Health of bus driver at is­sue

Li­cens­ing sys­tem de­pends on vol­un­tary dis­clo­sure of seizures

Baltimore Sun - - FRONT PAGE - By Scott Dance

The med­i­cal ex­am­i­na­tion that school bus driv­ers must pass be­fore be­ing per­mit­ted to trans­port chil­dren would not re­veal a seizure dis­or­der un­less the per­son vol­un­tar­ily dis­closed it or showed signs of a neu­ro­log­i­cal prob­lem, said doc­tors fa­mil­iar with the exam.

The med­i­cal his­tory of a Bal­ti­more school bus driver could be­come a fac­tor as in­ves­ti­ga­tors de­ter­mine what caused his bus to crash into a tran­sit bus in South­west Bal­ti­more on Nov. 1, killing him and five other adults. A spokesman for the Na­tional Trans­porta­tion Safety Board said that if in­ves­ti­ga­tors learn the driver was suf­fer­ing a seizure — he is be­lieved to have a his­tory of them — their re­port may in­clude pol­icy rec­om­men­da­tions to help pre­vent sim­i­lar ac­ci­dents in the fu­ture.

The driver phys­i­cals in­volve checks for vi­sion or hear­ing im­pair­ment and anal­y­sis of urine sam­ples for con­di­tions such as di­a­betes or kid­ney dis­ease. But a his­tory of seizures would only come to light if the driver in­cluded it on a med­i­cal his­tory list, which they sign un­der penalty of per­jury, or showed symp­toms such as de­layed re­flexes.

Pas­sen­ger safety re­lies on an as­sump­tion that driv­ers are hon­est, said Dr. Clay­ton Cowl, chair­man of the di­vi­sion of preventive, oc­cu­pa­tional and aerospace medicine at the Mayo Clinic. The med­i­cal ex­ams are re­quired of any­one op­er­at­ing a com­mer­cial ve­hi­cle, and air­craft pi­lots and ship cap­tains are sub­ject to sim­i­lar vet­ting.

“Ul­ti­mately it goes back to the driver mak­ing sure that ev­ery time they get be­hind Glenn Chap­pell

the wheel that they’re fit to drive,” Cowl said. “When you’re do­ing it for your liveli­hood, ob­vi­ously you’re con­flicted from the start.”

Fed­eral and state law­mak­ers and trans­porta­tion safety ad­vo­cates said they are ea­ger to see if the NTSB re­port rec­om­mends any changes in law or reg­u­la­tions.

“If any short­com­ings in our safety reg­u­la­tions are found, we must work to re­solve them im­me­di­ately to pre­vent ac­ci­dents and save lives in the fu­ture,” Rep. Eli­jah E. Cum­mings said in a state­ment.

Glenn Chap­pell, a driver for a Bal­ti­more City Pub­lic Schools con­trac­tor, was on his way to pick up stu­dents for Dal­las F. Nicholas El­e­men­tary School when his bus rear-ended a Ford Mus­tang, crossed into on­com­ing traf­fic and rammed a Mary­land Tran­sit Ad­min­is­tra­tion bus Nov. 1, po­lice said.

Chap­pell and five peo­ple aboard the MTA bus, in­clud­ing the driver, died. Eleven peo­ple were in­jured, in­clud­ing an aide who was the only other per­son on the school bus.

In­ves­ti­ga­tors are look­ing into whether Chap­pell suf­fered a med­i­cal emer­gency that caused the crash, af­ter they ruled out me­chan­i­cal fail­ure or an in­ten­tional act. Days af­ter the crash, it came to light that af­ter Chap­pell crashed his car in El­li­cott City in 2014, his wife told po­lice he had taken med­i­ca­tion to pre­vent seizures.

Mary­land Mo­tor Ve­hi­cle Ad­min­is­tra­tion of­fi­cials said that at the time of the crash Chap­pell had been barred since Sept. 1 from op­er­at­ing a com­mer­cial ve­hi­cle be­cause a cer­tifi­cate tes­ti­fy­ing that he was in good health had ex­pired. While he had not pro­vided a new one to the MVA, he did share doc­u­men­ta­tion with Bal­ti­more schools of­fi­cials that he passed a phys­i­cal in June.

