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Despite pulling the sleep apnea rule certified medical examiners can and will still determine if a person in a safetysensitive role like a truck driver or locomotive operator is at risk for this medical condition Photo Sleep Association
<p>Despite pulling the sleep apnea rule, certified medical examiners can and will still determine if a person in a safety-sensitive role like a truck driver or locomotive operator is at risk for this medical condition. (<em>Photo: Sleep Association</em>)</p>

Trucking still needs clarity regarding sleep apnea

Pulling the proposed obstructive sleep apnea rule may actually muddy the regulatory waters for trucking companies and their drivers.

Over his 20-year career of the transportation and logistics industry, Steven Garrish worked with a lot of truck drivers. His work experience includes 15 years with J.B. Hunt Transport Services in its human resources and safety departments, with another five years spent supporting Walmart’s private fleet, including serving as senior director of private fleet safety. Now, as the senior vice president of safety and regulatory compliance at SleepSafe Drivers, Garrish focuses on fatigue management issues – including how to effectively deal with obstructive sleep apnea or OSA. In this guest column, he argues that the recent decision by the Federal Motor Carrier Safety Administration (FMCSA) and the Federal Railroad Administration (FRA) to pull a proposed OSA rulemaking effort may actually end up creating more confusion for trucking companies and their drivers over how to handle this medical condition.

Over the past few weeks, you’ve probably read about the Trump Administration withdrawing a variety of proposed regulations. This included the withdrawal of one that would have provided clearer direction on how operators in the trucking and railroad industries should be identified and treated for moderate to severe OSA.

Steven Garrish

How does the withdrawal affect the operators and the companies they work for? The answer: It doesn’t. Nothing changes, for the original FMCSA guidance that this rule would’ve helped clarify is still in place.

No matter your position on the proposed rule, there will be no real change to the current way patients are identified, tested, and treated for OSA. And really, the withdrawal might just add to the confusion.

A certified medical examiner (CME) can and will still determine if a person in a safety-sensitive role like a truck driver or locomotive operator is at risk for OSA. Once identified, they will be referred to a sleep specialist to be tested for the condition.

The problem with the original guidance is just that; it is guidance and there are no standardized approaches. Each CME can address the condition as they see fit.

Over the years, in different roles within industry safety departments, I would speak to truck drivers as they returned from physicals with different CMEs and there seemed to be no continuity in any individual assessment.

Referrals for these tests increased dramatically after the May 2014 CME requirements were published and became part of the training for doctors performing fitness for duty exams. They have continued at a brisk pace to this day and will continue going forward.

Though the science supporting the value of OSA treatment is overwhelming, whether you agree there is enough evidence or not doesn’t matter; those referrals will continue.

The real question is not whether there will be changes in frequency and volume of these referrals for OSA testing post rule withdrawal. It’s actually about whether having a specific OSA regulation helps or hurts the currently undiagnosed and untreated operators. I expect the quantity of referrals to remain the same, but believe the focus should be on the quality of these referrals. Standardization for health and safety should be, well, standard.

If you take a look at what the FMCSA and FRA’s medical review boards recommended, there are clearly defined measures and factors that every doctor should use in determining whether to send a patient for sleep apnea testing.

Without having specific guidance, the referrals and treatment requirements will be seen as subjective and the industry will continue to question the validity and motives behind them. Basically, we’ll continue living in the wild west—no uniformity, no checks and balances—in terms of who is or isn’t referred for OSA testing.

Like any great old western, when you have no law, chaos ensues and people do their best to make it up as they go along.

The trucking fleets and railroad operators who care about their employees want to save healthcare costs and diminish risk will continue to be “proactive” and help get their employees tested and on therapy.

The FMCSA, FRA, and their medical review boards went to great lengths to gather data, medical opinion, industry insight, driver feedback, etc. The proposed rule would provide a greater sense of clarity and reduce the possibility of abuse or fraud.

Ironically, for years, some in the industry asked for additional clarity in the form of a “formal rule.” Yet when it was close to fruition, those very same folks fought it tooth and nail – and some even resorted to spreading misinformation. I believe that regulation can often stifle business, but this regulation would have protected individuals and made sure that the market as a whole would be treated fairly.

So, while we continue to debate a rule, truck drivers and locomotive operators will continue to be negatively impacted by an unregulated industry that is costly, confusing, and time consuming.

The wild west of unchecked professionals, high insurance charges and inconsistent approaches to care will continue.

I, for one, believe our nation’s transportation professionals and those of us on the roads and rail every day deserve better.

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