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What are some examples of doctors or nurses mocking patients, and were they called out?
I used to run a concrete plant and small trucking/hauling operation as part of a larger general construction company. Commercial drivers (i.e., those who hold commercial driver’s licenses [CDLs]) periodically must update their medical examiner’s certificates (more often called “health cards”). — It’s basically just a physical exam and then the issuance of a paper card, by the doctor, to the driver so that he can renew his CDL and show any inquisitive traffic authorities, should they ask for it.The physical exam part of it, of course, is filled out by the doctor, and I usually don’t care to look over that. It’s personal information; I don’t need to know if the driver has erectile dysfunction. I do need to get a copy of the health card to keep as part of his Driver Qualification (DQ) file. If anyone’s interested, this is part of the requirements of a motor carrier, at the federal level; specifically, Dept. of Transportation (DOT) / Federal Motor Carrier Safety Administration (FMCSA).The health card probably, as a matter of form, should just be filled out by the medical examiner and signed by the driver, but often, they rush the process by having the driver fill in their name and other personal information.One choice of boxes to check — a very important choice — is whether the driver is authorized to drive interstate or intrastate.I employed drivers who could drive concrete mixer trucks and tractor-trailer combinations (haul trucks), because we hauled in as much rock and sand as we could, on our own, and then subcontracted out the rest. In general, this reduced our costs of production; but, also, in general, you can’t pour concrete in the rain, so it gave me an alternative task for these drivers to do when the weather caused the cancelation of all of our orders for the day. — They could make runs to quarries to pick up materials.As not all quarries (or other construction-oriented destinations) were in-state, that meant the drivers needed to be fit to drive interstate. — A CDL does not, in and of itself, say if a driver can cross the state lines. The health card says which is true.Look at your Class C DL (regular ol’ DL); unless you’re awaiting trial or on probation or parole, typically, you can drive to any state you want. We’re not Soviet Russia; we don’t need papers or passports to leave our state and enter into one or more (or all) of the other various states.Also, you don’t need a medical examination to be determined to be fit to drive a sedan or pickup truck, or something like those. — For some people, perhaps, that’s a flawed process!In my part of Texas, it is common, in a clinic full of doctors, for the CDL medical examinations to be done by the token nurse practitioner (NP) or physician’s assistant (PA). — There’s no money in doing them. They are full medical exams, so they take a bunch of time. Nobody likes doing them, and drivers don’t like taking them.It’s just an all-around disliked thing. Nonetheless, they need to be done right.My story is of one that was done incorrectly, and the NP was snitty and evasive about it; and, what I did about it.I sent one of my drivers to a local clinic to get his health card renewed. The NP there did it and renewed his card for the maximum number of years she could. — If someone has health problems, they can be renewed for one year. I think the maximum term is two years. He was renewed for two years. He came back and gave me the card, as one copy of it was mine, and upon examining it (something I’d learned to do), I saw where, very clearly, it looked like he had marked the box for intrastate only travel.I asked him why he did that, but it’s just really not uncommon for drivers, especially when they’re nervous, to fail to be able to distinguish the difference between intra- and inter-.I called the clinic and told the receptionist that a mistake had been made and that the NP would need to correct and reissue the health card. The receptionist put me on hold; I was expecting to get the NP at the end of my hold. Instead, the receptionist told me that the NP said he would have to come back in and have it all done over again, because he had made the mistake.These examinations cost about $110. — That’s part of the reason NPs and doctors don’t like doing them, because instead of being able to charge $225 or more for 15 minutes, they have to spend much more time on the exam and can only charge a lesser amount; in part, because you can’t charge this against your health insurance (if you even carry health insurance, which is not guaranteed in this line of work [for drivers]); also, there may be some statutory maximum amount that can be charged.This made no sense to me. Also, I didn’t want to have to pay another $110. — In my mind, the medical examiner performs the exam and, then, decides, based on the health of the driver, if he’s safe and sound enough to drive only within the state or also between and among the various states.If it wasn’t that way, then why would the choice of boxes even be on the health card? It would seem like the driver could just make his own decision about all other aspects of the medical exam. — He could renew his own health card if he felt well, etc.Of course, the driver said he couldn’t remember who checked the box. The NP said he had done it. So, I got on the FMCSA’s website and found the email address for their headquarters in Washington, DC. Apparently, you could email them with questions. — I had no real expectation that I would get a response, but I emailed them, simply: “Who should fill out the box regarding intrastate or interstate travel on a Medical Examiner’s Certificate? The examiner or the driver?”After that, I went home for the day.The next morning, I had a very short email reply, from somebody at the FMCSA in Washington, DC, which said: “The medical professional performing the examination must make that choice and mark the appropriate box.”OK! So, we’re getting somewhere. — The NP claimed the driver had checked the box; this was improper procedure. I shouldn’t have to pay again. She should correct her mistake.Knowing this, I drove over to the plant and got the driver, and we both drove up to the clinic. I introduced myself to the receptionist as the person who had been bugging her about this issue and said that I had contacted the motor carrier safety people and they confirmed what I’d thought. The NP had made a mistake, and she needed to fix it. I’d brought the driver up there with me to facilitate the process.Wouldn’t you know? — She never came out to see us. She told the receptionist that she’d asked the driver which type of driver he was — intrastate or interstate — and, she’d checked the box according to what he told her.So, now, she had checked the box. However, it was still the driver’s fault because he told her the wrong thing, and I still would have to pay to redo the exam.I asked to speak with her. I’d driven up there and had the