A family doctor found himself frequently stopped on the street by patients hoping for a quick diagnosis of whatever ailed them. The doctor never wanted to offend his patients, but at the same time, he hesitated to provide medical advice outside his clinic. During one such episode, he saw his attorney on the other side of the street. After telling his patient to stay put, the doctor ran across to the lawyer and asked whether he should provide care away from the clinic setting. “Why don’t you make an appointment, and we can discuss that in my office,” was the attorney’s response.

The Federal Motor Carrier Safety Administration found itself in the same position as that family doctor. FMCSA, by law, is authorized to establish minimum physical qualification standards for drivers of commercial motor vehicles in interstate commerce. That statutory authorization arises from FMCSA’s mission to reduce crashes, injuries, and fatalities involving large trucks and buses. A variety of medical conditions could prevent a commercial vehicle driver from safely operating a truck, jeopardizing themselves and others.

Over the years, FMCSA has adopted federal regulations pertaining to several specific medical conditions. The agency also created the National Registry of Certified Medical Examiners (MEs), who are familiar with truck drivers’ work and conditions. In an effort to assist those MEs, FMCSA published a Medical Examiner’s Handbook in 2008. However, the agency went beyond its adopted medical regulations, providing prescriptive medical guidance in areas not covered by the regulations. This guidance amounted to so-called “streetside” advice that should have been left to the doctor-patient exam in a clinic setting. As a consequence, FMCSA withdrew the Medical Examiner’s Handbook in 2015.

Now FMCSA is acting like the attorney in the story. After holding public hearings and gathering advice from its Medical Review Board, the agency posted a new, proposed Medical Examiner’s Handbook. FMCSA is asking for public comment by Sept. 30, 2022, however, the agency extended the deadline until Oct. 31, 2022.

The 116-page draft handbook begins by emphasizing that:

“Unlike regulations, however, the recommendations and other guidance in this handbook do not have the force and effect of law and are not meant to bind MEs, drivers, or the public in any way. Rather, such guidance itself is only advisory and not mandatory.”

The draft handbook incorporates medical expert reports in many areas. However, FMCSA cautions:

“The reports do not reflect the official policy of FMCSA, nor do they constitute regulatory standards. Rather, they provide the ME medical information to consider when making a physical qualification determination.”

For further clarity, FMCSA underscores that the adopted medical regulations are the law and must be followed. Where specific regulations are not in place, the terms “may,” “should,” or “could” are used in a recommendatory or permissive sense and relate to guidance as opposed to a requirement.

Basically, has FMCSA met the attorney’s standards and avoided the temptation to give “streetside” medical advice? In controversial areas not covered by federal regulation, such as obstructive sleep apnea, has FMCSA offered appropriate guidance to MEs without overly suggesting sleep studies that may be costly and medically unnecessary for drivers?


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