Ep 75: Unfit Drivers & Medical Exams with Dr. David Fletcher

David J. Fletcher, M.D.: And as a medical examiner, you have to go into that exam believing a lot of drivers are going to lie to you because they have to protect their livelihood. And so it’s very important for medical examiners to spend quality time with the driver, really ask probing questions, especially if you get a bunch of no answers on the medical history.

David Craig – Host: I’m Attorney David Craig, managing partner and one of the founders of Craig, Kelley & Faultless. For over 35 years, I’ve dedicated my career to helping individuals and families who have been seriously injured or lost loved ones in devastating semi-truck, large truck, and other commercial motor vehicle accidents. When tragedy strikes, life can feel chaotic, overwhelming, and uncertain. Many people don’t even know where to begin or what questions to ask. That’s why I created After The Crash, a podcast designed to empower you with the knowledge and resources you need to navigate these challenging times. In each episode, I sit down with experts, professionals, victims, and others involved in truck wreck cases to give you insight, guidance, and practical advice. Together, we’ll help you understand your rights, protect your family, and move forward. This is After The Crash. Welcome, ladies and gentlemen, to another episode of After The Crash. Today, we have Dr. David Fletcher, a licensed physician from Illinois, as our special guest. He’s double board certified in occupational medicine, as well as preventive medicine. He’s a medical director and CEO of SafeWorks over in Illinois. He’s a certified medical review officer. But I think the thing that attracts me the most about Dr. Fletcher is that he’s an advocate for safety. He fights hard and has throughout his career to make sure that the drivers of semi-trucks, buses, and other commercial motor vehicles are safe, are healthy, are physically fit, as required by the federal rules. And he does that. And he goes around this country and he has testified as an expert witness, both for the plaintiffs and also as for the defense. So sometimes he’s representing or testifying on behalf of the victims of these horrible wrecks. And sometimes he’s been consulted or asked to testify or give his opinion by the trucking company or the truck drivers. Dr. Fletcher, welcome to another episode of After The Crash.

David J. Fletcher, M.D.: Hey, thanks for having me back. I enjoyed my time with you back in 2021. So, big fan of your show. I’ve watched several episodes.

David Craig – Host: Well, I appreciate it. And I think one of the things that you recently did, you testified in a case out of Montana, and I’m going to talk about that a little bit later.

David J. Fletcher, M.D.: Sure.

David Craig – Host: But I think that, when I see these cases, I’m board certified in truck accident law, just like you’re board certified and double board certified. And one of the things I see with lawyers who don’t do trucking regularly—sometimes they miss things. And all too often, the worst truckers, the worst trucking companies, are ones that are running with $750,000 worth of insurance or a million dollars worth of insurance. There’s a wreck, kill somebody or catastrophically injure someone, and a lawyer who doesn’t know trucking settles out with the trucking company and the truck drivers, and then that’s it. They say, “Okay, we’re done.” And you know that there can be other options, there can be other avenues. A truck accident attorney, somebody who’s board certified in truck accident law, they’re going to look and see, “Well, how do we help this family? Is there anybody else that we can look to help this family recover from the harm that’s been caused?” And one of the people that I don’t think is looked at often enough is the person who put the driver behind the wheel, who gave them their medical card, who gave them their DOT card. And so that’s one of the topics I want to talk about today. However, before we get there, let’s give a little bit of background, because I think it’s interesting. You’ve been doing this stuff for a longtime. You’ve been one of the advocates. You were one of the first ones to set up a program to teach other doctors how to do this. So let’s walk us through how you got into this, why you’re so passionate about safety on commercial motor vehicles. I mean, you do pilots as well, but tell me what got you motivated? Why do you do what you do?

David J. Fletcher, M.D.: Well, it’s a good series of questions. What got my passion started was when I began my private practice of occupational medicine back in the late ’80s, early ’90s. I was a certified aviation medical examiner, and I had the benefit of that system being set up, which there was oversight of the medical examiners. You could not doctor shop, pilots couldn’t go to another AME, Aviation Medical Examiner. There’s only 2000 in the country. And you get a medical card because they would be detected by the FAA. And I said to myself, “Why doesn’t the…” At that time, it was Department of Highway Safety Administration and became FMCSA later, “Why don’t they have a similar system?” And so that was sort of my early passion, was to set up a FAA lookalike system for commercial drivers. I mean, the system worked so well. It was definitely something that I felt that trucking needed to emulate. And so that was my early exposure, because I got to see how great it was with the FAA system where if I had to defer a pilot, I knew he wasn’t going to go out on the street and get his aviation medical license.

David Craig – Host: In the commercial motor vehicle world, it’s not the same. And I don’t know that people even know that. I mean, to get your medical card for a pilot is completely different than, or somewhat different, than what it is to drive a truck, or a bus. Yet we see these trucks and buses on the highways every day; we’re in close contact with them every single day, and we can be harmed if the wrong people are behind the wheel.