driver, still on the clock, being paid, and it seemed only fair that we talk about this. But, the receptionist came back, after speaking with her, with some sort of story about her being with a patient and the day being a busy one, so no go on that. — We left.First, the driver had checked the wrong box. After being told this was improper procedure, now, she had checked the correct box, because the box she checked was what the driver told her. Even though, for me, it was the incorrect box.Great. I figured I was screwed and took the driver back to the plant. I went back over to our main office and took one last look at his health card before I went home.That’s when I saw the most obvious thing. It was obvious; so obvious that it’s easy to miss.The next morning, after I got done, for the moment, at the plant I went back over to the main office and grabbed a couple of things, and then called the clinic back. Once again, I got the same receptionist, so I greeted her by name. — By now, I knew it.Few times do we ever want anyone to know what our full titles are at a business. I was, in fact, the concrete plant manager. The plant was a subsidiary of a mother corporation, of which I was its CFO. — Customers and suppliers hear CFO and all they see and hear is $$$$$$$. But, sometimes it helps.This time, I told her that I was the Chief Financial Officer of XYZ Corp. and the plant manager of XYZ Concrete; I’d been having trouble with their NP, and I new information that I thought would solve the problem.I would like to speak to the physician who oversaw the practice of the nurse practitioner — in person.I got put on hold, again, but this time — I got somewhere.The office manager of the clinic invited me to come in to speak with her.When I got there, I let some other receptionist know that I was not there for a checkup (you know — open the sliding glass window, please), and that I was there to see the office manager. She asked my name, and soon after, a well-appointed, business-looking lady came out to guide me back to her office.She said that she knew I’d been having some problems and that she’d do anything she could to help me. She’d talked to the nurse practitioner about the situation and understood how she felt about it.I passed her a copy of my email reply from the FMCSA (saying the medical examiner must check the box). She then pulled up, on her computer, their scanned copy of the health card they issued to the driver. She printed out a copy of it, and I saw immediately that it was in black and white.She read the email and agreed that it appeared the NP should have checked the box. The next part was just pure luck on my part.See, all she had was a scanned B&W copy of the health card. I had the original. And, on the original card, the NP had written everything out that she did in black ink.The driver had written on the card in blue ink, and the box referring to intra-/interstate was marked in blue.I handed her the original and said that, while it was possible that the NP and the driver had switched pens at the exact moment that box was checked, I thought that was very unlikely.She had been very welcoming and very business-like the entire time, and when she saw that, she said that she agreed with me.She excused herself for a moment, to go speak to the NP, and when she came back, she told me that they would redo the health card, free of charge, but that the driver would have to come back up there to sign it.I thanked her for resolving the matter and reminded her that I’d already brought him up there again, once, but the NP hadn’t even taken the time to speak with us. — I was now going to have to pay the guy, again, to come up there to fix the NP’s mistake.If the NP had just made herself more accessible to the idea that she was not a perfect person, this would have not caused all of us so much trouble. — The office manager apologized, and we were done.When I was walking out, back into the waiting room, the NP passed me and didn’t even say a word.
Is it possible for me to get my California CDL medical DOT updated in Illinois?
Any DOT certified physician should be able to update your CDL medical status. Case in point, I have a New Jersey license, but recently renewed my certification with a doctor in Nevada. The examination report has to be submitted to your home state motor vehicle department.I hope this answers your question.
Is it possible to have a truck driving career with a psychotic disorder you know maintain one and maybe retire from it?
From the FMCSA's FAQ page[1] :The truck driver must be medically qualified to not only drive the vehicle safely, but also to do pre and post trip safety inspections, secure the load and make sure it has not shifted. Bus drivers have different demands.By regulation, Specific Medically Disqualifying Conditions Found Under 49 CFR 391.41 [2] are Hearing Loss, Vision Loss, Epilepsy and Insulin Use.Drivers who require a Diabetes or Vision exemption to safely drive a CMV in addition to those pre-printed on the certification form are disqualified until they receive such an exemption.So, no psychiatric disorders are automatically disqualifying. Good news.However, the potentially bad news is twofold: first off, you'll have to convince the DOT medical examiner performing your evaluation that you can safely operate a truck. This will most likely involve the ME calling your psychiatrist and having a nice long chat. If your psychiatrist is convinced that your condition is well under control, and able to convince the ME of this, you should be good to go. The second part is regarding your medication(s): you, your psychiatrist, and your ME all need to know with absolute certainty that the meds you're on won't themselves impair your ability to drive safely. Benzodiazapines? No flipping way. Some antipsychotics are okay (aripiprazole among them), others aren't. If it's got a warning about operating heavy machinery on the label you can basically fugeddaboutit. You might need to change up your meds.If I were in your position I'd print out a copy of the FMCSA Medical Examiner's Handbook[3] , thoroughly read and understand it, and then bring it to your psychiatrist. Explain that you want to be a trucker and the potential pitfalls you've identified. Discuss possibly changing your meds, getting a happy smiley recommendation, and generally laying the groundwork. Then-BEFORE you even think about starting CDL school-go get a DOT medical card. Once you have that (they're good for two years most of the time, one year if you have some issues, 90 days very rarely) you should be good to go. However be prepared to repeat that process several times as generally your employer will want you to have a new physical done by their doctor; you'll probably have to explain everything yet again every few years thereafter.But yes, it absolutely is doable.Footnotes[1] What medical conditions disqualify a commercial bus or truck driver?[2] Electronic Code of Federal Regulations (eCFR)[3] FMCSA Medical Examiner Handbook
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