oversight

Highway Safety: Selected Cases of Commercial Drivers with Potentially Disqualifying Impairments

Published by the Government Accountability Office on 2012-11-30.

Below is a raw (and likely hideous) rendition of the original report. (PDF)

                United States Government Accountability Office

GAO             Report to the Chairman, Subcommittee
                on Surface Transportation and Merchant
                Marine Infrastructure, Safety, and
                Security, Committee on Commerce,
                Science, and Transportation, U.S. Senate

                HIGHWAY SAFETY
November 2012




                Selected Cases of
                Commercial Drivers
                with Potentially
                Disqualifying
                Impairments




GAO-13-13
                                                November 2012

                                                HIGHWAY SAFETY
                                                Selected Cases of Commercial Drivers with
                                                Potentially Disqualifying Impairments
Highlights of GAO-13-13, a report to the
Chairman, Subcommittee on Surface
Transportation and Merchant Marine
Infrastructure, Safety, and Security,
Committee on Commerce, Science, and
Transportation, U.S. Senate

Why GAO Did This Study                          What GAO Found
Commercial vehicles such as tractor             The Federal Motor Carrier Safety Administration (FMCSA), part of the Department of
trailers and school buses must be               Transportation (DOT), has established a number of key controls designed to prevent
operated by skilled drivers who are             commercial driver’s license (CDL) holders from operating commercial vehicles while
mentally and physically capable of              impaired. First, drivers are required to undergo regular medical exams by a certified
performing their jobs safely. Prior GAO         medical examiner. Second, employers are responsible for drug testing employees at
work has shown weaknesses in DOT’s              various points of employment. Third, state and federal roadside-inspection programs
oversight of CDLs, such as inadequate           are in place to identify impaired drivers and perform other safety checks. If these key
medical certifications for commercial           controls are operating effectively, they will help identify commercial drivers who are
drivers, potentially putting the public at      not capable of driving safely. However, GAO’s prior work has found that these
risk.                                           controls were vulnerable to abuse or manipulation. The Moving Ahead for Progress in
                                                the 21st Century Act, enacted in July 2012, will require additional measures to ensure
GAO was asked to update its work on
                                                that disqualified drivers do not operate commercial vehicles, and could help address
impaired commercial drivers. This
                                                some of these vulnerabilities. For example, the law requires DOT to implement a
report describes (1) key controls
                                                national clearinghouse of commercial-driver controlled-substance and alcohol test
designed to prevent medically unfit or
                                                results by July 2014. DOT has also taken some actions, and now requires CDL
impaired commercial drivers from
                                                holders to provide a copy of their medical certificates to the State licensing agency.
operating commercial vehicles and (2)
examples of commercial drivers with             Matching CDL holders with Social Security Administration (SSA) disability files
potentially disqualifying impairments           produced 204 commercial drivers who drove a commercial vehicle as recently as
related to epilepsy, drugs, or alcohol.         2011 despite having epilepsy, a disqualifying medical condition characterized by
                                                sudden seizures and unconsciousness. Thirty-one of these drivers were involved in
To identify key controls, GAO reviewed
                                                accidents, demonstrating the threat to public safety posed by medically impaired
FMCSA policies and regulations, and
                                                drivers. GAO also identified 23 cases where state licensing agencies issued or
interviewed officials. Cases were
                                                renewed CDLs for drivers after they were, according to SSA records, diagnosed with
identified on the basis of FMCSA
                                                epilepsy or had drug or alcohol dependence noted, which could also disqualify them
roadside-inspection data, DOT’s
                                                from driving under DOT regulations (see examples below).
Commercial Driver License Information
System (CDLIS), a national database             Examples of Commercial Drivers with Potential Driving Impairments
of all commercial drivers, and SSA                     Potential driving
disability insurance files. From this            State impairment        Details
analysis, GAO identified commercial              MS    Epilepsy,         Holding an active CDL, this individual was approved for SSA disability
drivers who were driving with an                       seizures,         benefits in June 2007. Although he informed SSA that he could not
                                                       blackouts, poor   drive because of his condition, he renewed his CDL in Mississippi in
epilepsy diagnosis. GAO also                           vision, substance 2008. In 2009, medical professionals informed him that he should not
randomly selected 100 individuals to                   abuse             be driving and that it was unsafe to hold a job. But again, he
determine whether the driver was                                         successfully renewed his CDL in August 2010. DOT records show that
receiving SSA disability benefits when                                   he was involved in a crash with a commercial vehicle in 2010.
the state issued or renewed the                  VA    Psychosis,        This driver began receiving SSA disability benefits in 2009 for
                                                       alcohol abuse,    psychosis. Alcohol abuse and drug dependence were also noted in
driver’s CDL. These cases cannot be                    drug dependence SSA records. According to SSA files, a physician stated in 2009 the
generalized beyond those presented.                                      driver was unable to participate in employment or training activities due
                                                                         to paranoid schizophrenia. However, the driver later obtained a CDL. In
GAO provided a draft of this report to                                   October 2010, he refused to submit to an alcohol test while operating a
SSA and DOT. SSA did not have any                                        commercial motor vehicle, which led to a driving-while-intoxicated
comments. DOT provided technical                                         conviction and permanent CDL suspension in February 2011.
comments, which have been                       Source: GAO
addressed in the report, as
appropriate.                                    However, because DOT did not require state licensing agencies to maintain drivers’
                                                medical certifications at the time of GAO’s review, it is unlikely that states knew of the
                                                drivers’ conditions. In fact, they were unable to provide medical certifications for any
                                                of the 23 individuals. States are now required to electronically store medical
View GAO-13-13. For more information,
contact Cathleen A. Berrick at (202) 512-6722
                                                certificates for new and renewing CDL applicants and will be required to electronically
or BerrickC@gao.gov.                            maintain this information for all CDL holders by January 2014. Doing so could help
                                                prevent ineligible drivers from obtaining or renewing CDLs in the future.
                                                                                               United States Government Accountability Office
Contents