David J. Fletcher, M.D.: Well, I certainly agree, David. And that was my impetus to get started to change the system in the early ’90s. And so I took upon leadership with the American College of Occupational and Environmental Medicine, to at least start some training for doctors, how to properly evaluate drivers. I had a corporate client that are no longer in business, named Robertson Trucking, which I was able to develop a very state-of-the-art system to vet their drivers. Each Monday, they would send 50 drivers to us; they were all over the country. And we’d have to vet them. And they didn’t have a problem with me getting sleep studies or cardiac studies on these people, because they knew they would have safe drivers. They had a situation where one of their drivers killed two people, and so they were very sensitive about health issues with drivers. And even better than getting good commercial drivers that were safe to be on the road, they found these programs saved them money on their health insurance. It’s because we were able to sort of vet these drivers, get them the treatment they needed if we identify high blood pressure, sleep apnea, diabetes, or whatever. And so it was really a good experience with that. I knew that trucking companies would see the benefit with a comprehensive program that thoroughly vetted their drivers. And so that was sort of my experience. And so I started this first course in the College of Occupational Medicine back in 1995. It was in Las Vegas of all places. And it was well attended, and it was obvious that physicians around the United States were just eager to get some good training. And so that nice response we got really pushed me to further change the system, basically revamped the FMCSA system with truck drivers to be like the FAA. And I made a lot of proposals, I got appointed to some national committees on that, but I got a lot of resistance, because some of the trucking industry didn’t think there’s going to be enough doctors to certify these drivers, and they were looking for drivers. They thought if the system was too stringent, they wouldn’t have anybody to haul their freight. So, I got a lot of resistance, but I kept at it. And the course that I did sort of morphed into, it’s a permanent course now, but in the late 1990s, I really pushed things and was sort of the impetus for the national registry program that finally got enacted in 2014. Very much watered down from my original proposals, but at least it was an attempt to make a determination if the examiners had some background and experience. I was able to also help get the DOT medical form changed back in the ’90s. They asked ridiculous questions like, did a driver have a urethral discharge, which has nothing to do with driving safety. So I got the form changed, got the impetus to get the registry started. What really helped further was the 1999 Mother’s Day crash in New Orleans, where a bus driver killed around 30 people. It was an older population going to a casino due to health reasons. And I got tapped to be the plaintiff’s expert in that case. I actually was in on the deposition of the examiner who certified this driver. But the NTSB did a major medical analysis of the situation and we were very critical of the system as far as certifying drivers, and they really wanted to make some changes. And that sort of sparked further development. So, the course I started in my impetus to change the system, that crash, there was momentum. It took a while, but the National Registry went into effect in May of 2014, still in effect now. It’s not perfect, it needs a lot of tweaking, but at least it’s a step in the right direction.

David Craig – Host: Let’s talk about, I guess in the beginning… Some folks who listen to this—as you know, it’s not just lawyers, we have lawyers who do listen to it, but the average everyday folks out there that may have had somebody injured or killed in a semi-wreck, or just kind of curious about this area of law—the first thing I think they need to understand is that not everybody can physically qualify to drive a semi, or a bus, or a commercial motor vehicle. So, let’s start there. So, is there restrictions on people to drive in interstate commerce, a commercial motor vehicle? And if so, what do they have to do to qualify?

David J. Fletcher, M.D.: Well, they have to have a medical examination that they meet the physical qualifications of a driver. There are 12 different qualifications. There used to be some absolute parts of that regulation that you could not change such as insulin-dependent diabetics, epilepsy, vision, and hearing. But since the last decade or so, there’s been exemption processes that allow some of those people to get certified in certain circumstances. So basically, you got to meet the physical qualifications of a driver. And it basically is looking for stuff that would indicate an immediate crash risk or a risk of incapacitation while driving. Looking at the heart, looking at the nervous system, looking at medications a driver takes. Is there any psych issue that could present a problem? So that’s what you’re looking at.

David Craig – Host: Okay. And who qualifies to perform these examinations?

David J. Fletcher, M.D.: Well, that’s a little bit controversial in that the FAA system was only medical doctors. But the FMCSA has allowed, not only medical doctors, but all their mid-levels, even physical therapists and acupuncturists are capable of doing them. I don’t personally feel they’re qualified. And then chiropractors, which is, in my opinion, is ill-founded, though I do know some chiropractors who really pride themselves in doing quality exams. My experience is that most chiropractors do not have the training. And in my opinion, really put the public safety at risk. I’ve actually been involved in probably seven or eight cases around the country where a chiropractor inappropriately put a driver on the road that led to a crash event.

David Craig – Host: Yeah, and I guess that’s a good question. I mean, I would assume there’s a chiropractor or a physical therapist or acupuncturist, they’re lacking the knowledge, the education, and the background that a medical doctor or M.D. has. So, how do they become qualified? I mean, do they just take a test? What is involved in these folks? How come they get to do this?

