FMCSA to clarify guidance to medical examiners on sleep apnea

By David Tanner, Land Line senior editor | Wednesday, November 26, 2014

The Federal Motor Carrier Safety Administration says it plans to issue a bulletin to certified medical examiners and medical trainers to clarify the differences among guidance, regulations and medical judgment on the topic of testing truckers for obstructive sleep apnea.

The bulletin comes in response to a letter of concern by two U.S. representatives claiming that third-party medical trainers are instructing certified medical examiners to test truckers for sleep apnea. Such an action flies in the face of a 2013 law that prohibits the FMCSA from implementing or enforcing requirements on sleep apnea without going through a formal rulemaking process.

FMCSA Acting Administrator Scott Darling wrote back to U.S. Reps. Larry Bucshon, R-Ind., and Daniel Lipinski, D-Ill., on Sunday, Nov. 23, to address the difference between interpretive guidance and the regulations.

“FMCSA’s current interpretive guidance concerning (obstructive sleep apnea, or OSA) was issued on October 5, 2000, as part of a set of advisory criteria for medical examiners to use in making the individual determination whether a driver meets the physical qualifications standards,” Darling stated in the letter.

“Based on the advisory criteria, a medical examiner should refer the driver to a specialist for evaluation and treatment if the examiner detects a respiratory dysfunction, such as moderate-to-severe OSA, that is likely to interfere with the driver’s ability to safely control and drive a commercial motor vehicle.”

With that said, Darling went on to explain how FMCSA does not prohibit training organizations from presenting more information to medical examiners about obstructive sleep apnea than the October 2000 guidance states. Darling said that FMCSA “neither reviews nor approves training materials or programs.”

Darling stated that the administration will issue a bulletin to all health care professionals on the National Registry of Certified Medical Examiners, including the training organizations, “to clarify that the current federal regulations and associated advisory criteria do not provide guidance for screening and testing drivers for moderate-to-severe OSA.”

“FMCSA will encourage medical examiners to explain to drivers the difference between actions based on the current regulations and advisory criteria versus actions based on the medical examiners’ professional judgment.”

Truckers have contacted OOIDA and the FMCSA about their medical examiners withholding or delaying driver medical cards until the drivers submit to sleep testing based on criteria such as neck size, snoring and body mass index. Many drivers report being told that sleep testing is part of a regulation.

OOIDA Director of Government Affairs Ryan Bowley questions how far the FMCSA’s bulletin to health care professionals will go to correct issues.

“We’ve highlighted this numerous times that it’s important that FMCSA be in touch with the examiner community as issues come up,” Bowley said. “If this bulletin shows they’re going to do that and be in communication with those folks, then that’s a good thing. The question is will this bulletin be part of the training and retraining that these medical examiners undergo?”

In Darling’s letter to lawmakers, he repeats something that former Administrator Anne Ferro said about future regulatory actions on apnea – that the FMCSA is considering a notice seeking information that would help the administration estimate the potential costs, benefits and safety implications.

OOIDA Director of Regulatory Affairs Scott Grenerth points out that the FMCSA has not provided a timeline for sending out its bulletin to medical examiners.

He adds that drivers should always be prepared with documentation when they show up to their DOT physicals.

“Even though the FMCSA is planning on issuing a bulletin, and even if it is useful, drivers still need to be informed consumers,” Grenerth said.

See related stories:
U.S. lawmakers call out medical examiners for pushing apnea tests for truckers
President signs bill to require full process on apnea regulation
OOIDA: Bill to limit apnea guidance is ‘common sense’

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