COMDTINST M16721.48 Merchant Mariner Medical Manual, 47141-47146 [2019-19370]
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Federal Register / Vol. 84, No. 174 / Monday, September 9, 2019 / Rules and Regulations
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Dated: August 21, 2019.
Donna Davis,
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Therefore, 40 CFR chapter I is
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2. In § 180.910, add alphabetically the
inert ingredient ‘‘Alcohols, C2–33, manuf.
of, by-products from, overheads (CAS
Reg. No. 876065–86–0)’’ to the table to
read as follows:
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§ 180.910 Inert ingredients used pre- and
post-harvest; exemptions from the
requirement of a tolerance.
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3. In § 180.930, add alphabetically the
inert ingredient ‘‘Alcohols, C2–33, manuf.
of, by-products from, overheads (CAS
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Reg. No. 876065–86–0)’’ to the table to
read as follows:
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§ 180.930 Inert ingredients applied to
animals; exemptions from the requirement
of a tolerance.
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[FR Doc. 2019–19398 Filed 9–6–19; 8:45 am]
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ACTION:
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Notification of availability.
BILLING CODE 6560–50–P
The Coast Guard announces
the availability of the Merchant Mariner
Medical Manual, Commandant
Instruction Manual (COMDTINST
M16721.48). The guidance in this
Manual should assist medical
practitioners, the maritime industry,
individual mariners, and Coast Guard
personnel in evaluating a mariner
applicant’s physical and medical status
to meet the requirements of the
merchant mariner medical certificate.
This Manual incorporates and
consolidates prior guidance on the
SUMMARY:
DEPARTMENT OF HOMELAND
SECURITY
Coast Guard
46 CFR Part 10
[Docket No. USCG–2018–0041]
COMDTINST M16721.48 Merchant
Mariner Medical Manual
AGENCY:
Coast Guard, DHS.
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List of Subjects in 40 CFR Part 180
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medical evaluation of merchant
mariners contained in several Coast
Guard documents. The Manual includes
guidance on the medical certificate and
related processes, including procedures
for application, issuance, and
cancellation of the medical certificate.
The Merchant Mariner Medical
Manual, COMDTINST M16721.4, is
effective on September 9, 2019.
DATES:
For
information about this document or to
suggest changes, call or email Adrienne
Buggs, M.D., United States Coast Guard,
Office of Merchant Mariner
FOR FURTHER INFORMATION CONTACT:
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Credentialing; telephone: 202–372–
2357, email: MMCPolicy@uscg.mil.
SUPPLEMENTARY INFORMATION:
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Viewing Documents
The Merchant Mariner Medical
Manual, COMDTINST M16721.4, is
available on the internet at: https://
www.dcms.uscg.mil/Our-Organization/
Assistant-Commandant-for-C4IT-CG-6/
The-Office-of-Information-ManagementCG-61/About-CG-Directives-System/ and
on CGPortal at: https://
cgportal2.uscg.mil/library/directives/
SitePages/Home.aspx. A link to the
document will also be located on the
National Maritime Center (NMC) site:
https://www.dco.uscg.mil/OurOrganization/Assistant-Commandantfor-Prevention-Policy-CG-5P/NationalMaritime-Center/.
Background and Discussion of the
Merchant Mariner Medical Manual
Coast Guard regulations contained in
46 CFR part 10, subpart C, provide the
medical and physical standards that
merchant mariner applicants must meet
prior to being issued a merchant
mariner medical certificate. The
Merchant Mariner Medical Manual
provides guidance to the regulated
community on how to comply with the
regulations pertaining to medical and
physical qualifications for merchant
mariners.
Previously, the Coast Guard provided
guidance on the medical and physical
requirements for merchant mariners in
the Medical and Physical Evaluation
Guidelines for Merchant Mariner
Credentials, Navigation and Inspection
Circular (NVIC) 04–08, Commandant
Publication (COMDTPUB) 16700.4; in
the Guidance on the Issuance of Medical
Certificates (NVIC 01–14); and in Part A
of the Marine Safety Manual, Volume
III, Marine Industry Personnel,
COMDTINST M16000.8 (Series) [MSM].
The Merchant Mariner Medical Manual
revises, updates and combines the
medical evaluation guidance previously
published in NVIC 04–08, Part A of the
MSM, Volume III, and NVIC 01–14. The
Coast Guard developed the draft Manual
in consultation with experienced
maritime community medical
practitioners and industry stakeholders
serving on the Merchant Mariner
Medical Advisory Committee
(MEDMAC) and the Merchant Marine
Personnel Advisory Committee
(MERPAC). The Manual reflects a
synthesis of their recommendations and
the medical requirements of title 46
Code of Federal Regulations (CFR) part
10, subpart C.
Members of the public participated in
the development of medical policy by
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providing comment and serving on
working groups at the public meetings
of MEDMAC and MERPAC.
Additionally, the public had the
opportunity to comment on drafts of
policies contained in this Manual, and
its predecessor, NVIC 04–08. See
requests for comment on proposed
policies regarding: Diabetes,
cardiomyopathy, and sleep disorders
(80 FR 8586, Feb. 18, 2015);
Medications (80 FR 4582, Jan. 28, 2015);
Seizures (78 FR 17917, Mar. 25, 2013);
and Implantable cardioverter
defibrillators (77 FR 55174, Sep. 7,
2012). The Coast Guard considered
these public comments when
developing this Manual.
Public Comments on the Draft Merchant
Mariner Medical Manual:
The Coast Guard published a draft of
the Merchant Mariner Medical Manual
in the Federal Register and sought input
from the public on the draft (83 FR
56272, Nov. 13, 2018). The current
version of the Manual includes
revisions made to address comments
received in response to the Federal
Register notification. While the Coast
Guard is not required to seek or respond
to public comments prior to publication
of a policy document, we chose to do so
in this case because of the perceived
complexity of the Merchant Mariner
Medical Manual, and because doing so
provides us the opportunity to (1) create
a guidance document that is more viable
and responsive to the needs of the
impacted community; and (2) to identify
and clarify remaining areas of confusion
and concern amongst the regulated
community.
The Coast Guard’s notification sought
general comments on the draft Medical
Manual, with emphasis on suggestions
to improve readability, clarity, and ease
of use; and comments on whether the
draft Manual’s proposed medical
certificate cancellation policy
adequately addresses safety concerns in
situations where the Coast Guard
receives information indicating that a
medical certificate holder has developed
a medical condition that poses a
significant risk of sudden
incapacitation, or is taking a medication
that poses a significant risk of
impairment. The Coast Guard received
37 comment letters in response.
General Comments
Ten comment letters provided a
general opinion of the draft Manual,
with the majority expressing an overall
positive opinion. These commenters
found the guidance in the Manual to be
thorough, straightforward and easy to
use, and they found that it answered
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many questions that had arisen with
previous medical policy documents.
The favorable commenters appreciated
that the document provides medical
evaluators, mariners and medical
providers with needed and relevant
information that will reduce the need
for ‘‘back and forth’’ between the
mariner and the National Maritime
Center. They also found it helpful that
the Manual outlines the Coast Guard’s
general concerns with particular
medical conditions and discusses the
general factors that the Coast Guard will
use to evaluate the medical condition
and make a fitness determination.
