Episode 15: Conversation with Dr. David Fletcher (The Medical Perspective)

Dr. David Fletcher:

The truck drivers are essential workers and are even more so now. So, they’re a very vital link, but at the same time, the concern is, are they safe on the road. Especially inexperienced drivers who are filling some of that gap.

David Craig – Host:

I’m attorney David Craig, managing partner, and one of the founders of the law firm of Craig, Kelley & Faultless. I’ve represented people who have been seriously injured, who have had a family member killed in a semi or other big truck wreck for over 30 years. Following the wreck, their lives are chaos. Often, they don’t even know enough about the process to ask the right questions. It is my goal to empower you by providing you with the information you need to protect yourself and your family. In each and every episode, I will interview top experts and professionals that are involved in truck wreck cases. This is After the Crash.

David Craig – Host:

Well, welcome to After the Crash. This is Dave Craig with the law firm of Craig, Kelley & Faultless, and today we’re interviewing Dr. David Fletcher. Dr. Fletcher is a licensed physician out of the state of Illinois. He’s a practicing doctor. He actually sees patients on a regular ongoing basis, and he is the medical director and CEO of SafeWorks, Illinois. He’s a Certified Medical Review Officer. He’s also a Certified Substance Abuse Professional. He full-time practices in occupational medicine. The key thing to me is that he is board certified in occupational and preventing medicine, but he has been on the leading forefront of truck driver and commercial motor vehicle drivers safety since 1995. So, he’s one of the earlier ones that got involved and is helping making the roads safe for everyone.

David Craig – Host:

He does this on behalf of trucking companies as well as folks who happen to be injured. He’s testified all over this country as an expert witness on both sides of the equation. Sometimes, working for the trucking company, like I said, talking about the drivers and that they are safe; sometimes for the victims when truck drivers are not safe. He’s an advocate for safety. He’s an advocate for having commercial motor vehicle drivers be in good physical shape as they’re required to be to be safe, which keeps all of us that are using the highway safe. Welcome Dr. Fletcher.

Dr. David Fletcher:

Well, thanks for a nice introduction, David. Glad to be here and I’m glad to be able to be on this show and help give my perspective on what is going on currently in regard to the safety of the traveling public as it deals with commercial truck drivers.

David Craig – Host:

I mean, there’s more and more truck drivers. I drive from my Indianapolis office to my St Louis office, and I see the highway’s flooded with semis. As an attorney who has been practicing for over 35 years and who has handled cases against negligent trucking companies and truck drivers for that same length of time, I get concerned. I get concerned because of the type of cases I’ve seen about just the health of the drivers that are behind the wheels of semis. Let’s just talk generally about the semi drivers and their health.

Semi Truck Drivers and Their Health

Dr. David Fletcher:

Well, I share your concerns about being on the highways these days, especially, the roads seem to be more crowded. Certainly, even during the pandemic, the truck drivers are essential workers and are even more so now, especially as the entire economy is dealing with concerns about supply chain. They’re a very vital link, but the same time the concern is if are they safe on the road, especially with inexperienced drivers who are filling some of that gap. So, that’s kind of my opening thoughts, that the roads are more crowded. We have got inexperienced drivers. So, I certainly share your concerns.

David Craig – Host:

And one of the things is, I just saw something on 60 Minutes yesterday I think, where they were talking about a shortage of drivers, and you can’t read anything in this industry where they don’t talk about the shortage of drivers and how they’re trying to find drivers, whether they’re going to younger drivers or they’re going back and pulling older drivers back into the field or they’re pulling inexperienced drivers and training them. So, there’s concern that we’re eager and we need competent drivers, but as a plaintiff lawyer, somebody who represents the victims of semi-tractor trailers, obviously there’s a concern that you’re putting the wrong people behind the wheel, and that worries me.

Dr. David Fletcher:

Well, I think, your worry is well founded, David. We have all this focus on airline safety and the FAA has almost 70 doctors working for the FAA. The Federal Motor Carrier Safety Administration has one physician out there monitoring the health of truck drivers. It’s a concern. I think you’re right on, and I think it gets back to that because of this shortage drivers that they’re not being vetted physically like they should be. The only thing I will say that’s advantageous during this recent pandemic that’s been beneficial is that the Federal Motor Safety Carrier Administration pioneered this new thing called the Clearinghouse where anybody who’s had a drug or alcohol violation since January 6th, 2020, has to be on the Clearinghouse. It’s a way when trucking companies look back at their drivers, they can query this trade database and see there’s been a violation.

