Highway hazard

Investigative Reporters and Editors, Inc. The IRE Journal, Mar/Apr 2002 by Twedt, Steve

Medical certification flaws keep unfit truckers on the road

As news tips go, it didn't pack the urgency of a four-alarm fire.

A local physician phoned in the autumn of 1996 to rant about a patient she'd seen a few months earlier.

The truck driver had come to her for a physical exam required of commercial truck and bus drivers every two years by the U.S. Department of Transportation. Because some of his medications might impair his alertness, she would not sign his medical card.

Now she'd learned that he'd gone to another doctor and, without mentioning his medications this time, passed his physical and was back on the road.

The federal officials she contacted shrugged their shoulders, making her mad enough to bust a blood pressure cuff.

But what kind of story was that? One trucker circumvented the rules to keep his job. She didn't know if he'd ever had an accident, or ever would. To preserve patient confidentiality, she wouldn't tell me his name or where he worked. It didn't warrant even a news brief.

That single anecdote, though, revealed something larger - a systemwide hole in the federal safety net meant to insure that commercial truck and bus drivers are healthy enough to drive their 80,000-pound rigs on America's highways.

No tracking system

During the next three years, I collected sources, stories, accident investigations and anything else I came across that involved a commercial driver with a serious medical condition who was involved in an accident.

It became almost a hobby, picking up these odd threads and adding them to the growing collection. I even took nine months off while in the Michigan Journalism Fellows program, though I made sure I met faculty members at the Ann Arbor university's highly regarded transportation research institute while I was there.

Here's what I learned early on: The Department of Transportation requires that every commercial driver carry a valid medical card certifying they are fit to drive a big rig. The card can be signed by anyone with state authorization to do physicals, including chiropractors and physician assistants. The examiner doesn't need to demonstrate any proficiency or understanding of DOT medical regulations. Also, as was apparent from that first phone call, no tracking system exists for drivers who fail a physical, allowing them to go from examiner to examiner until they find one who will pass them.

Some of the stories that surfaced just around Pittsburgh were equal parts horrifying and hilarious:

* The driver who passed his DOT physicals despite having narcolepsy so severe, he'd fall asleep mid-sentence at the dinner table. During the day he worked two jobs, hauling heating oil in the morning and driving children home on a school bus in the afternoon. None of his examiners had asked him if he had sleeping problems.

* An independent trucker who scouted examiners to avoid "by-the-book" types who would give him a thorough physical. He successfully passed the DOT physicals for 20 years before an examiner noticed he had an artificial leg. Another driver was routinely certified despite having only one eye (and no depth perception).

* A driver who, when informed that his anger-- control medication might make him sleepy, reassured the examiner that "I don't take it when I'm going to be driving."

Other stories tugged at the heart, like the 37-year-old driver who regretted telling his doctor about a heart attack suffered hauling a load of canned soup. That admission cost him his job and, if he had it to do over, he said he would keep driving so his family could collect the insurance. He figured when a massive heart attack hit him on the road, he'd stay conscious long enough to safely steer his truck off the highway.

Checking newspaper databases, various tragic stories came up across the U.S. There was the Florida gas hauler who hid his epilepsy from his employer, then had a seizure while driving. His tanker, loaded with 8,800 gallons of gasoline, went off the road, hit some trees and burst into flames, killing the driver.

And the diabetic Texas trucker who forgot to take his insulin, ran two red lights and rammed a sedan, killing the driver and injuring two small children. Under DOT regulations, insulin-dependent diabetics are not allowed to drive commercial vehicles unless they have a special exemption.

Another obvious database, DOT's Fatal Accident Reporting System, or FARS, proved less helpful. Setting up an Access query for FARS was easy enough, sorting out fatal accidents involving large commercial trucks and buses then cross-matching against the driver-related factors. From there, the data got murky.

Broader categories such as fatal accidents where the driver became ill or blacked out produced lots of hits but it wasn't clear which ones applied. A truck driver might pass out for lots of reasons, from a bad flu to a heart condition. On the other hand, an accident attributed to a truck straying from its lane may mask a medical problem with the driver. To determine which was which, I had to track down the investigating police department for each accident (it could be city, county or state police) and request the incident report.