishes regulations for the physical and medical qualifications  of CDL holders, develops standards to test and license commercial motor  vehicle drivers, and enforces commercial motor vehicle safety  regulations. Commercial drivers must be 21 years old to operate in  interstate commerce, read English, have successfully completed a  driver’s road test, be physically qualified to drive if operating in  nonexcepted interstate commerce, and hold a current and valid CDL.  Commercial drivers in intrastate commerce may operate commercial  vehicles at 18 years old, if permitted by state law. They must also have no  mental disease or psychiatric disorder that would interfere with their ability  to safely drive a commercial vehicle, not use a controlled substance or  habit-forming drug, and have no current clinical diagnosis of alcoholism. A  commercial driver may use a legal non-Schedule I drug or substance if  the drug or substance is prescribed by a licensed medical practitioner  who is familiar with the driver’s medical history, and has advised the  driver that the prescribed substance or drug will not adversely affect the  driver’s ability to safely operate a commercial motor vehicle.

Violations for impaired drivers can result in a range of penalties against  CDL holders. For example, a first conviction of driving under the influence  of alcohol or a controlled substance, regardless of whether it occurs in a  commercial or personal vehicle, results in immediate CDL suspension by  the issuing state for 12 months. A second results in permanent  suspension. Licensing states are required to maintain driver records  showing convictions for disqualifying federal violations and are to  disqualify commercial drivers convicted of those violations while driving a  commercial vehicle. Information on CDL holders must be exchanged  among states through a nationwide system. The CDLIS is a nationwide  computer system that, among other things, enables state driver-licensing  agencies to ensure that each commercial driver has only one driver’s  license and one complete driver record. State driver-licensing agencies  use CDLIS to complete various procedures, including transmitting out-of- state convictions and transferring the driver record when a commercial  driver’s license holder moves to another state.

section_title: FMCSA Controls for Commercial Drivers Include Medical Exams, Drug and Alcohol Testing, and Roadside Inspections
paragraphs: FMCSA has established a number of key controls that are designed to  prevent CDL holders from operating commercial vehicles while impaired  that generally cover three areas. First, drivers are required to undergo  regular medical exams by a certified medical examiner to determine if a  driver is physically qualified to operate a commercial vehicle. Second,  employers are responsible for drug testing employees at various points of  employment. Independent self-employed commercial vehicle operators  are required to meet drug testing requirements by being enrolled in a  random testing pool that includes other drivers and is managed by a  consortium or third-party administrator that provides drug or alcohol  testing services to DOT-regulated employers. Third, state and federal  roadside-inspection programs are intended to identify impaired drivers  and perform other safety checks. While our review did not evaluate  whether these controls were working as intended, in prior work we have  found that these controls were vulnerable to abuse or manipulation. With  the enhanced statutory authority and direction provided by the MAP-21  Act, DOT may be able to address some of these vulnerabilities. DOT is  required to issue implementing regulations by July 2014.
subsections: section_title: Medical Exams Are Used to Determine Drivers’ Physical Fitness to Operate a Commercial Motor Vehicle
paragraphs: FMCSA has established regulatory standards that require interstate  commercial drivers to be examined and certified by a licensed medical  examiner. The exams assess whether a driver meets minimum physical  qualifications before obtaining a CDL. The exams are generally repeated  at least every 2 years. Medical examiners must review the driver’s  medical history; perform vision, hearing, blood pressure, and other such  tests; and conduct a physical exam. The medical examiner must also  determine that the driver does not use any drugs or controlled substances  identified as a Schedule I drug. A CDL driver cannot use any non- Schedule I drug or controlled substance except when the drug or  substance has been prescribed by a licensed medical provider who is  familiar with the driver’s medical history and has determined that its use  would not adversely affect the driver’s ability to operate a commercial  vehicle. According to DOT, medical examiners do not give drivers drug or  alcohol tests and largely base determinations on the physical examination  and driver identification of prescribed medications, alcohol, or illegal drug  use information included in the examination form.

