Denial of Exemption Applications; Epilepsy and Seizure Disorders |
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Larry W. Minor
Federal Motor Carrier Safety Administration
June 24, 2015
[Federal Register Volume 80, Number 121 (Wednesday, June 24, 2015)]
[Notices]
[Pages 36399-36400]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2015-15520]
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DEPARTMENT OF TRANSPORTATION
Federal Motor Carrier Safety Administration
[Docket No. FMCSA-2015-0115]
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 8 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: Charles A. Horan, III, Director,
Office of Carrier, Driver and Vehicle Safety, (202) 366-4001, or via
email at fmcsamedical@dot.gov, or by letter to FMCSA, Room W64-113,
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 of the 2-year period. The 8
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. 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
[[Page 36400]]
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/medical/driver-medical-requirements/driver-medical-fitness-duty under
reports and are in the docket for this notice. 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).
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 drivers were listed previously in Federal
Register Notice FMCSA-2015-0115 published on May 8, 2015:
Henry A. Freiburger--Mr. Freiburger has a history of epilepsy. His
last seizure was in 2002. His anti-seizure medication was discontinued
for a brief period in 2014. He does not meet the MEP guidelines at this
time.
Timothy K. Jameson--Mr. Jameson has a history of epilepsy. His last
seizure was in 2010. He takes anti-seizure medication. He does not meet
the MEP guidelines at this time.
Matthew J. Murphy--Mr. Murphy has a history of seizure disorder.
His last seizure was in 2013. He takes anti-seizure medication. He does
not meet the MEP guidelines at this time.
David Joe Patterson--Mr. Patterson underwent a craniotomy for
aneurysm in 1988, has no history of seizure or loss of consciousness
and has never taken anti-seizure medication since 1988. He does not
meet the MEP guidelines at this time.
Charles E. Sprenger--Mr. Sprenger has a history of seizure related
to a brain tumor. The tumor was removed in 2008. He discontinued his
anti-seizure medication in 2013. He does not meet the MEP guidelines at
this time.
Michael E. Tuttle--Mr. Tuttle has a history of epilepsy. His last
seizure was February 2008. He takes anti-seizure medication. He does
not meet the MEP guidelines at this time.
Mohammad S. Warrad--Mr. Warrad has a history of seizures. His last
seizure was in 1999. His anti-seizure medication was changed in March
2014. He does not meet the MEP guidelines at this time.
Tyler David Williams--Mr. Williams has a history of epilepsy. His
last seizure was in 2009. He takes anti-seizure medication. He does not
meet the MEP guidelines at this time.
Issued on: June 17, 2015.
Larry W. Minor,
Associate Administrator for Policy.
[FR Doc. 2015-15520 Filed 6-23-15; 8:45 am]
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