A set of recommended sleep apnea screening protocols first recommended in 2016 appears to have been adopted by some medical examiners who perform Department of Transportation physicals. There’s evidence the screening criteria may have been plucked from a draft update to the Federal Motor Carrier Safety Administration’s official Medical Examiner handbook. The draft was posted online in April as part of the public record from an FMCSA Medical Review Board meeting that in part discussed potential updates to the handbook.
Publication of the draft does not violate the spirit of Congress’ 2013 requirement that FMCSA follow formal rulemaking procedures in any official guidance on apnea protocols, said FMCSA spokesman Duane DeBruyne. The draft, with its newly included sleep apnea screening guidelines, is a work in progress up for discussion, he said, and “does not provide current, official, FMCSA interpretation and guidance to medical screeners.”
Following Overdrive‘s inquiry, DeBruyne and FMCSA staff also discovered a “technical glitch” that might have contributed to confusion about the document’s status. Every page is clearly marked as a “draft” with a large watermark, at least for many viewers. But in some cases, depending on the software the reader is using to access the draft, the watermark sometimes is not visible.
“On my own home computer,” he added, “I likewise do not see the word/watermark ‘DRAFT’ anywhere in that document.” The agency is “feverishly working on solving” the problem, DeBruyne said.
Apnea screening protocols put forward as Medical Review Board recommendations in the draft closely resemble those drafted in 2016 when FMCSA was considering a rulemaking (later abandoned) around the condition. Among other things, it would require any driver with a body mass index measurement greater than or equal to 40 to receive a conditional certification pending results of diagnostic testing for sleep apnea. Other criteria specify a variety of screens for drivers with a body mass index greater than or equal to 33. The wide net the screens would cast, Overdrive research estimated at the time, might have screened between 25% and 38% of truckers then not being treated for apnea.
The recent draft was crafted as part of what the Medical Review Board had been tasked to complete by the end of 2017. There’s some evidence the technical glitch or simply the draft’s publication itself may have facilitated confusion for some medical screeners and third-party companies in the business of printing and distributing guidebooks and software.
Earlier this month, Ohio-based 18-year professional trucker Aaron McCloskey went in to do his medical certification renewal. The examiner recommend a three-month conditional certification on account of screening software that, nearing the end of his examination, popped up with a recommendation for sleep apnea screening.