Dr. David Fletcher:

And that is, I think, the most positive thing that’s been about safety over the last two years.  I believe it’s just going to really help prevent a lot of accidents, especially in this day and age with legalized marijuana. Marijuana is still not acceptable for a truck driver because it’s a safety sensitive drug. Even though it may be legal, you can’t be a truck driver and use it. Because of its legalization, a lot more people are using it, and so when they go take a physical for a trucking company you turn out positive. The nice thing about the Clearinghouse is that the company cannot hire them. They have to go through a substance abuse professional protocol.  Then, if they’re going to come back to work, they’re going to need a negative drug screen.  Then, they are subject to at least six random drug screens in the coming year.

David Craig – Host:

I know you’re a Certified Substance Abuse Professional, and I know that’s a growing area in this field. How knowledgeable do you think trucking companies are about this, and what are the qualifications of somebody who helps the trucking companies make sure that their drivers, first of all, that they use the Clearinghouse and that they make sure their drivers are being properly, not only detected, but then rehabilitated, I guess?

Do Trucking Companies Know About the Clearinghouse?

Dr. David Fletcher:

Good question. Well, first of all, they have to use the Clearinghouse. Any trucking company has to do a query on their driver in the Clearinghouse. So, what that does is prevent the driver from lying about his past violations. In the past, trucking companies depended upon a look back program to contact the prior employers for the last three years to see if there had been a violation. The cooperation on that has probably been about, from my experience, it has 50% at best. Now this program will have teeth in it. A driver won’t be able to jump from truck carrier to another carrier and lie about his past because they have to get off the Clearinghouse that they’re eligible and that they can perform safety sensitive tasks. I think that’s a major positive thing.

Dr. David Fletcher:

I think a lot of trucking companies still are struggling even almost two years after its introduction about the Clearinghouse and how to work with substance abuse professionals. One of the things, because I’m both a Medical Review Officer and a Substance Abuse Professional, very strange is that I have to have two separate email addresses for those services and rather than have the ability to consolidate all of them under one email. So, I have to have my MRO email and my SAP email, but we try to work with trucking companies and educate them. I think with more time, it’s going to be helpful. I really believe it’s taking the burden off companies who were struggling with their driver qualification investigation to get information from past employers.

David Craig – Host:

Well, let’s talk about it. As you know, this podcast, I put this out for just ordinary folks, people who may have been the victims or know somebody who has been a victim of a semi-tractor trailer wreck or another significant wreck with a commercial motor vehicle. And what I found through 35 years is these folks don’t even know what questions to ask. They have no idea how this industry works. They don’t have any idea how the lawsuit works or how a claim works. So, I think that my goal is to educate ordinary folks and help them understand. So, I think the first starting places for them to understand is that the Federal Motor Carrier Safety Regulations have certain requirements and that their requirements are designed to make the road safer by disqualifying drivers that shouldn’t drive and there are procedures in place that does that.

David Craig – Host:

Some folks may understand or have heard of a DOT exam or getting a medical card. There are qualified professionals who do these exams. So, let’s talk a little bit just, generally, about what is in place to make sure that semi-truck drivers are safe and healthy and physically fit to drive a truck.

How to Ensure that Semi Truck Drivers Are Safe and Healthy to Drive?

Dr. David Fletcher:

Well, I think you mentioned the most critical piece of information is the FMCSA regulations require trucking companies to only put on medically qualified drivers on the road. It also has the mechanics for a driver who has to have a medical examination periodically by a qualified medical examiner to make sure that they meet the physical qualifications of the standards. It obviously requires competent physicians, but it also really requires trucking companies to be involved and not just delegate all the decision making to the physician who provides the examination. So, I kind of like to say this, what I call a three-tier system of safety. Tier one in protecting the public is, the driver’s honesty about their health conditions. When they complete the commercial driver medical examination, which was called the FMCSA form 85-75 long form that they’re accurate and truthful about their history.