David J. Fletcher, M.D.: Well, they can apply for the continuing education to get the initial training, and they can take the certification examination. And if they pass the certification examination, they’re becoming a certified medical examiner. They have to take the exam again 10 years later, but that’s how it’s done. Now, there are some states, like New York, that does not allow chiropractors to do Department of Transportation medical examinations. But chiropractors, if they go through the steps, they can become certified.

David Craig – Host: So you’ve got these different types of people, different level of expertise that are out there in this country doing these examinations. So, what is involved? A truck driver decides, or a bus driver, they need to get a medical examination card and they needed to qualify. Tell me what’s involved. Do they bring in stuff with them? Do they come into your office, or another qualified medical examiner? Do they fill out a form? Explain to the audience what they do.

David J. Fletcher, M.D.: Well, they fill out the long form, which has gone through many modifications. The last changes were in the late 2010s, and they have filled out that form. They have to certify the answers are true or they could be prosecuted civilly. If they are not being truthful, answer a bunch of questions, specifically about past medical conditions. One of the questions was put on the form the last 10 to 15 years was about sleep apnea. They had a sleep test, did they snore at night, those type of things. So complete the form, and then the medical staff is going to take their blood pressure, do a urinalysis, do their height and weight, they’re going to measure their neck size. And then the medical examiner’s going to review their health history, which is the most important part of the medical examination. And as a medical examiner, you have to go into that exam believing a lot of drivers are going to lie to you because they have to protect their livelihood. And so it’s very important for medical examiners to spend quality time with that driver really ask probing questions, especially if you get a bunch of no answers on the medical history. A prime example: if someone comes to me and denies any snoring or waking up type at night symptoms, and their BMI or body mass index is greater than 40, their neck size is 18 or 19 side inches, I’m going to really question how legitimate they are as far as their responses. Because I’m certainly not going to put a driver who’s a poster child for sleep apnea on the road. I’m going to do my job as a medical examiner to protect the public safety.

David Craig – Host: Yeah. And I think that’s a key. I mean, these truckers, this is their livelihood, this is how they support their families. And so you may have some who just walk in and just lie, or you may have some that are just bad historians. They’re not real sure. They don’t pay that attention, they don’t go to the doctor regularly. And I guess that’s got to be a challenge in your industry, where you’re looking at this saying, “Okay, I got to make sure this person’s qualified,” and yet you feel like they’re fudging. I mean, as an attorney, I can usually talk to a truck driver and I can tell sometimes when they’re not giving me a straight answer. And so during a deposition, we follow up on that. But I assume you guys do the same thing. If you sense that you’re getting inaccurate information, then what do you do next? What can you do?

David J. Fletcher, M.D.: Well, what you do is you ask the probing questions, and if you still get negative responses, you say, “Hey, I can’t certify you until X is done. I need to get some medical records on you. I will get a sleep study on you before I’m going to certify you, or I’m going to get an updated hemoglobin A1C test for your diabetic control. I’m going to check your prescription monitoring program records for your state you live in if you’re on controlled substances such as hydrocodone, or something like Xanax, or something like that, which could interfere with driving.” So, I’m going to ask probing questions, but I’m going to do the follow-up. I’m going to get records. I sort of like to use the famous quote from President Reagan about, “Trust, but verify.” I like to give the drivers the benefit of the doubt, but I’m going to verify that. Again, I don’t have a patient-physician relationship with these drivers. I’m there to protect the public safety. And to protect my family from going on the road. One thing that, I don’t remember if I talked about in 2021, but for me, it’s a really particular subject of a personal passion, because my wife was killed on the highway, Interstate 80, in 2019, an impaired driver. And I had to testify at her victim impact statement, and I’ve got two kids and a single parent. So I know what it’s like in some of these families I deal with who’ve lost somebody. I know what it’s like. They share funeral pictures and I understand exactly what it’s like. And so that’s further fueled my passion of having my own personal loss due to a highway safety impairment issue. So, that’s kind of what you have to do, is you have to really think what your job is. And I’ve lost business because of it, I’ve also gained some business of it, because some trucking companies see the value in a quality exam. They’re going to have lower insurance costs, they’re going to have healthier drivers and so forth like this. So it’s like anything, you got to demonstrate your value, but the value I really believe by doing this thorough a vetting of drivers is the public safety.

David Craig – Host: Well, and I think that’s extraordinarily important, and I wish everybody who did these felt the same way. But unfortunately, we know some don’t. And I’ve seen them and I’ve deposed them before where it’s more of a rubber stamp for a trucking company. It’s just like, “Okay, at least run these people through a mill.” And so not everybody does that. And I guess that’s the question is, what is the duty of the qualified medical examiner? I mean, you mentioned, it’s not a patient-client, a patient-doctor relationship like you normally would have with somebody you’re treating. So this is a duty to, I assume, the public.

