Cover story: Medically Certified
In terms of the basics of driver medical certification, says Dr. Ronald Rush of Highway Health Care in Texarkana, Texas, “I really have not seen a lot of activity in the last few years to suggest that drivers are having a lot of problems with certification. The basic exam and qualifications are stable and we have not had to change much of anything.”
Diabetes and blood pressure rules remain stable — get a BP reading over 140/90 and you will get a one-time three-month certification to get it under control. If you’re an insulin-treated diabetic you must go through the rigorous Diabetes Exemption Program process to get certified.
“I think there are two or three states that do what Indiana does with medical certification. If an Illinois carrier can get away without doing as much as is required in Indiana, then there’s some resistance by Indiana carriers.”
– Kenneth Strickland, Administrator, FMCSA Indiana Division
“The exception,” Rush adds, “does seem to be in the area of sleep medicine.” As the science behind diagnosis of sleep apnea has become more well developed over the last two decades, the attention to sleep disorders’ affect on fatigue and thus driver safety has increased. While the Federal Motor Carrier Safety Administration says it does not plan to institute mandatory screening criteria for sleep apnea as a part of the Department of Transportation examination requirements, many carriers require it of drivers with various risk factors. “Many are being told by their companies that apnea testing is coming or their companies are instituting screening and testing programs,” says Rush, adding that most individual companies his facility works with “have some type of screen and only ask some [drivers] to be tested.”
A former commercial airline pilot, Mike Bartruff turned to trucking after an unsuccessful business venture with his son. He signed on with Prime Inc. in Missouri, whose Orion Healthcare clinic on-site at the main Springfield terminal oversees its medical program. The carrier required a sleep test after an initial screening showed Bartruff had a Body Mass Index measurement above 39. Orion’s Dr. John Abraham says, “We look at neck size, at their airway and how open that is. If it’s really closed off, they’ll be at risk as well.”
In addition, multiple health problems, from diabetes to heart attacks, strokes and high blood pressure, might suggest that sleep apnea could be present as a contributing factor.
In Bartruff’s case, a sleep study confirmed diagnosis of sleep apnea. His treatment includes nightly use of a continuous positive airway pressure (CPAP) machine. His overall cost was $1,900, though costs can certainly run higher that that.
The sleep test, says Dr. Rush, “for a private patient is generally in the $1,300 to $2,000 range in many clinics and can go even higher in a hospital setting. We generally charge the cash-paying trucker around $900.”
Driver Ed Webb, with Prime Hauling of Indiana, paid just $240 for his first CPAP. “I was fortunate enough to get on my employer’s insurance,” he says, “so it was only a $30-$40 copay” for the sleep test itself. Out-of-pocket it would have been $3,500, he says.
Webb is one of many drivers who’ve found themselves feeling “like a lab rat on a treadmill,” he says, in the medical-certification area of late, with the state directly involved in his sleep apnea treatment. His history with the condition starts during a five-month period when he was out of work, during which his girlfriend recommended he be tested for sleep apnea. Tested, he then found a machine on Craigslist and got it, but without a full-face mask at additional cost he was unable to get it to work for him effectively initially. Meanwhile, he went back to trucking with Prime Hauling.