Going Around to the Back Door

By Sandy Long

In 2006, the FMCSA Medical Review Board was chartered to look at different medical conditions relating to highway and truck driver safety and then make recommendations to the FMCSA.  The FMCSA can then choose, or not choose, to pursue those recommendations and then propose regulations concerning them. When Dr. Barbara Phillips M.D. (at the time also Chair of the National Sleep Foundation) took the chair of the board, sleep apnea and body mass index (BMI) came to the forefront of the board’s attention.

With the meetings heavily populated by medical device manufacturers and sleep clinic corporations, and after having sleep apnea seminars around the country, the board recommended that truck drivers needed to be sleep tested according to BMI and neck size.  Their supposed premise was that many truck drivers were obese therefore at risk of high incidence of sleep apnea and fatigued driving.  While it is true that many obese people may have sleep apnea, fatigued driving is not a major factor in crash causation; statistics show fatigue to be about 1.4% of the causes of crashes involving truck drivers.

While the FMCSA chose not to pursue this recommendation into regulatory process other than guidelines to doctors performing DOT physicals, the damage was done.  Fearful of losing drivers in mass if regulations came thru, companies started pushing sleep studies for their obese drivers, some going to the extent of posting on their websites, that if a driver was such or such BMI do not bother to apply.  Occupational clinics brought out their tape measures and started measuring necks then sending drivers for sleep studies arbitrarily to receive their DOT physicals.  Some companies are refusing to hire people who use a c-pap machine, the only device allowed truck drivers to treat sleep apnea outside of surgery.

The newest head of the Medical Review Board is Benjamin H. Hoffman, M.D. M.P.H. (Texas) who is the Global Chief Medical Officer at GE Energy.  GE Energy develops and markets c-pap machine parts.  Once again, sleep apnea and BMI are in the news.  The Medical Review Board is now recommending that truck drivers with a BMI of 35 or more be mandatorily tested for sleep apnea or they will not be allowed to drive.

Ignoring other statistics that shows that roughly, 16% of normal sized people have sleep apnea and other treatments for sleep apnea such as dental devices and medication, the board recommends that truck drivers use only c-pap machines that can be monitored thru recordings of the machine, and that cost $5000.  Add the cost of the sleep study, $2,000, and the amount of truck drivers who do not have adequate or any insurance, it is a given that many truck drivers will have to leave the industry.

Some industry experts are hoping that the FMCSA once again, chooses not to pursue regulations concerning sleep apnea and BMI, but as has been seen the damage is done; once again, truck drivers are being unfairly discriminated against, many because of the occupational hazard of weight gain.

What will obese truck drivers do if they cannot afford sleep studies and c-pap machines?  For older drivers, retirement is the only option or for them to go onto disability, most have been truck drivers all of their lives and have no other job skills.  Younger drivers may be able to lose enough weight, unless heredity or disease is the cause of it, to continue to drive after the weight loss or learn new job skills…how do they live until then?  Does anyone care?  Does not look like it to me.

On a personal note, a friend of mine and I got into a discussion about obesity, BMI and sleep apnea.  She asked me if I did not want truck drivers to get healthy.

In my opinion, many things would need to change in the trucking industry for truckers to become healthier.  Companies would have to stop having just in time freight so drivers had the time to exercise and eat properly during the workday.  Companies would also have to start treating their drivers as the valuable skilled people they are so stress levels from company interactions and policies would lower.  Truck stops would have to do away with junk food and fast food, and offer better service and choices in their restaurants.  Law enforcement would have to start targeting cars that act stupid around trucks.  The government would have to get out of our cabs and quit expecting so much from us thru unrealistic goals and regulations for us.

Finally, truck drivers would have to regain their pride not only in their jobs, but also in themselves; then their health would be between them and their personal doctors instead of having biased regulators try to make money off our backs thru medical regulations that are unreasonable, unfounded and unnecessary.

Will any of the above happen, perhaps, but until then we will have to put up with money hungry, discriminatory review boards that use whatever means to do what they want to do to further their agendas, even if they have to sneak those agendas thru the back door to achieve them.









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