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4/16/2015
Insulin Dependent School Bus
Drivers
Prior to June 22, 2010
 The school bus driver medical standards
were set by the Pupil Transportation Act, Act
187 of 1990. Under the rules, a bus driver
with diabetes qualified for a school bus
medical certificate provided they met certain
conditions.
 It was not a waiver
 No waivers were available.
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After June 22, 2010
 Public Act 93 of 2010 was signed into law
 As of this date, the medical requirements of
bus drivers changed to “the
requirements…found in 49 CFR 391.41 to
391.49.
 Commonly called the “DOT Physical”
 391.41(b)(3) disqualifies a driver that uses
insulin to control diabetes.
Two Exceptions
The requirement of 49 CFR 391.41 (b)(3)
does not apply if either of the following is
true:
The driver of the school bus has been
granted a waiver under section 3 of the
motor carrier safety act of 1963, 1963 PA
181, MCL 480.13.
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Two Exceptions
Or
The driver of the school bus is employed as
a school bus driver on the effective date of
the amendatory act that added this
subdivision, diabetes is noted at the time of
examination, and the requirements of
subdivision (c) are met. (Grandfathered)
Insulin Dependent School Bus
Drivers
Motor Carrier Safety Appeal
Board
Medical Waiver Process
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Medical Waiver Process
 Driver fails DOT Physical due to insulin use.
 The employer determines if they will support
the driver operating their school buses with
a medical waiver. They are not required to.
 A waiver packet is submitted to the State
Police Commercial Vehicle Enforcement
Division Medical Waiver Unit.
The application includes
 MC-027 Application for Intrastate Medical
Waiver
 MC-028 Physician’s Statement of
Examination
 MC-029 Vision Specialist Statement of
Examination
 Medical Examination Report for Commercial
Driver Fitness Determination (DOT Physical)
 60 days of blood sugar readings
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 Employment application
 Driving record
 Copy of accident reports for any accidents
applicant has been involved in the last five
years.
 May submit any other documentation to
support application.
Common Problems
 Incomplete forms. All information requested
is required.
 Each medical document must be completed
by a different medical professional.
 Paperwork too old. All exams must be
completed within the prior 60 days.
 Missing documentation. No blood sugar
reading, driving record, crash report…
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Appeal Board Meeting
 After the complete packet is submitted, the
driver will be scheduled to attend the next
appeal board meeting.
 The driver must attend or a waiver will not
be approved.
 The employer is encouraged to attend.
 The waiver will be approved or denied at the
meeting.
General Information
 The appeal board meets the third
Wednesday of the month in January, April,
July, and October.
 The application packet is due two weeks
before the appeal board hearing.
 The original waiver will generally be valid for
one year or less.
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General Information (cont.)
 The waiver is only valid for the company
(school district) listed on the waiver.
 The waiver is only valid for intrastate
operations. (Within Michigan)
 Driver may have more than one waiver.
Renewal
 Same packet is required except instead of
an employment application, a list of
accidents and sick time used since last
waiver was issued is required.
 Unless something unusual happened, the
applicant does not have to attend another
appeal board hearing.
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School bus driver on June 22, 2010 and
Diabetes was noted on the school bus
medical exam goes in the “file”
Grandfathered
School bus drivers
Once a driver is in the “file” they do
not come out.
All an employer would need to do is
see if the person is in the file.
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Be Proactive
 You already know if your driver qualifies for
the grandfather provision.
 Why not contact the medical examiner
before sending the driver for a physical?
 Provide the clinic/medical examiner with the
informational sheet produced by MSP and
MDE.
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Additional Information
 Michigan Department of Education Web
Page. www.michigan.gov/schoolbus
 Michigan Dept. of State Police Web Page.
www.michigan.gov/cvedmedicalwaiver
 Michigan State Police Medical Waiver Unit
(517)241-0542
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Daniel Fink, MD
Medical Director –
Henry Ford Occupational
Health
National Registry of Certified
Medical Examiners
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All “DOT Physicals” completed
on or after May 21, 2014, must be
done by a medical examiner
listed in the National Registry
Examinations conducted prior to that
remain valid until the expiration date on the
certificate.
Finding a Medical Examiner
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Enter City and State
or Zip Code
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Certified Medical Examiners:
 Must have training in the rules and
guidelines.