Comments provided by the National
Transportation Safety Board (NTSB)
found that the draft Medical Manual
aptly streamlines the medical
certification guidance and provides a
level of detail that should assist medical
personnel during the mariner medical
certification exams. The NTSB comment
letter also provided the following
observations:
The combination of the Coast Guard’s
increased oversight of medical certification
and development of medical guidance
appears to be highly effective at addressing
safety concerns regarding medical conditions
that pose a significant risk of sudden
incapacitation. Since 2009, the NTSB has not
found any medical conditions to have
contributed to the probable cause of a marine
accident. However, the NTSB continues to
find effects from impairing substances
(alcohol and over-the-counter, prescription,
or illicit drugs) to have contributed to the
probable cause across all modes of
transportation.
One comment letter expressed a
generally negative opinion of the draft
Medical Manual. This commenter
expressed concerns that the guidance in
the Medical Manual would sacrifice
maritime safety unless the Coast Guard
provided further clarification and a plan
for implementation. Additionally, the
commenter opined that the guidance
does not adequately ensure that medical
conditions are sufficiently controlled for
those mariners at higher risk, because
the Medical Manual does not establish
clear standards for specific medical
conditions. The Coast Guard does strive
to increase clarity with publication of
the Medical Manual, however, the Coast
Guard disagrees that improved clarity
requires publication of an
implementation plan. Discussion of the
Coast Guard’s internal implementation
plans are beyond the scope of the
Medical Manual. Moreover, the majority
of the policy contained in the mariner
medical manual is not new guidance. It
is the same guidance, explained in
greater detail, that was already
implemented in the years following the
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publication of NVIC 04–08. The Coast
Guard also disagrees with the assertion
that the Medical Manual should
establish condition-specific medical
standards. The medical and physical
standards for merchant mariner medical
certification have already been
established in 46 CFR part 10, subpart
C. Establishing new medical standards
is beyond the scope of a policy
document.
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Ease of Use and Clarity
A letter from another commenter
requested that the Coast Guard add an
appendix that puts common conditions
in a table format for quick reference,
similar to that used in the International
Maritime Organization’s (IMO)
Guidelines on the Medical Examination
of Seafarers. The Coast Guard disagrees
on the basis that a quick reference table
would not adequately capture the
discussion, explanation and rationale
that mariners, treating providers and
medical examiners need to understand
in order to provide quality examinations
to the Coast Guard.
Requirements for Medical Certification
Three comment letters recommended
that the Medical Manual provide
additional medical requirements for
medical certification. One letter
commented that the Medical Manual
should require all mariners to meet the
same medical standard, and should
provide ‘‘specific acceptable
parameters’’ for many conditions to
include BMI, pulmonary function,
glucose levels, blood pressure, and
cardiac function. Another comment
letter suggested that the Coast Guard
should implement a random medical
testing program, similar to that used for
drug testing. The third comment letter
stated that the physical ability
requirements should also include
criteria for the speed and facility with
which a mariner performs required
tasks. The Coast Guard disagrees with
these comments. While some of the
recommendations pertaining to medical
standards may warrant future
discussion, changes or additions to the
medical and physical requirements for
medical certification are beyond the
scope of this document. As discussed
earlier, the medical and physical
standards for medical certification are
provided in 46 CFR part 10, subpart C,
and changes to those requirements
would require a rulemaking.
Guidance on the Conduct of the General
Medical Examination
One comment letter addressed the
guidance pertaining to the general
medical examination and recommended
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that the mariner medical examination
include an evaluation of the mariner’s
oral/dental health condition to ensure
that there are no untreated infections or
other dental problems that could cause
significant impairment while at sea. The
Coast Guard agrees that such guidance
may prove helpful and will work with
MEDMAC to consider whether and what
type of guidance would be appropriate
for inclusion in a future version of the
Medical Manual.
Frequency of Required Medical
Examinations
Four comments letters addressed the
frequency of required medical
examinations. Three commenters
opined that it is excessive to require
mariners to undergo a medical
examination every two years. They
recommended that the medical
examination for all mariners, including
those sailing under the authority of their
Standards of Training, Certification, and
Watchkeeping (STCW) endorsement,
should remain valid for a period of 5
years, unless the mariner’s medical
condition warrants issuance of a
shorter-duration medical certificate. A
different commenter requested clarity
on how often a mariner is required to
obtain a medical exam, noting that in
some instances maritime employers
require an annual medical examination,
even when the Coast Guard does not.
The Merchant Mariner Medical
Manual provides detailed discussion of
medical examination and medical
certification requirements for specific
endorsements, and cites the
corresponding regulatory references. It
is important to note that the medical
certificate validity period and the
frequency of required medical
examinations may differ between
endorsements because of the differing
legal requirements. Since these
requirements are established in
regulation, changing them would
require a rulemaking and is beyond the
scope of this policy document. The
medical examination requirements of
individual employers are also outside
the scope of this policy document.
Medical Exam Forms
One comment letter requested that the
Medical Manual provide a list of
medical examination forms that would
be acceptable in place of the Form CG–
719K or KE. The Coast Guard disagrees
and did not provide a list of alternative
forms because 46 CFR 10.302(a) requires
the following: ‘‘to qualify for a medical
certificate, a mariner must provide
evidence of meeting the medical and
physical standards . . . on a CG–719–K
or CG–719–K/E, as appropriate.’’
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Medical Examiners
Ten comment letters provided
comments on the topic of medical
examiners. Three commenters requested
additional information on the
Designated Medical Examiner (DME)
program, with one requesting that the
Coast Guard publish its timeline and
intent to create the DME program. The
Coast Guard understands that there is
significant interest in the DME program
and will publish additional information,
as and when appropriate.
Five commenters recommended
changes to the regulations regarding
individuals who may perform
examinations for purposes of the
mariner medical certification
examination. The Coast Guard
considered each of these
recommendations, but noted that
changes to the regulations are beyond
the scope of this policy document.
Internal National Maritime Center
Processes
Two comment letters requested that
the Manual provide more detail on
internal National Maritime Center
(NMC) processes. One of these
comments expressed concern that the
Manual’s instructions would allow nonmedical personnel to make medical
determinations for U.S. mariners.’’ This
commenter recommended that the Coast
Guard add language to specify that all
medical certification decisions will be
supervised by a licensed medical
officer. The second comment noted that
the Manual does not contain ‘‘any
reassurance or check and balance of
examiners, examination quality, or the
NMC medical certification process.’’
This commenter requested that the
Coast Guard add language to address
these concerns. The Coast Guard
considered both of the comments, but
does not concur with them. The staffing
and internal quality assurance practices
of the NMC are beyond the scope of this
document. Nonetheless, the Coast Guard
affirms that the activities of the NMC
Medical Evaluations Division,
particularly those related to medical
certification, are supervised by a
licensed medical officer. On the issue of
providing quality assurance for medical
examiners, it is important to recognize
that medical examiners are not
regulated by the Coast Guard. Therefore,
providing reassurance or checks and
balances of examiners and their exam
quality, is inappropriate and is beyond
the scope of this document.