Dr. David Fletcher:

Unfortunately, a lot of truck drivers, because this affects their living, are not always truthful and admit stuff. The second tier of the system is the medical examiner such as myself.  You want a medical examiner who understands the regulations and who is quite aware that it’s common in the industry for truck drivers not to be truthful. So, that requires the medical examiner to really do a lot of probing questions and ask stuff about their sleep, and if they snore, if they lose their breath at night, if they’ve had a past history of any substance abuse, if they’ve had any heart conditions, blood pressure, diabetes, and more common diseases. It’s just doing a very thorough exam and getting good history. If you’re not sure if they tell you they’ve got something you trust, you verify, you get their medical records, you go over their medical records and verify the information they’re telling you.

Dr. David Fletcher:

You can defer those drivers for up to 45 days to make a final determination if they’re fit to drive. So, that’s the first two tiers. Well, unfortunately the second tier oftentimes fails because there are a lot of doctors out there and other health professionals doing these exams that don’t do a very thorough job. They allow some drivers to get on the road who shouldn’t be there because they’ve ignored important health conditions. Most common ones are diabetes, hypertension, heart disease, obstructive sleep apnea, seizure disorders, and medication issues. Those are the ones that are just commonly overlooked or not investigated thoroughly. So, what that requires then is the third tier which is the most important tier, the trucking company. As I said, David, the trucking company is ultimately responsible for putting medically qualified drivers on the road. They may not practice medicine, but that is their charge.

Dr. David Fletcher:

And so, they have the ability to supervise these physicians. They have language in the regs, 345F allows them to do a fitness for duty exam anytime they’re concerned about a driver’s mental health or physical ability to drive. They have the tools to do that anytime, and so, they have to watch their doctors. They have to properly vet their doctors, they’re competent. A lot of the trucking companies have learned the hard way that they’ve been burned by their doctors not doing a thorough job. They will have a system in place to review all the long forms, and they will do periodic audits of their doctors. So that’s kind of the three-tier system. Unfortunately, in a lot of the accidents that I’ve been involved with, as a plaintiff’s expert, all three of those tiers have been pierced. That’s why the public was not protected because of failure, the driver lied, the doctor didn’t do a thorough examination and the trucking company didn’t properly supervise or vet their medical examiner.

David Craig – Host:

Let’s go to that second tier with the folks that are doing the exams. Tell me, walk us through. I know you’ve done thousands of these exams, and I know your company has done thousands of these exams and does regularly, yearly, thousands of these exams. What’s involved in one of these exams?

What’s Involved in a Commercial Vehicle Medical Examination?

Dr. David Fletcher:

Well, what you’re talking about is a Commercial Vehicle Medical Examination, we call CDME or, traditionally, was known as the DOT medical. It is an examination that requires, number one, completing the FMCSA medical history form, actually signing it, and attesting that it’s accurate and being subject to prosecution if you lie or also revocation of your medical certificate. So, that’s the most important part is the history completed by the examinee. So, then the medical staff or the provider who’s doing the exam will do height and weight, which will be able to calculate a body mass index or a BMI. They will also do a hearing test. They’ll do a urinalysis test looking predominantly for any spelling of sugar that would indicate diabetes. That also includes taking blood pressure and pulse reading. All that is done prior to the examiner coming in and seeing the patient.

Dr. David Fletcher:

Once that’s all completed, it’s really the examiner who’s taking a more thorough history of looking at the responses on that long form and asking very probing questions. If you’re not satisfied with the answers, defer this person, do not qualify them, and recommend what you need to make a decision on their ability to safely drive a commercial vehicle. Ultimately, that medical examiner does have responsibility. They may not have doctor patient physician relationship with the driver, but ultimately, they are still responsible. If they negligently issue a medical certificate and that driver gets in an accident with a medical condition that should have precluded him from being on the roads, then that physician can be sued. I had been an expert witness in several cases where the medical examiner has been successfully sued for that reason.

David Craig – Host:

When I first started, there was no national registry as far as who these people were out there doing these exams. I know you were a big advocate and you’ve been an advocate of putting in more checkpoints and making it even safer than the system we have now. But now, we do have a national registry, which I think started in 2014, that lists the folks that are qualified to do these exams. I think people will be surprised that the type of people who do it, are they just medical doctors that are qualified to do that, or who else can do one of these exams to vet a truck driver before they take the road and get a license, a CDL?