If a medical examiner deems a driver fit to drive, the examiner must sign  and date a medical certificate. The medical examiner also keeps a paper  copy of the signed certificate and may provide another copy to the driver’s  employer if requested. As of January 30, 2012, individuals renewing or  applying for a CDL must submit a copy of their current medical certificate  to their state licensing agency, making state licensing agencies  responsible for ensuring that drivers have current medical certificates on  file. FMCSA does not maintain a copy or record of the medical  certificates.

GAO, Certification Process for Drivers with Serious Medical Conditions, GAO-08-826  (Washington, D.C.: June 30, 2008). the medical certification information on the electronic driving record.  The medical certificate information could then be reviewed during a  roadside inspection via a check of the driving record, such as through  the CDLIS. In the instance of a driver who fails to renew his medical  certificate on time, the States are required to downgrade the  individual’s CDL so that he must not operate a commercial motor  vehicle until a valid medical certificate has been submitted to the State  licensing agency.

In April 2012, FMCSA published a final rule establishing a National  Registry of Certified Medical Examiners.  The 2012 final rule  provides requirements for all healthcare professionals responsible for  issuing medical certificates for interstate truck and bus drivers to  complete a training course on the Federal physical qualifications rules  and to pass an examination to assess the examiners ability to apply  the rules, and advisory criteria in a consistent manner when making  the determination whether a driver meets the qualification standards.

FMCSA has announced its plans to initiate a new rulemaking that  would enable the agency to require medical examiners on the  National Registry to submit to the agency the medical certificate  information on each individual who applies for a medical certificate.  The agency would then have the ability to transmit to the state driver  licensing agency the medical certificate. This process will significantly  decrease the likelihood of drivers being able to falsify medical  certificates.

When implemented, these requirements could help improve the control  vulnerabilities identified in our prior work by ensuring that proper medical  reviews are conducted and medical certificates are prepared by qualified  medical examiners. However, additional work would need to be  conducted to assess their effectiveness.

section_title: Drug and Alcohol Testing by Employers Is Designed to Identify Unqualified Drivers
paragraphs: FMCSA regulations also require CDL holders to undergo periodic drug  and alcohol testing to identify unqualified drivers. Employers must test all  CDL holders during preemployment screening; upon reasonable  suspicion; randomly on a specific percentage; after a serious accident in  which the driver was issued a traffic citation; and for all fatal accidents. In  addition, according to DOT, employers must request a wide range of  information from drivers’ previous employers as disclosed by the driver on  his or her application for employment and pertaining to the driver’s history  in the DOT drug and alcohol testing program.

Each year, employers are also required to conduct random alcohol tests  for at least 10 percent of their average number of driver positions, and  random controlled substance or drug testing for at least 50 percent of  their average number of driver positions. According to DOT, FMCSA may  increase or decrease these percentages on the basis of self-reported  drug and alcohol testing information from a sample of 2,000 employers.

FMCSA regulations follow Department of Health and Human Services  (HHS) employee drug testing requirements according to the Omnibus   They use urine tests  Transportation Employee Testing Act of 1991.covering five categories of drugs: marijuana, cocaine, amphetamines  (dexadrine, adderall), opiates (heroin, morphine, codeine), and  phencyclidine (PCP). Each year, employers must conduct alcohol tests  equal to at least 10 percent of the average number of CDL drivers.  Alcohol tests of either the driver’s breath or saliva must be performed  immediately before, during, or after the driver’s performance of safety- sensitive duties such as operating a commercial vehicle. Drug tests are  required to be analyzed by HHS-certified labs. All test results must be  reviewed by a board-certified medical review officer (MRO) before being  reported to the driver’s employer. The MRO will interview the driver to  determine if there is a medical explanation for the driver’s use of the  prohibited substance. If the driver provides appropriate documentation  and the MRO determines that the driver has a legitimate medical reason  for using the prohibited substance, the result is reported as negative to  his or her employer. The MRO is required to report any safety concerns to  the driver’s employer with regard to drug abuse and discuss the driver’s  use of any prohibited substances with the prescribing physician.