Positive Drug Tests
Two comment letters complained that
the Manual does not provide guidance
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for the evaluation of mariners who test
positive for illegal drug use. One also
requested that the Coast Guard add
language to the Medical Manual
requiring medical treatment for any
mariner who fails a USCG required drug
test. The Coast Guard does not concur
with these commenters. The Medical
Manual does not address requirements
related to positive drug tests because the
regulations and guidance on the
management and disposition of
individuals who have a positive drug
test are contained in 46 CFR parts 5, 10,
and 16. Changes to the DOT and Coast
Guard drug testing regulation and policy
are beyond the scope of this policy
document. The Medical Manual
contains guidance on how the Coast
Guard will conduct the medical
certification evaluation for individuals
who have been diagnosed with a
substance abuse disorder. The Medical
Manual does not, however, direct
treatment nor provide diagnostic
instruction, because such areas are
beyond the scope this policy document.
Reporting Material Changes in Medical
Condition for Mariners
One commenter asked whether a
mariner who holds a medical waiver is
required to report a material change in
their medical condition. The Coast
Guard notes that the answer to this
question will depend on the provisions
outlined in the mariner’s medical
waiver letter. Some waiver letters
require that the mariner report changes
in medical condition to the Coast Guard
within a specified period of time. If no
such provision is provided in the
mariner’s waiver letter, then the mariner
is not required to disclose the change in
medical condition until the time of the
next medical certificate application.
Three commenters asked whether
employers have an obligation to report
to the Coast Guard information
regarding a change in condition. One of
these same commenters also asked how
employees could protect themselves
from inaccurate reports. The Coast
Guard considered each of these
comments and advises that this manual
does not impose any new reporting
requirements on anyone. In response to
the concerns about how mariners will
be able to protect themselves from
inaccurate reports, the Coast Guard
offers that the Merchant Mariner
Medical Manual only proposes to take
action on medical information that the
Coast Guard has determined as credible.
The information that the Coast Guard
would deem credible differs depending
upon the circumstances, but generally
will include medical provider
documentation, formal incident reports,
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emergency medical services reports, and
investigative reports. The Coast Guard
also asserts that mariners will be able to
protect themselves from inaccurate
reports because this manual provides a
standard process for evaluating these
reports and further provides mariners
with notice of, and the opportunity to
respond to, information that indicates
that they are no longer fit for medical
certification.
Medications
Two comment letters noticed
discrepancies in the language in Chapter
7 related to required disclosures of overthe-counter (OTC) medications. One of
the commenters also observed that the
guidance in the Manual highlighted an
error on the most recent version of the
Application for Medical Certificate
(Form CG–719K, Rev 04/17, Exp. Date
03/31/2021) which incorrectly states
that applicants must disclose all OTC
medications taken within 30 days prior
to the date the applicant signs the CG–
719K. Both commenters noted that prior
versions of the CG–719K and the
Medical Manual only instructed
mariners to disclose OTC medications if
the medications were used for a period
of 30 days or more within the 90 days
prior to the date the applicant signs the
application to the Coast Guard. They
requested that the Coast Guard provide
additional language in the Medical
Manual to clarify that applicants need
only disclose OTC medications, when
such medications were used for a period
of 30 days or more within the 90 days
prior to the date the applicant signs the
application to the Coast Guard. The
Coast Guard agrees that the language
change regarding OTC medication
disclosures on the most recent version
of the CG–719K was an inadvertent
change, and language was added to
Chapter 7 of the Medical Manual to
clarify the reporting requirements for
OTC medications. The Coast Guard will
be pursuing a change to CG–719K in the
future to correct this change.
Attendant with the language change
regarding OTC medications, the Coast
Guard also considered the NTSB’s
comments about impairing medication
effects that have contributed to the
probable cause of accidents across all
modes of transportation. In light of these
concerns, the Coast Guard determined
that it would be prudent to add
additional guidance regarding OTC
medications to the Important Safety
Warnings paragraph of Chapter 7.
Specifically, the additional guidance
warns that some OTC medications and
preparations may contain intoxicants or
other dangerous drugs prohibited by
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Department of Transportation
regulations.
NMC Medical Evaluation Procedures for
Mariners With Existing Waivers
One commenter expressed confusion
over the discussion of the term clear
error in Paragraph I.3. of Chapter 3 of
the Medical Manual. Paragraph I
discusses NMC medical evaluation
procedures for mariners with existing
waivers, and Paragraph I.3. states that
the Coast Guard is not bound to honor
a medical waiver that was issued in
clear error, contrary to duly
promulgated policy in effect at time of
issuance. The commenter mistakenly
interpreted the clear error discussion to
mean that the Coast Guard would not
take responsibility for any erroneous
certification decisions that might lead to
mishaps or untoward medical situations
at sea. In order to clear up this area of
confusion, the Coast Guard added
language to Paragraph I.3. of Chapter 3,
to clarify that the discussion of clear
error pertains to medical waivers that
were issued in error.
Alternative Testing Methodologies for
Color Vision
One comment letter asserted that the
discussion of alternative testing
methodologies for demonstrating
satisfactory color vision contained
Paragraph A.1.d.(2)(c) contains an error
because it indicates that the Farnsworth
D–15 may be used as a potential
alternative color vision test for Deck
personnel. The Coast Guard disagrees.
Title 46 CFR 10.305(a) provides that
mariners must demonstrate satisfactory
color sense through one of the tests
listed in the regulation, or through an
alternative test acceptable to the Coast
Guard. Paragraph A.1.d.(2) of the
Medical Manual provides guidance for
mariner applicants seeking to
demonstrate satisfactory color vision
sense through use of an alternative test,
and describes the type of information
that the Coast Guard will consider in
determining whether an alternative test
is sufficient for issuance of the medical
certificate. The guidance does not
guarantee that any singular test will be
accepted as an alternative methodology
for any particular mariner applicant, but
rather states that the Coast Guard retains
final authority for determining whether
the testing is acceptable, and
recommends that any alternative test be
accompanied by a formal color vision
evaluation from an ophthalmologist or
optometrist.
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Coast Guard Mission and Motives With
Respect to Medical Credentialing
One commenter asserted that the
Coast Guard should ‘‘consider its
mission and motives with respect to
medical credentialing,’’ and expressed
displeasure that the Medical Manual
focuses on ‘‘medical credentialing
without making any decisions on
mariner fitness for duty.’’ The Coast
Guard considered this commenter’s
concerns and noted that the Medical
Manual’s purpose, as stated in
Paragraph 1 of the Letter of
Promulgation for the Merchant Mariner
Medical Manual, is to ‘‘provide
guidance for evaluating the physical and
medical condition of applicants for
merchant mariner medical certificates.’’
The Coast Guard also notes that making
a determination of fitness for
certification is distinctly different from
making a determination of fitness for
duty, and refers the reader to the
discussion that follows.
Fitness-for-certification. The medical
and physical standards for merchant
mariner medical certification are
contained in 46 CFR part 10, subpart C.
The Coast Guard mariner medical
evaluation and certification process
seeks to determine whether an applicant
meets the medical and physical
standards for merchant mariners based
upon the information available to the
Coast Guard at the time of the
certification decision. In accordance
with 46 CFR 10.301, the Coast Guard
will issue a medical certificate to a
mariner meeting the medical and
physical standards for merchant
mariners. This decision is necessarily a
snapshot of the mariner’s medical and
physical condition at a single point in
time.