Letter                                                                                               1
           Background                                                                                3
           FMCSA Controls for Commercial Drivers Include Medical Exams,
             Drug and Alcohol Testing, and Roadside Inspections                                       5
           Examples of Commercial Drivers with Disqualifying Impairments
             Related to Epilepsy, Drugs, or Alcohol                                                  11




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           Page i                                                          GAO-13-13 Highway Safety
United States Government Accountability Office
Washington, DC 20548




                                   November 30, 2012

                                   The Honorable Frank R. Lautenberg
                                   Chairman
                                   Subcommittee on Surface Transportation and Merchant Marine
                                    Infrastructure, Safety, and Security
                                   Committee on Commerce, Science, and Transportation
                                   United States Senate

                                   Dear Mr. Chairman:

                                   Millions of Americans hold commercial driver’s licenses (CDL), allowing
                                   them to operate tractor trailers, school buses, cargo vans, or other
                                   commercial vehicles on our nation’s roads and highways. The Federal
                                   Motor Carrier Safety Administration (FMCSA) establishes regulations and
                                   oversees the safe operation of commercial vehicles, including preventing
                                   crashes, injuries, and fatalities. FMCSA partners with states to conduct
                                   roadside inspections and oversee CDLs in adherence to minimum federal
                                   requirements and guidance established by the Motor Carrier Safety
                                   Improvement Act of 1999.

                                   Commercial vehicles—large, and sometimes transporting hazardous
                                   materials—must be operated by skilled drivers who are mentally and
                                   physically capable of performing their jobs safely—any impairment can
                                   pose significant dangers to the public. Therefore, FMCSA regulations
                                   require that commercial drivers be tested for drug and alcohol use and
                                   undergo medical fitness certifications. Drug and alcohol testing is required
                                   before employment, randomly while employed, and after an accident
                                   where the CDL driver was at fault. Physical examinations, including vision
                                   and hearing tests and a review of the driver’s medical history, must be
                                   conducted by a medical examiner at least every 2 years.

                                   Over the past decade, the National Transportation Safety Board (NTSB)
                                   and others have reported gaps in enforcing drug and alcohol testing and
                                   medical fitness of commercial drivers. For example, the NTSB reported
                                   that commercial drivers could job-hop from one employer to another to
                                   hide their positive drug tests and that self-reporting positive drug test
                                   results would not effectively identify problem drivers. To address some of
                                   these gaps, in July 2012 the Moving Ahead for Progress in the 21st




                                   Page 1                                               GAO-13-13 Highway Safety
Century Act (MAP-21) was enacted into law, 1 which will require the
implementation of additional measures to ensure that the highest-risk
drivers do not operate commercial vehicles. For example, the law
requires the Department of Transportation (DOT) to implement a national
clearinghouse of commercial driver controlled-substance and alcohol test
results by July 2014 and a national registry of medical examiners qualified
to certify commercial driver fitness by July 2013.

Given that new requirements are not due to be implemented until 2013,
you asked us to describe (1) current key controls designed to prevent
medically unfit or impaired commercial drivers from operating commercial
vehicles and (2) examples of commercial drivers with potentially
disqualifying impairments related to epilepsy, drugs, or alcohol.

To describe key controls, we reviewed FMCSA’s policies and regulations
as well as legislation related to medical requirements and drug and
alcohol testing for commercial drivers. We also reviewed prior GAO
reports and other studies concerning the enforcement of drug and alcohol
testing and medical fitness of commercial drivers. Further, we interviewed
FMCSA officials about agency plans to improve the identification of these
drivers. To examine cases of commercial drivers with potentially
disqualifying impairments related to epilepsy, drugs, or alcohol, we
matched data from the Social Security Administration’s (SSA) disability
insurance database as of December 2010 to the Commercial Driver
License Information System (CDLIS) as of 2011 2 and crash and
inspection data from the FMCSA’s Motor Carrier Management Inspection
System (MCMIS). Because the number of cases examined was not
drawn from a statistical sample, none of our case selections provide
information that can be generalized beyond the specific cases provided.