Who Is Qualified to Perform These Exams?

Dr. David Fletcher:

Well, that’s an excellent question, David. Unfortunately, there is not that much restriction on the person to do the exams. It’s not just medical doctors like myself. It includes mid-level providers, such as nurse practitioners and physicians assistants, which I think is okay if they’re properly supervised, but it also allows as physical therapists, and it allows chiropractors to do it. I’m a very pro chiropractor for musculoskeletal conditions, but I don’t believe they have any business in making a determination about the fitness for a driver. They don’t have the training to make complex decisions on pharmaceutical issues, cardiovascular issues, diabetes, and so forth like this. And so, what happened when they expanded the system with the national registry, I think it was a step backwards as far as allowing, in my opinion, unqualified health professionals to certify these drivers. You said in the onset of your question about my own belief about the need to be even stronger.

Dr. David Fletcher:

So, I was the first physician in the United States to propose a FAA medical system lookalike for the Federal Motor Safety Carrier Administration. This was back in early ’90s.  I started the first training program for physicians regarding certifying truck drivers in 1995. That was through the American College of Occupational and Environmental Medicine, and that course continues to the present day. I was unsuccessful of being part of a Federal Highway Administration committee to get an FAA lookalike system. I still have not abandoned that because I believe even more so it is necessary. The FAA system has only 2000 physicians in the United States that does these examinations. Quick, very strict educational requirements, supervision, grading through exams. I can also look at prior exams from other examiners and see if there’s been past issues. It prevents doctor shopping. The national registry was a watered-down version of what I recommended, and currently it has almost 44,000 healthcare professionals that are able to do these examinations. This is way too much.

Dr. David Fletcher:

The quality is very uneven, even worse was the fact that a few years ago, the NRCME system got hacked for almost 9 or 10 months, and we were unable to send examinations in. Also, even more glaring was the government or county office earlier in 2021, issued a very scathing audit of the National Registry Program and the whole system as far as certifying drivers, and I certainly endorse that. As part of my leadership, I’m trying to, again, point direction to tighten up the quality of the program, and I believe the trucking companies would benefit significantly with this. You’ve got 44,000 people on a list, there’s some quality concerns. One aspect of it, you were supposed to do a continuing education every five years.

Dr. David Fletcher:

Well, that was in 2014, they’ve not set up any kind of follow up requirements for continuing medical education, and that should have been completed by 2019. We’re about to start 2022, there’s been no program in place at all for that. In fact, in 2024, you’re going to see 38,000 people who are medical examiners, who their certifications going to expire, and there’s no program in place for re-certifying it. So in my opinion, the NRCME had some good meaning, but it’s been an utter disaster in my book.

David Craig – Host:

Well, I think if the goal is to reduce and prevent truck accidents and fatalities, I can’t imagine anybody being against that. I mean, if that’s the ultimate goal, the trucking industry benefits from that, the consumer, the folks on the roadways benefit from that, but unfortunately, we still see pushback from the industry for a variety of different reasons. First of all, because I represent victims, I don’t want people listening to this to think that I think all trucking companies are bad because they’re not. There are some really good trucking companies that do the right thing and that make sure that their drivers are physically fit and capable of driving.

David Craig – Host:

There are some really good truck drivers who are educated, who have health issues, but are not afraid of losing their job because their employer, the trucking company, stands beside them and educates them on, “Hey, here’s what you need to do.” Like sleep apnea, we’ve talked about that before. That they help educate people that say, “Hey, look, once you start getting treated, you can get back behind the wheel.” So, there are good truck drivers, and there are good trucking companies out there. I assume you’ve seen the same thing.

Dr. David Fletcher:

I have. I certainly agree with you in that. What we try to do is be an advocate for the truck driver because oftentimes you’re the only healthcare professional they see because they’re out on the road, and their lifestyle is not very good. They’re often overweight because they’re eating on the road, making poor choices, and they can’t exercise as much. So, the DOT exams are really important outreach to this population. So, if you can educate that, be honest about your situation. Most of these conditions we can get you back out there driving. We’re not going to be able to get you back out there driving if you got a seizure disorder, but we are able to work with these drivers and explain to them what has to be done for them to be medically qualified and refer them to other specialists that are knowledgeable.