David J. Fletcher, M.D.: It’s a duty to the public. It’s a fitness for duty, a commitment to the public to make sure that person meets the physical qualifications of CFR 391.41, the physical qualifications of a driver. That is your duty for that examination. And I’ve pissed off a lot of people. I just had to answer a complaint about one of my mid-levels with a driver who had a BMI of 41 who gave my mid-level a very negative review, because she wouldn’t give him a card without getting a sleep study. He’d been in my office twice before and told he needed to get a sleep study, but she did her job. And I responded to him, I said I talked to him in person, he never did, but I outlined the regulations, I outlined what has to be done. Unfortunately, the FMCSA system still has vulnerability for doctor shopping. The National Registry has not done a very good job about getting drivers who’ve gone to another medical examiner removed from the system. I’ve had a situation a couple of times where drivers I explicitly failed, notified the FMCSA Washington office. I even had a driver who I failed, ended up forging a medical certificate on my signature, and still was driving. There’s no mechanism to remove that driver. And so it’s very scary out there, the environment that I’ve seen. And especially, I see it because of my expert witness work. It’s just really concerning, especially I think your point you said before, is many of these trucking companies have minimal insurance, and a million dollars can go pretty fast in a catastrophic accident, especially if someone survives and needs lifetime medical commitment, treatment.

David Craig – Host: Well, and I’ve had cases where the medical expenses are 750,000 or more. I mean, life care plans are way over a million dollars. And so it’s not enough money, it’s not enough insurance. It hasn’t been raised. We’ve been fighting to get it raised, but we’ve been unsuccessful at doing that. And I find that sometimes the worst companies are the smaller ones that are underbidding jobs, and they’re out there running on minimum insurance, and running on bad equipment, and bad drivers. And if they can get away with it, they do that, and they’re operating on very small margins. So, if I go in, I’ve got a big neck, I’m heavy, and I decide I want to be a truck driver. I walk into your office and you say, and I don’t get treatment for sleep apnea, I walk in, you say, “Hey boy, your neck, your weight, you look like maybe you are somebody that I ought to look into, and maybe I like you to do a sleep test,” and I say, “Well, thank you, doctor. I’ll go somewhere else.” And I walk out. Is there any way that documents that? Is there any way? So I go to a chiropractor who says, “Yeah, I’ll give you a card.”

David J. Fletcher, M.D.: Well, that’s the problem with the National Registry System. Now, if you came in on that scenario, we would complete the long form and submit the long form and the failure to the National Registry. It would be documented. But unfortunately, they don’t have the resources, the very small staff, to track these people down. And that’s why 30 years later after I first proposed an FAA-like system for the FMCSA, it’s needed more than ever, and I really want to make another run at that based on the experience of the National Registry and showcasing multiple of these cases. I’ve probably done, around the United States, at least 80 to 90 trucking cases where the health of the driver was a prime issue in the crash. And it’s just the tip of the iceberg. But with that experience, I do have some of my trucking clients listen to me about auditing their long forms, making a proper selection of their medical examiner to improve their quality, not just accept any nilly-willy exam from a medical examiner they’re not familiar with. Because ultimately, the regulations, they’re quite clear that even though trucking companies don’t practice medicine, ultimately they’re required to only put medically qualified drivers on the road. Oftentimes in these cases, the trucking companies will hide behind the shield of the medical examiner. But ultimately, they have the authority to get another person to review that person, another doctor. And the nice thing about the trucking regulations with the 345F regulation about fitness for duty, a trucking company, anytime they have concern about safety, can get a medical examination of a driver. And that’s one of the biggest things that is not done in cases, is taking advantage of that requirement. When a person’s been off work for a mental health or a physical reason, they have to be reexamined to make sure they continue to qualify for the physical qualifications of driver. You just don’t get a two-year blank check. When you get a certificate, you’ve got to continuously monitor the healthier drivers. And that’s sort of the lessons I’ve tried to share in the industry. And I’ve seen some trucking companies actually learn from it, and so that’s been beneficial. I mean, there’s got to be some more push. But again, quality exams matter. They make a big difference from a societal impact, they also save money for a trucking company, make them more competitive.

David Craig – Host: And I think you’ve described before a three-legged stool, and we look at the responsibility of three different… I mean, the driver, the trucking company, and the examiner, right?

David J. Fletcher, M.D.: Yeah, but the order is different. It’s the driver first, second is the medical examiner, third is a trucking company.

David Craig – Host: And each one of those could be responsible for a crash, correct?

David J. Fletcher, M.D.: Correct. I mean, I do get some drivers that come in and are very honest, and are very appreciative when we identify something that can be rectified and say, “This is not a permanent bar from you driving, but you need to get this taken care of.” Sleep apnea is a prime example. And I would say I’ve probably, in the last 10 years, probably recommended more than 500 sleep studies. And the ones who get it done, I’d say 95% of them are extremely thankful that they got the sleep study done, they started CPAP. It helps a lot, because I’ve had sleep apnea since 2012 I’ve used CPAP religiously. I think I’ve missed six nights in almost 15 years. And so I share my own experience. And so those are really positive experiences. The same thing with diabetes, or you identify some kind of issue, and you try to make sure that driver knows we’re not trying to take away their livelihood, we’re just trying to make them safe on the road. And that’s where the approach I take with that first step of the process of being here relying on the truthfulness and the veracity of the driver, that first leg of the system.

