§ 71.3. Physical examination.
(a) General rule. A physical examination shall be given by a school transportation medical practitioner, a physician, a chiropractor, a CRNP or a physician assistant:
(1) To every applicant for an S endorsement.
(2) Annually, to every holder of an S endorsement.
(b) Requirements of physical examination. A person is physically qualified to drive a school bus if the person:
(1) Meets the following visual requirements:
(i) Has distant visual acuity of at least 20/40 in the better eye without corrective lenses or visual acuity corrected to 20/40 or better.
(ii) Has at least 20/50 in the poorer eye without corrective lenses or visual acuity corrected to 20/50 or better.
(iii) Has distant binocular acuity of at least 20/40 in both eyes with or without corrective lenses.
(iv) Has a combined field of vision of at least 160° in the horizontal meridian, excepting the normal blind spots.
(v) Has the ability to determine the colors used in traffic signals and devices showing standard red, green, or amber.
(2) Has no loss of a foot, a leg, a hand, or an arm; or has been granted a waiver by the Department after competency has been demonstrated through a driving examination administered in accordance with § 71.4(b)(2) (ii) and (iii) (relating to driver’s examination).
(3) Has no impairment of:
(i) A hand or finger likely to impair prehension or power grasping, or has been granted a waiver by the Department after competency has been demonstrated through a driving examination administered in accordance with § 71.4(b)(2)(ii) and (iii).
(ii) One of the following:
(A) An arm, foot, or leg likely to impair the ability to perform normal tasks associated with driving a school bus.
(B) Another significant limb defect or limitation likely to impair the ability to perform normal tasks associated with driving a school bus.
(C) Has been granted a waiver by the Department after competency has been demonstrated through a driving examination.
(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 diabetic medications provided the individual meets all of the following:
(A) The individual’s health care provider verifies in writing that there has been no incident of a severe hypoglycemic reaction 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 12 months.
(B) The driver submits to a diabetic examination every 6 months, and submits the results of the examination and the results of an HbA1C test on a form provided by the Department. The healthcare provider reviewing the diabetic examination shall be familiar with the individual’s past diabetic history for 24 months or have access to that history and certify that the individual is under good diabetic control.
(I) An individual who has had two consecutive HbA1C test results of greater than 8% as required in this clause shall undergo additional diabetic examinations every 3 months. The health care provider shall review the self monitoring blood glucose logs and report the highest and lowest blood glucose levels for that 3-month period and certify that the observed blood glucose levels are not suggestive of hypoglycemic or hyperglycemic driving impairment on a form provided by the Department.
(II) Once the results of two consecutive HbA1C tests required in this clause are 8% or less, the individual may discontinue the additional examinations and reporting required in subclause (I).
(C) The driver submits to an annual dilated eye examination and submits the results of the examination on a form provided by the Department.
(D) Individuals, upon hire to drive a school bus, shall manage their diabetes by complying with the following requirements:
(I) Self-monitor 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 individual may not drive until appropriate measures are taken and the individual retests within this acceptable range.
(II) Submit the computerized glucometer results of blood glucose self-monitoring for review by the treating health care provider or a school transportation medical practitioner. The results shall also be submitted to the health care provider conducting the 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 health care provider conducting the 6-month diabetic examination.
(IV) 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 or symptomatic hyperglycemia as long as the individual has been free from severe hypoglycemic reactions or symptomatic hyperglycemia for the preceding 12 months and the subsequent severe hypoglycemic reaction or symptomatic hyperglycemia occurred while the individual was under the care of a treating health care provider, during or concurrent with a nonrecurring transient illness, toxic ingestion or metabolic imbalance. This 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 health care provider finding that the individual previously qualified for a waiver is not complying with the requirements in subsection (b)(4)(i), or is otherwise no longer qualified for the waiver shall promptly report these findings to the Department and the waiver will be rescinded.
(iv) If the individual requiring the use of oral hypoglycemic medication or insulin does not qualify for a waiver, that individual may request an independent review of 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.
(v) Submissions to the Department by physicians or other health care providers, including physician verifications and the results of diabetic examinations, shall be made on forms provided by the Department.
(5) Has no established medical history or clinical diagnosis of myocardial infarction, angina pectoris, coronary insufficiency or pacemaker insertion.