The med­i­cal ex­am­i­na­tion re­quired of bus driv­ers, or any­one op­er­at­ing a ve­hi­cle that car­ries 16 pas­sen­gers or more, is de­signed to en­sure a per­son is phys­i­cally and men­tally up to the task. Com­mer­cial driver’s li­cense­hold­ers are re­quired to pass the ex­am­i­na­tion at least once ev­ery two years, and more of­ten if they have a med­i­cal con­di­tion that bears mon­i­tor­ing, ac­cord­ing to the Fed­eral Mo­tor Car­rier Safety Ad­min­is­tra­tion, which over­sees the process.

The exam be­gins with ques­tions about a driver’s med­i­cal his­tory, and driv­ers must fill out a form in­di­cat­ing whether they ever had seizures, epilepsy or head or brain in­juries, among other con­di­tions. The driv­ers sign the form cer­ti­fy­ing that the in­for­ma­tion is “ac­cu­rate and com­plete,” and are warned that they could face civil or crim­i­nal penal­ties if it is not.

If a driver says they have a his­tory of seizures, doc­tors typ­i­cally end the ex­am­i­na­tion and dis­qual­ify the driver. For any­one with epilepsy, a cer­tifi­cate can’t be is­sued un­less the driver hasn’t had a seizure or taken seizure med­i­ca­tion in a decade.

“We don’t even fin­ish the exam if a per­son says they have epilepsy,” said Dr. Nel­lie Whi­taker, a Bal­ti­more physi­cian who this month be­came cer­ti­fied to per­form the driver phys­i­cals.

Since 2014, doc­tors have been re­quired to re­ceive spe­cial train­ing and pass a test in or­der to is­sue the med­i­cal cer­tifi­cates.

Other con­di­tions that could dis­qual­ify driv­ers in­clude hear­ing or vi­sion loss, nar­colepsy, hy­per­ten­sion and di­a­betes, though doc­tors can make some ex­cep­tions.

The driver’s exam tests hear­ing and vi­sion. Driv­ers must be able to hear a whis­per from 5 feet away. Their field of vi­sion must ex­tend 70 de­grees above and below a hor­i­zon­tal merid­ian, and they must be able to dis­tin­guish red, green and am­ber col­ors.

Doc­tors look for scars that might in­di­cate past heart surg­eries, and they check for her­nias. Driv­ers sub­mit to a urine sam­ple to check lev­els of glu­cose or de­tect any blood. Doc­tors ob­serve the driver climb­ing onto and off of the ex­am­i­na­tion bench, and ask them to raise their arms above their head.

It’s un­likely those tests would re­veal a seizure dis­or­der, Cowl said. A driver would only be re­ferred to a neu­rol­o­gist if an ex­am­iner no­ticed some­thing ab­nor­mal.

“The process is only as good as the driver be­ing hon­est and the med­i­cal ex­am­iner hav­ing some nat­u­ral cu­rios­ity,” he said.

When asked about the pos­si­bil­ity that driv­ers with seizure disor­ders could slip through, pub­lic of­fi­cials and safety ad­vo­cates said they are wait­ing to hear the re­sults of the NTSB’s in­ves­ti­ga­tion, and are ready to push for re­forms, if nec­es­sary.

Cum­mings said he and col­leagues on the House trans­porta­tion com­mit­tee “have been fight­ing to en­sure that com­mer­cial driv­ers are med­i­cally fit for duty and sys­tems are put in place to iden­tify in­di­vid­u­als who may pose safety risks.”

Rep. John Sar­banes said of­fi­cials must use the NTSB’s find­ings to “do ev­ery­thing we can to help im­prove trans­porta­tion safety and pre­vent fu­ture ac­ci­dents from tak­ing place.”

And state Del. Ku­mar P. Barve said he al­ready is plan­ning hear­ings be­fore the trans­porta­tion com­mit­tee that he chairs.

“Bu­reau­cracy failed here,” Barve said of the fa­tal bus crash. “We have to get to the bot­tom of why that hap­pened.”

Charles Hood, ex­ec­u­tive direc­tor of the Na­tional As­so­ci­a­tion of State Di­rec­tors of Pupil Trans­porta­tion Ser­vices, said that school buses are “far safer than the other ways stu­dents are trans­ported to and from school.”

But if the Bal­ti­more crash ex­poses a vul­ner­a­bil­ity in the sys­tem, he said he is ea­ger to hear any rec­om­men­da­tions to ad­dress it.

“I am con­fi­dent that the NTSB will delve into it,” he said.

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