David Craig – Host: Well, and so then the second leg is, which you mentioned, you touched on already, it was the trucking company.

David J. Fletcher, M.D.: No, second leg is the medical examiner.

David Craig – Host: Oh, doggone it. I’m going to fail my test.

David J. Fletcher, M.D.: Yeah, you’ll fail your test.

David Craig – Host: The second one is the medical examiner. And so the medical examiner, what are some of the common errors you’ve seen with the medical examiners that come back?

David J. Fletcher, M.D.: Well, the common errors are they don’t ask probing questions. They ignore the obvious. They don’t completely fill out the long form. They don’t fill out the section about driver history. They don’t investigate if they’re taking any prescription medications that may be impairing. Those are the more common things, it’s just the basics. They don’t do anything for a follow-up for blood pressure. They ignore vision issues that are there. They just don’t follow up on the history. I mean, a lot of this is very repetitive. Most of the failures are because of cardiac issues. And sleep stuff are the ones we see the most, but medications are often an issue. And I will take some accountability in my own medical practice. I had a physician’s assistant who doesn’t work for me anymore, certified a driver who had epilepsy and was on seizure meds, which he shouldn’t have done at all. But fortunately, a couple years before that, that company, I had been adverse to them in an expert witness case, and I talked to them about the value of audits of their long forms. And so they audited my PA’s long form, and that he shouldn’t have certified it. And they contacted me and I said, “I own the mistake. He shouldn’t have been certified.” But that was that third leg of the system with the motor carrier assuming the liability. They have to remember their medical examiners can screw up. They can only put medically qualified drivers in the road. And so it’s a perfect example of where trucking companies can learn. I mean, you get these trucking companies that say, “We can’t get the long form because of HIPAA,” and stuff like that. Well, HIPAA is always trumped by safety. And so what we do in our office is we always have a person signing HIPAA release so they can turn over the long form to the companies. And I will say my experience in 30 plus years of doing this, 99% of all companies want the long form. Even though they don’t keep those in the TQ file, they’ll keep them separate, it’s just good practices for them to audit them. You don’t have to be a doctor to necessarily audit them. If you can go through a protocol of looking at if they’re filled out correctly and looking at common mistakes, this is an area where companies can really do fantastic with safety by that simple audit of their long forms.

David Craig – Host: And the long form, I guess just explain to the audience who may not know what a long form is. And sometimes I take depositions and there is no long form, but tell us a little bit about what the long form is.

David J. Fletcher, M.D.: Well, the long form is the medical history, which starts off with asking questions about any surgeries or medications, and they certify that answers are true and accurate. And then the next page is a list of 20 plus questions that, yes or no answers, and they’re supposed to provide more detail. And at the bottom of that section is where the driver history section is to be completed by the medical examiner. The next page is blood pressure, vision, urinalysis results, basically testing that’s not done by the examiner. And then the next page is the physical exam section. And then you’re making the follow-up is the actual determination. Do they get certified? Is it a standard two-year certification? Or does it need to be a shortcard because of some kind of medical condition? And you specify why it is a shortcard. So that’s what the long form is. It’s just basically it’s a documentation of the medical record. And that’s just where companies could gain a lot of value. It’s just looking at those long forms and making sure they’re filled out correctly. I mean, I’ve seen so many long forms that are incomplete, inaccurate, and that’s just a really easy area where trucking companies could improve the safety of their drivers.

David Craig – Host: As a medical examiner, if you see something on the long form, or in questioning or probing the driver, can you request a stay and go ahead and get request records and do additional follow-up testing?

David J. Fletcher, M.D.: Yes. And that’s the nice thing about, from my efforts in the early 1990s, starting the training and trying to get the system changed, was the evolution of the long form. And in the current long-form iteration, it has a section where you can have what’s called determination pending, up to 45 days, where you’re going to get medical information records, talk to doctors to make a determination, and have the driver come back. And either you certify them or you don’t. But that process is very important because it allows a stay of the certification process, and it allows the medical examiner some time to make a very thorough, accurate decision that’s going to protect the public safety.

David Craig – Host: So, if a medical examiner doesn’t use reasonable care, and they don’t follow up and they don’t get those records like we just talked about, they just put them right behind the wheel and give them a card, can they be held negligent?

