When Is It OK For A Trucker To Get A Second Opinion On A DOT Physical?

When is it OK for a trucker to get a second opinion on a DOT physical?

The FMCSA has made an important clarification for truckers concerning medical and physical qualifications to drive. Specifically, the clarification has to do with whether a trucker can seek a second opinion when obtaining a physical from a DOT-certified medical examiner.

The short answer is yes, but there’s more to it.

Chuck Horan, who oversees the National Registry of Certified Medical Examiners administered by the Federal Motor Carrier Safety Administration, says he’s received questions and concerns from drivers who are told by a medical examiner or someone else in the chain that getting a second opinion is not allowed on a Department of Transportation physical.

Horan says yes, drivers can get a second opinion, as long as they provide a full and honest history to their medical examiners and do not cross the line into illegal “doctor shopping.”

“It’s important that any time you’re dealing with the medical profession and medical judgment that you should be allowed the opportunity to go get a second opinion – to find out if the (doctor) is being extremely conservative with his call,” Horan told Land Line.

“Some are very conservative and others are not so conservative, so you may get two different answers from two different doctors using the exact same information. … In those cases, we don’t see that as doctor shopping, as long as you provide the doctor with the same information to make the call.”

Horan says medical examiners and the FMCSA are concerned about drivers who do not divulge their full medical histories to a second – or sometimes third – medical examiner after an initial examiner restricts or disqualifies the driver.

“If you go down the street and leave part of that history out, and obviously the new doctor that you’re at doesn’t have the information to make a full assessment and ends up giving you a card, that is doctor shopping,” Horan said.

The National Registry of Certified Medical Examiners went live on May 21, requiring all commercial drivers to get their next physical from a FMCSA-certified examiner.

The first few months of the registry being active have revealed some flaws and complaints. 

Most of the concerns and complaints received by FMCSA – and by OOIDA’s regulatory and business services staffs – are about the inconsistency in how the certified medical examiners interpret DOT regs and guidance when conducting driver physicals.

Some examiners have run roughshod over drivers on the issue of sleep apnea , insisting that apnea testing is a regulation even though it is not. 

OOIDA Member Jeffrey Spear, aka “Cowboy,” had a negative experience a few months ago when he went for a driver physical at Agnesian HealthCare in his hometown of Fond du Lac, Wis.

“They were looking to fail me and do anything they could to get me to take a sleep test,” Spear told Land Line.

Spear says the examiner measured him an inch shorter than he is, said he was heavier than he is, and measured his neck size an inch larger than it is. The examiner insisted Spear be tested for sleep apnea even though Spear had a note from his family doctor saying he did not have sleep apnea.

“(The doctor) had me down for a three-month card and I was to have a sleep study done at that time,” Spear said.

OOIDA Director of Regulatory Affairs Scott Grenerth said what Spear did next was within his rights based on the clarified FMCSA position on second opinion.

Spear sought his second opinion from Lynn Biese-Carroll, a certified examiner who is part of a medical team working out of the Highlands Petro in Racine. 

According to Spear, Biese-Carroll did not think he was at risk for sleep apnea. She issued him a one-year medical card and did not order a sleep test, although Spear is to return to discuss his progress in being treated for blood pressure.

“It’s up to the doctor to do a thorough exam to see if drivers are at risk of a sudden, incapacitating event,” Biese-Carroll told Land Line in October.

“Because there is gray area (in DOT guidance), it’s up to the doctor’s medical opinion what the recommendation for follow up should be,” she said.

“We see a wide gap in practical application of the DOT’s regulations and recommendations – with some clinics being very lax, and some people being too rigid in the application of the DOT’s intended rules and regulations. We think that somewhere in the middle is probably where most of the doctors hopefully exist, with an interest in helping the drivers become healthier while still applying the rules that keep the driver road safe.”

Horan explained what the FMCSA does when two medical opinions exist for a driver.

“When we get two records on one particular driver, we have the capability of pulling the long form from both medical examiners and look at the long forms back-to-back. If they’re identical, if you have a doctor that lets you have a six-month, one-year, or two-year card, that card is good,” he said. “That card would be the card of record.”

The latest word on sleep apnea

According to a bill passed by Congress and signed into law in October 2013, the Federal Motor Carrier Safety Administration shall not issue guidance to medical examiners on sleep apnea or advance an apnea restriction without first going through a full rulemaking process that includes a public comment period.

See more at: http://www.landlinemag.com/Story.aspx?StoryID=27988#.VJmKfMB_QA

Thanks for the update and article. I just got my first physical and the doc only gave me one year since I didn't provide my last lab results from my physician. I passed EVERYTHING but fessed up to my type II diabetes. She was under the impression that diet and pill control was on a restricted status. As of now, she's wrong but try arguing with a medic of any type! (I'm married to an RN, you won't win!). Anyway, I'm good for a year and my sugar is under control. I could see getting a second opinion if I'd gotten a 3 month due to the physician's incorrect understanding of the standards...

I just did my DOT a few weeks ago (early December 2017) in preparation for my CDL training at a local community college. The Doctor gave me a three month card because my BP was elevated. Instead of taking it when I first walked in, they waited until all of the other testing was complete, which probably elevated my BP a bit as some of it was a bit stressful.

He said to get a "note from my primary care physician stating that my BP is okay and my meds do not need to be modified." He said if I do that, then to bring the note back to him and he will issue me a card for a year. I thought cool - no problem. So I go to my Primary Care Physician, get my BP checked (which was fine) and get the note and bring it back to the DOT physician. Come to find out that his DOT certification had expired during that 10 day period since I last saw him! Therefore, he couldn't give me the newer card. I tracked down another DOT physician within the same state-wide medical practice and I told her about the note. She said that she wouldn't accept that! At that point I simply fell on my sword, accepted my fate, and asked what it is she needs from me in order to update my medical form to a year? She told me that I need to do is go back in and have her check my BP again.

One thing I noticed and found a bit concerning was that during the "forced whisper" part of the test, the physician stood about 20 feet away. I could swear that I read somewhere that this portion of the test was to be done "no less than 5 feet" from the person. Also, it was actually kind of funny. When she did the whisper test (20 feet away), she covered her mouth with a notepad. So I'm looking at her like, "what did you say?" Ah... had to be there to appreciate it :)

I guess like any new system there will be a time where folks are not yet on the same page.