To identify commercial drivers who had been involved in a crash or
roadside inspection involving a commercial motor vehicle who had an
impairment based on the severity of their epilepsy, we matched crash and
inspection data from MCMIS with individuals who were receiving SSA
disability benefits on the basis of an epilepsy impairment. We randomly




1
Pub. Law No. 112-141 (July 6, 2012).
2
DOT is the parent agency of FMCSA.




Page 2                                               GAO-13-13 Highway Safety
             selected nine of these drivers for more in-depth review. 3 We used the
             CDLIS and SSA data to identify examples of individuals who renewed or
             obtained a new CDL with medical impairments related to epilepsy, drugs,
             or alcohol. We matched the Social Security number of CDL holders from
             CDLIS to individuals in the Social Security Administration (SSA) disability
             insurance files who were eligible for disability benefits. From this match,
             we extracted 13,281 individuals who had a primary or secondary
             impairment for epilepsy or where drug or alcohol dependence was noted
             in SSA’s electronic file. However, CDLIS includes drivers who have
             inactive CDLs, so we randomly made a nongeneralizable selection of 100
             individuals to identify drivers who had an active CDL at the time SSA
             determined their disability began. For these 100 cases, we obtained and
             reviewed individuals’ state driving records and SSA disability records, and
             requested CDL medical-examination reports and certificates from the
             respective states.

             We assessed the reliability of the data file that FMCSA and SSA provided
             by performing electronic data testing for errors in accuracy and
             completeness, reviewing existing information about the data and the
             system that produced the data, and interviewing agency officials
             knowledgeable about the data. We determined that the data were
             sufficiently reliable for the purposes of this report.

             We conducted this performance audit from December 2010 to November
             2012 in accordance with generally accepted government auditing
             standards. Those standards require that we plan and perform the audit to
             obtain sufficient, appropriate evidence to provide a reasonable basis for
             our findings and conclusions based on the audit objectives. We believe
             that the evidence obtained provides a reasonable basis for our findings
             and conclusions based on our audit objectives.


             FMCSA establishes regulations for the physical and medical qualifications
Background   of CDL holders, develops standards to test and license commercial motor
             vehicle drivers, and enforces commercial motor vehicle safety
             regulations. Commercial drivers must be 21 years old to operate in
             interstate commerce, read English, have successfully completed a



             3
              We originally selected a sample of 10 drivers, but one of the sampled cases did not
             receive SSA benefits and was subsequently removed from our review.




             Page 3                                                          GAO-13-13 Highway Safety
driver’s road test, be physically qualified to drive if operating in
nonexcepted interstate commerce, and hold a current and valid CDL. 4
Commercial drivers in intrastate commerce may operate commercial
vehicles at 18 years old, if permitted by state law. They must also have no
mental disease or psychiatric disorder that would interfere with their ability
to safely drive a commercial vehicle, not use a controlled substance or
habit-forming drug, and have no current clinical diagnosis of alcoholism. A
commercial driver may use a legal non-Schedule I 5 drug or substance if
the drug or substance is prescribed by a licensed medical practitioner
who is familiar with the driver’s medical history, and has advised the
driver that the prescribed substance or drug will not adversely affect the
driver’s ability to safely operate a commercial motor vehicle.

Violations for impaired drivers can result in a range of penalties against
CDL holders. For example, a first conviction of driving under the influence
of alcohol or a controlled substance, regardless of whether it occurs in a
commercial or personal vehicle, results in immediate CDL suspension by
the issuing state for 12 months. A second results in permanent
suspension. Licensing states are required to maintain driver records
showing convictions for disqualifying federal violations and are to
disqualify commercial drivers convicted of those violations while driving a
commercial vehicle. Information on CDL holders must be exchanged
among states through a nationwide system. The CDLIS is a nationwide
computer system that, among other things, enables state driver-licensing
agencies to ensure that each commercial driver has only one driver’s
license and one complete driver record. State driver-licensing agencies
use CDLIS to complete various procedures, including transmitting out-of-
state convictions and transferring the driver record when a commercial
driver’s license holder moves to another state.


4
 Most commercial drivers operating in interstate commerce are nonexcepted drivers.
Excepted drivers include those who operate a commercial vehicle in interstate commerce:
(1) as a federal, state, or local government employee; (2) to transport human corpses or
sick and injured persons; (3) to respond during emergencies or other related activities
while operating a fire truck or other rescue vehicles; (4) to transport migrant workers in
most circumstances; (5) to transport propane heating fuel when responding to an
emergency condition and to respond to a pipeline emergency condition; and (6) in certain
instances, to transport farm machinery and supplies.
5
 Schedule I substances have a high potential for abuse, and have no currently accepted
medical use in treatment in the United States. Examples include heroin, lysergic acid
diethylamide (LSD), peyote, methaqualone, and 3,4-methylenedioxymethamphetamine
(“ecstasy”).