Fitness-for-duty. In general, fitness for
duty refers to an employee’s ability to
perform his/her essential job functions,
as specified by the employer, without
impairment from medical conditions or
medications. There are some important
considerations with respect to fitness for
duty. First, an individual’s fitness-forduty status is not static, thus it should
be considered whenever an individual
reports for duty. Fitness-for-duty status
can change suddenly due to an acute
illness, injury or incident. As an
example, an individual with no medical
problems who has been issued a
medical certificate and who normally
performs their essential job functions
without impairment, could become
‘‘not-fit-for duty’’ because of an
impairing illness such as the flu, and/
or due to impairing medications used to
treat an acute illness. The second
important consideration is that a
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‘‘fitness-for duty’’ determination refers
to an evaluation ordered by an employer
to assess an employee’s ability to
perform the essential functions of their
assigned job (as specified by the
employer). Such an evaluation might be
requested when the employer has a
reasonable belief that an employee will
not be able to perform essential job
functions because of their medical
condition. A variety of state and Federal
laws govern fitness for duty
determinations depending upon the
specific circumstances. Generally, a
fitness for duty physical must be jobrelated and consistent with business
necessity. One other important
consideration is that the merchant
mariner medical qualification standards
in part 10, subpart C, are the minimum
acceptable standards. Some maritime
employers may choose to establish
medical and/or physical ability
requirements for their employees that
are more stringent than the Coast Guard
medical certification standards based on
factors such as specific duty
requirements, austere work
environments, and operational tempo.
In these cases, the employer’s fitnessfor-duty determinations may differ from
the medical certification determination
because they are based upon different
standards. The Merchant Mariner
Medical Manual does not preclude
marine employers from establishing
more rigorous medical or physical
ability guidelines; however, there are
additional laws and regulations that
apply.
Line-by-Line List of Changes
Two commenters requested a
detailed, line-by-line list of proposed
changes that compares the current
language in NVIC 04–08 with each
change, addition and deletion made in
the Medical Manual. The Coast Guard
considered this comment, but
determined that a line-by-line list of
changes would not be helpful because of
the extensive changes in wording,
format and organization between the
two documents. Instead, the Coast
Guard has already provided a fairly
comprehensive discussion of the major
changes in Paragraph 6 of the Letter of
Promulgation for the Medical Manual.
Medical Certificate Cancellation
Commenters were both supportive of,
and objected to, the proposed medical
certificate cancellation policy. After
considering the comments, we decided
to proceed with the proposed policy.
One commenter who opposed the policy
nevertheless provided a number of
suggested edits to the text which were
adopted. Those opposed to the
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Frm 00031
Fmt 4700
Sfmt 4700
47145
cancellation policy suggested the
Suspension and Revocation (S&R)
process (46 CFR part 5) as an
alternative. The Suspension and
Revocation (S&R) process has limited
jurisdiction over mariner medical
issues. On this subject, S&R is
authorized in circumstances where a
credentialed mariner has committed an
act of incompetence relating to the
operation of a vessel (see 46 U.S.C.
7703(4)). A mariner having a
disqualifying medical condition is not
something addressed through S&R
unless and until it has impacted vessel
operation. Accordingly, the medical
certificate cancellation and waiver
processes set forth in the manual
effectively address mariner medical
qualification and fitness for duty
concerns in ways that the S&R system
cannot. There are also situations such as
mariners using dangerous drugs or
operating vessels under the influence of
alcohol or other intoxicants that present
both medical qualification and S&R
concerns, so it may be appropriate for
the Coast Guard to utilize both the
procedures set forth in this manual and
the S&R process to address and resolve
these issues in the interest of safety.
Waivers, Limitations, Restrictions
One commenter requested more detail
on limitations and restrictions. The
commenter noted that waivers seem not
to have been consistently applied to
conditions. The Coast Guard agrees in
part and over the last few years has
provided further guidance on waivers
for the most frequently occurring
conditions. Those changes to NVIC 04–
08 have been carried forward into this
manual.
Process for Removing Waivers,
Limitations and Restrictions
One commenter complained that the
process for removing restrictions and
waivers ‘‘seems uncomfortably weighted
toward taking away one’s ability to sail,
without considering that many
conditions—even very serious ones—are
temporary in nature.’’ The Coast Guard
disagrees and notes that the Medical
Manual provides specific guidance on
medical evaluation procedures for
mariners with short-term conditions
(see paragraph J. of Chapter 3 of the
Medical Manual). These provisions
were included to reduce the burden of
imposing and then removing waivers
and restrictions for conditions that are
expected to resolve in the short-term.
This document is issued under the
authority of 5 U.S.C. 552(a), 46 U.S.C.
7101, and 46 U.S.C. 7302.
E:\FR\FM\09SER1.SGM
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47146
Federal Register / Vol. 84, No. 174 / Monday, September 9, 2019 / Rules and Regulations
Dated: September 3, 2019.
J. G. Lantz,
Director, Commercial Regulations and
Standards, U.S. Coast Guard.
[FR Doc. 2019–19370 Filed 9–6–19; 8:45 am]
BILLING CODE 9110–04–P
FEDERAL COMMUNICATIONS
COMMISSION
47 CFR Part 25
[GN Docket No. 14–177, FCC 19–30]
Use of Spectrum Bands Above 24 GHz
for Mobile Radio Services
Federal Communications
Commission.
ACTION: Final rule; announcement of
compliance date.
AGENCY:
In this document, the
Commission announces that the Office
of Management and Budget (OMB) has
approved the information collection
associated with a rule for specific
millimeter wave bands above 24 GHz in
the Commission’s Fifth Report and
Order, FCC 19–30, and that compliance
with the modified rule is now required.
It removes paragraphs advising that
compliance was not required until OMB
approval was obtained. This document
is consistent with the Fifth Report and
Order FCC 19–30, which states the
Commission will publish a document in
the Federal Register announcing a
compliance date for the modified rule
section and revise the rule accordingly.
DATES: Effective date: This rule is
effective September 9, 2019.
Compliance date: Compliance with 47
CFR 25.136(e), (f), and (g), published 84
FR 20810 on May 13, 2019, is required
as of September 9, 2019.
FOR FURTHER INFORMATION CONTACT: John
Schauble of the Wireless
Telecommunications Bureau,
Broadband Division at (202) 418–0797
or John.Schauble@fcc.gov, Michael Ha
of the Office of Engineering and
Technology, Policy and Rules Division,
at 202–418–2099 or Michael.Ha@
fcc.gov, or Jose Albuquerque of the
International Bureau, Satellite Division,
at 202–418–2288 or Jose.Albuquerque@
fcc.gov.
SUPPLEMENTARY INFORMATION: This
document announces that OMB
approved the information collection
requirement in § 25.136(e), (f), and (g)
on August 27, 2019. The rule was
modified in the Fifth Report and Order,
FCC 19–30, published 84 FR 20810,
May 13, 2019. The Commission
publishes this document as an
announcement of the compliance date
jbell on DSK3GLQ082PROD with RULES
SUMMARY:
VerDate Sep<11>2014
15:58 Sep 06, 2019
Jkt 247001
of the rules. The other rule amendments
adopted in the Fifth Report and Order,
which did not require OMB approval,
became effective on June 12, 2019. If
you have any comments on the burden
estimates listed below, or how the
Commission can improve the
collections and reduce any burdens
caused thereby, please contact Cathy
Williams, Federal Communications
Commission, Room 1–C823, 445 12th
Street SW, Washington, DC 20554,
regarding OMB Control Number 3060–
1215. Please include the applicable
OMB Control Number in your
correspondence. The Commission will
also accept your comments via email at
PRA@fcc.gov.