Dr. David Fletcher:

I think the important part is that you need to understand that there are trucking companies out there that do like quality exams, and that they know that saves them money, and that a lot of companies, I’m going to give you an example, is one is like Schneider. They’ve kind of pioneered their sleep apnea program. Well, actually, the trucking company that’s no longer in existence that I was a Medical Director for called Rovers and Trucking. We started their sleep apnea program in 1995 and they paid for the testing for sleep studies. They got them on insurance, and they saved a lot of money on their healthcare costs by having me as their Medical Director identify these health conditions. So, they found it economically by helping their drivers qualify and be healthier was a major cost savings, plus that also helped them in their retention of drivers.

Dr. David Fletcher:

So, I think forward thinking companies realize that quality exams do matter, and a lot of the trucking companies I deal with will also utilize, what I talked about earlier, David, that fitness for duty provision called the 345F exam. I have multiple of my trucking companies from all over the state that they have somebody that’s up in like Rockford or Peoria that has been off work. They want me to see the person before they go back driving even though they still have a valid DOT medical certificate, and educating trucking companies about that is so very, very, very helpful because that’s going to stop accidents and make a major difference.

Dr. David Fletcher:

So, I mean, I know there are a lot of pluses out there. So, I think it’s educating them, such as your program, educating the public about this, educating trucking companies that, “We know you want drivers, but find quality drivers.” If you have incentive programs such as insurance to pay for CPAP for sleep apnea, you’re going to get drivers, and if you’re concerned about their wellness and health and you’re doing stuff for them, I think it’s only going to add more quality of your drivers and more retention.

David Craig – Host:

I see that. I mean in the cases that I handle where people are killed or seriously injured, they are the companies that are putting profits ahead of safety. They’re cutting corners. They’re just trying to get people behind the wheel. They’re trying to find the cheapest drivers, not necessarily the most qualified drivers, and that’s a problem. You mentioned epilepsy. I handled a case where a trucking company had a driver who was epileptic. So, they told him he couldn’t drive. He had a seizure at work. They took him off the road, but then got in a pinch. They didn’t have enough drivers. They went back to that driver, knowing he had epilepsy, knowing he had seizure disorder, knowing that they had seen him have a seizure.

David Craig – Host:

They sent him to a doctor who they knew would rubber stamp his card, and I did the deposition of this doctor, and this is a doctor who was at the end of his career. He had not much of a practice left, and he was making money by running trucking companies who are running people through his office. I talked to depose a staff and these exams, supposedly exams, they were going back into the back room with the doctor coming out in five minutes and with a card. That’s the problem when you have unqualified people out there doing these exams, because the bad companies will seek them out and find them and then use them. Then, this man had a seizure behind the wheel and severely injured my client.

David Craig – Host:

So, the good companies will seek out the good, qualified healthcare providers to do their exams because they want to prevent wrecks. Unfortunately, the bad companies, if there’s not a good system in place that weed out the bad healthcare providers, the bad companies will seek out and find, and I’ve done more than one deposition of bad doctors doing exams. Or sometimes companies will have captured, where they send all their drivers to one place, and they want to keep those drivers on the road. So, those doctors are somewhat biased and not doing quite as an objective job. I assume you’ve seen that as well.

Dr. David Fletcher:

I have, unfortunately, and I hope that the doctor involved in the deposition got criminally prosecuted.

David Craig – Host:

He’s longer practicing.

Dr. David Fletcher:

So, I mean, it’s getting more teeth into the prosecution area regarding some of these physicians who are doing slip shot work, who are basically a mill, aren’t doing quality exams. There’s a case recently in Georgia where a doctor was claiming that he is doing 25 exams an hour which is impossible. So, it’s going to take more cases like that. I think, also when a physician realizes they’re going to get sued for negligent issuance, it helps in that. You obviously, have represented families who’ve have suffered severe, severe trauma from a loved one, either being killed or severely maimed. Until 2019, I never had an experience, and then in 2019, my first wife, the mother of my two kids was killed on Interstate 80 from a reckless driver. It wasn’t a truck driver.

