Truckers to FMCSA: Make sure medical examiners are on same page relative to sleep apnea

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sleep apneaSeveral trucking industry stakeholders weighed in during an FMCSA fact-finding session held May 25, intended to aid the agency in determining whether a rule is needed within the trucking industry to regulate sleep apnea screening and treatment among truck drivers. The May 25 session was the third of three scheduled for this month by FMCSA and its sister agency the Federal Railroad Administration.

Commenters on Wednesday echoed the feedback offered at the two previous listening sessions (coverage can be found here and here), their key point being that obstructive sleep apnea isn’t the only reason drivers can be fatigued.

“It’s important to reiterate other comments we’ve heard in previous listening sessions…driver fatigue can often arise from many different factors beyond OSA,” said Kevin Walgenbach of the National Ready Mix Concrete Association. “Crashes due to fatigue occur for many different reasons than OSA. Should the agencies move forward with a rulemaking, we believe it should be based on sound science, concrete data and comprehensive analysis.”

Walgenbach also suggested the agency pursue a pilot program to help determine what the practical costs and implications of such a rule would be.

“Not all insurance providers cover screenings, equipment and everything that goes along with OSA,” he said. “There is coverage out there that may cover these things in full, or in large part, but there are also a good number that don’t cover it at all. On the low end, we’ve seen drivers pay as much as $2,000 out of pocket, and on the high end between $12,000 and $15,000.”

Walgenbach, along with Vallejo, Calif.-based driver Dave Haley, said if a rulemaking is pursued, medical examiners need to be on the same page so there are uniform diagnoses.

Haley said he was sent for a sleep test, which resulted in a diagnosis of minor sleep apnea, but still wasn’t granted his medical certification by the first ME he saw because, Haley said, the ME wasn’t satisfied with the results. Haley then went for a second opinion and was cleared for a one-year certification within 30 minutes of seeing the doctor.

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“FMCSA needs to make rules so the MEs are all on the same page,” he said.

Larry Minor, associate administrator for policy at FMCSA, said a bulletin was issued earlier this year to MEs, which stated that current regulations “do not include guidelines concerning OSA screening, diagnosis and treatment.”

“Medical examiners should rely upon their medical training and expertise in determining whether a driver exhibits symptoms and/or multiple risk factors for OSA, and they should explain to the driver the basis for their decision if the examiner decides to issue a medical certificate for a period of less than two years to allow for further evaluation, or to deny a driver the medical certificate,” he said.

Tami Friedrich Trach, a board member for Citizens for Reliable and Safe Highways (CRASH) and a volunteer with the Truck Safety Coalition, said more needs to be done to combat fatigue-related crashes in the trucking industry.

“Drivers who don’t adhere to OSA treatment are five times more likely to be involved in a crash,” she said. “We can’t allow tired truckers on our roads. It’s not an acceptable risk of getting on the road.”

One independent owner-operator, Tilden Curl, said he was diagnosed in 2003 with a thyroid condition that had similar symptoms to OSA. Curl added he believes if he was seen for that condition today, he would be sent for a sleep study and “treatment of my real problem might not happen until much later” because of pressure from FMCSA to find OSA cases.

“FMCSA should get out of the medical field and leave it to the doctors,” Curl said. “Doctors should be the only ones deciding if drivers are fit to be on the road.”

The agencies asked specific questions in the fact-finding ANPRM, which can be seen here, for commenters to answer in their comments. Those wishing to comment can do so here.

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