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Guest UVAPAC

Alcoholism and DOT Physical

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Guest UVAPAC

I had a patient with glycosuria on DOT physical examination.  I had the patient see their primary care physician for HA1C.  

I received a letter stating in regards to the above stating:  He was seen in the office and had a negative urine analysis, a normal fasting blood sugar, and a normal HA1C.  

Wonderful right??  The letter continued:

He does engage in moderate/heavy alcohol use and I recommend cessation.  His LFTs are markedly elevated.  He should be following up with his GI specialist.  I do recommend control, if not cessation of alcohol intake prior to approving for CDL.  He may benefit from alcohol rehab, and I will be happy to facilitate this.

How do I proceed with this without throwing his PCP under the bus?  I assume that the above is enough to constitute alcoholism even though one could have markedly elevated LFTs after a big weekend of drinking.

 

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2 hours ago, UVAPAC said:

I had a patient with glycosuria on DOT physical examination.  I had the patient see their primary care physician for HA1C.  

I received a letter stating in regards to the above stating:  He was seen in the office and had a negative urine analysis, a normal fasting blood sugar, and a normal HA1C.  

Wonderful right??  The letter continued:

He does engage in moderate/heavy alcohol use and I recommend cessation.  His LFTs are markedly elevated.  He should be following up with his GI specialist.  I do recommend control, if not cessation of alcohol intake prior to approving for CDL.  He may benefit from alcohol rehab, and I will be happy to facilitate this.

How do I proceed with this without throwing his PCP under the bus?  I assume that the above is enough to constitute alcoholism even though one could have markedly elevated LFTs after a big weekend of drinking.

 

Follow the regulations/standards...........

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If you know he actively drinks every day and shows signs of alcoholism - do not sign his card.

What if he withdraws and has DTs while driving and takes out a busload of kids or nuns - or someone you know in the car in the next lane?

PUBLIC SAFETY. This is not about the driver's PCP or his employer. This is about public safety.

An ethyl glucoronide test will show alcohol intake in roughly the past 72 hours. It is a bit of a dodgy test to interpret - I use it to see if my narcotic patients are drinking.

Don't sign it - tell the patient he shows signs of a condition that make him a dangerous driver. Tell the employer he does not pass and they should talk to him about it.

You wouldn't be doing anyone any favors by signing that card.

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10 hours ago, UVAPAC said:

You must not perform DOT physicals as there are no current "regulations/standards."  

That criteria was pulled offline in 2015 and has had a general disclaimer of:  https://www.fmcsa.dot.gov/regulations/medical/fmcsa-medical-examiner-handbook

 

Correct,I stopped working in practices that perform these exams back in 2012. Absent a regulation, there are standards that are applied to CDL holders or there wouldn't be a need for the exam/medical card.

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Guest UVAPAC
13 hours ago, CAdamsPAC said:

Correct,I stopped working in practices that perform these exams back in 2012. Absent a regulation, there are standards that are applied to CDL holders or there wouldn't be a need for the exam/medical card.

Things have changed drastically since 2012.  There are "medical review board recommendations" but no actual regulations.  Obviously alcoholism is a condition with great risk to both the driver and the public.  The medical review board suggested several years ago they are referred to a substance abuse counselor for "evaluation and treatment" and when they obtain a clearance letter may be re-considered for CDL activity.

It would be very easy for one to complete a week or two rehab, get a note, and go back to drinking.  This is very similar to how I have had driver's obtain a letter stating they will no longer be prescribed opioids, they abstain for several months, get issued a card, and then return to filling large quantities for opioids/benzos/etc.  

For the most part the system is very broken.  It is based on "the honor system" which obviously does not work. 

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7 hours ago, UVAPAC said:

Things have changed drastically since 2012.  There are "medical review board recommendations" but no actual regulations.  Obviously alcoholism is a condition with great risk to both the driver and the public.  The medical review board suggested several years ago they are referred to a substance abuse counselor for "evaluation and treatment" and when they obtain a clearance letter may be re-considered for CDL activity.

It would be very easy for one to complete a week or two rehab, get a note, and go back to drinking.  This is very similar to how I have had driver's obtain a letter stating they will no longer be prescribed opioids, they abstain for several months, get issued a card, and then return to filling large quantities for opioids/benzos/etc.  

For the most part the system is very broken.  It is based on "the honor system" which obviously does not work. 

So, your position is ,there are no standards or guidelines, just the clinicians judgement?

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Guest UVAPAC
6 hours ago, CAdamsPAC said:

So, your position is ,there are no standards or guidelines, just the clinicians judgement?

I am saying what one clinician deems disqualifying, another may have no issue with.  I can deny this patient a card, and he can walk into another clinic tomorrow afternoon and be issued a card.  Nothing in place to stop this.

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2 hours ago, UVAPAC said:

I am saying what one clinician deems disqualifying, another may have no issue with.  I can deny this patient a card, and he can walk into another clinic tomorrow afternoon and be issued a card.  Nothing in place to stop this.

To me this seems to be another example of Catch-22; one's condition is only disqualifying if the person signing the document thinks so at that point and time, while someone else wouldn't think so. My question remains, are you saying, there are no standards for the issuance of the medical card, except personal preference or judgement? Why again does this requirement even exist, if there are no standards?

 

Edited by CAdamsPAC

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Guest UVAPAC
5 hours ago, CAdamsPAC said:

To me this seems to be another example of Catch-22; one's condition is only disqualifying if the person signing the document thinks so at that point and time, while someone else wouldn't think so. My question remains, are you saying, there are no standards for the issuance of the medical card, except personal preference or judgement? Why again does this requirement even exist, if there are no standards?

 

I am saying exactly what I said above.  If you follow the link there is no medical examiner handbook.  This is what had all of the standards for passing/failing an examination.  These have been offline for 3+ years now.  Our practice has continued to use the older standards and medical review board recommendations.

 

The other funny thing is FMCSA website has now been down for roughly 6 months.  No one can become a certified medical examiner at this time.  No one can upload their exams to the national registry, and they expect them all to be uploaded whenever their website is fixed.  

 

The system is a total mess.

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On 4/27/2018 at 2:36 AM, UVAPAC said:

The other funny thing is FMCSA website has now been down for roughly 6 months.  No one can become a certified medical examiner at this time.  No one can upload their exams to the national registry, and they expect them all to be uploaded whenever their website is fixed.  

 

The system is a total mess.

I got an email yesterday saying the FMCSA website was going to be integrated to login.gov or something.  Great.  Now my password will have to consist of uppercase, lowercase, special characters, numbers, small furry animals, and at least one tropical fruit, be changed every 60 days, and no part of any previous password can ever appear in any future password for the natural life of the account holder.

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16 minutes ago, rev ronin said:

I got an email yesterday saying the FMCSA website was going to be integrated to login.gov or something.  Great.  Now my password will have to consist of uppercase, lowercase, special characters, numbers, small furry animals, and at least one tropical fruit, be changed every 60 days, and no part of any previous password can ever appear in any future password for the natural life of the account holder.

yup, I feel the same about the state PDMP systems. Fortunately, the new EDIE system incorporates all that stuff (as long as the pt registers with their real name).

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