Dr. David Fletcher:

But I’ve experienced on a personal level, the agony that a family that deals with a sudden tragic death on the highways. In this particular case, the driver is still under criminal prosecution in California, but it’s just horrible and it’s something you have to deal with every day the rest of your life. So, I empathize with the families you represent. I know a lot of the cases where I’m a plaintiff’s expert, the families are particularly interested in preventing a similar tragedy to happen to some other family. Each of these cases that you take care of are further, further pressure on trucking companies, physicians as well as drivers, is that we have to do a better job about vetting the drivers that go out in our highways and byways.

David Craig – Host:

Yes, and I would encourage people listening to this that if you are a family of someone and you are going through this process, oftentimes my clients as part of the process would like to make the road safer. You and I worked on a case, and we can’t say the name of the company, but you and I worked on a case recently with sleep apnea. My clients felt very strongly that they not only wanted this case resolved, but the only way they would resolve it would be if the company he would make changes to their policies and procedures, and we could document that, and they could verify that to me on sleep apnea and trying to prevent drivers who aren’t physically fit for driving vehicles. In that case, you actually, did an exam of the driver and you came to the opinion that he had sleep apnea, and yet he had a card.

David Craig – Host:

He was approved by one of the physicians that the trucking company had sent him to, but that physician didn’t have all the information. Like you said, sometimes truck drivers don’t tell the whole story because they don’t want to be taken off the road. They don’t want to lose their livelihood. When you did the exam, you actually got information, and you asked questions about snoring. You found out that this man was a loud snorer. You found out that his neck size was, I think, it was 17 and a half. His BMI was high. He was over 60. The checklist of looking for sleep apnea, and he hit most of them. Yet, he still was approved to drive a truck. Unfortunately, six people died because he fell asleep at the wheel.

Dr. David Fletcher:

I know, and those are the cases that I live to take care of to help prevent that from happening to someone else. Because that family, it was two different families involved, just devastated with that and it should have never happened. That driver obviously had sleep apnea and was undiagnosed. The physician who certified him ignored all the various scientific information out there.  The guy was a poster child for sleep apnea, yet he was approved. If that company had a good auditing program in place to supervise their drivers, they would’ve had him examined by someone else and would’ve been taken off the road until he got a sleep test and treated for sleep apnea. So now, they’ve taken the economic hit for that accident, and hopefully they’ll reflect on the fact that not only was this a tragedy but was an opportunity for us to learn from, and hopefully to meet your client’s needs, that they’ve actually made corporate changes to improve their vetting of drivers.

David Craig – Host:

How big is sleep apnea? How big of a problem is sleep apnea in the industry?

How Big of a Problem is Sleep Apnea in the Trucking Industry?

Dr. David Fletcher:

It’s a big problem because of the demographics of drivers. More drivers are males, and more drivers over 45 years old. Again, you have a high percent of obesity. You have people that are sedentary, and they’ve got high blood pressure. So, they’re set up for all the risk factors. I mean, studies say it’s only 5% to 6% of the population has obstructive sleep apnea. I say, “It’s garbage.” It’s one of the most unrecognized, public health problems that exist.  I know firsthand I’ve had obstructive sleep apnea myself since 2011, I’ve used CPAP and I can remember a couple times almost getting, driving late at night, in crashes myself. So, I’ve kind of experienced that.

Dr. David Fletcher:

So, I actually like CPAP, it makes me feel much more refreshed and better, but as far as the scope of the problem in the truck industry, it’s not 4% to 5%, in my opinion, based on my experience for 35 years, I would probably estimate that at least 30% to 35% of drivers in the United States have undiagnosed obstructive sleep apnea. Fortunately, trucking companies have learned, I’ve been seeing a high percentage of drivers who come to my office who are on CPAP, they love it. They provide compliance, that allows them to continue to be safe on the road. So, it’s an unrecognized problem, if I was a trucking company, some of these basic things, such as heart disease, diabetes, sleep apnea, substance abuse, concentrate on those core top areas. We’re going to have lot safer drivers.

David Craig – Host:

Again, you see some companies trying to do that. Unfortunately, there are still those that aren’t. You worked with our office with someone whose truck driver who had a heart attack and plowed into my client. It was in a motor home at a gas station, and we still see heart attacks. You still see sleep apnea and the drug issues. I mean, we’re still seeing a fair amount of drug issues as well, and drivers that have those issues.