David J. Fletcher, M.D.: Yes, they can. They can be held negligent. And one of the first cases that ever came out was back in the 1970’s called the Bridges case, which was a vision issue that led to a crash event. And the trucking company went after the medical examiner, one of the early cases out there. And I’ve been involved in probably around 10 cases where there has been alleged deviation from the standard of care to certify a driver. And so it’s not well-known, but there are cases out there, and I think it’s something that I think needs to be further evaluated. Lots of times when I get involved with cases, the plaintiff’s attorney is reluctant to sue the medical examiner. Or they come in late, there’s a statute problem, that they have blown the statute, and so they’re kind of out of luck. But also what happens now, I’ve probably had the situation, David, five or six times around the country, where the trucking company who’s been sued by the plaintiff has pointed the finger at the medical examiner, “Hey, we don’t practice medicine. They’re the wrongdoer here.” And that’s forced plaintiff attorneys to sue the medical examiner, which they were usually reluctant to. So that’s sort of a trend I’ve seen.

David Craig – Host: Well, and let’s talk about it, a little bit about, the driver walks in and they sign something under the penalties of perjury that what the information they’re giving the medical examiner is accurate. So, let’s assume that information’s not accurate. Does that get the medical examiner off the hook?

David J. Fletcher, M.D.: Well, it doesn’t. I mean, the thing is that you’ll have the medical examiners who get sued in these cases for negligent issuance, is the medical legal concept, is that they will say, “I relied on the answers of the driver.” And how I respond to that, you have to remember that three-tier system. The first tier is you’re depending on the veracity of the driver and taking into account that most drivers are going to lie to you to protect their livelihood. And so you got to ask the right questions if you have any doubts about their safety to qualify as a driver out there on the public highways and byways.

David Craig – Host: And so let’s walk through… Well, before I ask, you said you’ve done about 10 or so of these cases.

David J. Fletcher, M.D.: Yes.

David Craig – Host: I’m just curious, were they chiropractors? Were they more often M.D.s, D.O.s? Or is there any kind of more one than the other?

David J. Fletcher, M.D.: No, it wasn’t more one than another. I’d say probably more of the trend toward chiropractors, but I’ve been in, I think, three M.D. cases. The case of the famous New Orleans case in the 1999 Mother’s Day crash; the medical examiner was a medical doctor, no training or qualifications. That way before the certification process for medical examiners was in place. I’ve had nurse practitioners, physician’s assistants. So, it’s been the whole realm of medical examiners as far as their medical training and qualifications.

David Craig – Host: I was just curious. I mean, I’ve deposed medical doctors though, the cases that I’ve had have actually been medical doctors. So, let’s walk through, I know you testified recently in Montana on a case. It was the most recent one that I’ve seen that explored this possibility of suing the medical examiner. And kind of walk us through what these cases are about, and what should a plaintiff lawyer look for? What should the lawyer look at when they see these kind of cases? And then how do they go about developing a case? How do they consult? Who do they work with? Those type of things.

David J. Fletcher, M.D.: Well, I think usually these cases start out they’re suing the trucking company, and they don’t really get an opinion about, “Is there any malfeasance on the part of the medical examiner?” So, I think it’s important for a plaintiff’s trucking expert to get involved early on a medical reconstruction of that driver’s health as soon as possible. And I will flip that, that’s the same thing I tell defense cases, is the same thing. And I can share an example later where I was hired as a defense expert four days after a triple fatality case in Ohio, where I examined the driver four days later, and it really was very successful in proving there was a medical emergency that was able to mitigate some of the damages. So, I think it’s something that trucking litigation attorneys such yourself, both sides of the bar, they’re always looking at the accident reconstruction, the physics of the car crash or truck crashes. They don’t look enough at the human factors. And I think looking at early on for a plaintiff’s firm is one of the first things you need to get, is that DQ file from the trucking company, see what their medical certificates are. I’ve had some cases where drivers never even had a medical exam. The trucking company put them on the road without a pre-employment drug test or a medical card. So I think you’ve got to think in the beginning, especially with the low dollar liability coverage, it really helps if you’re a plaintiff’s attorney to know there’s another source of some funds for your client. And so I don’t think enough plaintiff attorneys think of this. What usually happens, they’re forced to think about it because the trucking company will raise the medical examiner as their defense. We just file what the medical examiner has done. And the particular case in Montana that I was involved with the last three years, that was the situation originally when I got retained by the plaintiff’s counsel as far as against the trucking company, I reviewed the file and I said, “You’ve got a big case against the chiropractor.” And so, it was a small trucking outfit. They had, I think, less than a million dollars worth of coverage, something like that. And the plaintiff’s attorney decided to go after the chiropractor. And in that particular case, the trucking company settled out before the chiropractor did. And the chiropractor, it actually went to trial, and I testified for five hours or so in mid-September of 2025, and the plaintiff’s counsel was able to have a very successful verdict of $8.8 million. And it was, to me, a very textbook case how to litigate against the medical examiner.

David Craig – Host: Yeah. And I know in that case there was a defense expert as well. You were kind enough to let me look at some of the transcript. And you did an excellent job, as did the plaintiff lawyer asking you, making it simple so a jury could understand. But this chiropractor just didn’t do his job, correct?