To request materials in accessible
formats for people with disabilities
(Braille, large print, electronic files,
audio format), send an email to fcc504@
fcc.gov or call the Consumer and
Governmental Affairs Bureau at (202)
418–0530 (voice), (202) 418–0432
(TTY). This document also removes
§ 25.136(h) of the Commission’s rules,
which advised that compliance was not
required until OMB approval was
obtained.
Synopsis
As required by the Paperwork
Reduction Act of 1995 (44 U.S.C. 3507),
the FCC is notifying the public that it
received final OMB approval on August
27, 2019, for the information collection
requirement contained in the
modification to § 25.136(e), (f), and (g).
Under 5 CFR part 1320, an agency may
not conduct or sponsor a collection of
information unless it displays a current,
valid OMB Control Number.
No person shall be subject to any
penalty for failing to comply with a
collection of information subject to the
Paperwork Reduction Act that does not
display a current, valid OMB Control
Number. The OMB Control Number for
the information collection requirement
in § 25.136(e), (f), and (g) is 3060–1215.
The foregoing notice is required by
the Paperwork Reduction Act of 1995,
Public Law 104–13, October 1, 1995,
and 44 U.S.C. 3507.
The total annual reporting burdens
and costs for the respondents are as
follows:
OMB Control Number: 3060–1215.
OMB Approval Date: August 27, 2019.
OMB Expiration Date: August 31,
2022.
Title: Use of Spectrum Bands Above
24 GHz for Mobile Radio Services.
Form Number: N/A.
Respondents: Business or other forprofit, not-for-profit institutions, and
state, local and tribal government.
PO 00000
Frm 00032
Fmt 4700
Sfmt 4700
Number of Respondents and
Responses: 1,230 respondents; 1,230
responses.
Estimated Time per Response: .5–10
hours.
Frequency of Response: On occasion
reporting requirement; third party
disclosure requirement; recordkeeping;
upon commencement of service, or
within 3 years of effective date of rules;
and at end of license term, or 2024 for
incumbent licensees.
Obligation to Respond: Statutory
authority for this collection are
contained in sections 1, 2, 3, 4, 5, 7, 10,
201, 225, 227, 301, 302, 302a, 303, 304,
307, 309, 310, 316, 319, 332, and 336 of
the Communications Act of 1934, 47
U.S.C. 151, 152, 153, 154, 155, 157, 160,
201, 225, 227, 301, 302, 302a, 303, 304,
307, 309, 310, 316, 319, 332, 336,
Section 706 of the Telecommunications
Act of 1996, as amended, 47 U.S.C.
1302.
Total Annual Burden: 735 hours.
Total Annual Cost: $540,000.
Privacy Act Impact Assessment: No
impact(s).
Nature and Extent of Confidentiality:
There is no need for confidentiality with
this collection of information.
Needs and Uses: In this collection, the
Commission amended in the Fifth
Report and Order’s § 25.136 by revising
the section heading and revising
paragraphs (e), (f), and (g) and adding
paragraphs (e)(1), (2), (3), and (e)(4)(i),
(ii), (iii), and (iv). The Fifth Report and
Order was adopted on April 12, 2019
and released on April 15, 2019. The
Commission added the 50 GHz band
(50.4–51.4 GHz) to the bands that are
subject to the framework for sharing
between the Upper Microwave Flexible
Use Service (UMFUS) and the FixedSatellite Service (FSS) established in
that rule. In turn, since the rules now
apply in additional bands, the number
of respondents, the annual number of
responses, annual burden hours and
annual costs will increase for this
collection. In addition, the
Commission re-orders the paragraphs
in § 25.136.
List of Subjects in 47 CFR Part 25
Satellite communication.
Federal Communications Commission.
Marlene Dortch,
Secretary.
Final Rules
For the reason discussed in the
preamble, the Federal Communications
Commission amends 47 CFR part 25 as
follows:
E:\FR\FM\09SER1.SGM
09SER1
]]>Agencies
[Federal Register Volume 84, Number 174 (Monday, September 9, 2019)]
[Rules and Regulations]
[Pages 47141-47146]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2019-19370]
=======================================================================
-----------------------------------------------------------------------
DEPARTMENT OF HOMELAND SECURITY
Coast Guard
46 CFR Part 10
[Docket No. USCG-2018-0041]
COMDTINST M16721.48 Merchant Mariner Medical Manual
AGENCY: Coast Guard, DHS.
ACTION: Notification of availability.
-----------------------------------------------------------------------
SUMMARY: The Coast Guard announces the availability of the Merchant
Mariner Medical Manual, Commandant Instruction Manual (COMDTINST
M16721.48). The guidance in this Manual should assist medical
practitioners, the maritime industry, individual mariners, and Coast
Guard personnel in evaluating a mariner applicant's physical and
medical status to meet the requirements of the merchant mariner medical
certificate. This Manual incorporates and consolidates prior guidance
on the medical evaluation of merchant mariners contained in several
Coast Guard documents. The Manual includes guidance on the medical
certificate and related processes, including procedures for
application, issuance, and cancellation of the medical certificate.
DATES: The Merchant Mariner Medical Manual, COMDTINST M16721.4, is
effective on September 9, 2019.
FOR FURTHER INFORMATION CONTACT: For information about this document or
to suggest changes, call or email Adrienne Buggs, M.D., United States
Coast Guard, Office of Merchant Mariner
[[Page 47142]]
Credentialing; telephone: 202-372-2357, email: [email protected].
SUPPLEMENTARY INFORMATION:
Viewing Documents
The Merchant Mariner Medical Manual, COMDTINST M16721.4, is
available on the internet at: https://www.dcms.uscg.mil/Our-Organization/Assistant-Commandant-for-C4IT-CG-6/The-Office-of-Information-Management-CG-61/About-CG-Directives-System/ and on
CGPortal at: https://cgportal2.uscg.mil/library/directives/SitePages/Home.aspx. A link to the document will also be located on the National
Maritime Center (NMC) site: https://www.dco.uscg.mil/Our-Organization/Assistant-Commandant-for-Prevention-Policy-CG-5P/National-Maritime-Center/.
Background and Discussion of the Merchant Mariner Medical Manual
Coast Guard regulations contained in 46 CFR part 10, subpart C,
provide the medical and physical standards that merchant mariner
applicants must meet prior to being issued a merchant mariner medical
certificate. The Merchant Mariner Medical Manual provides guidance to
the regulated community on how to comply with the regulations
pertaining to medical and physical qualifications for merchant
mariners.
