EDMONTON, Alta. –A disastrous crash near Edmonton on Mar. 31 that was broadcast from coast-to-coast, and over the Internet has many in the trucking industry questioning medical standards for commercial truck drivers.

A 25-year-old truck driver died in the fiery crash after a 20-kilo-metre (some reports say 40 km) drive the wrong way down Yellowhead Trail. People close to the driver, Mark Santos, have indicated the bizarre behaviour may have been caused by his well-reported medical affliction: Type 1 diabetes.

Santos’ friends, family and coworkers, appear to have known about the condition. Preliminary toxicology reports have more recently indicated diabetes may not have been a factor, according to the Edmonton Journal newspaper. Whether it was diabetes or hypoglycemia, Santos’ medical fitness to drive a commercial vehicle, has been cast in doubt.

The Alberta Ministry of Transportation is responsible for determining driver fitness and making decisions regarding a person’s ability to drive any vehicle. A medical report is required when applying for or renewing a Class 1, 2 or 4 commercial vehicle licence, according to the ministry’s Web site. The presence of a related medical condition does not necessarily mean that a person’s ability to drive will be restricted.

Alberta Transportation will issue Class 1 commercial licences to drivers with medical conditions such as heart disease, insulin-dependent diabetes and epilepsy, under certain conditions, according to a spokesman for Alberta Transportation.

“If you’ve got a commercial licence you also have to have a medical fitness certificate,” said Jerry Bellikka, who recently spoke to the Edmonton Journal on the topic. “It’s a report from your doctor that says you’re medically fit to drive. There is a higher degree of risk involved when driving bigger trucks with cargo. The onus is on the driver, under the law, to report any medical conditions such as a hypoglycemic incident or epileptic seizure.

“If you are a Class 1 driver and you’re under the age of 45, you need to have a medical exam every five years,” Bellikka said. “If you have a diabetic condition, you are required to have a medical exam and a medical form every year. That form has to document any episodes you’ve had in the last 12 months and be signed by the doctor.”

Are medicals stringent enough?

Despite these requirements, some members of the Alberta trucking industry are still concerned about the medical standards for commercial truck drivers – especially the doctor’s physical exam. Gene Orlick, the president of the Alberta Motor Transport Association and a fleet operator, recently spoke to a 60-year-old driver about a medical required to update a Class 1 licence.

“He said the doctor did not even take his blood pressure,” said Orlick. “They’re just signing these documents, taking the $95 and (saying): ‘Have a nice day.’ There’s a lot of that going on. I think that is where the problem may lie.”

As a fleet operator, Orlick is concerned that the person he hires to drive, has a valid class 1 licence, a valid driver’s abstract, and that he has disclosed medical conditions such as a requirement for glasses. Those medical requirements must be listed on that licence, as well as proof that there was a recent medical exam.

“So we trust the medical community, that when this guy gets his renewal, that he’s actually healthy,” he said.

Another member of the Alberta trucking industry has similar concerns. Ric Bolton trains commercial drivers at a driving school in Alberta, and has also driven commercial trucks for 32 years. He says the medical standard is basically up to the discretion of the physician, who may, or may not, do a thorough exam.

“They do a basic, very basic medical for vision, urine analysis, (but) not blood tests,” he said.

Furthermore, a commercial driver pays anywhere from between $80 to $150 for the medical exam in Alberta, a procedure that Bolton, a part-time commercial driver, must undertake every two years, now that he is an older driver.

“Some of those medicals were: ‘How do you feel?'” he explained, of the interview portion of the exam, which he doesn’t consider as thorough as one might expect. “That was the extent of it.”

“Is that enough? I don’t know. It hasn’t changed in some time,” he added.

Despite the preliminary toxicology report, Santos’ father Julio told the Edmonton Journal that he still believes the tragic crash was caused by his son’s diabetes, and he described a hypoglycemic episode the younger Santos had experienced a few years earlier.

“We thought he had some kind of brain hemorrhage, so we (the ambulance attendants and Julio) started to drive him to the hospital in Grande Prairie,” he recalled.

The Alberta Ministry of Transportation gets its medical standards from the Canadian Council of Motor Transport Administrators’ (CCMTA’s) criteria developed by each of the provincial transportation ministries, which are potentially used to establish whether drivers are medically fit to drive a commercial vehicle. One of the main points in the list of the CCMTA medical standards is related to hypoglycemia, a medical condition which does not qualify for any type of motor vehicle licence, unless “treated, and the cause eliminated.”