Page 4                                                          GAO-13-13 Highway Safety
                         FMCSA has established a number of key controls that are designed to
FMCSA Controls for       prevent CDL holders from operating commercial vehicles while impaired
Commercial Drivers       that generally cover three areas. First, drivers are required to undergo
                         regular medical exams by a certified medical examiner to determine if a
Include Medical          driver is physically qualified to operate a commercial vehicle. Second,
Exams, Drug and          employers are responsible for drug testing employees at various points of
                         employment. Independent self-employed commercial vehicle operators
Alcohol Testing, and     are required to meet drug testing requirements by being enrolled in a
Roadside Inspections     random testing pool that includes other drivers and is managed by a
                         consortium or third-party administrator that provides drug or alcohol
                         testing services to DOT-regulated employers. Third, state and federal
                         roadside-inspection programs are intended to identify impaired drivers
                         and perform other safety checks. While our review did not evaluate
                         whether these controls were working as intended, in prior work we have
                         found that these controls were vulnerable to abuse or manipulation. 6 With
                         the enhanced statutory authority and direction provided by the MAP-21
                         Act, DOT may be able to address some of these vulnerabilities. DOT is
                         required to issue implementing regulations by July 2014.


Medical Exams Are Used   FMCSA has established regulatory standards that require interstate
to Determine Drivers’    commercial drivers to be examined and certified by a licensed medical
Physical Fitness to      examiner. The exams assess whether a driver meets minimum physical
                         qualifications before obtaining a CDL. The exams are generally repeated
Operate a Commercial     at least every 2 years. Medical examiners must review the driver’s
Motor Vehicle            medical history; perform vision, hearing, blood pressure, and other such
                         tests; and conduct a physical exam. The medical examiner must also
                         determine that the driver does not use any drugs or controlled substances
                         identified as a Schedule I drug. A CDL driver cannot use any non-
                         Schedule I drug or controlled substance except when the drug or
                         substance has been prescribed by a licensed medical provider who is
                         familiar with the driver’s medical history and has determined that its use
                         would not adversely affect the driver’s ability to operate a commercial
                         vehicle. According to DOT, medical examiners do not give drivers drug or
                         alcohol tests and largely base determinations on the physical examination
                         and driver identification of prescribed medications, alcohol, or illegal drug
                         use information included in the examination form.


                         6
                          GAO, Certification Process for Drivers with Serious Medical Conditions, GAO-08-826
                         (Washington, D.C.: June 30, 2008); Examples of Job Hopping by Commercial Drivers
                         after Failing Drug Tests, GAO-08-829R (Washington, D.C.: June 30, 2008).




                         Page 5                                                       GAO-13-13 Highway Safety
If a medical examiner deems a driver fit to drive, the examiner must sign
and date a medical certificate. The medical examiner also keeps a paper
copy of the signed certificate and may provide another copy to the driver’s
employer if requested. As of January 30, 2012, individuals renewing or
applying for a CDL must submit a copy of their current medical certificate
to their state licensing agency, making state licensing agencies
responsible for ensuring that drivers have current medical certificates on
file. 7 FMCSA does not maintain a copy or record of the medical
certificates.

Drivers with serious medical conditions can still meet DOT medical fitness
requirements to safely operate a commercial vehicle and hold CDLs.
Because medical determinations rely on subjective factors and patient
self-reporting, it is not possible to systematically determine whether these
drivers had disqualifying medical conditions. According to DOT, medical
examiners are not required to review nor do they have access to SSA
disability databases. Nonetheless, we issued a report in 2008 showing
that 563,000 CDL holders were also eligible for full federal medical
disability benefits. 8 This represented over 4 percent of all CDL holders in
DOT’s CDLIS database. In our 2008 report, we detailed 15 examples of
CDL holders receiving full disability benefits who did not undergo a
careful medical evaluation required by FMCSA regulations. While not
generalizable to all CDL holders, these examples included instances of
forged medical certificates, false assertions on self-certifications, and
medical examiners not following federal requirements in the determination
of medical fitness for commercial drivers. The MAP-21 Act requires that
DOT set up a national registry of medical examiners and seeks to ensure
that medical certificates are provided to DOT and state licensing agencies
electronically. According to DOT, FMCSA has taken regulatory steps to
improve medical reviews and medical certification processes, including: 9

•     In December 2008, FMCSA published a final rule concerning the
      merger of the medical certification and CDL issuance and renewal
      process. The rule requires that drivers provide a copy of their medical
      certificates to the State licensing agency and that the State include


7
49 C.F.R. § 383.71(h)(1).
8
 GAO, Certification Process for Drivers with Serious Medical Conditions, GAO-08-826
(Washington, D.C.: June 30, 2008).
9
    73 Fed. Reg. 73096 (Dec 1, 2008).




Page 6                                                       GAO-13-13 Highway Safety
                                 the medical certification information on the electronic driving record.
                                 The medical certificate information could then be reviewed during a
                                 roadside inspection via a check of the driving record, such as through
                                 the CDLIS. In the instance of a driver who fails to renew his medical
                                 certificate on time, the States are required to downgrade the
                                 individual’s CDL so that he must not operate a commercial motor
                                 vehicle until a valid medical certificate has been submitted to the State
                                 licensing agency.

                           •     In April 2012, FMCSA published a final rule establishing a National
                                 Registry of Certified Medical Examiners. 10 The 2012 final rule
                                 provides requirements for all healthcare professionals responsible for
                                 issuing medical certificates for interstate truck and bus drivers to
                                 complete a training course on the Federal physical qualifications rules
                                 and to pass an examination to assess the examiners ability to apply
                                 the rules, and advisory criteria in a consistent manner when making
                                 the determination whether a driver meets the qualification standards.