(i) Waivers may be granted to those individuals with a history of coronary artery disease, previous myocardial infarction, congenital heart defects, cardiomyopathy, pericarditis, myocarditis, chronic atrial flutter/fibrillation or valvular heart disease, and individuals who have undergone corrective surgery for congenital heart defects, coronary angioplasty, valve repair/replacement, coronary artery bypass graft surgery, or ablative surgery for paroxysmal supraventricular arrhythmias, if the individual annually meets these criteria:
(A) The individual is asymptomatic from the disorder or is receiving medication used to treat the disorder and is asymptomatic on medication.
(B) The individual completes seven Mets (metabolic equivalents) on a treadmill stress EKG (electrocardiogram) test preferably following the Bruce or Balke Protocols and achieves 85% of the predicted maximal heart rate without symptoms or EKG changes. If the resting EKG is abnormal, or the individual is on digoxin, then a stress thallium test should be performed.
(C) An echo, gated blood pool scan or left ventriculogram performed on the individual measures a left ventricular ejection fraction of 40% or greater.
(ii) In the case of a permanent pacemaker insertion, the individual shall be 2 months post insertion, asymptomatic and demonstrate that he is undergoing regular pacemaker follow up.
(iii) In the case of chronic atrial flutter/fibrillation, the individual shall be on anticoagulant therapy with aspirin or Coumadin and demonstrate adequate rate control when exercising on a treadmill as listed in subparagraph (i)(B).
(iv) Waivers may not be granted to individuals:
(A) Diagnosed with symptomatic coronary artery disease (angina), cardiomyopathy, pericarditis, myocarditis, congenital or valvular heart disease.
(B) Within 2 months of a myocardial infarction, open heart surgery or pacemaker insertion.
(C) Implanted with an automatic cardioverter/defibrillators or antitachycardic device.
(D) With any history of ventricular tachycardia (excluding couplets and triplets), ventricular fibrillation or sudden cardiac death with successful resuscitation.
(E) With any history of paroxysmal supraventricular tachycardia.
(F) With any history of carotid sinus hypersensitivity, sick sinus syndrome, second degree heart block or third degree heart block unless a pacemaker has been inserted.
(6) Has no established medical history or clinical diagnosis of other cardiovascular disease resulting in syncope, dyspnea, loss or impairment of consciousness, collapse, or congestive cardiac failure.
(7) Has no current clinical diagnosis of hypertension resulting in syncope, dyspnea, loss or impairment of consciousness, collapse, or congestive cardiac failure.
(8) Has no established medical history or clinical diagnosis of a respiratory dysfunction likely to impair the ability to drive a school bus safely.
(9) Has no established medical history or clinical diagnosis of rheumatic, arthritic, orthopedic, muscular, neuromuscular, or vascular disease likely to impair the ability to drive a school bus safely.
(10) Has no established medical history or clinical diagnosis of seizure disorders or another condition likely to cause loss or impairment of consciousness or loss of ability to drive a school bus safely.
(i) A waiver may be granted to these persons provided:
(A) There has been no more than a single, nonrecurring episode of altered consciousness or loss of bodily control, occurring at least 2 years preceding application, which did not require treatment.
(B) A seizure disorder has been diagnosed, but the person has been episode-free for at least 5 years preceding application and has not required treatment for at least 5 years preceding application.
(11) Has no mental, emotional or psychiatric disorder whether functional or organic which may be manifested in a condition likely to impair the ability to drive a school bus safely, such as inattentiveness, despondency, aggressiveness, or lack of concern for the safety of self or others.
(12) Has no hearing loss greater than 40 decibels in the better ear, without a hearing aid, at frequencies of 500, 1,000, and 2,000 Hz. (Reference American National Standards Institute (ANSI) 1969 for earphones: Dirks and others, Journal of Speech and Hearing Disorders, J.S.H.D. Vol. 44, 2/79, 34-54- in a sound field for warble tones). A person who is required to wear a hearing aid to meet the standards of this paragraph shall be tested by an audiologist or a licensed physician—M.D. or D.O.—who specializes in the treatment of otolaryngology. An audiologist is an individual who has a certificate of clinical competence in audiology awarded by the American Speech, Language and Hearing Association or is licensed as an audiologist under the Speech-Language and Hearing Licensure Act (63 P. S. § § 1701—1719). The individual who performs the test shall certify that the person has passed the test. A person who requires a hearing aid to meet the requirements of this paragraph shall also:
(i) Have a speech reception threshold of 40 decibels H. L. or better in the better ear with a hearing aid, as tested with speech presented in monaural direct mode—45° Azimuth to the right ear or 315° Azimuth to the left ear; reference 0 decibels H. L.=13 decibels S.P.L. for sound field speaker.
