Commercial Drivers: Certification Process for Drivers with
Serious Medical Conditions (24-JUL-08, GAO-08-1030T).
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. Because
the effectiveness of the medical certification process is not
known, this testimony, and the accompanying report (GAO-08-826)
that GAO is releasing today focuses on (1) GAO's analyses of the
magnitude of commercial drivers with serious medical conditions,
and (2) examples of cases where careful medical examinations did
not occur on commercial drivers with serious medical conditions.
To examine the extent individuals holding CDLs have significant
disabilities, GAO identified those who were in both DOT's CDL
database and selected disability databases of 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. GAO
obtained current CDL data from 12 selected states. To provide
case studies, GAO focused on 4 states--Florida, Maryland,
Minnesota, and Virginia. For 15 drivers identified from data
mining, GAO interviewed, as appropriate, the driver, the driver's
employer and the driver's physician.
-------------------------Indexing Terms-------------------------
REPORTNUM: GAO-08-1030T
ACCNO: A83048
TITLE: Commercial Drivers: Certification Process for Drivers
with Serious Medical Conditions
DATE: 07/24/2008
SUBJECT: Bus drivers
Commercial motor vehicle operators
Disabilities
Disability benefits
Drivers' licenses
Eligibility determinations
Federal regulations
Federal/state relations
Impaired motor vehicle operators
Licenses
Medical certification
Medical examinations
Medical records
Motor vehicle safety
Motor vehicle standards
Motor vehicles
Persons with disabilities
Program evaluation
Risk management
Safety standards
Social security benefits
Standards evaluation
Transportation industry
Transportation safety
Transportation workers
Truck drivers
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GAO-08-1030T
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Testimony:
Before the Committee on Transportation and Infrastructure, House of
Representatives:
United States Government Accountability Office:
GAO:
For Release on Delivery:
Expected at 2:00 p.m. EDT:
Thursday, July 24, 2008:
Commercial Drivers:
Certification Process for Drivers with Serious Medical Conditions:
Statement of Gregory D. Kutz, Managing Director: Forensic Audits and
Special Investigations:
GAO-08-1030T:
GAO Highlights:
Highlights of GAO-08-1030T, a testimony before the Committee on
Transportation and Infrastructure, House of Representatives.
Why GAO Did This Study:
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.
Because the effectiveness of the medical certification process is not
known, this testimony, and the accompanying report (GAO-08-826) that
GAO is releasing today focuses on (1) GAO�s analyses of the magnitude
of commercial drivers with serious medical conditions, and (2) examples
of cases where careful medical examinations did not occur on commercial
drivers with serious medical conditions.
To examine the extent individuals holding CDLs have significant
disabilities, GAO identified those who were in both DOT�s CDL database
and selected disability databases of 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. GAO obtained current CDL data from 12 selected
states. To provide case studies, GAO focused on 4 states�Florida,
Maryland, Minnesota, and Virginia. For 15 drivers identified from data
mining, GAO interviewed, as appropriate, the driver, the driver�s
employer and the driver�s physician.
What GAO Found:
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.
GAO�s 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 individuals had commercial driver licenses and
were determined by the federal government to be eligible for full
disability benefits. This represented about 4 percent of all commercial
drivers in the DOT database. The 12 selected states we analyzed
represent about 135,000 of these commercial drivers. For these 12
selected states, our analysis indicates that about 85 percent of these
commercial drivers still have active licenses. The majority of these
drivers were issued a CDL after being approved for full federal
disability benefits.
GAO�s 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. The following table
details some of the more egregious examples from our investigation.
Table: Examples of Commercial Drivers with Serious Medical Conditions:
Type of driver: Bus;
State: Florida;
Medical condition: Driver receives disability benefits due to breathing
insufficiency, for which he uses three daily inhalers. He stated that
he �occasionally blacks out and forgets things,� but continues to hold
a CDL and be hired as a substitute bus driver, despite not having the
required medical certificate.
Type of driver: Bus;
State: Minnesota;
Medical condition: Driver receives disability benefits due to epilepsy.
He also suffers from headaches, sleep apnea, asthma, and high blood
pressure. Driver and medical examiner agreed that if the driver felt
�loopy� he would not drive a commercial vehicle.
Type of driver: Truck;
State: Florida;
Medical condition: Driver receives disability benefits for multiple
sclerosis, which causes fatigue. Driver hauls circus equipment to
various shows, despite not having the required medical certificate.
Type of driver: Truck;
State: Maryland;
Medical condition: Driver receives disability benefits for complete
deafness. Medical examiner acknowledged error in certifying medical
fitness of driver.
Source: GAO.
[End of table]
To view the full product, including the scope and methodology, click on
[hyperlink, http://www.gao.gov/cgi-bin/getrpt?GAO-08-1030T]. For more
information, contact Greg Kutz at (202)512-6722 or [email protected].