                           •     FMCSA has announced its plans to initiate a new rulemaking that
                                 would enable the agency to require medical examiners on the
                                 National Registry to submit to the agency the medical certificate
                                 information on each individual who applies for a medical certificate.
                                 The agency would then have the ability to transmit to the state driver
                                 licensing agency the medical certificate. This process will significantly
                                 decrease the likelihood of drivers being able to falsify medical
                                 certificates.

                           When implemented, these requirements could help improve the control
                           vulnerabilities identified in our prior work by ensuring that proper medical
                           reviews are conducted and medical certificates are prepared by qualified
                           medical examiners. However, additional work would need to be
                           conducted to assess their effectiveness.


Drug and Alcohol Testing   FMCSA regulations also require CDL holders to undergo periodic drug
by Employers Is Designed   and alcohol testing to identify unqualified drivers. Employers must test all
to Identify Unqualified    CDL holders during preemployment screening; upon reasonable
                           suspicion; randomly on a specific percentage; after a serious accident in
Drivers                    which the driver was issued a traffic citation; and for all fatal accidents. In


                           10
                                77 Fed. Reg. 24104 (April 20, 2012).




                           Page 7                                                   GAO-13-13 Highway Safety
addition, according to DOT, employers must request a wide range of
information from drivers’ previous employers as disclosed by the driver on
his or her application for employment and pertaining to the driver’s history
in the DOT drug and alcohol testing program.

Each year, employers are also required to conduct random alcohol tests
for at least 10 percent of their average number of driver positions, and
random controlled substance or drug testing for at least 50 percent of
their average number of driver positions. According to DOT, FMCSA may
increase or decrease these percentages on the basis of self-reported
drug and alcohol testing information from a sample of 2,000 employers.

FMCSA regulations follow Department of Health and Human Services
(HHS) employee drug testing requirements according to the Omnibus
Transportation Employee Testing Act of 1991. 11 They use urine tests
covering five categories of drugs: marijuana, cocaine, amphetamines
(dexadrine, adderall), opiates (heroin, morphine, codeine), and
phencyclidine (PCP). Each year, employers must conduct alcohol tests
equal to at least 10 percent of the average number of CDL drivers.
Alcohol tests of either the driver’s breath or saliva must be performed
immediately before, during, or after the driver’s performance of safety-
sensitive duties such as operating a commercial vehicle. Drug tests are
required to be analyzed by HHS-certified labs. All test results must be
reviewed by a board-certified medical review officer (MRO) before being
reported to the driver’s employer. The MRO will interview the driver to
determine if there is a medical explanation for the driver’s use of the
prohibited substance. If the driver provides appropriate documentation
and the MRO determines that the driver has a legitimate medical reason
for using the prohibited substance, the result is reported as negative to
his or her employer. The MRO is required to report any safety concerns to
the driver’s employer with regard to drug abuse and discuss the driver’s
use of any prohibited substances with the prescribing physician.

According to FMCSA regulations, the driver must be removed from
safety-sensitive duty if the MRO reports a positive drug or alcohol test
result to the driver’s employer. The driver cannot return to a safety-
sensitive function, such as operating a commercial vehicle, until he or she
has completed the return-to-duty process, which includes being evaluated



11
 Title V of Pub. L. No. 102-143, 105 Stat. 917, 952 (Oct. 28, 1991).




Page 8                                                          GAO-13-13 Highway Safety
by a substance-abuse professional, successfully complying with
prescribed education or treatment, and passing a return-to-duty alcohol or
drug test. FMCSA officials stated that follow-up testing to monitor the
driver’s continued abstinence from drug use is also required. FMCSA
regulations state that any driver, including independent self-employed
operators who refuse to submit to a drug or alcohol test are not permitted
to perform safety-sensitive functions until they complete a return-to-duty
process.

FMCSA officials stated that the results of drug tests are not directly
reported to FMCSA, but rather processed and maintained by the current
employers. Officials noted that FMCSA audits CDL employers for
compliance with FMCSA testing regulations.

In 2008, we reported examples of job hopping by commercial drivers who
failed a drug test. 12 After losing employment for a positive test, job-
hoppers then test negative on a preemployment test for another carrier
and return to duty. In each of the 19 cases of job hopping we reported in
our 2008 report, the second employer stated that knowledge of a previous
positive drug test would have disqualified the driver. Some of the19
drivers operated trucks carrying hazardous materials for periods of a
month to over a year. These 19 cases were not generalizable to the
population of CDL holders.

The MAP-21 Act could help improve the control vulnerabilities identified
by our prior work. Specifically, the law requires DOT to establish, operate,
and maintain a national clearinghouse with records relating to the results
of positive drug and alcohol tests of commercial drivers or instances of
refused tests. Once the clearinghouse has been established, employers
must request and review their CDL drivers’ records from the
clearinghouse annually. The MAP-21 Act also requires DOT to develop a
method to electronically notify an employer of each additional positive test
result or other noncompliance.