Previously, the Coast Guard provided guidance on the medical and
physical requirements for merchant mariners in the Medical and Physical
Evaluation Guidelines for Merchant Mariner Credentials, Navigation and
Inspection Circular (NVIC) 04-08, Commandant Publication (COMDTPUB)
16700.4; in the Guidance on the Issuance of Medical Certificates (NVIC
01-14); and in Part A of the Marine Safety Manual, Volume III, Marine
Industry Personnel, COMDTINST M16000.8 (Series) [MSM]. The Merchant
Mariner Medical Manual revises, updates and combines the medical
evaluation guidance previously published in NVIC 04-08, Part A of the
MSM, Volume III, and NVIC 01-14. The Coast Guard developed the draft
Manual in consultation with experienced maritime community medical
practitioners and industry stakeholders serving on the Merchant Mariner
Medical Advisory Committee (MEDMAC) and the Merchant Marine Personnel
Advisory Committee (MERPAC). The Manual reflects a synthesis of their
recommendations and the medical requirements of title 46 Code of
Federal Regulations (CFR) part 10, subpart C.
Members of the public participated in the development of medical
policy by providing comment and serving on working groups at the public
meetings of MEDMAC and MERPAC. Additionally, the public had the
opportunity to comment on drafts of policies contained in this Manual,
and its predecessor, NVIC 04-08. See requests for comment on proposed
policies regarding: Diabetes, cardiomyopathy, and sleep disorders (80
FR 8586, Feb. 18, 2015); Medications (80 FR 4582, Jan. 28, 2015);
Seizures (78 FR 17917, Mar. 25, 2013); and Implantable cardioverter
defibrillators (77 FR 55174, Sep. 7, 2012). The Coast Guard considered
these public comments when developing this Manual.
Public Comments on the Draft Merchant Mariner Medical Manual:
The Coast Guard published a draft of the Merchant Mariner Medical
Manual in the Federal Register and sought input from the public on the
draft (83 FR 56272, Nov. 13, 2018). The current version of the Manual
includes revisions made to address comments received in response to the
Federal Register notification. While the Coast Guard is not required to
seek or respond to public comments prior to publication of a policy
document, we chose to do so in this case because of the perceived
complexity of the Merchant Mariner Medical Manual, and because doing so
provides us the opportunity to (1) create a guidance document that is
more viable and responsive to the needs of the impacted community; and
(2) to identify and clarify remaining areas of confusion and concern
amongst the regulated community.
The Coast Guard's notification sought general comments on the draft
Medical Manual, with emphasis on suggestions to improve readability,
clarity, and ease of use; and comments on whether the draft Manual's
proposed medical certificate cancellation policy adequately addresses
safety concerns in situations where the Coast Guard receives
information indicating that a medical certificate holder has developed
a medical condition that poses a significant risk of sudden
incapacitation, or is taking a medication that poses a significant risk
of impairment. The Coast Guard received 37 comment letters in response.
General Comments
Ten comment letters provided a general opinion of the draft Manual,
with the majority expressing an overall positive opinion. These
commenters found the guidance in the Manual to be thorough,
straightforward and easy to use, and they found that it answered many
questions that had arisen with previous medical policy documents. The
favorable commenters appreciated that the document provides medical
evaluators, mariners and medical providers with needed and relevant
information that will reduce the need for ``back and forth'' between
the mariner and the National Maritime Center. They also found it
helpful that the Manual outlines the Coast Guard's general concerns
with particular medical conditions and discusses the general factors
that the Coast Guard will use to evaluate the medical condition and
make a fitness determination. Comments provided by the National
Transportation Safety Board (NTSB) found that the draft Medical Manual
aptly streamlines the medical certification guidance and provides a
level of detail that should assist medical personnel during the mariner
medical certification exams. The NTSB comment letter also provided the
following observations:
The combination of the Coast Guard's increased oversight of
medical certification and development of medical guidance appears to
be highly effective at addressing safety concerns regarding medical
conditions that pose a significant risk of sudden incapacitation.
Since 2009, the NTSB has not found any medical conditions to have
contributed to the probable cause of a marine accident. However, the
NTSB continues to find effects from impairing substances (alcohol
and over-the-counter, prescription, or illicit drugs) to have
contributed to the probable cause across all modes of
transportation.
One comment letter expressed a generally negative opinion of the
draft Medical Manual. This commenter expressed concerns that the
guidance in the Medical Manual would sacrifice maritime safety unless
the Coast Guard provided further clarification and a plan for
implementation. Additionally, the commenter opined that the guidance
does not adequately ensure that medical conditions are sufficiently
controlled for those mariners at higher risk, because the Medical
Manual does not establish clear standards for specific medical
conditions. The Coast Guard does strive to increase clarity with
publication of the Medical Manual, however, the Coast Guard disagrees
that improved clarity requires publication of an implementation plan.
Discussion of the Coast Guard's internal implementation plans are
beyond the scope of the Medical Manual. Moreover, the majority of the
policy contained in the mariner medical manual is not new guidance. It
is the same guidance, explained in greater detail, that was already
implemented in the years following the
[[Page 47143]]
publication of NVIC 04-08. The Coast Guard also disagrees with the
assertion that the Medical Manual should establish condition-specific
medical standards. The medical and physical standards for merchant
mariner medical certification have already been established in 46 CFR
part 10, subpart C. Establishing new medical standards is beyond the
scope of a policy document.
Ease of Use and Clarity
A letter from another commenter requested that the Coast Guard add
an appendix that puts common conditions in a table format for quick
reference, similar to that used in the International Maritime
Organization's (IMO) Guidelines on the Medical Examination of
Seafarers. The Coast Guard disagrees on the basis that a quick
reference table would not adequately capture the discussion,
explanation and rationale that mariners, treating providers and medical
examiners need to understand in order to provide quality examinations
to the Coast Guard.
Requirements for Medical Certification
Three comment letters recommended that the Medical Manual provide
additional medical requirements for medical certification. One letter
commented that the Medical Manual should require all mariners to meet
the same medical standard, and should provide ``specific acceptable
parameters'' for many conditions to include BMI, pulmonary function,
glucose levels, blood pressure, and cardiac function. Another comment
letter suggested that the Coast Guard should implement a random medical
testing program, similar to that used for drug testing. The third
comment letter stated that the physical ability requirements should
also include criteria for the speed and facility with which a mariner
performs required tasks. The Coast Guard disagrees with these comments.
While some of the recommendations pertaining to medical standards may
warrant future discussion, changes or additions to the medical and
physical requirements for medical certification are beyond the scope of
this document. As discussed earlier, the medical and physical standards
for medical certification are provided in 46 CFR part 10, subpart C,
and changes to those requirements would require a rulemaking.
Guidance on the Conduct of the General Medical Examination
One comment letter addressed the guidance pertaining to the general
medical examination and recommended that the mariner medical
examination include an evaluation of the mariner's oral/dental health
condition to ensure that there are no untreated infections or other
dental problems that could cause significant impairment while at sea.
The Coast Guard agrees that such guidance may prove helpful and will
work with MEDMAC to consider whether and what type of guidance would be
appropriate for inclusion in a future version of the Medical Manual.
Frequency of Required Medical Examinations
Four comments letters addressed the frequency of required medical
examinations. Three commenters opined that it is excessive to require
mariners to undergo a medical examination every two years. They
recommended that the medical examination for all mariners, including
those sailing under the authority of their Standards of Training,
Certification, and Watchkeeping (STCW) endorsement, should remain valid
for a period of 5 years, unless the mariner's medical condition
warrants issuance of a shorter-duration medical certificate. A
different commenter requested clarity on how often a mariner is
required to obtain a medical exam, noting that in some instances
maritime employers require an annual medical examination, even when the
Coast Guard does not.
