Crash Rates Are More Than 5 Times for Stubborn Apnea Truck Drivers (Who Don’t Use Device)

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Truck drivers who ignore their sleep apnea treatment have a five times higher preventable crash rate than drivers without apnea, says a new study in Sleep journal.

A 2002 study found that up to 28.1% of heavy truck drivers have mild, moderate or severe sleep apnea, according to the the Federal Motor Carrier Safety Administration (FMCSA). the most common of several types of sleep disorders, in which breathing repeatedly stops and starts during sleep.

This new study is called “Non-Adherence with Employer-Mandated Sleep Apnea Treatment and Increased Risk of Serious Truck Crashes,” Sleep, March 21, 2016. Lead author is Stephen V. Burks, Professor of Economics and Management at the University of Minnesota, Morris (UMM).

In this study 1613 drivers at Schneider National, who were diagnosed with sleep apnea, were prescribed positive airway pressure (PAP) therapy and provided with a self-adjusting CPAP machine. Results of the study were compared to a control group of the same number of drivers.

“We found that truck drivers with untreated obstructive sleep apnea are at dramatically greater risk of serious, preventable truck crashes, consistent with the greatly increased risk of motor vehicle crashes among automobile drivers with untreated obstructive sleep apnea,” said study co-author Charles A. Czeisler, PhD, MD, FRCP, chief of the Division of Sleep and Circadian Disorders at Brigham and Women’s Hospital, and Baldino Professor of Sleep Medicine at Harvard Medical School in Boston.

Drivers with sleep apnea who did not follow therapy eventually were terminated after given the another chance and choice to stick to the treatment.

Facts about Sleep Apnea

Sleep apnea is a treatable sleep disorder.

“An apnea is defined as complete or near cessation of airflow for a minimum of 10 sec with or without associated oxygen destaturation and sleep fragmentation.” Principles and Practice of Sleep Medicine 5th ed.

OSA, if untreated, can lead to daytime sleepiness and increases fall-asleep-crash risk.

Over 10% of truck drivers have moderate to severe OSA.

This high prevalence of OSA in truck drivers is unsurprising, as they tend to be middle-aged, male, and obese, according to a paper cited by the NCBI.

OSA remains largely undiagnosed in commercial truck drivers.

Doctors usually can’t detect the condition during routine office visits. Also, no blood test can help diagnose the condition.  U.S. National Heart, Lung, and Blood Institute

Polysomnography (PSG) aka sleep study or Sleep Lab (technologist attended), is only accurate test, know as the gold standard, as the Portable monitoring study while a less costly alternative method is not as accurate.

The Problem(s)

Several people I have spoken who were prescribed CPAP machines don’t use them because they don’t like the mask. Some don’t the feel of the mask or don’t like getting wrapped up in the hose at night. Older machines tended to be loud at night. Truck driver Christopher Hill says it’s no big deal.

Another problem is cost. Sleep studies can run into thousands of dollars and are generally an out-of-pocket expense as sleep studies are not covered by health insurance. The CPAP machine runs into hundreds of dollars and the mask and head-straps have to be replaced several times a year. As these items are federally regulated medical devices, nothing is ever cheap.

Public law 113-45, signed into law on October 15, 2014, requires  the FMCSA to enact rules “if the agency decides to establish requirements for commercial truckers to address certain sleep disorders among drivers.”

In January 2015, the Federal Motor Carrier Safety Administration (FMCSA) issued a Bulletin on the physical qualification requirements for drivers with obstructive sleep apnea (OSA).  The American Trucking Association stated this was in error as it contained no specific guidelines and violated the spirit of PL 113-45 which requires an objective cost-benefits analysis.

On Tuesday, March 8th, 2016 the FMCSA opened a ninety day period for public comments on sleep apnea.

While we can expect FMCSA rulemaking in the future, the controversy about truck drivers and sleep apnea will probably not end there.

Is there a problem with truck drivers with sleep apnea? If so, who should make that determination?

