Medical reciprocity deal raises more questions than answers

TORONTO (Jan. 18) — The reciprocity accord reached between the United States and Canada on medical fitness requirements for truck and bus drivers is generating more questions than answers, especially as it relates to the National Safety Code.

The agreement, outlined in letters exchanged between Transport Canada and the U.S. Dept. of Transportation Dec. 30, means the countries will recognize one another’s rules governing medical qualifications for commercial drivers starting March 31. Transport officials will use the 90-day interim period to notify licensed drivers and enforcement authorities of the change, and to work out lingering details. At the end of the transition period Canadian drivers will no longer be required to carry a medical fitness certificate to operate in the United States.

However, for U.S. officials, the agreement is predicated on the medical provisions outlined by the National Safety Code being “equivalent” to fitness requirements outlined in the U.S. Federal Motor Carrier Safety Regulations. “It is … our understanding, based on the assurance of Transport Canada, that all Canadian provinces and territories, with the exception of Saskatchewan, have now implemented the NSC ‘Medical Standards for Drivers,’ ” writes George L. Reagle, associate administrator for motor carriers at the Federal Highway Administration. “Transport Canada has indicated that Saskatchewan is currently reviewing its medical standard for (commercial motor vehicle) drivers.”

The agreement does not explain how the agencies would account for variations among the jurisdictions’ specific medical standards under the NSC, however. Nor does it detail how U.S. officials would treat drivers licensed by Saskatchewan starting March 31.

The letters also say there will be no reciprocal acceptance of waivers issued by a province or state. These physical conditions include diabetes that requires insulin, hearing impairment, an established medical history or clinical diagnosis of epilepsy, and minimum standards for vision.

“The letters create a number of unanswered questions that I’m sure will keep both sides very busy through the end of March,” said Judith Hines, a program specialist with the Federal Highway Administration Office of Motor Carriers regional office in Montpelier, Vt. “But that is why the 90-day period exists.”

Meanwhile, Canadian Trucking Alliance chief executive David Bradley says his association has been trying to broker an interim measure that would give doctors assurance that they would not risk medical liability were they to resume conducting medical exams for commercial drivers right away.

“We’re leaving no stone unturned,” Bradley said. “We’re hopeful that we, along with Transport Canada, can reach a solution. It’s proving difficult — a challenge — but we’re not going to give up.”

Many doctors have refused to conduct medical exams required by the DOT since late September, when the Canadian Medical Protective Association, which insures more than 56,000 physicians in Canada, told members that conducting the exams would increase their risk of medical liability in the United States. DOT medical forms constitute U.S. legal documents, the group said, opening the door for a person injured in the U.S. by a Canadian driver to sue the doctor should the driver’s medical condition at the time be called into question. The CMPA doesn’t protect members for work performed on behalf of jurisdictions outside Canada.

Bradley encouraged carriers and drivers to contact the CMPA and urge it to advise doctors to sign the DOT medical certification. Contact: Dr. Guy Lemay, Associate Secretary Treasurer, Canadian Medical Protective Association, P.O. Box 8225, Station T, Ottawa, ON K1Q 3H7; 1-800-267-6522; fax: 613/725-1300.