The Apnea Hurdle
“It will set the bar a little higher in terms of medical examiners,” says Anne-Marie Puricelli, a veteran CDL medical examiner.
Chiropractor Clinton Smith, president of NRCME Training Systems in Breese, Ill., concurs. “It’s going to corral all the examiners and truckers,” Smith says. “There are too many loopholes,” he says of current procedures for selecting examiners. He points out that dangerous drug and alcohol levels too often go unreported. “There will be more accountability.”
Chiropractic physicians, medical and osteopathic doctors, advanced nurse practitioners and physician assistants may still become certified medical examiners, according to the docket for the final rule. An examiner will have to take eight hours of training and be tested on it to become certified. Retraining would be required every three to five years.
Every month examiners will report DOT medical exam results to FMCSA. Carriers will be required to verify drivers’ health certificates that are signed by an examiner in the registry. For more information on the system, visit nrcme.fmcsa.dot.gov/about.aspx.
Drivers who live in rural regions initially might have difficulty finding certified examiners close by. “But by implementing the registry slowly, the hope is that enough examiners will sign up,” Smith says. Currently about 200,000 examiners conduct tests, he says. That number is expected to drop due to the time and cost of becoming certified, but longtime observers say that 40,000 examiners will suffice for the program to function.
Truckers, especially in rural areas, also can expect to pay $100 to $120 for the exam, which often costs $60 to $75 now. “Just based on supply and demand, the assumption is that for truckers in areas where there is no competition and until the examiners pool builds up, there may be some initial higher costs,” Smith says.
The National Registry also will input drivers’ exam results into the national driver database, as part of the system that merges driver medical records with CDL records, which began in January. “This whole thing is dovetailing, implemented in stages, to have one large driver database,” Smith explains.
For a listing by state of medical examiners who paid to be included in an online directory, go to teamcme.com.
Advances for sleep apnea treatment
The most common successful treatments for obstructive sleep apnea are breathing devices. The sleeper wears a mask hooked to a machine that pushes air into the lungs — either a CPAP (continuous positive airway pressure) or APAP (auto-titrated airway pressure) machine.
For patients with mild to moderate apnea, dental devices can help by moving the lower jaw forward.
A new treatment involving a tiny surgical implant under the skin is being tested at Tampa General Hospital’s Sleep Disorder Center, says Dr. William McDowell, who heads the center. He notes that, generally, costs for diagnosing sleep apnea in-lab and monitoring devices for treating the condition are decreasing. Weight loss, the least expensive treatment, has also been shown to help, he says.
McDowell and Duke Naipohn, CEO of sleep apnea treatment provider SleepPointe, based in Wichita, Kan., urge drivers to be tested and treated if diagnosed with the potentially dangerous disorder. “We’re going to have drivers who will have to deal with this. It’s hit the radar, and it’s not going away,” Naipohn says.
SleepPointe is one of several sleep providers that have helped carriers develop fatigue management programs in the last several years. Prime Inc. and Schneider National started programs years ago. J.B. Hunt, Swift Transportation Corp., Crete Carrier Corp., H.O. Wolding and Ryder System Inc. are among fleets that have recently partnered with sleep labs to treat drivers.