Thank you for reading this.

Lessons Learned: The DOT Medical Exam in Hiring

Unreasonable beyond this point.

A large Indiana-based trucking firm was fined $200,000 by the U.S. Equal Employment Opportunity Commission (EEOC) for its driver medical policies according to Crain Communications’ Business Insurance.

One error was having drivers undergo a DOT medical exam before making a *conditional offer of employment — a violation of the Americans with Disabilities Act (ADA).

(*Conditional offer of employment refers to an offer of employment that is dependent on the completion of certain conditions or passing certain tests.)

When should an organization employing DOT regulated drivers make a conditional offer of employment?

Best transportation-industry driver hiring practices include:

  • administration of a road test, and
  • (if a CDL driver) receiving the results of the DOT pre-hire drug test/screen

before making a conditional job offer. Once a conditional job offer is made, a candidate can then be asked to undergo a DOT physical or medical examination.

A second error by this carrier was asking disability-related questions before a conditional job offer was made. Once a conditional job offer is made, Federal law permits medically-related inquiries of drivers, if the questions are (1.) job-related, and (2.) consistent with business-related necessity.

 . . .if a job applicant volunteers such information, the interviewer is not permitted to pursue inquiries about the nature of the medical condition or disability. Instead, the interview should be refocused so that emphasis is on the ability of the applicant to perform the job, not on the disability.

Motor carriers should also be cautious of any broad medical-clearance policies as: a requirement to notify the company of any contact with medical professionals, or deploying overly broad medical-release forms.

Summary:

It is unlawful under the ADA to ask drivers questions about medical conditions and/or a disability before a conditional job offer is made. Steer clear of this topic in a pre-hire interview.

Medical records of all applicants and employees must be kept separate from all other personnel information.

Keep any employee medical records in a secure area (under lock and key) with limited access.

Be sure to review your policies, procedures and company manuals to comply with the ADA requirements.

To learn more, see The DOT Safety Audit Guide.

Thank you for reading this.

Medical Cards for Drivers

Part 391

Donald Jerrell of HNi recently posted a blog about driver DOT medical cards (certification).

Deadlines for Medical Cards for Drivers

Some important dates for medical certification to keep in mind include:

  • Jan. 30, 2014: This is the effective date (now passed) that commercial drivers must submit their medical certificate to their state Department of Motor Vehicles.
  • Jan. 30, 2015: Interstate commercial drivers must keep copies of their medical examiner’s certifications with them in their vehicle until this date.
  • May 21, 2014: As of this date, all drivers must get medical certification from a health care pro listed in the National Registry of Certified Medical Examiners.

Finding a Certified Doctor

Drivers only can get medical certification from a certified medical examiner who’s on the National Registry. The state DMV syncs its records of who’s a certified medical pro with the registry.

NOTE the REQUIRED NOTE

A company must verify that a doctor is certified, according to 391.51 (requirements for driver qualification file):

(9) A note relating to verification of medical examiner listing on the National Registry of Certified Medical Examiners required by §391.23(m).

 

Notification of Expiration of Medical Certification

Surprise, Surprise, Surprise.

Who is responsible to notify a CDL driver that his DOT physical is due to expire?

Responsibility = response + ability, or the ability to respond.

Due to the stringent DOT medical examination requirements, I recommend every driver renew his medical certificate at least 30 days before it is due to expire. Both the driver and his or her organization should have a reminder system in place so this gets done.

About one out of three men have sleep apnea, many times due to a buildup of fatty tissue in the neck. Testing or retesting may be required.

Rushing to do your medical exam (or drinking coffee, taking cold medication, etc.) can raise your blood pressure, resulting in a 90 day card, and another visit to the examiner.

For best results, plan well ahead of the due date, relax, do the exam and get your medical certificate. And don’t forget to take it to your DMV or Secretary of State, etc., so your federal records can be updated.

If a driver fails or is not recertified for a DOT Medical Certificate?

