Denial of Exemption Applications; Epilepsy and Seizure Disorders |
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Larry W. Minor
Federal Motor Carrier Safety Administration
October 1, 2014
[Federal Register Volume 79, Number 190 (Wednesday, October 1, 2014)]
[Notices]
[Pages 59346-59348]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2014-23437]
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DEPARTMENT OF TRANSPORTATION
Federal Motor Carrier Safety Administration
[Docket No. FMCSA-2011-0089; FMCSA-2011-0389; FMCSA-2012-0050; FMCSA-
2012-0094; FMCSA-2013-0106; FMCSA-2013-0108; FMCSA-2013-0109]
Denial of Exemption Applications; Epilepsy and Seizure Disorders
AGENCY: Federal Motor Carrier Safety Administration (FMCSA), DOT.
ACTION: Notice of denial of applications for seizure exemptions.
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SUMMARY: FMCSA announces the denial of 24 individuals' applications for
exemptions from the rule prohibiting persons with a clinical diagnosis
of epilepsy or any other condition that is likely to cause a loss of
consciousness or any loss of ability to operate a commercial motor
vehicle (CMV) from operating CMVs in interstate commerce. The reason
for each of the denials is listed after the individual's name.
FOR FURTHER INFORMATION CONTACT: Elaine M. Papp, R.N., Chief of the
Medical Programs Division, (202) 366-4001, fmcsamedical@dot.gov, FMCSA,
Room W64-224, Department of Transportation, 1200 New Jersey Avenue SE.,
Washington, DC 20590-0001. Office hours are from 8:30 a.m. to 5 p.m.,
Monday through Friday, except Federal holidays.
SUPPLEMENTARY INFORMATION:
Background
Under 49 U.S.C. 31315 and 31136(e), FMCSA may grant an exemption
for a 2-year period if it finds ``such exemption would likely achieve a
level of safety that is equivalent to, or greater than, the level that
would be achieved absent such exemption.'' The statutes allow the
Agency to renew exemptions at the end
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of the 2-year period. The 24 individuals listed in this notice have
requested an exemption from the epilepsy and seizure disorder standard
in 49 CFR 391.41(b)(8), which applies to drivers who operate CMVs as
defined in 49 CFR 390.5, in interstate commerce. Section 391.41(b)(8)
states that a person is qualified physically to drive a CMV if that
person has no established medical history or clinical diagnosis of
epilepsy or any other condition which is likely to cause the loss of
consciousness or any loss of ability to control a CMV.
In order to make an evidence-based decision, FMCSA conducted a
comprehensive review of scientific literature and convened a panel of
medical experts in the field of neurology to evaluate key questions
regarding seizure and anti-seizure medication related to the safe
operation of a CMV. In reaching the determination to grant or deny
exemption requests for individuals who have experienced a seizure, the
Agency considered both current medical literature and information and
the 2007 recommendations of the Agency's Medical Expert Panel (MEP).
Previously, the Agency gathered evidence for decision making concerning
potential changes to the regulation by conducting a comprehensive
review of scientific literature that was compiled into a report
entitled, ``Evidence Report on Seizure Disorders and Commercial Vehicle
Driving'' (Evidence Report) [CD-ROM HD TL230.3 .E95 2007]. The Agency
then convened a MEP in the field of neurology on May 14-15, 2007, to
review 49 CFR 391.41(b)(8) and the advisory criteria regarding
individuals who have experienced a seizure and the 2007 Evidence
Report. The Evidence Report and the MEP recommendations are published
on-line at http://www.fmcsa.dot.gov/rules-regulations/topics/mep/mep-reports.htm under Seizure Disorders and are in the docket for this
notice.
MEP Criteria for Evaluation
On October 15, 2007, the MEP issued the following recommended
criteria for evaluating whether an individual with epilepsy or a
seizure disorder should be allowed to operate a CMV.\1\ The MEP
recommendations are included in an appendix at the end of this notice
and in each of the previously published dockets.
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\1\ Engel, J., Fisher, R.S., Krauss, G.L., Krumholz, A., and
Quigg, M.S., ``Expert Panel Recommendations: Seizure Disorders and
Commercial Motor Vehicle Driver Safety,'' FMCSA, October 15, 2007.