David J. Fletcher, M.D.: He didn’t do his job, he was very arrogant about it, and it was a situation where, you talked about you’ve had cases where he didn’t have long forms. Well, that was his defense here, that his computer crashed, and the long forms weren’t available. Plaintiff’s counsel did a great job, got a forensic computer expert and was able to prove that there was no forms in the first place. The belief was that this chiropractor basically, at the end of the workday, just manufactured a certificate to give to the driver, who was an insulin-dependent driver who had horrible vision issues, that should not have been qualified. And the chiropractor in his defense said “My computer crashed”. And so it was very strange for me to deal with a case where there was no long form. Basically, he was saying that he didn’t know this guy was an insulin-dependent diabetic. Again, if this guy’s control of his diabetes was terrible, if he had actually done a urinalysis like he’s supposed to, he would’ve been spilling sugar. If he had actually done a proper examination of the driver and looked in his eyes with a fundoscope, he would’ve seen he had diabetic retinopathy. One of the chiropractor’s defenses was that it’s not required to use a fundoscope to examine a driver’s eye. He has no training to do that. I mean, it’s a prime example of why chiropractors should not be doing these exams. So, it was a situation where I was able to clearly state that deviation from the standard of care, and that he obviously didn’t take an accurate health history. He had seen the guy even two years before, gave him a two-year card, even though he was insulin-dependent diabetic, and didn’t make any attempt to get any medical records. He claims the driver lied to him. The driver testified that he told the chiropractor that he had insulin-dependent diabetes. So, it was the situation where the chiropractor had no defense of his records. It was all oral history. And the plaintiff’s attorney was very concerned about the jury that had been selected, and he was somewhat not optimistic about the results of the case, but he just did a phenomenal job. I was the first witness after they selected the jury and basically outlined what a standard exam should be, what the deviations from the standard of care were in this case. I gave some rebuttal to the chiropractor expert that was helping defend the defendant chiropractor. And I think one thing I think for your listeners to know was, during my live testimony in Montana, your podcast came up. And so I said, “I’m flattered, the defense counsel, that you liked it.” And that’s where the defense counsel asked me about the three-tier system. And that’s where I said that ultimately trucking companies have the ultimate responsibility. And he tried to say, “Well, the chiropractor, shouldn’t the chiropractor have the trucking company be the one that blamed because they didn’t overrule him?” And they didn’t know, but I thought it was kind of funny to have that. So, it was really funny to have that.

David Craig – Host: Well, so I mean, for our audience, the biggest takeaway from this case, and from the other cases that you worked on, let’s start with the defense. Let’s start with the defense. I mean, what’s the biggest takeaway for the defense? What should the defense be looking for? What should they be talking to you about in order to avoid an eight million or plus verdict?

David J. Fletcher, M.D.: Well, I think they should get a medical expert that’s going to give them the truth. I mean, I had a case, it’s a very famous case that was front page of New York Times, a Baltimore school district bus accident. I think eight people got killed. And originally, I was hired by the defense to review the case. I only read the NTSB report, didn’t see any kind of privileged work product. And what I said to them, just based on that, is, “You need to settle this case. You’re going to lose this case.” It was against Concentra, one of the largest occupational medicine providers, said, “You’re not going to win this case. I can’t help you.” And they said, “We don’t want you to write a report.” I didn’t write a report, I didn’t have a confidentiality agreement. I didn’t even have a retention letter. And so about six weeks later, the plaintiffs on their own found me and I testified exactly what I told the defense counsel. I think find somebody that’s going to tell you the truth, whether you got a case or not. And I’ve done a lot of successful defense cases where I’ve been able to be very truthful about what they did in that particular case that was not a deviation from the standard of care, or that the trucking company ignored a health issue. A lot of those have been with medical emergency situations. I’ve had cases like that. I had a case, a Maryland case, where a driver was criminally charged with manslaughter, and I got him off that case, and acquitted because of what I did. Actually, the driver ended up driving from Baltimore to Champaign, and I was able to say it was a medical emergency. This guy had no idea about sleep apnea, wasn’t untruthful, didn’t try to hide away, and he got off. So, I think it’s trying to get good medical opinions right from the beginning. As I said before, I think this is an area of trucking litigation is, usually we’re like the last in the case. Most trucking cases, they’ve hired a trucking expert, they’ve had an accident reconstruction, they’ve even started getting into life care plans and economics, and then it’s kind of an afterthought, “Maybe we need to get the medical looked at.” And so I think the message I think would be helpful is, why it’s important to get a physician such as myself early in the case to give you an honest opinion. I mean, I’m going to tell a trucking company they’re going to lose this case and it’s going to be better for them rather than save money and spend money in litigation that’s going to be fruitless to get it resolved. And then just give a very accurate picture of what the situation of the case is.