(ii) Achieve a score of 60% or better in a speech discrimination test of phonetically balanced words. Presented at 50 decibels H. L. + 12 decibels S/N—Average sound levels plus background noise. The tested shall use:
(A) C.I.D. W-22 word lists.
(B) Masking noise consisting of speech spectrum noise or white noise, which shall be presented in monaural indirect mode—45° Azimuth for left ear and 315° Azimuth for right ear.
(iii) Wear the aid and keep it operational at all times when driving the school bus.
(iv) Keep a good spare battery source on their person whenever driving the school bus.
(v) Present, at the time of the hearing test, an electroacoustic analysis test report of the hearing aid which indicates that the aid meets manufacturer’s specifications.
(13) Does not abuse alcohol or another drug or substance known to impair skill or functions which may be manifested in a condition such as inattentiveness, despondency, aggressiveness or lack of concern for the safety of self or others.
(14) Has no type of tuberculosis in a transmittable stage and has taken the tuberculin test every 2 years as required by section 1418(b) of the Public School Code (24 P. S. § 14-1418(b)).
(15) Has no other condition which in the opinion of the examining physician is likely to impair the ability to drive a school bus safely.
(c) Physical examination certificate. The examining school transportation medical practitioner, physician, chiropractor, CRNP or physician assistant shall issue a certificate, valid for the ensuing year, to every driver who passes a physical examination.
(1) A certificate shall become void if a condition occurs which would have disqualified the driver at the time of the examination.
(2) A school bus driver whose certificate becomes void may request a re-examination.
(3) The original of the physical examination form or a copy or photocopy executed by the doctor and driver shall be forwarded to the Pupil Transportation Section.
(d) Additional requirements. Every school bus driver shall:
(1) Comply with local school district policies regarding communicable diseases and 28 Pa. Code Chapter 27 (relating to communicable and noncommunicable diseases).
(2) Consume no alcoholic beverage or controlled substance within 8 hours in advance of and while driving a school bus.
(e) Application for waiver. Application for waiver under this section may be obtained from the Department at the time of application for a school bus driver endorsement or thereafter.
Authority The provisions of this § 71.3 amended under the Vehicle Code, 75 Pa.C.S. § § 1504(c), 1508, 1508.1, 1509 and 6103.
Source The provisions of this § 71.3 adopted September 23, 1977, effective September 24, 1977, 7 Pa.B. 2702; amended April 11, 1980, effective April 12, 1980, 10 Pa.B. 1542; amended May 24, 1985, effective May 11, 1985, provided that subsection (b)(12) shall possess a sunset of 3 years after the date of adoption, 15 Pa.B. 1918; subsection (b)(12) readopted May 20, 1988, effective May 11, 1988, 18 Pa.B. 2301; readopted May 11, 1990, effective immediately and apply retroactively to May 11, 1990, 20 Pa.B. 2524; amended January 13, 1995, effective January 14, 1995, 25 Pa.B. 160; amended January 23, 1998, effective January 24, 1998, 28 Pa.B. 364; amended November 26, 2003, effective November 29, 2003, 33 Pa.B. 5817; amended August 24, 2007, effective August 25, 2007, 37 Pa.B. 4621; amended October 8, 2010, effective October 9, 2010, 40 Pa.B. 5809. Immediately preceding text appears at serial pages (329367) to (329372) and (337685) to (337686).
Notes of Decisions The existence of the medical condition of epilepsy is not controlling; the determinative factor is whether the medical condition affects an individual’s ability to drive a school bus. Department of Transportation v. Chalfant, 565 A.2d 1252 (Pa. Cmwlth. 1989).
Bus driver whose license was revoked because she was diabetic, even though diabetes had been under control for years, could assert rights under the Rehabilitation Act of 1973 (29 U.S.C.A. § 794), and administration of blood sugar level test prior to each bus trip wasn’t undue burden on employer. Department of Transportation v. Tinsley, 564 A.2d 286 (Pa. Cmwlth. 1989); appeal denied 575 A.2d 570 (Pa. 1990).