 Must take and pass a test on the rules and
guidelines.
 Must submit a report at least every 30
days of drivers who passed and failed the
exam.
Intent
 The NRCME and CDL self certification are
the first steps in removing medically
unqualified drivers from the roads.
 The proposed final phase is to have the
medical examiner upload examination
results daily to FMCSA, who will in turn
send it to the State Drivers License
Authority (SOS) to add to the driver’s
record.
 3rd Highest Fatality Rate Among U.S.
Occupations
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Physical Qualification for
Commercial Motor Vehicle
Drivers and Summary of the
Advisory Criteria for
Evaluation
A person is physically qualified to drive a
commercial motor vehicle if that person:
 1. Has no loss of a foot, leg, hand, or arm, or has been granted an
SPE certificate*
 2. Has no impairment of a hand or finger that interferes with
prehension or power grasping; has no impairment of an arm, foot, or
leg that interferes with the ability to perform normal tasks associated
with operating a commercial motor vehicle; has no other significant
limb defects or limitations that interfere with the ability to perform
normal tasks associated with operating a commercial motor vehicle;
or has been granted an SPE certificate* Summary of advisory
criteria: the SPE Certificate Program may allow those persons with
amputation or impairment to qualify under the Federal Motor Carrier
Safety Regulations by use of prosthetic devices or equipment
modifications. If the examiner finds the person otherwise medically
qualified, they must check on the medical certificate that the driver is
qualified only if accompanied by an SPE certificate.
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A person is physically qualified to drive a
commercial motor vehicle if that person:
 3. Has no established medical history or clinical
diagnosis of diabetes mellitus currently requiring
insulin for control Summary of advisory criteria: the
FMCSA has consistently stated that a person with
diabetes who uses insulin for control does not meet
the minimum physical requirements of the Federal
Motor Carrier Safety Regulations. If the condition can
be controlled by the use of oral medication and diet,
then a person may be qualified under the present rule.
Drivers who do not meet the federal diabetes standard
may call 202-366-1790 for an application for a
diabetes exemption.
A person is physically qualified to drive a
commercial motor vehicle if that person:
 4. Has no current clinical diagnosis of myocardial infarction,
angina pectoris, coronary insufficiency, thrombosis, or any
other cardiovascular disease of a variety known to be
accompanied by syncope, dyspnea, collapse, or congestive
cardiac failure Summary of advisory criteria: the examiner
must determine if the nature and severity of a person's
cardiovascular condition will likely cause the symptoms of
cardiovascular insufficiency mentioned above. After an
occurrence of cardiovascular insufficiency (e.g., myocardial
infarction, thrombosis), before a driver is certified, he or she
must have a normal resting and stress electrocardiography,
no residual complications, no physical limitations, and should
be taking no medication likely to interfere with safe driving.
Coronary artery bypass surgery and pacemaker implantation
are not necessarily disqualifying, but implantable cardioverter
defibrillators are because of the risk of syncope.
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A person is physically qualified to drive a
commercial motor vehicle if that person:
 5. Has no established medical history or clinical diagnosis of a
respiratory dysfunction likely to interfere with the ability to control
and drive a commercial motor vehicle safely Summary of advisory
criteria: slight impairment in respiratory function under emergency
conditions may be detrimental to safe driving. Conditions that may
interfere with oxygen exchange and may result in incapacitation
include emphysema, chronic asthma, carcinoma, tuberculosis,
chronic bronchitis, and sleep apnea. If the medical examiner detects
a respiratory dysfunction that in any way is likely to interfere with the
driver's ability to safely control and drive a commercial motor
vehicle, the driver must be referred to a specialist for further
evaluation and therapy. Anticoagulation therapy for deep venous
thrombosis and/or pulmonary thromboembolism is not unqualifying
once optimal dose is achieved, provided lower extremity venous
examinations remain normal and the treating physician gives a
favorable recommendation.
A person is physically qualified to drive a
commercial motor vehicle if that person:
 6. Has no current clinical diagnosis of high blood
pressure likely to interfere with the ability to
operate a commercial motor vehicle safely
Summary of advisory criteria: hypertension alone
is unlikely to cause sudden collapse; however, the
likelihood increases when target organ damage,
particularly cerebral vascular disease, is present
(see Table 3).