12
  GAO-08-829R.




Page 9                                                GAO-13-13 Highway Safety
States and FMCSA          FMCSA also conducts commercial vehicle and driver inspections as part
Conduct Roadside          of its roadside vehicle-inspection program. States can apply for Motor
Inspections to Identify   Carrier Safety Assistance Program grant funds for financial assistance in
                          reducing the number and severity of crashes, injuries, and fatalities
Impaired Drivers and      involving commercial vehicles. According to DOT, as a condition of
Perform Safety Checks     receiving these funds, states must conduct these types of inspections. A
                          software program is made available by FMCSA to identify which drivers
                          or vehicles are recommended for inspection.

                          During an inspection, a FMCSA or state officer will generally examine the
                          vehicle and its equipment, as well as the driver’s license, medical
                          certificate, and whether the driver is under the influence of alcohol or a
                          prohibited drug. According to DOT, enforcement officials may demand to
                          see a driver’s medical certificate; however, they would not be able to
                          make an independent assessment of the driver’s medical condition
                          absent any obvious indications of a problem. The roadside inspector
                          would also only be able to address epilepsy or drugs and alcohol if the
                          driver exhibited certain signs. FMCSA officials stated that drivers found to
                          be using or possessing drugs or alcohol are reported into the MCMIS
                          system, and additional actions (such as arrests or “out of service”
                          indications in which the driver is immediately placed out of service and
                          prohibited from operating the vehicle) may occur. In fiscal year 2011, over
                          3.5 million roadside inspections were conducted in which over 7 million
                          violations were recorded, and of those violations, approximately 14
                          percent resulted in an out-of-service violation in which the driver, motor
                          vehicle, or motor carrier was placed out of service because of safety
                          issues. 13

                          In addition to the roadside-inspection program, FMCSA conducts annual
                          drug and alcohol strike-force sweeps. During the 2012 2-week sweep,
                          FMCSA identified 287 commercial drivers who did not adhere to federal
                          drug and alcohol regulations and who now face possible monetary fines
                          and disqualification from operating a commercial vehicle. FMCSA also
                          identified 128 truck and bus companies who now face possible
                          enforcement actions for violations such as hiring drivers who had tested
                          positive for illegal drugs and not implementing a drug and alcohol testing
                          program. By conducting these sweeps, FMCSA has taken positive steps
                          to help remove drivers that pose a risk to public safety from the road.



                          13
                           Drivers can be cited for multiple safety violations during a single roadside inspection.




                          Page 10                                                          GAO-13-13 Highway Safety
                         We identified instances of drivers who operated—and sometimes
Examples of              crashed—commercial vehicles despite having medical conditions such as
Commercial Drivers       epilepsy. Epilepsy is a chronic disease characterized by seizures, loss of
                         bodily control, and unconsciousness. We also found instances of state
with Disqualifying       licensing agencies issuing or reissuing CDLs to commercial drivers with
Impairments Related      epilepsy or drug or alcohol dependence noted in their medical histories.
                         FMCSA recommendations state that a person with an established history
to Epilepsy, Drugs, or   or clinical diagnosis of epilepsy is not physically qualified to drive a
Alcohol                  commercial vehicle for interstate commerce if he or she is taking
                         antiseizure medication or has had a history of epilepsy or seizures within
                         the past 10 years. These recommendations also state that individuals
                         who use a controlled substance or habit-forming drug or who have a
                         clinical diagnosis of alcoholism are not physically qualified to drive a
                         commercial vehicle. The MAP-21 Act requires medical-certificate
                         information to be transmitted to DOT on a monthly basis and mandates
                         that states establish and maintain the capability to receive an electronic
                         copy of a medical examiner’s certificate for each CDL holder licensed in
                         that state.


Drivers Operated         Out of millions of CDL holders, we identified 230 individuals who were in
Commercial Vehicles      an accident or had a roadside inspection in a commercial motor vehicle at
Despite Medical          some point between 2008 and 2011, after they started receiving SSA
                         disability benefits for epilepsy. Thirty-one of the 230 individuals we
Impairments Related to   identified were involved in accidents while driving a commercial vehicle
Epilepsy                 during this time. However, because DOT’s database of crashes does not
                         identify whether the driver’s medical condition may have contributed to
                         the accident, we could not determine the extent to which the epilepsy
                         impairment actually caused the accident. We plan to refer these 230
                         individuals to DOT for appropriate action as warranted. We randomly
                         selected for further investigation 5 of the individuals involved in
                         commercial vehicle accidents and 4 of the 199 drivers selected for an
                         FMCSA roadside inspection to confirm that they were driving commercial
                         vehicles.

                         Eight of these 9 drivers selected for further investigation obtained CDLs
                         after their epilepsy impairment date, with at least 6 of the 8 drivers
                         obtaining their license within 10 years of having a seizure, a physical




                         Page 11                                              GAO-13-13 Highway Safety
disqualification for obtaining a CDL. 14 Eight of the drivers were still
entitled to SSA benefits for epilepsy because SSA continued to determine
that they could not work due to their impairment. In two of the cases that
resulted in an accident, a health-care professional had noted in SSA
documentation that the individual should not be driving. Because state
driver’s license agencies nationwide only began requiring applicants’
presentation of a medical certificate after January 30, 2012, we were
unable to obtain medical examination reports from all states or drivers
and do not know whether their medical examiners were aware of their
conditions. We plan to refer these 9 individuals to their state driver’s
licensing agency for appropriate action as warranted.