According to FMCSA regulations, the driver must be removed from  safety-sensitive duty if the MRO reports a positive drug or alcohol test  result to the driver’s employer. The driver cannot return to a safety- sensitive function, such as operating a commercial vehicle, until he or she  has completed the return-to-duty process, which includes being evaluated  by a substance-abuse professional, successfully complying with  prescribed education or treatment, and passing a return-to-duty alcohol or  drug test. FMCSA officials stated that follow-up testing to monitor the  driver’s continued abstinence from drug use is also required. FMCSA  regulations state that any driver, including independent self-employed  operators who refuse to submit to a drug or alcohol test are not permitted  to perform safety-sensitive functions until they complete a return-to-duty  process.

FMCSA officials stated that the results of drug tests are not directly  reported to FMCSA, but rather processed and maintained by the current  employers. Officials noted that FMCSA audits CDL employers for  compliance with FMCSA testing regulations.

In 2008, we reported examples of job hopping by commercial drivers who  failed a drug test. After losing employment for a positive test, job- hoppers then test negative on a preemployment test for another carrier  and return to duty. In each of the 19 cases of job hopping we reported in  our 2008 report, the second employer stated that knowledge of a previous  positive drug test would have disqualified the driver. Some of the19  drivers operated trucks carrying hazardous materials for periods of a  month to over a year. These 19 cases were not generalizable to the  population of CDL holders.

The MAP-21 Act could help improve the control vulnerabilities identified  by our prior work. Specifically, the law requires DOT to establish, operate,  and maintain a national clearinghouse with records relating to the results  of positive drug and alcohol tests of commercial drivers or instances of  refused tests. Once the clearinghouse has been established, employers  must request and review their CDL drivers’ records from the  clearinghouse annually. The MAP-21 Act also requires DOT to develop a  method to electronically notify an employer of each additional positive test  result or other noncompliance.

section_title: States and FMCSA Conduct Roadside Inspections to Identify Impaired Drivers and Perform Safety Checks
paragraphs: FMCSA also conducts commercial vehicle and driver inspections as part  of its roadside vehicle-inspection program. States can apply for Motor  Carrier Safety Assistance Program grant funds for financial assistance in  reducing the number and severity of crashes, injuries, and fatalities  involving commercial vehicles. According to DOT, as a condition of  receiving these funds, states must conduct these types of inspections. A  software program is made available by FMCSA to identify which drivers  or vehicles are recommended for inspection.

During an inspection, a FMCSA or state officer will generally examine the  vehicle and its equipment, as well as the driver’s license, medical  certificate, and whether the driver is under the influence of alcohol or a  prohibited drug. According to DOT, enforcement officials may demand to  see a driver’s medical certificate; however, they would not be able to  make an independent assessment of the driver’s medical condition  absent any obvious indications of a problem. The roadside inspector  would also only be able to address epilepsy or drugs and alcohol if the  driver exhibited certain signs. FMCSA officials stated that drivers found to  be using or possessing drugs or alcohol are reported into the MCMIS  system, and additional actions (such as arrests or “out of service”  indications in which the driver is immediately placed out of service and  prohibited from operating the vehicle) may occur. In fiscal year 2011, over  3.5 million roadside inspections were conducted in which over 7 million  violations were recorded, and of those violations, approximately 14  percent resulted in an out-of-service violation in which the driver, motor  vehicle, or motor carrier was placed out of service because of safety  issues.