[End of section]
Mr. Chairman and Members of the Committee:
Thank you for the opportunity to discuss commercial drivers with
serious medical conditions. Millions of American drivers hold a
commercial driver license (CDL) that allows them to operate a variety
of commercial vehicles such as school buses, cargo vans, and tractor
trailers. To help prevent accidents resulting from commercial drivers
with medical conditions, federal law requires medical examiners to
certify that commercial drivers are medically fit to operate their
vehicles. Not all serious medical conditions interfere with the safe
operation of a commercial vehicle. In fact, some federal disability
programs appropriately try to encourage individuals to work. However,
some serious medical conditions can and should disqualify a driver from
being medically certified according to Department of Transportation
(DOT) regulations.
Because the effectiveness of the current medical certification process
is not known, our testimony, and the accompanying report that we are
releasing today,[Footnote 1] provide a starting point for this
discussion. Today's testimony focuses on (1) our analyses of the
magnitude of commercial drivers with serious medical conditions, and
(2) examples of cases where careful medical examinations did not occur
on commercial drivers with serious medical conditions.
To examine the extent to which individuals holding CDLs have serious
medical conditions, we identified people who were in both DOT's CDL
database and selected federal disability databases--Social Security
Administration (SSA), Office of Personnel Management (OPM), the
Department of Veterans Affairs (VA), and the Department of Labor (DOL)-
-and have been identified as 100 percent disabled according to the
program's criteria. Because DOT's data also include inactive licenses,
we obtained current CDL data from 12 selected states (based primarily
on the size of CDL population) to identify active CDL license holders
who are receiving full federal disability benefits. To provide case
study examples we focused on 4 states--Florida, Maryland, Minnesota,
and Virginia. For 15 drivers identified from data mining, we
interviewed, as appropriate, the driver, driver's employer, and
driver's physician. 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.
Summary:
Commercial drivers with serious medical conditions, even those
determined to be 100 percent disabled, can still meet DOT medical
fitness requirements to safely operate a commercial vehicle and thus
hold CDLs. As such our 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 SSA, VA, OPM, and DOL found that about 563,000 individuals
had CDLs and were determined by the federal government to be fully
disabled.[Footnote 2] This represented about 4 percent of all CDLs in
the DOT database. Our analysis of persons with CDLs who are receiving
full federal disability benefits from 12 selected states (135,000)
indicates that most of these commercial drivers still have active
licenses. Specifically, about 85 percent (114,000) had a current CDL. A
majority of these drivers (85,000) were issued a CDL after being
approved for full federal disability benefits.
Our investigations detail 15 cases where careful medical evaluations
did not occur on commercial drivers who were fully disabled. Some of
the more egregious examples of our investigations include:
* A bus driver in Maryland has been receiving Social Security
disability benefits since March 2006 due to his heart condition. In
June 2006, approximately 3 months after Social Security determined the
driver was fully disabled, the Maryland driver license agency renewed
his CDL. The bus driver provided our investigator a forged medical
certificate.
* A bus driver in Florida has been receiving Social Security disability
benefits since 1994 for breathing deficiencies. The bus driver
currently uses three daily inhalers to control his breathing. The bus
driver stated that he "occasionally blacks out and forgets things."
However, the driver stated that he continues to be hired as a
substitute bus driver even though he does not have the required medical
certification.
Serious Medical Conditions and Commercial Driver Licenses:
Commercial drivers with disabilities, even those determined to be 100
percent disabled, can still meet DOT medical fitness requirements for
operating a commercial vehicle and thus hold CDLs. Although we fully
support individuals with serious medical conditions receiving the
training and certifications necessary to safely operate commercial
vehicles, 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 mining
and data matching the extent to which disabled commercial drivers have
a medical condition that precludes them from safely driving a
commercial vehicle and therefore if the certification process is
effective. 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.[Footnote 3] This represented about 4 percent of
all CDLs in the DOT database.[Footnote 4]
As shown in figure 1, of the 563,000 CDL holders nationwide who are
receiving full federal disability benefits, about 135,000 are from our
12 selected states. About 114,000 of these 135,000 individuals, or
about 85 percent, had an active CDL according to data provided by the
12 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, were issued a CDL
after the federal agency determined that they met the federal
requirements for full disability benefits.
Figure 1: CDL Drivers with Full Federal Disabilities for 12 Selected
States:
[See PDF for image]
This figure is an illustration of CDL drivers receiving full federal
disability benefits for 12 selected states, as follows:
Data match:
DOT CDL data are matched against data from four federal agencies
administering disability programs.
50-state population:
Total 50-state population of CDL holders receiving medical disability
is 563,000.
12-state analysis (135,000):
12 states are selected for analysis: CA, FL, IL, KY, MD, MI, MN, MT,
TN, TX, VA, WI.
85% of licenses are active:
114,000 licenses (85%) are still active despite conditions including
vision, hearing, and seizure disorders.
63% are active and issued after disability:
85,000 licenses (63%) have an issue date after disability benefit start
date.
Source: GAO (data), Art Explosion (graphics).
[End of figure]
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 discussed 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.[Footnote 5] However, because these individuals are receiving
full disability benefits, it is likely that these medical conditions
are severe. Further analysis 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.
[Footnote 6]
Examples of Commercial Drivers with Serious Medical Impairments:
Our investigations detail 15 cases where careful medical evaluations
did not occur on commercial drivers who were receiving full medical
disability benefits. In 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. We referred all
15 cases to their respective state driver license agencies for further
investigation. In table 1, we summarize 5 of the more egregious cases.