The affirmative defense of section 504 of the Rehabilitation Act of 1973 (29 U.S.C.A. § 794) to challenge the recall of licenses is allowed and drivers may present evidence that current heart or epileptic conditions do not pose an appreciable risk. Department of Transportation v. Brown, 558 A.2d 121 (Pa. Cmwlth. 1989); vacated and remanded 620 A.2d 1139 (Pa. 1993); affirmed 630 A.2d 927 (Pa. 1993); affirmed 684 A.2d 1060 (Pa. 1996).
Once a licensee presents a prima facie case of discrimination by handicap under section 504 of the Rehabilitation Act of 1973 (29 U.S.C.A. § 794), the licensee is entitled to proof by the Department that he is not otherwise qualified. In re Stober, 524 A.2d 535 (Pa. Cmwlth. 1987), affirmed on reargument, 546 A.2d 155 (Pa. Cmwlth. 1988).
Department of Transportation could recall a school bus driver’s class 4 license on the grounds that he had a history of myocardial infarction and coronary arterial disease. Department of Transportation v. Spagenberg, 519 A.2d 1118 (Pa. Cmwlth. 1987).
Although bus driver never suffered a heart attack, his ‘‘technical history of heart problems’’ and by-pass surgery evidenced a ‘‘history of coronary insufficiency’’ which is a valid basis for recall of bus driving privileges under 67 Pa. Code § 71.3. Department of Transportation v. Walko, 510 A.2d 398 (Pa. Cmwlth. 1986).
Regulation at 67 Pa. Code § 71.3(b)(5) [changed to (b)(12)] prohibiting licensure of school bus drivers with hearing loss greater than 25 decibels, does not discriminate against the hearing impaired since there is a rational relationship to safety goals, it does not violate substantive due process, and it constitutes an appropriate job qualification. Giampa v. Commonwealth, 492 A.2d 504 (Pa. Cmwlth. 1985).
Although school bus operator is currently physically competent, the fact that he underwent heart surgery to correct a 95 percent blockage in a coronary artery presupposes a medical history of coronary insufficiency, thus disqualifying him as an operator under 67 Pa. Code § 71.3 (b)(3)(ii) [changed to (b)(5)]. Department of Transportation v. Miller, 492 A.2d 121 (Pa. Cmwlth. 1985).
Previous decision at 84 Pa. Cmwlth. 26, 478 A.2d 521 (1984) vacated. Subsection (b) is not arbitrary or capricious and provides a valid basis for recall of the license of a school bus driver who is in currently good physical condition but has a history of heart attack. Department of Transportation v. Johnson, 489 A.2d 960 (Pa. Cmwlth. 1985); 478 A.2d 521 (1984).
Panel opinion, 84 Pa. Cmwlth. 26, 478 A.2d 521, vacated. Person without any current impairment may be denied school bus driving privileges solely on basis of history of heart attack. 67 Pa. Code § 71.3 is reasonable, and hence valid under substantive due process tests. Department of Transportation v. Johnson, 489 A.2d 960 (Pa. Cmwlth. 1985).
Because the history of a disorder is not synonymous with the current existence of a disorder, the court held that the Department’s application of subsection (b) was unlawful where the petitioner was determined to be physically unqualified solely on the basis of his ‘‘established medical history’’ of a myocardial infarction. Department of Transportation v. Johnson, 478 A.2d 521 (Pa. Cmwlth. 1984). Reargument granted.
In vacating and remanding the District Court’s decision suspending plaintiff’s Class 4 driver’s license under subsection (b)(5), for wearing an eyeglass type of hearing aid the Court noted that the Department allows the granting of school bus driver’s licenses to individuals who must wear eyeglasses in order to meet Department vision standards, under subsection (b)(1)(i). Strathie v. Department of Transportation, 716 F.2d 227 (3d Cir. 1983).
In vacating and remanding the District Court’s decision suspending plaintiff’s Class 4 driver’s license under subsection (b)(5), the Court ruled that there was no factual basis in the record reasonably demonstrating that wearing a stereo hearing aid was such a physical ailment as would ‘‘likely interfere with the ability to drive a school bus with safety’’ and which would present an appreciable risk to the safety and control of school bus passengers if permitted. Strathie v. Department of Transportation, 716 F.2d 227 (3d Cir. 1983).
The suspension under this section of the Class 4 license of a driver who had diabetes and was taking 500 mg. of a hypoglycemic drug daily was held to be within the power of the Department and not in violation of the driver’s Fourteenth Amendment rights. Department of Transportation v. Slater, 462 A.2d 870 (Pa. Cmwlth. 1983).
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