News from Federal Public Hearings on Sleep Apnea
As has been reported on here at Sleep Scholar the Federal Motor Carrier Safety Administration (FMCSA) and Federal Rail Authority (FRA) are jointly seeking information on sleep apnea for safety sensitive position within each agency. In plain English…. They want to know about sleep apnea for truck drivers, bus and motor coach drivers, and train crews.
Toward that end the agencies scheduled listening sessions (AKA public hearings) where anyone interested can come and make their views known in comments to a panel from the agencies.
The first 2 are done. The third and final session is Wednesday May 25 in Los Angeles, CA. This final listening session will be webcast. You can participate via e-mail. FMCSA will post links on its Facebook page. Archives of the webcasts of the first 2 are also available there.
What’s been interesting is who has NOT been making comments. There have been no public comments from medical professionals involved in the administration of DOT medical exams. The American College of Occupational and Environmental Medicine (ACOEM) is the group representing Occ-Med doctors who normally give DOT physicals under the NRCME examiner system. There also have been NO public comments from the American Academy of Sleep Medicine (AASM). Tuesday May 12 the listening session was in downtown Chicago. With the AASM based in Darien IL a Chicago suburb it was surprising no one from AASM made public comments. They may have had staff at the meeting that chose to not make comments.
There also have not been public comments from what in trucking are known as the highway safety advocacy groups. The Truck Safety Coalition, The Lindsay Foundation, Parents Against Tired Truckers, and Citizens for Reliable And Safe Highways have all been silent.
Groups that have commented include Dr. Richard Klein from the ASBA who made oral comments at the Washing DC session. He pointed out that in the general population CPAP compliance is 50% or less. Comments from other commenters at the Chicago session pointed out CPAP compliance in CMV operators is 96-98% due to the requirement they show compliance to get a DOT medical card and keep their job. Issues around safety sensitive position workers being able to work or not while oral appliances are titrated is still a debated issue.
Comments from Dr Kerstettler a Sleep Specialist at the Chicago session suggested using a 3 night HST protocol. Costs issues for this were discussed. Comments from Dr. Langford with Sleep Safe Drivers a specialty firm working in transportation provided good information.
As expected the Owner Operator Independent Operator Association (OOIDA) had several members give comments generally in opposition to OSA testing and treatment. A lengthy discussion of the available research on sleep apnea crash risk in CMV operators was part of the comments. The fact that there is research on both sides of the topic as has been discussed in other Sleep Scholar articles was brought up. Yet, the robustness of the recent Burks et al study was part of comments.
What was dismaying was the drivers at both the Washington DC and Chicago sessions who had tales of the administrative nightmares they went through because of sleep apnea testing and treatment. Carla Williams a driver for a major motor carrier told of her saga of getting a PSG from a testing firm under contract with a motor carrier showing an AHI of 19. When retested via PSG in a lab of her primary care physician’s recommendation she showed an AHI of .8. (Yes .8). The motor carrier on the recommendation of the contracted physician from the first study will not accept the second no treatment recommendation and she is facing loss of employment. A driver had passionate comments about his saga at the Washington DC session.
Sleep medicine professionals need to become involved with comments on the ANPRM to give the agencies realistic medically correct information.
Topics as simple as screening criteria for CMV operators that establish “medical necessity” for insurance purposes are not fully understood. A common thread in driver “horror” stories was being screened high risk by a DOT medical examiner but the criteria used did not establish “medical necessity” for insurance. After testing they were faced with paying out of pocket due an insurance claim denial. Stories of sleep study results being held hostage until bills of $ 800 or more for an HST came out.
Comments on the ANPRM are open until June 8 and can be submitted through the regulations.gov cite on docket number FMCSA–2015–0419. Comments submitted already make some interesting reading.