What are the rules, if a driver fails or is not recertified for a DOT Medical Certificate, due to the particular type of medicine he is on?

A Medical Examiner’s Certificate, which is also known as a DOT Medical Card, is required for every Commercial Motor Vehicle (CMV) driver. The card is issued by a DOT Medical Examiner after a “DOT physical examination.” A driver is asked to fill out a form called a “Medical Examination Report for Commercial Driver Fitness Determination,” also known as the “long form” which details the driver’s medical history and lists all current medications. To show that the driver is “fit” or medically qualified to drive, the card is required to be carried by all CMV drivers (and CDL drivers until at least January 30, 2015). This information will become part of a driver’s motor vehicle record (MVR) when the CDL driver “self-certifies” or updates the information at his Department of Motor Vehicles (DMV). Carriers and organizations should retain a copy of the card for the driver’s qualification file (QF). For most drivers, this card is valid for a period of two years. Before the expiration date of the card, the driver should recertify with another DOT examination.

If there is a change in a driver’s health status, the driver may be medically unqualified to drive and the card would become invalid. Here are a few actual situations concerning a driver’s health status:

Example 1:
A CMV driver had a “sleep study” at a sleep clinic and left for a two week trip. When he was 351 miles from home, he was informed that he was diagnosed with sleep apnea. He informed his dispatch of the results of the sleep study. The driver was told to secure and clean out the truck, then load his personal belongings on a Greyhound bus and return home. The driver was off work for four weeks waiting for a sleep study appointment, then getting his CPAP machine. He was on the CPAP for 7 days before a DOT Examiner certified and released him to return to work as a CMV truck driver.

Example 2:
A CMV driver had a mild cold. He did not see a doctor or take any medication or over-the-counter cold medication, as he felt he did not need it and the mild cold did not impair his driving. As such, his medical card was in effect and no other action was required.

Example 3:
A CMV driver with a chronic medical condition was issued medication with the warning on the bottle saying “DO NOT OPERATE HEAVY EQUIPMENT.” When the driver began taking the medication, he was not medically qualified to operate his truck and the medical card became invalid. The driver should see a medical examiner for a new card, if his medical condition improves and that particular medication is not needed.

Example 4:

A CMV driver was helping a friend on the weekend do a roofing job. His ladder slipped as he started to climb, he was knocked out and taken to the hospital. In his state, “a loss of consciousness” means “loss of all driving privileges” for six months. The driver should see a DOT Examiner for an examination after the mandatory six month period.

If a driver experiences a change in his health status, he may be medically unqualified to operate a CMV. He should consult with appropriate medical professionals before resuming to drive a CMV.

CSA EFFECTS

A DOT medical card (Part 391) violation falls under the Driver Fitness SMS BASIC Category in CSA. Violations in the Driver Fitness BASIC are the cause of 9% of DOT Interventions/ Investigations according to Patti Gillette of the Colorado Motor Carriers Association. There are 30 Driver Fitness violations that can affect your CSA scores according to the Table of Driver Fitness BASIC Violations.

A driver cited for failure to carry a medical card (Part 391.41) adds 3 points to the CSA score (1 point times a CSA Time Weight of three = three points). Violation of 391.41A No Medical Card in Possession continues to be a top violation year after year. Best Practice: keep a photocopy of the card in the truck.

A driver with a history of driving without a valid medical card (no card in possession or an expired card in possession) may be placed Out Of Service (OOS), which would add another six CSA points (2 points times a CSA Time Weight of three = 6 points), as of April 1, 2012, according to the North American Standard Out-of-Service Criteria (OOSC).

CSA points follow carriers for 24 months, but fall off over time:

Time Weights (Carriers)
0-6 months old = 3
6-12 months old = 2
12-24 months old = 1

SUMMARY

CMV drivers need to carry or keep a copy of a valid DOT medical certificate with them when driving (CDL drivers until at least January 30, 2015), and recertify their certification before their current DOT Medical Certificate expires. CDL drivers need to make their medical certification a part of their CDL driving record.