In addition to the roadside-inspection program, FMCSA conducts annual  drug and alcohol strike-force sweeps. During the 2012 2-week sweep,  FMCSA identified 287 commercial drivers who did not adhere to federal  drug and alcohol regulations and who now face possible monetary fines  and disqualification from operating a commercial vehicle. FMCSA also  identified 128 truck and bus companies who now face possible  enforcement actions for violations such as hiring drivers who had tested  positive for illegal drugs and not implementing a drug and alcohol testing  program. By conducting these sweeps, FMCSA has taken positive steps  to help remove drivers that pose a risk to public safety from the road.

section_title: Examples of Commercial Drivers with Disqualifying Impairments Related to Epilepsy, Drugs, or Alcohol
paragraphs: We identified instances of drivers who operated—and sometimes  crashed—commercial vehicles despite having medical conditions such as  epilepsy. Epilepsy is a chronic disease characterized by seizures, loss of  bodily control, and unconsciousness. We also found instances of state  licensing agencies issuing or reissuing CDLs to commercial drivers with  epilepsy or drug or alcohol dependence noted in their medical histories.  FMCSA recommendations state that a person with an established history  or clinical diagnosis of epilepsy is not physically qualified to drive a  commercial vehicle for interstate commerce if he or she is taking  antiseizure medication or has had a history of epilepsy or seizures within  the past 10 years. These recommendations also state that individuals  who use a controlled substance or habit-forming drug or who have a  clinical diagnosis of alcoholism are not physically qualified to drive a  commercial vehicle. The MAP-21 Act requires medical-certificate  information to be transmitted to DOT on a monthly basis and mandates  that states establish and maintain the capability to receive an electronic  copy of a medical examiner’s certificate for each CDL holder licensed in  that state.
subsections: section_title: Drivers Operated Commercial Vehicles Despite Medical Impairments Related to Epilepsy
paragraphs: Out of millions of CDL holders, we identified 230 individuals who were in  an accident or had a roadside inspection in a commercial motor vehicle at  some point between 2008 and 2011, after they started receiving SSA  disability benefits for epilepsy. Thirty-one of the 230 individuals we  identified were involved in accidents while driving a commercial vehicle  during this time. However, because DOT’s database of crashes does not  identify whether the driver’s medical condition may have contributed to  the accident, we could not determine the extent to which the epilepsy  impairment actually caused the accident. We plan to refer these 230  individuals to DOT for appropriate action as warranted. We randomly  selected for further investigation 5 of the individuals involved in  commercial vehicle accidents and 4 of the 199 drivers selected for an  FMCSA roadside inspection to confirm that they were driving commercial  vehicles.

Eight of these 9 drivers selected for further investigation obtained CDLs  after their epilepsy impairment date, with at least 6 of the 8 drivers  obtaining their license within 10 years of having a seizure, a physical  disqualification for obtaining a CDL.entitled to SSA benefits for epilepsy because SSA continued to determine  that they could not work due to their impairment. In two of the cases that  resulted in an accident, a health-care professional had noted in SSA  documentation that the individual should not be driving. Because state  driver’s license agencies nationwide only began requiring applicants’  presentation of a medical certificate after January 30, 2012, we were  unable to obtain medical examination reports from all states or drivers  and do not know whether their medical examiners were aware of their  conditions. We plan to refer these 9 individuals to their state driver’s  licensing agency for appropriate action as warranted.

Eight of the drivers were still  Examples of individuals who were driving commercial vehicles after being  diagnosed with epilepsy include the following:

Crash after epilepsy impairment. According to SSA documentation,  this individual suffered from epilepsy, seizures, blackouts, memory  loss, vision problems, substance abuse, and affective mood disorder.  Holding an active CDL, he was approved for SSA disability benefits in  December 2007. He informed SSA that he had been involved in an  auto accident but had no idea how it occurred, and that he could no  longer drive due to his condition. He added that he had been a truck  driver since 1977, but due to his confusion, his employer had sent  drivers after him on three different occasions. We did not receive a  medical examination form or certificate for this individual from the  state that issued his CDL and thus were unable to determine whether  a medical examiner considered or was aware of the driver’s condition  or whether a medical examination occurred. According to medical  records contained in SSA documentation, medical professionals  informed this individual in 2009 that he should not be driving and that  it was unsafe to hold a job. However, he successfully renewed his  CDL in August 2010. DOT records show that he was involved in a  crash with a commercial vehicle 4 months later in December 2010.  Because DOT’s database did not identify whether the driver’s medical  condition may have contributed to the accident, we could not  determine the extent to which the epilepsy impairment actually caused  the accident.