Dr. David Fletcher:

Unfortunately, we are. I mean, I do feel that there’s been some awakening in the industry, and I’ve been involved as a defense expert for trucking companies where they’ve done all the right things, where they’ve had a legitimate, unforeseen medical emergency of their driver that wouldn’t have been picked up by the DOT process. We always have a lot to improve upon, but I think it shows like yours and the work that you do, and your firm does that, it just, every step helps make our highways safer. I’ve been doing expert witness work in this field for 21-22 years. Unfortunately, cases keep piling up, but I do see some improvement.

David Craig – Host:

I mean, I think, your three safety tiers. I think, the third one, in my opinion, is the most critical and that’s the trucking companies.

Dr. David Fletcher:

So do I. I’ve said that so many times and I always kind of throw my hands up. “Well, we don’t practice medicine.” Well, you may not practice medicine, but you’re still in charge of making sure they’re medically qualified. Tools are there to make sure you put the right drivers on it. Plus, you have economic incentive to make sure they are not going to be out there when they shouldn’t be. I know that they want to fill those bodies, but you just gave a great example of a seizure disorder. I mean, to me, that’s criminal behavior on the part of the trucking company.

David Craig – Host:

Right. I mean, I don’t know how many times I still hear trucking companies tell me, “Well, he had a valid card. He went through and got a DOT card. He’s okay. He’s allowed to drive.”  They ignore the fact that, “No, the requirements are, he has to be physically fit and capable of driving safely, not just that he has a card.” Right?

Dr. David Fletcher:

I have complete agreement with that. I hate when I hear it. “Well, he had a valid medical certificate.” It doesn’t mean anything because I’ve given expert opinion on multiple occasions that the certification was invalid. I mean, just for the instance I said earlier that if a person falsified his medical history, that invalidates the card on the spot, they could be criminally prosecuted. Again, the trucking companies have to make sure they meet the physical qualifications, and there are 12 specific areas that they have to meet including the drug and alcohol, which is the last regulation. So again, the trucking company, they’re the ultimate ones who make the biggest difference.

David Craig – Host:

I mean, you could have a medical certification, say you got it today. Let’s assume the driver told the truth, that he had a valid and a good capable, qualified physician, and they approved him. Then, that card will be good for a period of time, but tomorrow they could have a stroke, or they could have something else happen to them that no longer makes them qualified. They’re not physically capable anymore of driving. The doctors wouldn’t know about it. That’s where your trucking company, if they saw that, they see the drivers, they have the incentive to monitor the health of the drivers. If something happens after the issuance of the card, before it’s renewed, they have a duty to step in and take that driver off the road until he is physically fit to qualify to drive.

Dr. David Fletcher:

That’s extremely correct. Just because you have a certificate for two years, doesn’t mean you have a blank check to drive every day, and you give a perfect example as you can have an intervening health event happen in that period. So, there’s a duty for the trucking company to intervene and get that person examined. They have the tools. It’s not like they can complain, “Hey, we can’t get a driver seen because he’s got a valid card.” Well, again, you have a duty to only put fit drivers on the road and you have information that this person’s fitness for duty is questionable. You got to get him evaluated.

David Craig – Host:

So, what are the biggest problems that you see, that we haven’t talked about? Is there anything else that we haven’t talked about that you see in this area, that you would like to either see improved or that you see as a continuing ongoing problem?

Quality Exams Can Save Trucking Companies Money

Dr. David Fletcher:

Well, I think as far as improvement is trying to educate trucking companies that quality exams really save them money. There are ways that your providers can help keep those drivers on the road and the process behind that, and that investing in your driver’s health to keep them fit is actually a good investment for your company, especially, with all the turnover out there in the market. So, that’s kind of the first thing, is quality exams matter, invest in your drivers. Secondly, we’ve got to improve the system. The NRCME system, in my opinion sucks. Again, I think I’ve been involved with five or six different cases with chiropractors that had no business certifying the driver. I do know, the state of New York has a specific regulation. They do not allow chiropractors to certify drivers in New York.