David Craig – Host: Well, and from the plaintiff’s side, I would think the same thing applies. I mean, you’re looking for a doctor who gives you the straight scoop and tells you the truth. But also I think time is of the essence. If you’ve been doing this for a while, you know, okay, there’s something going on here, where there’s an unexplained, something that happened that’s unexplained. So maybe there’s a health issue, maybe it’s sleep apnea, maybe it’s a distraction. You don’t know what it is, but you know something is there. Or you’ll sense. A lot of times I’ll sense, “Okay, there’s going to be a medical emergency raised.” In most states, medical emergency can help the defense get out of the responsibility. And so if you see that, and I won’t talk specifics about the case, but I’ve retained you when I first saw the police report and it said that the driver lost consciousness or something, was chugging water or doing something. And it was just like, okay, that fact alone, I don’t need to know more. I need to know, let’s get this information to a doctor, and let’s start monitoring this and just doing the discovery. Rather than wait, I think you should be hired, or a doctor should be hired as soon as possible.

David J. Fletcher, M.D.: Well, I would agree. I mean, I think that’s the message to leave with this podcast for other attorneys who are looking at both the sides of the bar, is you need an accurate medical picture right from the beginning. And especially if there are potentially drug or alcohol issues involved, those are even more complicated. I get involved, I’m involved in some malpractice cases, they’re not the medical examiner, but the medical review officer of the commercial driver who failed to do their job. And a prime example is where a medical review officer did an MRO review of a driver who had a positive hydrocodone test, but didn’t tell the trucking company that this person was on hydrocodone. And the regs allow you to do that, and the trucking company can get a fitness for duty examination. I mean, I certainly don’t condone commercial drivers driving with hydrocodone. And so in this particular case, the MRO failed to notify the trucking company. And they sued the MRO, and they lost big time. And so it’s a little bit of a different wrinkle, is to look at the medical review officer component of it. And also I’ve been involved in a couple of cases as the substance abuse professional, who has been accused of malpractice and things like that. I was a defense expert in one case, a plaintiff’s expert. So, a lot of different wrinkles to it. Again, I think the message is, have somebody qualified that can look, “Is there a health issue in this case that needs to be further investigated?” Rather than some other cause such as a distraction, cell phone use, those type of things, and get us experts involved early on.

David Craig – Host: Doctor, I do have defense lawyers who listen to this as well as plaintiff lawyers, as you know, because they cross-examined you about it. But I have defense lawyers who reach out to me and talk to me, and all I try to do is hire truthful experts. So, I don’t really care if they listen to it or not. But let’s say it’s a defense lawyer or a plaintiff lawyer and they’re looking to consult with you. How do they find you?

David J. Fletcher, M.D.: Well, most of them find me online because of my name, safeworksillinois.com website. I do have an expert witness site, but I think most people can just Google me, David Fletcher, and they find me that way. I mean, I’ve certainly not had any problems finding me. I’ve been very fortunate. Both sides of the bar have recommended me. So, I think the testament the most is doing consistently both sides of the bar gives you credibility. And I mean, I’ve turned down cases for both sides, and I think that helps. So I think people can find me pretty easily. And I enjoy these cases because I believe there’s a lot of social value in prevention. Again, I enjoy it when I have a defense case where I’m able to make some policy changes for that trucking company, because that’s going to help down the road. I mean, for me, I mean, obviously my life has been forever changed as a single parent due to the tragedy in my life. It’s scary out there on the road. I know too much. And it really is concerning about our public highways and byways as far as who’s out there, as opposed to the FAA medical system, which continues to be the envy of the world, as far as its medical certification process.

David Craig – Host: Well, doctor, is there anything else you would like to add that we haven’t touched on today?

David J. Fletcher, M.D.: No. I think. Again, I hope a couple years down the road we get to visit again. I think you do a great job. I’ve enjoyed working with your firm. I think it’s a leadership where there’s a lot of sharing of information. And I’m glad that defense counsels will look at this podcast, because I think they can learn some stuff that they can bring back to their clients. I think that the trucking defense attorneys who bring the most value are the ones that are going to learn from this and make some suggestions such as the audits of the long forms, getting doctors involved, vetting your physicians. Those are all really good best practices that can make a huge difference. And I think the other thing that what helps me is trucking companies when they do that annual motor vehicle record requirement, part of that, they can look at prescription drug aspects, and none enough companies do that. In the cases where I’ve had prescription drugs being the cause of a fatality, these were some situations where a trucking company had the tools to prevent that crash and they failed to use them. And so I think it’s just a lot of stuff can be improved, and that’s what I enjoyed so much, is a lot of these cases are like puzzles and putting them together, but at the end of the day, if I can help the victim’s family, help them, get what they deserve for the tragedy, that’s what it’s about.

David Craig – Host: Well, doctor, thank you so much for taking the time to be on this episode of After The Crash.

David J. Fletcher, M.D.: Well, thank you so much, David.

David Craig – Host: This is David Craig, and you’ve been listening to After The Crash. If you’d like more information about me or my law firm, please go to our website, ckflaw.com. Or if you’d like to talk to me, you can call 1-800-Ask-David. If you would like a guide on what to do after a truck wreck, then pick up my book, Semitruck Wreck, A Guide for Victims and Their Families, which is available on Amazon, or you can download it for free on our website, ckflaw.com.