 Annual recertification is recommended if the
medical examiner does not know the severity of
hypertension before treatment. An elevated blood
pressure finding should be confirmed by at least
two subsequent measurements on different days.
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A person is physically qualified to drive a
commercial motor vehicle if that person:
 7. Has no established medical history or clinical diagnosis of a
rheumatic, arthritic, orthopedic, muscular, neuromuscular, or
vascular disease that interferes with the ability to control and
operate a commercial motor vehicle Summary of advisory criteria:
diseases that have acute episodes of transient muscle weakness,
poor muscular coordination, abnormal sensations, decreased
muscle tone, visual disturbances, and pain may be suddenly
incapacitating and interfere with safe driving. Those with more
insidious onset may not suddenly incapacitate a person but may
restrict his or her movements and eventually interfere with the ability
to safely operate a motor vehicle. The physician, when examining a
person, should consider the following: (1) the nature and severity of
the person's condition; (2) the degree of limitation present; (3) the
likelihood of progressive limitation; and (4) the likelihood of sudden
incapacitation. If severe functional impairment exists, the driver does
not qualify. In cases in which more frequent monitoring is required, a
certificate for a shorter period of time may be issued.
A person is physically qualified to drive a
commercial motor vehicle if that person:



8. Has no established medical history or clinical diagnosis of epilepsy or any other
condition likely to cause loss of consciousness, or any loss of ability to control a
commercial motor vehicle Summary of advisory criteria: the following drivers cannot
be qualified: (1) a driver with a medical history of epilepsy; (2) a driver with a current
clinical diagnosis of epilepsy; or (3) a driver who is taking antiseizure medication.
If the person has a sudden episode of a nonepileptic seizure or loss of consciousness
of unknown cause that did not require antiseizure medication, the decision as to
whether that person's condition will likely cause the loss of consciousness or loss of
ability to control a commercial motor vehicle is made on an individual basis by the
medical examiner in consultation with the treating physician. A six-month waiting
period from the episode and a complete neurologic evaluation is recommended
before certification is considered. If the examination is normal and antiseizure
medication is not required, then the driver may be qualified. With a seizure or episode
of loss of consciousness from a known medical condition, certification should be
deferred until the driver has fully recovered from that condition, has no existing
residual complications, and is not taking antiseizure medication.
Drivers with a history of epilepsy or seizures must be off antiseizure medication and
seizure-free for 10 years to be qualified to operate a commercial motor vehicle in
interstate commerce. Drivers with a history of a single unprovoked seizure may be
qualified if they are seizure-free and off antiseizure medication for five years or
longer.
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A person is physically qualified to drive a
commercial motor vehicle if that person:

9. Has no mental, nervous, organic, or functional disease or psychiatric
disorder likely to interfere with the ability to drive a commercial motor
vehicle safely Summary of advisory criteria: conditions that may affect
memory, reasoning, attention, and judgment or cause drowsiness,
dizziness, confusion, weakness, or paralysis may lead to incoordination,
inattention, loss of functional control, and susceptibility to crashes while
driving. These conditions and symptoms should be thoroughly evaluated
when determining a person's overall fitness to drive. Disorders of a
periodically incapacitating nature, even in the early stages of development,
may warrant disqualification. The degree to which a person is able to
appreciate, evaluate, and adequately respond to environmental strain and
emotional stress is critical when assessing a person's mental alertness and
flexibility to cope with the stresses of commercial motor vehicle driving.
Disqualification may be warranted in persons who are highly susceptible to
frequent states of emotional instability (e.g., schizophrenia, affective
psychoses, paranoia, anxiety, depressive neurosis). Careful consideration
should be given to the adverse effects and interactions of medications in the
overall certification determination.
A person is physically qualified to drive a
commercial motor vehicle if that person:


10. Has a distant visual acuity of at least 20/40 (Snellen) in each eye with or
without corrective lenses, or visual acuity separately corrected to 20/40
(Snellen) or better with corrective lenses; distant binocular acuity of at least
20/40 (Snellen) in both eyes with or without corrective lenses; field of vision
of at least 70 degrees in the horizontal meridian in each eye; and the ability
to recognize the colors of traffic control signals and devices showing
standard red, green, and amber Summary of advisory criteria: the minimum
standard is met if the person is able to recognize and distinguish among
traffic control signals and devices showing standard red, green, and amber.
