Overdrive

September 2014

Overdrive Magazine | Trucking Business News & Owner Operator Info

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28 | Overdrive | September 2014 sleep apnea q&a at the clinic stressed that federal rules required the test based on those specific BMI criteria, as well as the hold on his certification, until he received results of a sleep study. If it was negative for apnea, he could get his certification. If positive, treatment would need to begin before his certification could be issued. LeVan is not the only driver to find new emphasis being placed on apnea screen- ing and tests during their most recent cer- tification. Nor is he alone in being taken off the road indefinitely simply because he's considered at-risk for the condition. With federal regulations regarding the condition long in limbo and several sets of cases that actually contradict federal pan- el-issued guidance available for examiners to consult, knowing what to expect from apnea screening has grown more difficult. Drivers who suspect they may be at risk would be advised to get out ahead of the issue by settling their diagnosis outside of the medical certification process. One in five respondents to an Overdrive poll conducted in June said their most recent certification resulted in apnea test- ing and/or treatment. Half of that 20 percent said no temporary certification – an option available to the examiner at his or her discretion – was issued to bridge the gap and keep the driver rolling during the time it took to test and treat. When LeVan spoke with Overdrive in June, he was $2,000 in arrears consid- ering downtime, lost pay and associated expenses. What's in the regulations on sleep apnea? Very little, notes Federal Motor Carrier Safety Administration spokeswoman Marissa Padilla. The condition is mentioned in Title 49 of the Code of Federal Regulations, section 391.41(b)(5): A person is physically qualified to drive a commercial motor vehicle if that person: Has no established medical history or clinical diagnosis of a respiratory dysfunction likely to in- terfere with ability to control and drive a commercial motor vehicle safely. Since a driver must be alert at all times, any change in his or her mental state is in direct conflict with highway safety. Even the slightest impairment in respiratory function under emergency conditions (when greater oxygen supply is necessary for performance) may be detrimental to safe driving. There are many conditions that interfere with oxygen exchange and may result in incapacitation, including emphysema, chronic asthma, carcinoma, tuberculosis, chronic bronchitis and sleep apnea. The regulation goes on to state that if examiners detect "a respiratory dysfunc- tion that in any way is likely to interfere with a driver's ability to safely control and drive a commercial motor vehicle, the driver must be referred to a specialist for further evaluation and therapy." There is no official regulatory guid- ance on the subject, though in 2012 the agency accidentally released – and later retracted – what appeared to be a pro- posal to adopt official guidance. It hewed closely to recommendations issued by a joint meeting of the agency's Medical Review Board of doctors and the Motor Carrier Safety Advisory Committee. Those recommendations, however, continue to be in the less-official realm of general guidance. That's a distinction many medical examiners don't under- stand, says driver Bob Stanton, co- founder of Truckers for a Cause, a sleep apnea support group and a chapter of the American Sleep Apnea Association's A.W.A.K.E. organization. Stanton defines regulatory guidance as where "FMCSA has officially adopted recommendations of outside medical groups or advisory panels and incor- porated it in the instruction." He uses the somewhat clear-cut blood-pressure guidance as an example. With general guidance, however, "the medical examiner is supposed to use his Short answer: Yes. That's from agency spokesperson Ma- rissa Padilla, though the issue is not on DOT's regulatory calendar as of the most recent publication, and outgoing Admin- istrator Anne Ferro said in a relatively recent congressional hearing that there were no near-term plans for a rule. Padilla emphasizes, however, that fol- lowing 2013 legislation Congress passed to require "FMCSA to address any further guidance on obstructive sleep apnea through the formal rulemaking process," the agency will pursue such a rulemaking. DOES FMCSA PLAN TO PURSUE A RULEMAKING RELATIVE TO SLEEP APNEA TESTING AND TREATMENT? Has your medical examiner during a certification exam in the last two years required sleep apnea testing or treatment as a condition of certification? OverdriveOnline.com poll, 692 respondents Examiner issued a short-term certification while I got tested and/or treated 10% Examiner refused to certify me until I got tested and/or treated 10% No 80% Dr. Randolph Rosarion shares insights on being a U.S. Department of Transportation medical examiner and other issues via his Dotmedicalexaminer.com website. Courtesy of Dr. Randolph Rosarion

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