[ 67 PA. CODE CH. 71 ]
School Bus Drivers
[38 Pa.B. 3503]
[Saturday, June 28, 2008]
The Department of Transportation (Department), under 75 Pa.C.S. § 1509 (relating to qualifications for school bus driver endorsement), proposes to amend §§ 71.2 and 71.3 (relating to definitions; and physical examination), as set forth in Annex A.
Purpose of Chapter
The purpose of Chapter 71 is to define more fully the requirements of 75 Pa.C.S. § 1509 by listing minimum medical requirements for school bus drivers.
Purpose of the Proposed Amendments
The purpose of the proposed amendments to §§ 71.2 and 71.3 is to update the medical requirements and standards for school bus drivers that are being treated for diabetes mellitus. Diabetes management and testing continues to evolve. The Department is updating our minimum standards to ensure that only school bus drivers under good control are qualified for the waiver to transport children.
Summary of Significant Amendments
Section 71.2 has been amended to correct the term ''CRNP--Certified Registered Nurse Practitioner.'' This certification is obtained solely by the State Board of Nursing; the State Board of Medicine is no longer involved.
We have also added the terms ''HbA1C, hyperglycemia, hypoglycemia, symptomatic hyperglycemia, Type I Diabetes mellitus and Type II Diabetes mellitus.'' In addition, we have also categorized ''hypoglycemia reactions'' by different degrees of severity. These additions reflect current guidelines established by the American Diabetes Association.
Section 71.3 has been amended to include the categories of hypoglycemic reactions established by the American Diabetes Association. We are adding the requirement for school bus drivers to submit their average Hemoglobin A1C (HbA1C) readings. Our minimum standard is an average of 8% or lower, which indicates that the diabetes is under good control. We are also adding the requirement for the driver to have an annual dilated eye examination.
In addition, the Department has added a waiver provision for individuals that have experienced an episode that would disqualify them from the waiver if the episode was as a result of a nonrecurring transient illness, toxic ingestion or metabolic imbalance as long as the treating physician verifies that it is a temporary condition or isolated incident not likely to recur.
Persons and Entities Affected
These amendments affect all licensed school bus drivers or persons interested in becoming a school bus driver that are currently being treated for diabetes mellitus.
Implementation of these amendments will not require the expenditure of any additional funds by the Commonwealth or local municipalities. These amendments will not impose any additional costs on the medical community, licensed school bus drivers or applicants for a school bus learner's permit.
Under section 5(a) of the Regulatory Review Act (71 P. S. § 745.5(a)), the agency submitted a copy of these proposed amendments, on June 18, 2008 to the Independent Regulatory Review Commission (IRRC) and to the Chairpersons of the House and Senate Transportation Committees (Committees). In addition to submitting the proposed amendments, the agency has provided IRRC and the Committees with a copy of a detailed Regulatory Analysis Form. A copy of this material is available to the public upon request.
Under section 5(g) of the Regulatory Review Act, IRRC may convey any comments, recommendations or objections to the proposed amendments within 30 days of the close of the public comment period. The comments, recommendations or objections shall specify the regulatory review criteria that have not been met. The Regulatory Review Act specifies detailed procedures for review, prior to final publication of the regulation, by the Department, the General Assembly and the Governor of comments, recommendation or objections.
The Department will make these amendments effective upon publication in final-form following appropriate evaluation of any comments, suggestions or objections received during the period allowed for public comment. The Department is not establishing a sunset date for these regulations, since these regulations are needed to administer provisions required under to the Vehicle Code. The Department, however, will continue to closely monitor these regulations for their effectiveness.
Interested persons are invited to submit written comments, suggestions or objections regarding the proposed amendments to Janet L. Dolan, Director, Bureau of Driver Licensing, P. O. Box 68676, Harrisburg, PA 17106-8676 within 30 days of the publication of this notice in the Pennsylvania Bulletin.
The contact person for technical questions about the proposed amendments is Scott Shenk, Manager, Driver Safety Division, Department of Transportation, Bureau of Driver Licensing, P. O. Box 68676, Harrisburg, PA 17106-8676, (717) 783-4534.
ALLEN D. BIEHLER, P. E.,
Fiscal Note: 18-410. No fiscal impact; (8) recommends adoption.
TITLE 67. TRANSPORTATION
PART I. DEPARTMENT OF TRANSPORTATION
Subpart A. VEHICLE CODE PROVISIONS
ARTICLE IV. LICENSING
CHAPTER 71. SCHOOL BUS DRIVERS
§ 71.2. Definitions.
The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise:
CRNP--Certified registered nurse practitioner--A registered nurse licensed in this Commonwealth who is certified[,] by [both] the State Board of Nursing [and the State Board of Medicine,] in a particular clinical specialty area and who, while functioning in the expanded role as a professional nurse, performs acts of medical diagnosis or prescription of medical therapeutic or corrective measures in collaboration with and under the direction of a physician licensed to practice medicine in this Commonwealth.
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HbA1C test--A Hemoglobin A1C test monitors the long-term control of diabetes mellitus.
Hyperglycemia--When the level of glucose (sugar) in the blood is too high based on current guidelines established by the American Diabetes Association.
