Fed up, sleep apnea and your medical card.

Technically any medical condition that may interfere with driving must be addressed. No the DOT doesn’t list out every possible one, but they are technically allowed to test for it

 

I find it interesting that nobody ever mentions getting a second opinion when posting about DOT physicals. Here is an interesting article I found on the subject.

The FMCSA has made an important clarification for truckers concerning medical and physical qualifications to drive. Specifically, the clarification has to do with whether a trucker can seek a second opinion when obtaining a physical from a DOT-certified medical examiner.

The short answer is yes, but there’s more to it.

Chuck Horan, who oversees the National Registry of Certified Medical Examiners administered by the Federal Motor Carrier Safety Administration, says he’s received questions and concerns from drivers who are told by a medical examiner or someone else in the chain that getting a second opinion is not allowed on a Department of Transportation physical.

Horan says yes, drivers can get a second opinion, as long as they provide a full and honest history to their medical examiners and do not cross the line into illegal “doctor shopping.”

“It’s important that any time you’re dealing with the medical profession and medical judgment that you should be allowed the opportunity to go get a second opinion – to find out if the (doctor) is being extremely conservative with his call,” Horan told Land Line.

“Some are very conservative and others are not so conservative, so you may get two different answers from two different doctors using the exact same information. … In those cases, we don’t see that as doctor shopping, as long as you provide the doctor with the same information to make the call.”

Horan says medical examiners and the FMCSA are concerned about drivers who do not divulge their full medical histories to a second – or sometimes third – medical examiner after an initial examiner restricts or disqualifies the driver.

“If you go down the street and leave part of that history out, and obviously the new doctor that you’re at doesn’t have the information to make a full assessment and ends up giving you a card, that is doctor shopping,” Horan said.

The National Registry of Certified Medical Examiners went live on May 21, requiring all commercial drivers to get their next physical from a FMCSA-certified examiner.

The first few months of the registry being active have revealed some flaws and complaints.

Most of the concerns and complaints received by FMCSA – and by OOIDA’s regulatory and business services staffs – are about the inconsistency in how the certified medical examiners interpret DOT regs and guidance when conducting driver physicals.

Some examiners have run roughshod over drivers on the issue of sleep apnea, insisting that apnea testing is a regulation even though it is not.

OOIDA Member Jeffrey Spear, aka “Cowboy,” had a negative experience a few months ago when he went for a driver physical at Agnesian HealthCare in his hometown of Fond du Lac, Wis.

“They were looking to fail me and do anything they could to get me to take a sleep test,” Spear told Land Line.

Spear says the examiner measured him an inch shorter than he is, said he was heavier than he is, and measured his neck size an inch larger than it is. The examiner insisted Spear be tested for sleep apnea even though Spear had a note from his family doctor saying he did not have sleep apnea.

“(The doctor) had me down for a three-month card and I was to have a sleep study done at that time,” Spear said.

OOIDA Director of Regulatory Affairs Scott Grenerth said what Spear did next was within his rights based on the clarified FMCSA position on second opinion.

Spear sought his second opinion from Lynn Biese-Carroll, a certified examiner who is part of a medical team working out of the Highlands Petro in Racine.

According to Spear, Biese-Carroll did not think he was at risk for sleep apnea. She issued him a one-year medical card and did not order a sleep test, although Spear is to return to discuss his progress in being treated for blood pressure.

“It’s up to the doctor to do a thorough exam to see if drivers are at risk of a sudden, incapacitating event,” Biese-Carroll told Land Line in October.

“Because there is gray area (in DOT guidance), it’s up to the doctor’s medical opinion what the recommendation for follow up should be,” she said.

“We see a wide gap in practical application of the DOT’s regulations and recommendations – with some clinics being very lax, and some people being too rigid in the application of the DOT’s intended rules and regulations. We think that somewhere in the middle is probably where most of the doctors hopefully exist, with an interest in helping the drivers become healthier while still applying the rules that keep the driver road safe.”

Horan explained what the FMCSA does when two medical opinions exist for a driver.

“When we get two records on one particular driver, we have the capability of pulling the long form from both medical examiners and look at the long forms back-to-back. If they’re identical, if you have a doctor that lets you have a six-month, one-year, or two-year card, that card is good,” he said. “That card would be the card of record.”

The latest word on sleep apnea
According to a bill passed by Congress and signed into law in October 2013, the Federal Motor Carrier Safety Administration shall not issue guidance to medical examiners on sleep apnea or advance an apnea restriction without first going through a full rulemaking process that includes a public comment period.

