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Todd Dills

Docs’ sleep apnea approach getting aggressive — and confused?

| April 08, 2014
Driver Ed Webb told his apnea story, about his dealing with Indiana's unique apnea-treatment audit program, in this story.

Driver Ed Webb told his apnea story, about his dealing with Indiana’s unique apnea-treatment audit program, in this 2011 story.

Reading my colleague James Jaillet’s report on the sleep-apnea-related seminar held at the Mid-America Trucking Show, a week and more back, I was immediately reminded of the case of Kenneth Dice of Romney, W.Va. Dice is a former OTR driver and owner-operator, now a retired part-time local hauler getting up in age and running a triaxle dump intrastate on a local highway project. Dice has been treated for sleep apnea with a Continuous Positive Airway Pressure machine for many years now. His longtime doctor, with whom Dice has worked to successfully treat the condition these many years, is no longer doing DOT physicals for medical recertification. He stopped giving them because of the nonsense that goes along with it,” says Dice, so when “my physical ran out … I came to a licensed practitioner’s office near my town. When she found out that I have sleep apnea, she said, ‘Nope.’”

The examiner, says Dice, essentially refused to certify him as medically fit to operate because he was being treated for apnea. Dice then turned to a former West Virginia DOT officer who said the examiner was flat wrong in her determination. “I have since talked to a federal DOT officer,” says Dice, who noted it was the examiner’s prerogative “not to pass me,” as he puts it, though sleep apnea is not as yet a condition that automatically triggers a DOT physical failure.

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I’ve put in a call to the examiner’s office, but my message for the medical assistant there has yet to be returned. My question today has to do with what the rest of you have seen around the country. It wouldn’t be the first time inconsistent practices from docs’ offices relative to sleep apnea have been documented, of course, though West Virginia doesn’t appear to have an apnea-treatment-audit program similar to Indiana’s, documented in the story at the previous link. Anybody else in W.Va. seen similar from examiners there, by chance?

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In the report on the MATS seminar, Greg McDermand of Phoenix Sleep Solutions warns drivers of docs’ growing perception of liability relative to sleep apnea and the willingness of many around the nation to test and treat drivers for apnea before certifying them through the DOT physical — even with the absence of any requirement for such in rules and guidance on the DOT physical. As Jaillet reported:

“Examiners are getting very aggressive because of liability,” McDermand said. “They’re not comfortable letting people walk out” if they may be at risk for apnea, he said.

McDermand went on to recommend that drivers “find a place to get tested so you can walk in with a clean piece of paper that says you’re treated with a CPAP or that says you’re negative and they’ll leave you alone.” 

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Seminar: Medical registry rule upping urgency of sleep apnea testing

The looming deadline for truckers to be medically certified by examiners approved by FMCSA has ratcheted up the pressure for those who may be at risk for sleep apnea to be tested and treated, said a speaker this week in Louisville, Ky.

Such may not, however, have worked for Dice in this case. “If I could get a regular doctor to get recertified,” he says, “it’ll cost me another DOT physical and another $75.” All the same, there’s great import to it for him. “I’ll be 72 years old come Memorial Day,” he says. “I’ve got a lot of driver left in me, I’ll say, and while my health is really good I’d like to be able to work for at least another year.” 

That he is being held up by his successfully treated sleep apnea “makes little sense,” he says. “I was certified and running interstate [for years with apnea] in a semi, but now I’m retired and working a part-time job in a tri-axle going nowhere, home every night to use the machine, and now I’m uncertified for it?”

  • pj

    I have had no problems getting my med cert thru my primary medical office as I have Kaiser and they are the ones that diagnosed my condition. whether that will remain the case I don’t know.

  • Pingback: Docs’ sleep apnea approach getting aggressive — and confused? « dotmedicalblog| Queens, NY

  • Dr Slim

    My company uses Concentra and while I believe they can be harsh and even irrational in some of there delays and hold ups, I have never had a major issue. That being said, my old CPAP machine didn’t have the ability to be downloaded and they told me “…either get a new one or we will not give you another card…”. Now I have BiPAP and they get their download every year, everyone’s happy…

  • Bob Stanton

    Mr Dice needs to reach out for help. There is an appeals process through the FMCSA office of medical programs for dot physicals.

    The question is does the cpap machine he is using have compliance and efficacy data capability? The story mentions that he has been on cpap for several years. If he is using an older cpap it might just be an issue on getting compliance data. Without compliance data the DOT medical examiner shouldn’t issue a certificate. Also the medical examiner will not return calls to a reporter unless the patient has signed a HIPPA release. Medical examiner are bound by the patient confidentiality rules. Getting a Hippa release is not a big thing.

    If Mr Dice needs but honestly can’t afford a new compliance data capable cpap there are limited charity programs he can be referred to for help.

    We have a driver to driver support group for drivers with sleep apnea Truckers for a Cause Awake where we do what we can to help drivers like Ken.

  • ToucheTurtle

    As with all gov’t programs that are configured to intrude into our personal lives as well as our private businesses, there are unintended consequences, and frankly the FMCSA is not concerned with nor are they intending to remedy these nasty consequences to their ridiculous hoops we must jump through.

    We are currently facing the same kind of problem with the Compliance Date of Medical Registry Rule . . . the system isn’t ready but you MUST file your medical certificate with your state and STILL carry your medical card because it is just another technology mess.

    Can you imagine what is going to happen when they decide that we must comply with E-Logging regulations?

    Just remember, when you hear the words, “I am from the government, and I am here to help you,” the wisest thing you can do is say “NO!”

  • MercenaryMan

    TYPICAL sleep apnea mafia tactics you better buy the same stock the medical board guys have cuz that’s about to DOUBLE, TRIPLE, QUADRUPLE in value, Resmed, GE, Phillips and all the DOT Money mill non clinics are opening new banks to keep the money in, nobody wants to say yes, no, maybe just GOTCHA…and you’ll be on it for LIFE,….liability my a $$ more like buffoons in a barrel

  • MercenaryMan

    Speaking of money mills

  • Joe Green

    If you need to be tested for sleep apnea, try to save money by doing the at home test, which is about 1/4 the price as an overnight stay.
    I used Delta Sleep in Woodridge, Illinois. They prescribed a CPAP and it changed my life for the better.
    To me the CPAPS are cheaper than the test, they should just let you try one for 2 weeks and see if you feel more rested. If not, then go for the test.

  • Brad Kayganich