Numerous accidents after epilepsy impairment. A Washington  state agency noted in 1989 that this driver’s seizure disorder made it  unsafe for him to drive any vehicle, commercial or otherwise. In 1990,  SSA determined this individual was disabled due to epilepsy and  organic brain syndrome, which is a decreased mental function due to  a medical disease other than a psychiatric illness. According to a  medical evaluation in this driver’s SSA disability file, he began  suffering from seizures and blackouts after an auto accident in 1976  but did not report them so he could continue driving tractor trailers. In  2000, the driver reported to SSA that medication did not prevent his  weekly seizures. Despite this, Washington state issued him a CDL in  2002, 2005, and 2007. Washington state driving records reveal that  he was involved in collisions in his commercial vehicle in 2005, 2006,  and 2009. In 2009, a representative from this driver’s employer  informed SSA that the individual had been driving a truck for 4 years,  but was fired for being involved in too many accidents. SSA  suspended this individual’s disability benefits from 2006 to 2009 while  he was earning employment income. This individual surrendered his  CDL in January 2012. Because DOT’s database did not identify  whether the driver’s medical condition may have contributed to the  accident, we could not determine the extent to which the epilepsy  impairment actually caused the accidents.

section_title: CDLs Were Issued or Reissued to Drivers with Impairments Related to Epilepsy, Drugs, and Alcohol
paragraphs: From our random selection of 100 CDL holders, we identified 22 CDL  holders who received SSA disability benefits where epilepsy, alcohol  addiction, or drug dependence was a listed medical impairment and had  CDLs issued or renewed after becoming eligible for those benefits.  Specifically, according to SSA’s disability database, 10 of the 22  individuals had epilepsy or a seizure disorder identified as a medical  impairment in their disability records. The remaining 12 had alcohol or  drug dependence noted in their disability records. According to DOT,  FMCSA and the states do not obtain complete information on whether  individuals are driving on the road, and we were not able to determine  whether all of these individuals were actually driving a commercial vehicle  after their CDLs were issued or renewed. We are referring any cases  where an individual had a disqualifying impairment yet still had an active  CDL to the state driver’s licensing agency for appropriate action as  warranted.

Examples of individuals who obtained or renewed a CDL license after  SSA determined they were eligible for disability benefits include the  following:

CDL issued despite epilepsy impairment. This driver reported to  SSA that he suffered from sudden seizures, sometimes daily,  beginning in 1999. The driver reported having seizures as often as  three times a week, taking 20 minutes to 2 hours to recover from each  episode. According to medical documentation in the claimant’s SSA  disability file, he was also resistant to antiseizure medication.  According to SSA documentation, the driver reported suffering from  seizures as recent as 2008. The driver stated that he was unable to  stand, walk, or sit for extended periods and that he suffered from  memory loss, fatigue, and difficulty breathing. The driver was issued a  new CDL by the state in November 2011 with endorsements allowing  him to operate, among other things, school buses and passenger  vehicles. To obtain this CDL, the driver certified to the state driver’s  licensing agency that he did not have a physical condition preventing  him for exercising reasonable and ordinary control of a motor vehicle.  This individual continues to receive SSA disability benefits for epilepsy  while holding an active CDL. We did not receive a medical  examination form or certificate for this individual from the state that  issued his CDL and thus were unable to determine whether a medical  examiner considered or was aware of the driver’s condition or whether  a medical examination occurred.