As for injectable insulin-treated diabetes, candidates are eligible for a Class 5 licence if there are no other disqualifying complications and they are not subject to hypoglycemia.

According to the CCMTA, the candidate “may be considered for Class 1, 2, 3 or 4 (licences) only if the following conditions are met: 1) no hypoglycemic episode requiring the need for intervention within the past two years; 2) no evidence of hypoglycemia unawareness; 3) the diabetes is wellcontrolled; 4) self-monitoring is adequate (a verifiable glycemic log is maintained); 5) knowledge of the disease and the causes, symptoms and treatment of hypoglycemia is adequate; 6) no other disqualifying complications; 7) (candidate) observes the guidelines for driving recommended by the Canadian Diabetes Association dated June 1991; and 8) (an) annual medical review including a complete eye examination including a dilated retinal examination in the presence of retinopathy, an examination by an ophthalmologist is required.”

So how was Santos driving a commercial truck, if the medical requirements indicate that he was unlikely qualified, if everything his family, friends and co-workers, say about his Type 1 diabetic condition, is true?

A senior communications officer for the Alberta government indicates that physicians are required to examine individuals for each of the medical conditions outlined on the medical examination for motor vehicle operator’s form, using criteria set out in the CCMTA medical standards for drivers, as a guideline.

“The department does not prescribe how a physician is to conduct a medical examination for motor vehicle operators, nor speak to the ‘standard of care’ exercised by a physician,” said a senior communications officer for Alberta Transportation, Eileen McDonald, who intimates that the process may not be without fault.

“Perhaps this is a question better answered by the Alberta College of Physicians and Surgeons,” she said, adding that the CCMTA is also open to changes.

“Considerations are always being made to improve or enhance the form to obtain better medical data of drivers, (and) to ensure driver fitness and traffic safety. Future form revisions are being considered in conjunction with future initiatives.”

All information considered

McDonald says the Alberta government considers all the medical information provided by the physician and the applicant and determines the medical and physical fitness to drive based on this information and the CCMTA medical standards.

“The form is designed to have the specific questions responded to in a manner that will ensure the government has the necessary medical data, to make an informed decision regardi
ng the person’s ability to operate a motor vehicle safely,” she added.

While it is the driver candidate’s responsibility to disclose any medical/physical conditions which may be expected to interfere with the safe operation of a motor vehicle, full disclosure is a requirement by all parties. Yet, the physician is not subject to any liability regarding the medical exam, according to Alberta Transportation.

“Physicians are not legally obligated to report,” said Olga Tvares, the director of Alberta driver fitness and monitoring. “However, should they: no liability will be accrued as stipulated in the Alberta Traffic Safety Act.”

Are drivers withholding information?

Therefore, if the individual is not forthcoming about a disability, and the physician did not show due diligence with the medical exam, the Alberta government is also excluded from liability, according to Tvares. “Government is excluded and the individual would be responsible.”

As for the College of Physicians of Alberta, the organization doesn’t dictate how a physician should run an office, or examine a patient. The organization will get involved if there is an issue of concern.

“Our complaints department certainly would be interested,” said the manager of communications for the college, Kelly Eby.

The president of the AMTA is not satisfied with this medical protocol, and wonders how many drivers are hesitant to disclose their disease, especially if the exam is not completely thorough.

“I wonder how many people have eye disease, epilepsy or heart trouble for example and won’t get checked for fear of losing their licence to drive?” questioned Orlick. “I actually found one of my drivers to have diabetes and we discussed it, and because his doctor didn’t say anything about the diabetes and driving, he didn’t talk about it either, to protect his career. This reality is scary: my guy is on pills and from what I know he should be a lesser risk. But how do I really know if the doctors don’t become involved, and more importantly become responsible for their reports?”

As far as the diabetic driver from Edmonton, Orlick can only wonder what the cause is, like many other observers.

“I feel for the family. Everyone needs reasons for closure. They can only speculate, just like us now,” he said.

From 2002 to 2006, a driver’s medical condition was involved in one in 200 fatal accidents and one in 180 injury accidents in Alberta, according to Alberta Transportation.

The CCMTA indicates that it doesn’t collect that type of information nation-wide.

“That type of statistic would have to be generated by each province individually, and even then, I don’t know if they could all do it,” says Audrey Henderson, the director of programs for the CCMTA. “So, the simple answer is: I don’t have that number for Canada or any of the other provinces.”