While U.S. government slumbers, President signs a commercial driver sleep disorder bill

Transportation companies, commercial drivers and the medical professionals who certify them as physically fit for duty may be in for another long ride – legislatively speaking, that is.

During the government shutdown, the President signed a bill (HR 3095) approved by both houses of Congress to “ensure that any new or revised requirement providing for the screening, testing, or treatment of individuals operating commercial motor vehicles for sleep disorders is adopted pursuant to a rulemaking proceeding.”

This bill piles onto other commercial driver-related legislation, most notably hours-of-service rules and introduction of the new National Registry of Certified Medical Examiners, which goes into effect next May after years in the making. There’s so much back story here, it’s impossible to cover it in this space.

Commenting last week in an online forum, Dr. Natalie Hartenbaum, a national authority on transportation medicine, said the bill “does not require that a regulation or standard be promulgated nor does it prohibit guidance, only that any requirement be adopted through rule making.”

Right now, she said, the only requirement is that an applicant for a commercial driver’s medical certificate must be found to have “no established medical history or clinical diagnosis of a respiratory dysfunction likely to interfere with his/her ability to control and drive a commercial motor vehicle safely.” All else, including what is in the Federal Motor Carrier Safety Administration’s Medical Examiner Handbook, is guidance, Dr. Hartenbaum says.

Join us Nov. 4 when Dr. Hartenbaum will be our guest speaker a free webinar, Are you ready for new commercial driver medical rules?

Proponents of the bill signed into law said rulemaking in lieu of guidance would allow stakeholders to submit comments as the FMCSA attempts to resolve how to best protect the public and reduce risk for drivers with sleep disorders that cause fatigue and drowsiness. A former president of the American College of Occupational and Environmental Medicine (ACOEM), Dr. Hartenbaum said the agency had indicated in a letter to ACOEM that it would use a notice and comment process regardless of whether it pursued guidance or rulemaking.

Medical examiners are always expected to adhere to best practices. “Nothing in the bill changes that – examiners should use best current clinical judgment to evaluate a driver’s fitness to drive, his risk of having or developing a medical condition which may cause sudden or gradual incapacitation or impairment, and obtain and review any appropriate diagnostic studies,” Dr. Hartenbaum said.

Sleep Apnea and Drivers

All CMV operators must pass an exam to obtain a medical certificate that is valid up to 24 months. Of the more than 4.6 million truck and bus drivers in the U.S. who undergo mandatory exams each year, a significant percentage have potentially disqualifying medical conditions, including OSA.

There are established links between OSA and obesity. However, there has been professional discord about whether it is effective to use body mass index (BMI) as a screening factor for it. The FMCSA and its Compliance, Safety, Accountability program do not restrict drivers based on BMI, weight or neck size. (A neck size of 17 inches or greater for men, 16 inches or greater for women as an indicator of sleep apnea is generally not considered as informative as BMI.) Examiners refer drivers with symptoms of sleep apnea to a specialist for evaluation and possible treatment before they can be qualified to drive.

As a group, commercial drivers keep pace with the nationally reported obesity rate of nearly 36 percent of the U.S. population. Among 14 occupational groups in a Gallup survey of more than 139,000 American workers, the commercial driver group ranked first for obesity. Meanwhile, FMCSA reports up to 28 percent of CMV license holders may have sleep apnea. If left untreated, the condition places drivers (and anyone else on the nation’s roads) at increased risk for motor vehicle crashes that can result in tragic loss.

How will the new rules impact occupational health providers and employers with commercial vehicle operations? Join us for a complimentary webinar on new commercial driver medical exam rules — to find out.