CDL issued and renewed despite epilepsy impairment. According  to SSA documentation, this individual began receiving disability  benefits for a seizure disorder in 2001 and informed SSA that he  stopped driving when his seizures began in 1999. He suffered from  seizures and unconsciousness. For example, according to SSA  documentation he passed out while driving a truck and awoke while  walking in the street with no recollection of what had occurred. SSA  documents included a physician’s note stating that the driver was  medically disabled from any form of gainful occupation due to a  diagnosis of intractable seizure disorder. Despite his medical history,  he was issued a first-time CDL in 2005, which was renewed in 2009.  When applying for his CDL, he certified to the state driver’s licensing  agency that he did not have a condition that could cause a loss of  consciousness. He continues to receive SSA disability benefits for  seizures. We did not receive a medical examination form or certificate  for this individual from the state that issued his CDL and thus were  unable to determine whether a medical examiner considered or was  aware of the driver’s condition or whether a medical examination  occurred.

CDL issued despite drug dependence. In 2005, this individual’s  personal driver’s license was suspended for 12 months after a Driving  While Intoxicated (DWI) conviction. According to SSA documentation,  in 2007 he was diagnosed with psychosis, a history of alcohol abuse,  and cannabis abuse following a mental-health hospitalization. He  stated that his illness began to interfere with his work in 2006 and that  he became unable to work in 2009. He began receiving SSA disability  benefits the following year for functional psychiatric disorders. Drug  dependency was also noted in his file. SSA documentation states that  in January 2009, a physician noted that this individual was unable to  participate in employment or training activities in any capacity due to  paranoid schizophrenia. However, this individual obtained a CDL from  Virginia in June 2010. We did not receive a medical examination form  or certificate for this individual from the state that issued his CDL and  thus were unable to determine whether a medical examiner  considered or was aware of the driver’s condition or whether a  medical examination occurred. In October 2010, he refused to submit  to an alcohol test while operating a commercial motor vehicle. This  refusal led to a DWI conviction and permanent CDL suspension in  February 2011.

section_title: States Could Not Provide Medical Examination Certificates
paragraphs: Since most state driver’s licensing agencies do not require a medical  examination report to be presented to them, according to DOT, they were  unable to provide these reports or medical certificates that we requested  for 29 of the 30 individuals who had CDLs issued or renewed after  becoming eligible for SSA benefits. We were therefore unable to  determine whether medical examiners considered or were aware of each  driver’s conditions or whether a medical examination occurred for these   individuals. While FMCSA regulations are meant to prevent an individual  with these conditions from receiving or renewing a CDL, states were not  required to obtain and maintain medical certifications or medical  examination reports at the time of our review. According to DOT, only a  few states on their own authority required CDL holders to provide either a  medical examination report or medical certificate. As mentioned earlier,  as of January 30, 2012, FMCSA requires states to electronically store  medical certificates for new and renewing CDL applicants and are  required to electronically post this information for all CDL holders to the  state’s CDLIS driver records. States will also be required to report the  date of the medical certification to the state’s CDLIS driver record. In  addition, the MAP-21 Act requires medical certificate information to be  transmitted to DOT on a monthly basis and mandates that states  establish and maintain the capability to receive an electronic copy of a  medical examiner’s certificate for each CDL holder licensed in that state  who operates or intends to operate in interstate commerce. If these  requirements are properly implemented and followed, they should help to  prevent situations similar to these case studies from recurring.

section_title: Agency Comments and Our Evaluation
paragraphs: We provided a draft copy of this report to SSA and DOT. SSA did not  have any comments. DOT’s Director of Audit Relations, Office of the  Secretary of Transportation, provided technical comments on the report,  which have been incorporated as appropriate.

We are sending copies of this report to interested congressional  committees, the Secretary of Transportation, the Commissioner of the  Social Security Administration and other interested parties. In addition,  this report is also available at no charge on the GAO website at  http://www.gao.gov.