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Epilepsy diagnosis. If there is an epilepsy diagnosis, the
applicant should be seizure-free for 8 years, on or off medication. If
the individual is taking anti-seizure medication(s), the plan for
medication should be stable for 2 years. Stable means no changes in
medication, dosage, or frequency of medication administration.
Recertification for drivers with an epilepsy diagnosis should be
performed every year.
Single unprovoked seizure. If there is a single unprovoked seizure
(i.e., there is no known trigger for the seizure), the individual
should be seizure-free for 4 years, on or off medication. If the
individual is taking anti-seizure medication(s), the plan for
medication should be stable for 2 years. Stable means no changes in
medication, dosage, or frequency of medication administration.
Recertification for drivers with a single unprovoked seizure should be
performed every 2 years.
Single provoked seizure. If there is a single provoked seizure
(i.e., there is a known reason for the seizure), the Agency should
consider specific criteria that fall into the following two categories:
Low-risk factors for recurrence and moderate-to-high risk factors for
recurrence.
Examples of low-risk factors for recurrence include
seizures that were caused by a medication; by non-penetrating head
injury with loss of consciousness less than or equal to 30 minutes; by
a brief loss of consciousness not likely to recur while driving; by
metabolic derangement not likely to recur; or by alcohol or illicit
drug withdrawal.
Examples of moderate-to-high-risk factors for recurrence
include seizures caused by non-penetrating head injury with loss of
consciousness or amnesia greater than 30 minutes or penetrating head
injury; intracerebral hemorrhage associated with a stroke or trauma;
infections; intracranial hemorrhage; post-operative complications from
brain surgery with significant brain hemorrhage; brain tumor; or
stroke.
The MEP report indicates that individuals with moderate to high-
risk conditions should not be certified. Drivers with a history of a
single provoked seizure with low risk factors for recurrence should be
recertified every year.
Medical Review Board Recommendations and Agency Decision
FMCSA presented the MEP's findings and the Evidence Report to the
Medical Review Board (MRB) for consideration. The MRB reviewed and
considered the 2007 ``Seizure Disorders and Commercial Driver Safety''
evidence report and the 2007 MEP recommendations. The MRB recommended
maintaining the current advisory criteria, which provide that ``drivers
with a history of epilepsy/seizures off anti-seizure medication and
seizure-free for 10 years may be qualified to drive a CMV in interstate
commerce. Interstate drivers with a history of a single unprovoked
seizure may be qualified to drive a CMV in interstate commerce if
seizure-free and off anti-seizure medication for a 5 year period or
more'' [Advisory criteria to 49 CFR 391.43(f)].
The Agency acknowledges the MRB's position on the issue but
believes current relevant medical evidence supports a less conservative
approach. The medical advisory criteria for epilepsy and other seizure
or loss of consciousness episodes was based on the 1988 ``Conference of
Neurological Disorders and Commercial Driving'' (NITS Accession No.
PB89-158950/AS). A copy of the report can be found in the docket
referenced in this notice.
The MRB's recommendation treats all drivers who have experienced a
seizure the same, regardless of individual medical conditions and
circumstances. In addition, the recommendation to continue prohibiting
drivers who are taking anti-seizure medication from operating a CMV in
interstate commerce does not consider a driver's actual seizure history
and time since the last seizure. The Agency has decided to use the 2007
MEP recommendations as the basis for evaluating applications for an
exemption from the seizure regulation on an individual, case-by-case
basis. The disposition of applications announced in this notice applies
the 2007 MEP recommendations.
Denials and Reasons
The following driver was listed previously in Federal
Register Notice FMCSA-2011-0089 published April 05, 2011:
Darren Keith--Mr. Keith has a history of a seizure disorder. His
last seizure was in 2009. He will have been seizure-free for 8 years,
as required by the MEP guidelines, in 2017. He may reapply at that
time.
The following drivers were listed previously in Federal
Register Notice FMCSA-2011-0389 published January 05, 2012:
Christopher Boddie--Mr. Boddie has a history of a seizure in 2011.
He does not meet the exemption criteria at this time.