The Merchant Mariner Medical Manual provides detailed discussion of
medical examination and medical certification requirements for specific
endorsements, and cites the corresponding regulatory references. It is
important to note that the medical certificate validity period and the
frequency of required medical examinations may differ between
endorsements because of the differing legal requirements. Since these
requirements are established in regulation, changing them would require
a rulemaking and is beyond the scope of this policy document. The
medical examination requirements of individual employers are also
outside the scope of this policy document.
Medical Exam Forms
One comment letter requested that the Medical Manual provide a list
of medical examination forms that would be acceptable in place of the
Form CG-719K or KE. The Coast Guard disagrees and did not provide a
list of alternative forms because 46 CFR 10.302(a) requires the
following: ``to qualify for a medical certificate, a mariner must
provide evidence of meeting the medical and physical standards . . . on
a CG-719-K or CG-719-K/E, as appropriate.''
Medical Examiners
Ten comment letters provided comments on the topic of medical
examiners. Three commenters requested additional information on the
Designated Medical Examiner (DME) program, with one requesting that the
Coast Guard publish its timeline and intent to create the DME program.
The Coast Guard understands that there is significant interest in the
DME program and will publish additional information, as and when
appropriate.
Five commenters recommended changes to the regulations regarding
individuals who may perform examinations for purposes of the mariner
medical certification examination. The Coast Guard considered each of
these recommendations, but noted that changes to the regulations are
beyond the scope of this policy document.
Internal National Maritime Center Processes
Two comment letters requested that the Manual provide more detail
on internal National Maritime Center (NMC) processes. One of these
comments expressed concern that the Manual's instructions would allow
non-medical personnel to make medical determinations for U.S.
mariners.'' This commenter recommended that the Coast Guard add
language to specify that all medical certification decisions will be
supervised by a licensed medical officer. The second comment noted that
the Manual does not contain ``any reassurance or check and balance of
examiners, examination quality, or the NMC medical certification
process.'' This commenter requested that the Coast Guard add language
to address these concerns. The Coast Guard considered both of the
comments, but does not concur with them. The staffing and internal
quality assurance practices of the NMC are beyond the scope of this
document. Nonetheless, the Coast Guard affirms that the activities of
the NMC Medical Evaluations Division, particularly those related to
medical certification, are supervised by a licensed medical officer. On
the issue of providing quality assurance for medical examiners, it is
important to recognize that medical examiners are not regulated by the
Coast Guard. Therefore, providing reassurance or checks and balances of
examiners and their exam quality, is inappropriate and is beyond the
scope of this document.
Positive Drug Tests
Two comment letters complained that the Manual does not provide
guidance
[[Page 47144]]
for the evaluation of mariners who test positive for illegal drug use.
One also requested that the Coast Guard add language to the Medical
Manual requiring medical treatment for any mariner who fails a USCG
required drug test. The Coast Guard does not concur with these
commenters. The Medical Manual does not address requirements related to
positive drug tests because the regulations and guidance on the
management and disposition of individuals who have a positive drug test
are contained in 46 CFR parts 5, 10, and 16. Changes to the DOT and
Coast Guard drug testing regulation and policy are beyond the scope of
this policy document. The Medical Manual contains guidance on how the
Coast Guard will conduct the medical certification evaluation for
individuals who have been diagnosed with a substance abuse disorder.
The Medical Manual does not, however, direct treatment nor provide
diagnostic instruction, because such areas are beyond the scope this
policy document.
Reporting Material Changes in Medical Condition for Mariners
One commenter asked whether a mariner who holds a medical waiver is
required to report a material change in their medical condition. The
Coast Guard notes that the answer to this question will depend on the
provisions outlined in the mariner's medical waiver letter. Some waiver
letters require that the mariner report changes in medical condition to
the Coast Guard within a specified period of time. If no such provision
is provided in the mariner's waiver letter, then the mariner is not
required to disclose the change in medical condition until the time of
the next medical certificate application.
Three commenters asked whether employers have an obligation to
report to the Coast Guard information regarding a change in condition.
One of these same commenters also asked how employees could protect
themselves from inaccurate reports. The Coast Guard considered each of
these comments and advises that this manual does not impose any new
reporting requirements on anyone. In response to the concerns about how
mariners will be able to protect themselves from inaccurate reports,
the Coast Guard offers that the Merchant Mariner Medical Manual only
proposes to take action on medical information that the Coast Guard has
determined as credible. The information that the Coast Guard would deem
credible differs depending upon the circumstances, but generally will
include medical provider documentation, formal incident reports,
emergency medical services reports, and investigative reports. The
Coast Guard also asserts that mariners will be able to protect
themselves from inaccurate reports because this manual provides a
standard process for evaluating these reports and further provides
mariners with notice of, and the opportunity to respond to, information
that indicates that they are no longer fit for medical certification.
Medications
Two comment letters noticed discrepancies in the language in
Chapter 7 related to required disclosures of over-the-counter (OTC)
medications. One of the commenters also observed that the guidance in
the Manual highlighted an error on the most recent version of the
Application for Medical Certificate (Form CG-719K, Rev 04/17, Exp. Date
03/31/2021) which incorrectly states that applicants must disclose all
OTC medications taken within 30 days prior to the date the applicant
signs the CG-719K. Both commenters noted that prior versions of the CG-
719K and the Medical Manual only instructed mariners to disclose OTC
medications if the medications were used for a period of 30 days or
more within the 90 days prior to the date the applicant signs the
application to the Coast Guard. They requested that the Coast Guard
provide additional language in the Medical Manual to clarify that
applicants need only disclose OTC medications, when such medications
were used for a period of 30 days or more within the 90 days prior to
the date the applicant signs the application to the Coast Guard. The
Coast Guard agrees that the language change regarding OTC medication
disclosures on the most recent version of the CG-719K was an
inadvertent change, and language was added to Chapter 7 of the Medical
Manual to clarify the reporting requirements for OTC medications. The
Coast Guard will be pursuing a change to CG-719K in the future to
correct this change.
Attendant with the language change regarding OTC medications, the
Coast Guard also considered the NTSB's comments about impairing
medication effects that have contributed to the probable cause of
accidents across all modes of transportation. In light of these
concerns, the Coast Guard determined that it would be prudent to add
additional guidance regarding OTC medications to the Important Safety
Warnings paragraph of Chapter 7. Specifically, the additional guidance
warns that some OTC medications and preparations may contain
intoxicants or other dangerous drugs prohibited by Department of
Transportation regulations.
NMC Medical Evaluation Procedures for Mariners With Existing Waivers
One commenter expressed confusion over the discussion of the term
clear error in Paragraph I.3. of Chapter 3 of the Medical Manual.
Paragraph I discusses NMC medical evaluation procedures for mariners
with existing waivers, and Paragraph I.3. states that the Coast Guard
is not bound to honor a medical waiver that was issued in clear error,
contrary to duly promulgated policy in effect at time of issuance. The
commenter mistakenly interpreted the clear error discussion to mean
that the Coast Guard would not take responsibility for any erroneous
certification decisions that might lead to mishaps or untoward medical
situations at sea. In order to clear up this area of confusion, the
Coast Guard added language to Paragraph I.3. of Chapter 3, to clarify
that the discussion of clear error pertains to medical waivers that
were issued in error.
