The Federal Motor Carrier Safety Administration (FMCSA) released the updated Medical Examiner’s Handbook (MEH) on Jan. 22, which includes revisions to the Medical Advisory Criteria found in the Code of Federal Regulations.
The FMCSA said that the handbook “is a guidance document that does not amend any agency regulation or establish any requirements for MEs or drivers not found in existing regulations.”
Originally introduced in 2008, the MEH serves as a comprehensive resource outlining regulatory prerequisites and offering guidance to MEs regarding the physical qualification standards stipulated in regulations and the execution of DOT physical exams.
Over the years, the handbook has undergone scrutiny and adjustments to align with evolving industry needs. Notably, the MEH was informally discontinued in 2015 due to obsolete information and its prescriptive nature, with FMCSA advising examiners and training organizations against considering it as agency guidance.
In 2022, the agency presented a draft handbook with proposed changes, seeking public input on the revisions. An aspect of concern for truck drivers has been the guidance surrounding obstructive sleep apnea (OSA).
In response to increased referrals for apnea testing during DOT physicals in 2013, Congress enacted legislation preventing FMCSA from establishing official apnea guidelines outside of a comprehensive rulemaking process.
The FMCSA said they went “to great efforts throughout the MEH to distinguish between regulatory requirements and non-binding guidance.” The handbook emphasizes that doctors have the autonomy to decide whether to incorporate such guidance into their decision-making process.
The handbook says that federal regulations “do not include requirements for MEs to screen individuals for OSA or to recommend that an individual be referred for OSA testing and do not include preferred diagnostic testing methods, treatment methods, or requirements by which to assess compliance with treatment. Instead, the MEH presents various considerations for ME[s] when making a physical qualification determination. … The MEH guidance leaves it to the ME to determine whether an individual needs to be screened [for sleep apnea] based on the individual circumstances.”
Noteworthy modifications in the updated handbook include the removal of the hypertension table to prevent potential confusion, with FMCSA opting to adhere to the guidance in the Medical Advisory Criteria regarding hypertension.
Additionally, the handbook offers supplementary insights into non-insulin-treated diabetes mellitus, outlining considerations for MEs in making physical qualification determinations for individuals with this condition. FMCSA is in the process of seeking approval for a new Non-Insulin-Treated Diabetes Mellitus Assessment Form, which, if sanctioned, can be used as an optional tool by MEs to request additional information, subject to the driver’s consent.
FMCSA plans to review the handbook’s guidance comprehensively within five years of its publication, deciding whether it should be withdrawn, reissued, or incorporated into regulations.
Source: Overdrive