Table 1: Summary Information on Five Commercial Drivers with Active
Licenses despite Serious Medical Conditions:
Case: 1;
State: Maryland;
Details:
* Bus driver has received Social Security disability benefits since
March 2006 due to an aneurysm of the aorta and valvular heart disease;
* Three months after disability determination, the state renewed bus
driver's CDL for 5 years;
* The bus driver provided our investigator a forged medical certificate
without the required medical license number. Medical examiner denied
conducting CDL medical exam or signing the medical certificate.
Case: 2;
State:
Florida;
Details:
* Bus driver has received Social Security disability benefits since
1994 for chronic obstructive pulmonary disorder (COPD).[A];
* Bus driver currently uses three daily inhalers to control breathing,
and stated that he "occasionally blacks out and forgets things";
* Driver continues to be hired as a substitute bus driver, despite not
having a medical certificate;
* Bus driver's CDL expires in 2010.
Case: 3;
State: Minnesota;
Details:
* Bus driver has received Social Security disability benefits since
2004 for epilepsy, among other medical conditions;
* Medical examiner certified the driver in 2007 despite previously
prescribing him daily antiseizure medication. DOT guidance states that
this disqualifies the driver;
* The driver and medical examiner agreed that if the driver felt
"loopy" he would not drive a commercial vehicle;
* Driver stated that he also suffers from headaches, sleep apnea,
asthma, and high blood pressure;
* The state driver license agency renewed the CDL for 4 years in 2007.
Case: 4;
State: Florida;
Details:
* Truck driver has received Veteran Affairs disability benefits since
1990 for multiple sclerosis;
* Driver stated that the medical condition causes fatigue;
* Driver stated he received his last medical certificate in the late
1990s;
* The driver's relative occasionally employs the driver to haul circus
equipment to various shows, despite not having a current medical
certificate;
* The state driver license agency renewed the CDL for about 4 years in
2007.
Case: 5;
State: Maryland;
Details:
* Truck driver has received Social Security disability benefits since
2001 due to complete deafness;
* Truck driver operates a dump truck as part of an excavating business;
* Medical examiner admitted error in certifying medical fitness of
driver;
* The state driver license agency last renewed the CDL in 2006.
Source: GAO.
[A] Chronic obstructive pulmonary disease (COPD) is a term referring to
two lung diseases, chronic bronchitis and emphysema.
[End of table]
The above cases illustrate instances where careful medical examinations
did not occur. Based on our investigations, we found:
* 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.[Footnote 7] 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.
* 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.
* Certain medical examiners did not follow the federal requirements in
the determination of medical fitness of commercial drivers. For
example, one medical examiner told GAO that she did not know that a
driver's deafness disqualifies the driver from receiving a medical
certification.
Mr. Chairman and Members of the Committee, this concludes my statement.
I would be pleased to answer any questions that you or other members of
the committee may have at this time.
Contacts and Staff Acknowledgments:
For further information about this testimony, please contact Gregory D.
Kutz at (202) 512-6722 or [email protected]. Contact points for our Offices
of Congressional Relations and Public Affairs may be found on the last
page of this testimony. GAO staff who made major contributions to this
report include Matthew Harris, Assistant Director; Andrew O'Connell,
Assistant Director; Matthew Valenta, Assistant Director; Gary Bianchi;
Sunny Chang; Paul DeSaulniers; Eric Eskew; Craig Fischer; John Kelly;
Jeffrey McDermott; Andrew McIntosh; Philip Reiff; Ray Rodriguez; Daniel
Silva; Nathaniel Taylor; and Lindsay Welter.
[End of section]
Footnotes:
[1] GAO, Commercial Drivers: Certification Process for Drivers with
Serious Medical Conditions, [hyperlink, http://www.gao.gov/cgi-
bin/getrpt?GAO-08-826] (Washington, D.C.: June 30, 2008).
[2] A certain number of commercial drivers may also not be legally
entitled to federal disability payments because they do not have a
qualifying disability. For example, our review did not make a
determination as to whether commercial drivers committed fraud in their
application for disability benefits.
[3] SSA and VA accounted for 99 percent of the identified drivers.
[4] Because DOT's database includes drivers with suspended, revoked, or
lapsed licenses, the actual number of active commercial drivers who
receive full federal disability benefits cannot be determined. Also,
our analysis does not include drivers with severe medical conditions
who are not in the specific disability programs we selected.
[5] Federal disability programs such as SSA's "Ticket to Work" allow
certain fully disabled recipients to work and still receive disability
benefits.
[6] 49 C.F.R. �391.41(b).
[7] DOT is finalizing a proposed rule to merge information from the
medical examiner's certificate into the commercial driver license
process as required by the Motor Carrier Safety Improvement Act of
1999. The new rule would require drivers to provide a copy of their
current medical examiner's certificate to their state driver license
agency. This new rule would make the state driver license agencies
responsible for ensuring that holders of commercial driver licenses
have current medical certificates.
[End of section]
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