 

This is true. The FMCSA leaves it up to the ME when determining fitness to drive. My only point with my comments is medical examiners use non existent rules and guidelines like this. Especially when they send drivers to sleep labs where they have invested money!

 

I did make a vague reference to a 2nd exam but make sure you tell the 2nd examiner about the 1st. You do have the right to a 2nd opinion. I would just add that that last part has been addressed by the DOT last year. They have dropped all these standards. Expect rule making though at a later date. Till then tell these MEs that keep saying "oh it's the guidelines" to stick it and go see a ME that actually knows the rules.

 

I'll ask you again, does the FMCSA have a mechanism in place to ensure that an individual who holds a CDL, and has been diagnosed with sleep apnea is compliant with the prescribed medical treatment of said condition?

If not, how would a person who is diagnosed with sleep apnea and is prescribed treatment be able to demonstrate to the FMCSA they are compliant with prescribed treatment?

Especially, since right on the ME longform certificate questionnaire, the question is asked on line 26 "Have you ever had a sleep test?"

If you have and are truthful about not only having had the test, but were determined to have sleep apnea with prescribed treatment, the ME is required to provide an explanation in writing on the form BEFORE he can issue a medical certification qualification for operating a motor vehicle.

What would he do, just say the applicant claims to be compliant with his prescription and said he feels good?

Of course not. He has to provide documentation of compliance with the prescription on a form which is submitted to the FMCSA.

However, it doesn't surprise me that some encourage lying on their DOT medical questionnaire. I've read guys do that on this forum about everything from previous work injuries to diabetes.

 

I'll ask you again, does the FMCSA have a mechanism in place to ensure that an individual who holds a CDL, and has been diagnosed with sleep apnea is compliant with the prescribed medical treatment of said condition? NO THEY DO NOT!

If not, how would a person who is diagnosed with sleep apnea and is prescribed treatment be able to demonstrate to the FMCSA they are compliant with prescribed treatment? THEY DON"T HAVE TOO!

Especially, since right on the ME longform certificate questionnaire, the question is asked on line 26 "Have you ever had a sleep test?" Yes sleep questions are on the long form. (at least the last one I looked at) This does NOT mean anything in regard to guidelines or standards.

If you have and are truthful about not only having had the test, but were determined to have sleep apnea with prescribed treatment, the ME is required to provide an explanation in writing on the form BEFORE he can issue a medical certification qualification for operating a motor vehicle. NO, the ME is not!

What would he do, just say the applicant claims to be compliant with his prescription and said he feels good? IT Does not matter, there are no sleep apnea rules!

Of course not. He has to provide documentation of compliance with the prescription on a form which is submitted to the FMCSA.Again there are NO FMCSA rules on sleep apnea!

However, it doesn't surprise me that some encourage lying on their DOT medical questionnaire. I've read guys do that on this forum about everything from previous work injuries to diabetes. Yes unfortunately drivers lie on just about everything they can get by with.



Look I know it is tough for some to understand. However the FMCSA removed everything dealing with Sleep Apnea. There is no language in the FMCSA ME Handbook, or 391.43. Nothing. The FMCSA removed it all. In fact this new handbook has not been out long because the FMCSA has reworked it.

To the best of my knowledge the only thing about Sleep Apnea is some general questions on the long form. That's it.

 

Well then, every single CDL holder that has sleep apnea and are currently using using a medically prescribed PAP machine, you're off the hook!

On your next physical, answer yes on line 26 of your questionnaire, when he/she ask you for an explanation, tell them you stopped using it and to stick it where the sun don't shine.

Come back here and let me know how it went LOL.

 

I won't answer that comment like you made it. I am just going back to my comment. There are NO standards or Guidelines for sleep apnea. None. Not a single one. I know this is hard for you to accept. However congress got involved and stopped this several years ago. Then the DOT made it official last year. Your relationship with your Doctor/Medical Examiner is up to you. All I know is even if I had sleep apnea and was still driving I would not put up with that crap! Now I understand that there are a lot of drivers having to deal with this in relation to their carrier. I'm not trying to pick any fights tonight. I'm just trying to get drivers to understand you don't have to put up with this crap.

 

Skinny people can have it. Fat people can not have it. Doesn't fit that little fairytale those groups are selling but that is fact.

 

There is a simple fix. Stop working for baby truck companies.
We do have the power to force them to change, if we simply refuse to work there.