Captain John Cota, the San Francisco Bay ships pilot that was aboard the Cosco Busan when it allided with the Bay Bridge in November 2007, had numerous health problems and was taking a variety of medications. According to National Transportation Safety Board Medical Officer, Cota had a long history of kidney stones, pancreatic disease, headaches, depression, abdominal pain, back pain, glaucoma, and digestive difficulties. He had also struggled in the past with alcoholism and sleep apnea.

In the 60 days prior to the accident, which resulted in a spill of more than 53,000 gallons of bunker fuel into the bay, Cota had filled prescriptions for 90 sertraline tablets, 180 lorazepam tablets, 120 diazepam tablets, 190 propoxyphene tablets, 90 modafinal tablets, 27 sumatriptan tablets, 200 hydrocodone/acetaminophen tablets, 50 prochlorperazine tablets, 50 pentazocine/nanoxone tablets, and 100 diphenoxylate/atropine tablets.
A drug and alcohol test administered shortly after the accident revealed no dangerous drugs or alcohol in Cota's system.

Although the State Board of Pilot Commissioners requires pilots to undergo annual physicals to make sure they are fit for the job, it relies on the report of the physician, who merely responds with a three-item multiple-choice form which states whether the pilot is fit for duty, not fit for duty, or permanently not fit for duty.

 - The Cunningham Report