National Registry of Certified Medical Examiners (NRCME) DOT Practice Exam

What are the FMCSA guidelines for certification of a driver on Coumadin who is compliant with INR monitoring?

1. Disqualify

2. Use clinical judgment, based upon the underlying disease

3. Certify for a maximum of 1 year

4. Certify for a maximum of 6 months

The correct answer is: Use clinical judgment, based upon the underlying disease

The appropriate guideline for certifying a driver on Coumadin, provided they are compliant with INR monitoring, is to use clinical judgment based on the underlying disease. This approach emphasizes the importance of assessing the individual's overall health status and the specifics of their condition rather than applying a one-size-fits-all rule. Clinical judgment allows the medical examiner to consider various factors, such as the reason for the Coumadin prescription (for example, atrial fibrillation, deep vein thrombosis, or other thromboembolic disorders), the stability of the driver's INR levels, and any potential risks associated with their medical condition. By looking at these considerations, the examiner can make a more informed decision that balances safety with the individual's right to drive. This nuanced approach acknowledges that some individuals on Coumadin may be stable and safe to operate commercial vehicles, while others may pose a greater risk due to their underlying health issues. Therefore, the guidelines supporting the use of clinical judgment help ensure that decisions are made on a case-by-case basis, promoting both safety on the roads and fairness in the certification process.