Examples of individuals who were driving commercial vehicles after being
diagnosed with epilepsy include the following:

•    Crash after epilepsy impairment. According to SSA documentation,
     this individual suffered from epilepsy, seizures, blackouts, memory
     loss, vision problems, substance abuse, and affective mood disorder.
     Holding an active CDL, he was approved for SSA disability benefits in
     December 2007. He informed SSA that he had been involved in an
     auto accident but had no idea how it occurred, and that he could no
     longer drive due to his condition. He added that he had been a truck
     driver since 1977, but due to his confusion, his employer had sent
     drivers after him on three different occasions. We did not receive a
     medical examination form or certificate for this individual from the
     state that issued his CDL and thus were unable to determine whether
     a medical examiner considered or was aware of the driver’s condition
     or whether a medical examination occurred. According to medical
     records contained in SSA documentation, medical professionals
     informed this individual in 2009 that he should not be driving and that
     it was unsafe to hold a job. However, he successfully renewed his
     CDL in August 2010. DOT records show that he was involved in a
     crash with a commercial vehicle 4 months later in December 2010.
     Because DOT’s database did not identify whether the driver’s medical
     condition may have contributed to the accident, we could not
     determine the extent to which the epilepsy impairment actually caused
     the accident.




14
   For the other 2 drivers, we could not determine whether the individual had a seizure
within 10 years of obtaining their license.




Page 12                                                         GAO-13-13 Highway Safety
                           •    Numerous accidents after epilepsy impairment. A Washington
                                state agency noted in 1989 that this driver’s seizure disorder made it
                                unsafe for him to drive any vehicle, commercial or otherwise. In 1990,
                                SSA determined this individual was disabled due to epilepsy and
                                organic brain syndrome, which is a decreased mental function due to
                                a medical disease other than a psychiatric illness. According to a
                                medical evaluation in this driver’s SSA disability file, he began
                                suffering from seizures and blackouts after an auto accident in 1976
                                but did not report them so he could continue driving tractor trailers. In
                                2000, the driver reported to SSA that medication did not prevent his
                                weekly seizures. Despite this, Washington state issued him a CDL in
                                2002, 2005, and 2007. Washington state driving records reveal that
                                he was involved in collisions in his commercial vehicle in 2005, 2006,
                                and 2009. In 2009, a representative from this driver’s employer
                                informed SSA that the individual had been driving a truck for 4 years,
                                but was fired for being involved in too many accidents. SSA
                                suspended this individual’s disability benefits from 2006 to 2009 while
                                he was earning employment income. This individual surrendered his
                                CDL in January 2012. Because DOT’s database did not identify
                                whether the driver’s medical condition may have contributed to the
                                accident, we could not determine the extent to which the epilepsy
                                impairment actually caused the accidents.

CDLs Were Issued or        From our random selection of 100 CDL holders, we identified 22 CDL
Reissued to Drivers with   holders who received SSA disability benefits where epilepsy, alcohol
Impairments Related to     addiction, or drug dependence was a listed medical impairment and had
                           CDLs issued or renewed after becoming eligible for those benefits.
Epilepsy, Drugs, and       Specifically, according to SSA’s disability database, 10 of the 22
Alcohol                    individuals had epilepsy or a seizure disorder identified as a medical
                           impairment in their disability records. The remaining 12 had alcohol or
                           drug dependence noted in their disability records. 15 According to DOT,
                           FMCSA and the states do not obtain complete information on whether
                           individuals are driving on the road, and we were not able to determine
                           whether all of these individuals were actually driving a commercial vehicle
                           after their CDLs were issued or renewed. We are referring any cases
                           where an individual had a disqualifying impairment yet still had an active



                           15
                             Each of the drivers we identified with drug or alcohol dependence noted in SSA’s
                           disability files also had another disabling condition noted in the files. Drug or alcohol
                           dependence is not used as a basis to determine disability.




                           Page 13                                                             GAO-13-13 Highway Safety
CDL to the state driver’s licensing agency for appropriate action as
warranted.

Examples of individuals who obtained or renewed a CDL license after
SSA determined they were eligible for disability benefits include the
following:

•    CDL issued despite epilepsy impairment. This driver reported to
     SSA that he suffered from sudden seizures, sometimes daily,
     beginning in 1999. The driver reported having seizures as often as
     three times a week, taking 20 minutes to 2 hours to recover from each
     episode. According to medical documentation in the claimant’s SSA
     disability file, he was also resistant to antiseizure medication.
     According to SSA documentation, the driver reported suffering from
     seizures as recent as 2008. The driver stated that he was unable to
     stand, walk, or sit for extended periods and that he suffered from
     memory loss, fatigue, and difficulty breathing. The driver was issued a
     new CDL by the state in November 2011 with endorsements allowing
     him to operate, among other things, school buses and passenger
     vehicles. To obtain this CDL, the driver certified to the state driver’s
     licensing agency that he did not have a physical condition preventing
     him for exercising reasonable and ordinary control of a motor vehicle.
     This individual continues to receive SSA disability benefits for epilepsy
     while holding an active CDL. We did not receive a medical
     examination form or certificate for this individual from the state that
     issued his CDL and thus were unable to determine whether a medical
     examiner considered or was aware of the driver’s condition or whether
     a medical examination occurred. 16