Dr. David Fletcher:

Again, I have great respect for chiropractors for musculoskeletal conditions, but not for making complex decisions on the ability to go out and have a multi-ton vehicle go out and potentially kill somebody. So, I think just a little overhauling of the system, and I’m a big believer in the FAA system. I still think that would be really good because right now there’s no recourse for us as physicians to defer somebody and have the Federal Carrier Safety Administration office help assist in the decision making. The whole reason I got involved in the whole aspect of trying to improve the system was I have been an FAA medical examiner since 1988, and the FAA system is the greatest in the country in that there’s only 2000 examiners, computerized system, a MedExpress software, and that’s just wonderful. That’s done before the person comes into the office, and you’ve got all these consultants you can get involved with and help you make decisions.

Dr. David Fletcher:

You’ve got backup and you’ve got a scientific department. Despite all that, fatalities we have with trucking compared to the number of aviation fatalities we have each year. I think the resources are in the wrong place. Not that I want to see the FAA system lessened because I think it’s a wonderful system, but if you were going put resources in from a fatality number, and I keep hearing the thing, “Well, there’s 14 million potential truck and bus drivers out there compared to 600,000 pilots.” I still think we need to put the resources in the medical system to make sure that 14 million should be on the road right now. Our country is not protected like it should be.

David Craig – Host:

I agree, a hundred percent. I mean, it makes sense. Maybe it’s just lack of information because the people that hire me, they don’t know about truck wrecks until their family is in one. They don’t know the statistic. But why wouldn’t we want to adopt such a system?

Dr. David Fletcher:

Well, I think a lot of it is because there’s this mistake in belief that there won’t be enough examiners out there to certify that number of truck drivers. As I said, 2000 or about there, for 600,000 pilots. I think if we had a system, eight to 10,000 medical examiners, then I think that would meet the needs for the Federal Motor Carrier Safety Administration and the FTA, Federal Transit Administration. A lot of it is just because of that aspect. Also, they’re afraid they’re not going to have drivers. You have a more regimented system, and it’s going to eliminate lot of drivers. I mean, I have drivers right now, David, that we’ve failed. I’ve had drivers who falsified a medical certificate from my office who I’ve reported the FMCSA, they get a card from someone else, they’re out there driving.

Dr. David Fletcher:

There’s no program in place. And we’ve reported people who’ve lied to us, and all sorts of things. Until a year ago, there wasn’t even a physician in the FMCSA office. Again, right now they’re doing this whole reboot of the NRCME system and medical examiner’s system. So, it’s something I would like to take up with the Transportation Secretary, Mayor Pete, and try to get his interest in it and educated. I mean, it’s obviously more regulations, but I think ultimately a cost analysis. This would be a positive thing for trucking companies.

David Craig – Host:

Well, I appreciate everything you’ve done to make the road safer, and hopefully, you will keep championing that cause because we’re all affected. When my client made a decision here recently, and I’ve had other clients do the same thing, where they would rather take less money and have companies change their policies and procedures. I’m a big advocate of that. I mean, it’s not all about the money, we have to take care of our clients, but if we can make each company, one at a time, a little bit safer then we’ve accomplished something and what you’re doing is trying to make the whole industry safer, and I really appreciate that on behalf of all of us that use the highways.

Dr. David Fletcher:

Well, thank you. I mean, it’s a joint effort from all of us. What you do is so important getting your clients to understand that it’s not all about the money. It’s about making a difference and that’s what I’ve enjoyed. I feel like I’ve made a contribution to the debate and I want to continue to provide some leadership out there. It’s sad that we still have these cases accumulating.

David Craig – Host:

Yeah. Well, Doctor, I appreciate it. Thank you very much. Is there anything else you would like to add?

Dr. David Fletcher:

No, just thank you for your efforts. My experience dealing with your firm in a couple of cases has been wonderful, and I think you really do a great job representing your clients and achieving good results and explaining things. So, I certainly want to give an endorsement for the great work you’re doing.

David Craig – Host:

Well. I appreciate that. Thank you very much, Doctor.

Dr. David Fletcher:

All right. Thank you. I’ve got to get back and see some patients. See you.

David Craig – Host

Thanks.

David Craig – Host:

This is David Craig and you’ve been listening to After The Crash. If you’d like more information about me or my law firm, please go to our website at ckflaw.com, or if you’d like to talk to me, you can call 1-800-ASK-DAVID. If you would like a guide on what to do after a truck wreck, then pick up my book, Semitruck Wreck, a Guide for Victims and Their Families, which is available on Amazon or you can download it for free on our website, ckflaw.com.