Roger Corvasce--We were unable to contact Mr. Corvasce by phone or
mail to ascertain his status.
Michael Drake--Mr. Drake has a history of epilepsy. His last
seizure was in 2009. He will have been seizure-free
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for 8 years, as required by the MEP guidelines, in 2017. He may reapply
at that time.
Virgil Godbey--We were unable to contact Mr. Godbey by phone or
mail to ascertain his status.
Glen Hogan--Mr. Hogan withdrew his request for a seizure exemption.
Jordan Hyster--Mr. Hyster has a diagnosis of epilepsy, and his last
seizure was 2009. He will have been seizure-free for 8 years, as
required by the MEP guidelines, in 2017. He may reapply at that time.
Phillip McLain--Mr. McLain withdrew his request for a seizure
exemption.
Mark Smith--Mr. Smith has a history of a seizure disorder. His last
seizure was in 2010. He will have been seizure-free for 8 years, as
required by the MEP guidelines, in 2018. He may reapply at that time.
Cheryl Woskie -We were unable to contact Ms. Woskie by phone mail
to ascertain her status.
The following drivers were listed previously in Federal
Register Notice FMCSA-2012-0050 published on February 29, 2012:
Darren Carroll--Mr. Carroll has a history of a seizure in 2011. He
does not meet the exemption criteria at this time.
Charles Johnson--Mr. Johnson has a history of a seizure disorder.
His last seizure was in 2011. He will have been seizure-free for 8
years, as required by the MEP guidelines, in 2019.
He may reapply at that time.
The following drivers were listed previously in Federal
Register Notice FMCSA-2012-0094 published on January 15, 2013:
Sonja Cottle--Ms. Cottle does not require an exemption from the
epilepsy and seizure standard because she does not have a history of
seizure and is not taking anti-seizure medication.
Jeffrey Davis--Mr. Davis has a history of a seizure in 2011. He
does not meet the exemption criteria at this time.
Juan Flores--Mr. Flores has a history of a seizure disorder. His
last seizure was in 2011. He will have been seizure-free for 8 years,
as required by the MEP guidelines, in 2019. He may reapply at that
time.
Glenn Gervais--Mr. Gervais has a history of a seizure in 2011. He
does not meet the exemption criteria at this time.
Daryl Goodman--We were unable to contact Mr. Goodman by phone or
mail to ascertain his status.
Gary Osley--We were unable to contact Mr. Osley by phone or mail to
ascertain his status.
The following driver was listed previously in Federal
Register Notice FMCSA-2013-0106 published on April 24, 2013:
James Kivett - Mr. Kivett has a history of a seizure in 2011. He
does not meet the exemption criteria at this time.
The following driver was listed previously in Federal
Register Notice FMCSA-2013-0108 published on September 16, 2013:
Paul Kane--Mr. Kane has a diagnosis of epilepsy, and his last
seizure was 2009. He will have been seizure-free for 8 years, as
required by the MEP guidelines, in 2017. He may reapply at that time.
The following drivers were listed previously in Federal
Register Notice FMCSA-2013-0109 published on November 13, 2013:
Montie Bullis--Mr. Bullis has a diagnosis of a seizure disorder,
and his last seizure was in 2009. He will have been seizure-free for 8
years, as required by the MEP guidelines, in 2017. He may reapply at
that time.
Rick Cote--Mr. Cote has a diagnosis of epilepsy, and his last
seizure was in 2009. He will have been seizure-free for 8 years, as
required by the MEP guidelines, in 2017. He may reapply at that time.
Barry Von Gulner--Mr. Von Gulner has a diagnosis of probable
epilepsy, and his last seizure was in 2008. He will have been seizure-
free for 8 years, as required by the MEP guidelines, in 2016. He may
reapply at that time.
John Welch--Mr. Welch has a diagnosis of epilepsy, and his last
seizure was in 2000. He discontinued his anti-seizure medication in
2009. He will have been stable, off of anti-seizure medication for 8
years, as required by the MEP guidelines, in 2017.
Issued On: September 23, 2014.
Larry W. Minor,
Associate Administrator for Policy.
[FR Doc. 2014-23437 Filed 9-30-14; 8:45 am]
BILLING CODE 4910-EX-P