Alternative Testing Methodologies for Color Vision
One comment letter asserted that the discussion of alternative
testing methodologies for demonstrating satisfactory color vision
contained Paragraph A.1.d.(2)(c) contains an error because it indicates
that the Farnsworth D-15 may be used as a potential alternative color
vision test for Deck personnel. The Coast Guard disagrees. Title 46 CFR
10.305(a) provides that mariners must demonstrate satisfactory color
sense through one of the tests listed in the regulation, or through an
alternative test acceptable to the Coast Guard. Paragraph A.1.d.(2) of
the Medical Manual provides guidance for mariner applicants seeking to
demonstrate satisfactory color vision sense through use of an
alternative test, and describes the type of information that the Coast
Guard will consider in determining whether an alternative test is
sufficient for issuance of the medical certificate. The guidance does
not guarantee that any singular test will be accepted as an alternative
methodology for any particular mariner applicant, but rather states
that the Coast Guard retains final authority for determining whether
the testing is acceptable, and recommends that any alternative test be
accompanied by a formal color vision evaluation from an ophthalmologist
or optometrist.
[[Page 47145]]
Coast Guard Mission and Motives With Respect to Medical Credentialing
One commenter asserted that the Coast Guard should ``consider its
mission and motives with respect to medical credentialing,'' and
expressed displeasure that the Medical Manual focuses on ``medical
credentialing without making any decisions on mariner fitness for
duty.'' The Coast Guard considered this commenter's concerns and noted
that the Medical Manual's purpose, as stated in Paragraph 1 of the
Letter of Promulgation for the Merchant Mariner Medical Manual, is to
``provide guidance for evaluating the physical and medical condition of
applicants for merchant mariner medical certificates.'' The Coast Guard
also notes that making a determination of fitness for certification is
distinctly different from making a determination of fitness for duty,
and refers the reader to the discussion that follows.
Fitness-for-certification. The medical and physical standards for
merchant mariner medical certification are contained in 46 CFR part 10,
subpart C. The Coast Guard mariner medical evaluation and certification
process seeks to determine whether an applicant meets the medical and
physical standards for merchant mariners based upon the information
available to the Coast Guard at the time of the certification decision.
In accordance with 46 CFR 10.301, the Coast Guard will issue a medical
certificate to a mariner meeting the medical and physical standards for
merchant mariners. This decision is necessarily a snapshot of the
mariner's medical and physical condition at a single point in time.
Fitness-for-duty. In general, fitness for duty refers to an
employee's ability to perform his/her essential job functions, as
specified by the employer, without impairment from medical conditions
or medications. There are some important considerations with respect to
fitness for duty. First, an individual's fitness-for-duty status is not
static, thus it should be considered whenever an individual reports for
duty. Fitness-for-duty status can change suddenly due to an acute
illness, injury or incident. As an example, an individual with no
medical problems who has been issued a medical certificate and who
normally performs their essential job functions without impairment,
could become ``not-fit-for duty'' because of an impairing illness such
as the flu, and/or due to impairing medications used to treat an acute
illness. The second important consideration is that a ``fitness-for
duty'' determination refers to an evaluation ordered by an employer to
assess an employee's ability to perform the essential functions of
their assigned job (as specified by the employer). Such an evaluation
might be requested when the employer has a reasonable belief that an
employee will not be able to perform essential job functions because of
their medical condition. A variety of state and Federal laws govern
fitness for duty determinations depending upon the specific
circumstances. Generally, a fitness for duty physical must be job-
related and consistent with business necessity. One other important
consideration is that the merchant mariner medical qualification
standards in part 10, subpart C, are the minimum acceptable standards.
Some maritime employers may choose to establish medical and/or physical
ability requirements for their employees that are more stringent than
the Coast Guard medical certification standards based on factors such
as specific duty requirements, austere work environments, and
operational tempo. In these cases, the employer's fitness-for-duty
determinations may differ from the medical certification determination
because they are based upon different standards. The Merchant Mariner
Medical Manual does not preclude marine employers from establishing
more rigorous medical or physical ability guidelines; however, there
are additional laws and regulations that apply.
Line-by-Line List of Changes
Two commenters requested a detailed, line-by-line list of proposed
changes that compares the current language in NVIC 04-08 with each
change, addition and deletion made in the Medical Manual. The Coast
Guard considered this comment, but determined that a line-by-line list
of changes would not be helpful because of the extensive changes in
wording, format and organization between the two documents. Instead,
the Coast Guard has already provided a fairly comprehensive discussion
of the major changes in Paragraph 6 of the Letter of Promulgation for
the Medical Manual.
Medical Certificate Cancellation
Commenters were both supportive of, and objected to, the proposed
medical certificate cancellation policy. After considering the
comments, we decided to proceed with the proposed policy. One commenter
who opposed the policy nevertheless provided a number of suggested
edits to the text which were adopted. Those opposed to the cancellation
policy suggested the Suspension and Revocation (S&R) process (46 CFR
part 5) as an alternative. The Suspension and Revocation (S&R) process
has limited jurisdiction over mariner medical issues. On this subject,
S&R is authorized in circumstances where a credentialed mariner has
committed an act of incompetence relating to the operation of a vessel
(see 46 U.S.C. 7703(4)). A mariner having a disqualifying medical
condition is not something addressed through S&R unless and until it
has impacted vessel operation. Accordingly, the medical certificate
cancellation and waiver processes set forth in the manual effectively
address mariner medical qualification and fitness for duty concerns in
ways that the S&R system cannot. There are also situations such as
mariners using dangerous drugs or operating vessels under the influence
of alcohol or other intoxicants that present both medical qualification
and S&R concerns, so it may be appropriate for the Coast Guard to
utilize both the procedures set forth in this manual and the S&R
process to address and resolve these issues in the interest of safety.
Waivers, Limitations, Restrictions
One commenter requested more detail on limitations and
restrictions. The commenter noted that waivers seem not to have been
consistently applied to conditions. The Coast Guard agrees in part and
over the last few years has provided further guidance on waivers for
the most frequently occurring conditions. Those changes to NVIC 04-08
have been carried forward into this manual.
Process for Removing Waivers, Limitations and Restrictions
One commenter complained that the process for removing restrictions
and waivers ``seems uncomfortably weighted toward taking away one's
ability to sail, without considering that many conditions--even very
serious ones--are temporary in nature.'' The Coast Guard disagrees and
notes that the Medical Manual provides specific guidance on medical
evaluation procedures for mariners with short-term conditions (see
paragraph J. of Chapter 3 of the Medical Manual). These provisions were
included to reduce the burden of imposing and then removing waivers and
restrictions for conditions that are expected to resolve in the short-
term.
This document is issued under the authority of 5 U.S.C. 552(a), 46
U.S.C. 7101, and 46 U.S.C. 7302.
[[Page 47146]]
Dated: September 3, 2019.
J. G. Lantz,
Director, Commercial Regulations and Standards, U.S. Coast Guard.
[FR Doc. 2019-19370 Filed 9-6-19; 8:45 am]
BILLING CODE 9110-04-P