Hypoglycemic reactions--Different degrees of hypoglycemia which are classified as follows:
(i) Mild--Hypoglycemia that signals a blood glucose drop, which the individual can self-correct with oral carbohydrates.
(ii) Severe--Hypoglycemia that requires outside intervention or assistance of others or that produces confusion, loss of attention or a loss of consciousness.
Hypoglycemia unawareness--A condition when the individual no longer recognizes the body's usual signals of low blood glucose so the first sign of hypoglycemia will often be confusion or loss of consciousness.
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Symptomatic hyperglycemia--High glucose levels in the blood that may cause a loss of consciousness or an altered state of perception, including, but not limited to, decreased reaction time, impaired vision or hearing, or confusion.
Type I Diabetes mellitus--A chronic disease caused by the pancreas producing too little insulin to regulate blood sugar levels.
Type II Diabetes mellitus--A chronic disease marked by high levels of sugar in the blood caused by the body failing to respond correctly to natural insulin.
§ 71.3. Physical examination.
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(b) Requirements of physical examination. A person is physically qualified to drive a school bus if the person:
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(4) Has no established medical history or clinical diagnosis of diabetes mellitus currently requiring use of insulin or other hypoglycemic medication.
(i) A waiver may be granted to an individual requiring the use of [oral hypoglycemic medication] diabetic medications provided:
(A) The individual's physician verifies in writing that there has been no incident of a severe hypoglycemic reaction, hypoglycemia unawareness or symptomatic hyperglycemia and the individual has been free from insulin reaction resulting in loss of consciousness, attention or awareness or the requirement of assistance from another person, for the preceding [2 years] 12 months.
(B) The driver submits to a HbA1C test every 3 months and submits to a diabetic examination every 6 months, and submits the results of the examination and the results of 2 consecutive HbA1C tests, on a form provided by the Department, showing an average HbA1C of 8% or lower indicating that the diabetes is under good control. The physician reviewing the diabetic examination shall be familiar with the individual's past diabetic history for 24 months or have access to that history.
(C) The driver submits to an annual dilated eye examination and submits the results of the examination on a form provided by the Department.
[(ii) A waiver may be granted to a person requiring the use of insulin provided:
(A) The person's physician verifies in writing to the Department that there has been no incident of hypoglycemic or hyperglycemic reaction and the person has been free from insulin reaction (including loss of consciousness, attention or awareness) or the requirement of assistance from another person, for the preceding 2 years.
(B) The person submits to a diabetic examination every 6 months, including a Hemoglobin A1C, and to a review of the prior 6-month history of blood glucose monitoring. The physician conducting the diabetic examination shall be familiar with the person's past diabetic history for 24 months or have access to that history.]
[(C) The person,] (D) Individuals, upon hire to drive a school bus, shall [demonstrate his willingness to] manage [his] their diabetes by complying with the following requirements:
(I) Self-monitoring blood glucose 1 hour before driving, and at least every 4 hours while driving or while otherwise on duty, by using a portable blood glucose monitoring device with a computerized memory. If blood glucose is below 80 mg/dL or above 350 mg/dL the [person] individual may not drive until [he takes] appropriate measures are taken and the individual retests within this acceptable range.
(II) [Submitting monthly] Submit the computerized glucometer results of blood glucose self-monitoring for review by [a physician, certified nurse practitioner, physician's assistant, registered nurse or other health care provider selected by the school district] the treating physician or a school transportation physician. The results shall also be submitted to the physician conducting the 6-month diabetic examination required by clause (B).
(III) Maintaining a manual blood glucose monitoring log and submitting it, together with the glucose monitoring device's computerized log, every 6 months to the physician conducting the [person's] 6-month diabetic examination.
(IV) [Having in his possession] Carrying a source of rapidly absorbable glucose at all times while driving a school bus.
(ii) Notwithstanding the provisions in subparagraph (i), a waiver may be granted to an individual who has recently suffered from a severe hypoglycemic reaction, hypoglycemia unawareness or symptomatic hyperglycemia as long as the individual has been free from severe hypoglycemic reactions, hypoglycemia unawareness or symptomatic hyperglycemia for the preceding 12 months and the subsequent severe hypoglycemic reaction, hypoglycemia unawareness or symptomatic hyperglycemia occurred while the individual was under the care of a treating physician, during or concurrent with a nonrecurring transient illness, toxic ingestion or metabolic imbalance. The waiver will only be granted if the treating physician submits written certification indicating it is a temporary condition or isolated incident not likely to recur.
(iii) A reviewing physician finding that [a person] the individual previously qualified for a waiver is not complying with the requirements in subparagraph [(ii)(C)] (i) and (ii) or is otherwise no longer qualified for the waiver shall promptly report these findings to the Department and the waiver [shall] will be rescinded.
(iv) If [a person] the individual requiring the use of oral hypoglycemic medication or [a person requiring the use of] insulin does not qualify for a waiver, that [person] individual may request an independent review of [his] the individual's medical records. The review will be conducted by a member of the Medical Advisory Board or by another physician designated by the Department.
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[Pa.B. Doc. No. 08-1196. Filed for public inspection June 27, 2008, 9:00 a.m.]
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