If you have any questions concerning this report, please contact me at  (202) 512-6722 or BerrickC@gao.gov. Contact points for our Offices of   Congressional Relations and Public Affairs may be found on the last page  of this report.


Question-summary annotations: questions: question: What has the FMCSA done to prevent CDL holders from operating commercial vehicles while impaired?
answer: The Federal Motor Carrier Safety Administration (FMCSA), part of the Department of Transportation (DOT), has established a number of key controls designed to prevent commercial driver’s license (CDL) holders from operating commercial vehicles while impaired.
child_questions: question: What are the key controls intended to identify commercial drivers not capable of driving safely?
answer: First, drivers are required to undergo regular medical exams by a certified medical examiner. Second, employers are responsible for drug testing employees at various points of employment. Third, state and federal roadside-inspection programs are in place to identify impaired drivers and perform other safety checks. If these key controls are operating effectively, they will help identify commercial drivers who are not capable of driving safely.

question: Why does the GAO say these key controls are flawed?
answer: However, GAO’s prior work has found that these controls were vulnerable to abuse or manipulation.

question: What act is intended to address some of these vulnerabilities?
answer: The Moving Ahead for Progress in the 21st Century Act, enacted in July 2012, will require additional measures to ensure that disqualified drivers do not operate commercial vehicles, and could help address some of these vulnerabilities.
child_questions: question: What is an example of one of these additional measures?
answer: For example, the law requires DOT to implement a national clearinghouse of commercial-driver controlled-substance and alcohol test results by July 2014.

question: What has the DOT done to prevent CDL holders from operating commercial vehicles while impaired?
answer: DOT has also taken some actions, and now requires CDL holders to provide a copy of their medical certificates to the State licensing agency.

questions: question: How does epilepsy affect commercial drivers?
answer: Matching CDL holders with Social Security Administration (SSA) disability files produced 204 commercial drivers who drove a commercial vehicle as recently as 2011 despite having epilepsy, a disqualifying medical condition characterized by sudden seizures and unconsciousness.
child_questions: question: What is the evidence for the threat to public safety posed by medically impaired drivers?
answer: Thirty-one of these drivers were involved in accidents, demonstrating the threat to public safety posed by medically impaired drivers.

question: In what other ways have commercial drivers been allowed to drive while potentially impaired?
answer: GAO also identified 23 cases where state licensing agencies issued or renewed CDLs for drivers after they were, according to SSA records, diagnosed with epilepsy or had drug or alcohol dependence noted, which could also disqualify them from driving under DOT regulations.

questions: question: Why is it unlikely that states knew of the drivers’ conditions when the CDL's were issued?
answer: However, because DOT did not require state licensing agencies to maintain drivers’ medical certifications at the time of GAO’s review, it is unlikely that states knew of the drivers’ conditions. In fact, they were unable to provide medical certifications for any of the 23 individuals.

question: How are states reacting to the issue?
answer: States are now required to electronically store medical certificates for new and renewing CDL applicants and will be required to electronically maintain this information for all CDL holders by January 2014.
child_questions: question: What is the effect of these new requirements?
answer: Doing so could help prevent ineligible drivers from obtaining or renewing CDLs in the future.

questions: question: How did the GAO identify key controls?
answer: To identify key controls, GAO reviewed FMCSA policies and regulations, and interviewed officials.
child_questions: question: What basis were these cases identified on?
answer: Cases were identified on the basis of FMCSA roadside-inspection data, DOT’s Commercial Driver License Information System (CDLIS), a national database of all commercial drivers, and SSA disability insurance files.

question: What was the result of GAO's analysis?
answer: From this analysis, GAO identified commercial drivers who were driving with an epilepsy diagnosis. GAO also randomly selected 100 individuals to determine whether the driver was receiving SSA disability benefits when the state issued or renewed the driver’s CDL. These cases cannot be generalized beyond those presented.