Contact lenses are permissible if the driver has good tolerance and is well
adapted to their use. Use of a contact lens in one eye for distant visual
acuity and another lens in the other eye for near vision is not acceptable,
nor are telescopic lenses acceptable.
If a person meets the criteria by the use of glasses or contact lenses, the
following statement shall appear on the medical examiner's certificate:
“Qualified only if wearing corrective lenses.” Commercial motor vehicle
drivers who do not meet the federal vision standards may be eligible for an
exemption from the vision standard.
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A person is physically qualified to drive a
commercial motor vehicle if that person:

11. First perceives a forced whispered voice in the better ear at not less
than five feet with or without the use of a hearing aid or, if tested by use of
an audiometric device, does not have an average hearing loss in the better
ear greater than 40 decibels at 500 Hz, 1,000 Hz, and 2,000 Hz with or
without a hearing aid when the audiometric device is calibrated to the
American National Standard (formerly American Standard Association)
Summary of advisory criteria: for the whispered voice test, the person
should stand at least five feet from the examiner with the ear being tested
turned toward the examiner and the other ear covered. Using the breath
that remains after a normal expiration, the examiner whispers words or
random numbers and should not use only sibilants (s-sounding test
materials). If the person fails the whispered voice test, the audiometric test
should be administered. If a person meets the criteria by using a hearing
aid, the driver must use that hearing aid at all times while driving and have a
spare power source for the hearing aid with him or her. If a person meets
the criteria by the use of a hearing aid, the following statement must appear
on the medical examiner's certificate: “Qualified only when wearing a
hearing aid.”
A person is physically qualified to drive a
commercial motor vehicle if that person:
 12. Does not use a controlled substance†, an amphetamine, a
narcotic, or any other habit-forming drug
 Exception: a driver may use such a substance or drug if the
substance or drug is prescribed by a licensed medical
professional who is familiar with the driver's medical history
and assigned duties 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;
this exception does not apply to the use of methadone.
 Summary of advisory criteria: if the driver is using any of the
substances named above that can interfere with safe
operation of the motor vehicle, it may be cause for the driver
to be found medically unqualified. Motor carriers are
encouraged to obtain a medical professional's written
statement about the effects on transportation safety from the
use of a particular drug. A test for controlled substances is not
required as part of this biennial certification process.
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A person is physically qualified to drive a
commercial motor vehicle if that person:
 13. Has no current clinical diagnosis of
alcoholism Summary of advisory criteria: the
term “current clinical diagnosis” refers to a
current alcoholic illness in which the physical
condition has not fully stabilized, regardless of
the time element. If a person shows signs of
having an alcohol-use problem, he or she should
be referred to a specialist. After counseling
and/or treatment, he or she may be considered
for certification.
Key Resources for the Commercial Motor Vehicle Driver Medical Certification
Examination
Federal Motor Carrier Safety Administration (http://www.fmcsa.dot.gov/) Medical
examiner handbook (http://nrcme.fmcsa.dot.gov/MEhandbook.htm)
Medical expert panel reports (http://www.mrb.fmcsa.dot.gov/reports.htm)
Medical frequently asked questions (http://www.fmcsa.dot.gov/rulesregulations/topics/medical/faq.asp)
Medical programs (http://www.fmcsa.dot.gov/rulesregulations/topics/medical/medical.htm)
Medical reports (http://www.fmcsa.dot.gov/facts-research/researchtechnology/publications/medreports.htm)
Medical review board (http://www.mrb.fmcsa.dot.gov/) National Registry of Certified
Medical Examiners
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SECOND
OPINION
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Contact Information
Daniel Fink, MD
Medical Director –
Henry Ford Occupational Health
22505 Allen Road
Woodhaven, MI 48183
734-671-2870 Office
313-570-9600 Cell
734-671-2860 Fax
[email protected]
Henryford.com/occupationalhealth
Motor Carrier Spl/Sgt. Joseph Austin
Medical Waiver Unit
Commercial Vehicle Enforcement Division
Michigan State Police
PO Box 30634
Lansing, MI 48909-0634
517-241-0542 Office
517-241-0501 Fax
[email protected]
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