•    CDL issued and renewed despite epilepsy impairment. According
     to SSA documentation, this individual began receiving disability
     benefits for a seizure disorder in 2001 and informed SSA that he
     stopped driving when his seizures began in 1999. He suffered from
     seizures and unconsciousness. For example, according to SSA
     documentation he passed out while driving a truck and awoke while
     walking in the street with no recollection of what had occurred. SSA
     documents included a physician’s note stating that the driver was
     medically disabled from any form of gainful occupation due to a



16
  According to DOT, most states do not require provision of the medical examination form
on the state’s own authority.




Page 14                                                       GAO-13-13 Highway Safety
                               diagnosis of intractable seizure disorder. Despite his medical history,
                               he was issued a first-time CDL in 2005, which was renewed in 2009.
                               When applying for his CDL, he certified to the state driver’s licensing
                               agency that he did not have a condition that could cause a loss of
                               consciousness. He continues to receive SSA disability benefits for
                               seizures. We did not receive a medical examination form or certificate
                               for this individual from the state that issued his CDL and thus were
                               unable to determine whether a medical examiner considered or was
                               aware of the driver’s condition or whether a medical examination
                               occurred.

                           •   CDL issued despite drug dependence. In 2005, this individual’s
                               personal driver’s license was suspended for 12 months after a Driving
                               While Intoxicated (DWI) conviction. According to SSA documentation,
                               in 2007 he was diagnosed with psychosis, a history of alcohol abuse,
                               and cannabis abuse following a mental-health hospitalization. He
                               stated that his illness began to interfere with his work in 2006 and that
                               he became unable to work in 2009. He began receiving SSA disability
                               benefits the following year for functional psychiatric disorders. Drug
                               dependency was also noted in his file. SSA documentation states that
                               in January 2009, a physician noted that this individual was unable to
                               participate in employment or training activities in any capacity due to
                               paranoid schizophrenia. However, this individual obtained a CDL from
                               Virginia in June 2010. We did not receive a medical examination form
                               or certificate for this individual from the state that issued his CDL and
                               thus were unable to determine whether a medical examiner
                               considered or was aware of the driver’s condition or whether a
                               medical examination occurred. In October 2010, he refused to submit
                               to an alcohol test while operating a commercial motor vehicle. This
                               refusal led to a DWI conviction and permanent CDL suspension in
                               February 2011.

States Could Not Provide   Since most state driver’s licensing agencies do not require a medical
Medical Examination        examination report to be presented to them, according to DOT, they were
Certificates               unable to provide these reports or medical certificates that we requested
                           for 29 of the 30 individuals who had CDLs issued or renewed after
                           becoming eligible for SSA benefits. We were therefore unable to
                           determine whether medical examiners considered or were aware of each
                           driver’s conditions or whether a medical examination occurred for these




                           Page 15                                               GAO-13-13 Highway Safety
                      individuals. While FMCSA regulations are meant to prevent an individual
                      with these conditions from receiving or renewing a CDL, states were not
                      required to obtain and maintain medical certifications or medical
                      examination reports at the time of our review. According to DOT, only a
                      few states on their own authority required CDL holders to provide either a
                      medical examination report or medical certificate. As mentioned earlier,
                      as of January 30, 2012, FMCSA requires states to electronically store
                      medical certificates for new and renewing CDL applicants and are
                      required to electronically post this information for all CDL holders to the
                      state’s CDLIS driver records. States will also be required to report the
                      date of the medical certification to the state’s CDLIS driver record. In
                      addition, the MAP-21 Act requires medical certificate information to be
                      transmitted to DOT on a monthly basis and mandates that states
                      establish and maintain the capability to receive an electronic copy of a
                      medical examiner’s certificate for each CDL holder licensed in that state
                      who operates or intends to operate in interstate commerce. If these
                      requirements are properly implemented and followed, they should help to
                      prevent situations similar to these case studies from recurring.


Agency Comments and   We provided a draft copy of this report to SSA and DOT. SSA did not
Our Evaluation        have any comments. DOT’s Director of Audit Relations, Office of the
                      Secretary of Transportation, provided technical comments on the report,
                      which have been incorporated as appropriate.


                      We are sending copies of this report to interested congressional
                      committees, the Secretary of Transportation, the Commissioner of the
                      Social Security Administration and other interested parties. In addition,
                      this report is also available at no charge on the GAO website at
                      http://www.gao.gov.

                      If you have any questions concerning this report, please contact me at
                      (202) 512-6722 or BerrickC@gao.gov. Contact points for our Offices of




                      Page 16                                               GAO-13-13 Highway Safety
           Congressional Relations and Public Affairs may be found on the last page
           of this report.

           Sincerely yours,




           Cathleen A. Berrick
           Managing Director
           Forensic Audits and Investigative Service




(192374)
           Page 17                                            GAO-13-13 Highway Safety
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