Lost in certification

By Mark Schremmer, staff writer

Edward McMillen has been a truck driver for 36 years. He said he hasn’t had an accident for the past 34 years.

Entering his 2015 Department of Transportation physical, the OOIDA life member from Indiana said he had never complained of any problems sleeping or episodes of daytime drowsiness.

Regardless, McMillen was told by a certified medical examiner that he was required to have a sleep study.

According to McMillen, that decision was the beginning of a difficult journey that has caused him to sleep less and has cost him thousands of dollars.

McMillen said he has received conflicting medical advice, been forced to wear a CPAP machine, incurred out-of-pocket medical expenses of more than $3,000, and suffered about $10,000 in lost wages since being told to have a sleep study.

“I figure it’s about $13,000 that it’s cost me, plus all the sleep that I’ve lost,” McMillen said.

Sadly, his story is not all that uncommon. McMillen is one of thousands of truck drivers who have encountered difficulties regarding the medical certification process. The goal is to confront the problems before the costs spiral out of control and your health or commercial driver’s license is endangered. Or, better yet, take the proper steps to help prevent the problem from arising in the first place.

But in cases such as McMillen’s, it’s not always easy.

After being told by his certified medical examiner that he needed to be screened for obstructive sleep apnea (OSA), McMillen went to the Iowa Clinic West Lakes Sleep Center. McMillen said the staff performed a full evaluation and found no reason for him to undergo a sleep study.

However, the certified medical examiner still demanded that a sleep study be performed. After paying for the out-of-pocket test, the sleep study showed McMillen had an apnea hypopnea index (AHI) of 6.2. According to the American Academy of Sleep Medicine, a 6.2 AHI is on the low end for mild OSA. Severe OSA, which the academy says can cause involuntary sleepiness during such activities as driving, registers an AHI of more than 30.

Despite the mild diagnosis, the certified medical examiner said McMillen was required to use a CPAP device. According to the Mayo Clinic’s website, mild sleep apnea can be treated by making lifestyle changes, such as losing weight, quitting smoking, or treating your nasal allergies. The website says a number of treatments, including a CPAP machine, are available for moderate to severe sleep apnea.

What makes McMillen’s case even more interesting is that the sleep specialist and certified medical examiner recorded much different findings. His certified medical examiner at Concentra indicated that McMillen weighed 271 pounds and had a blood pressure of 136/68. One week later, the sleep specialist reported that McMillen weighed 242 pounds and had a blood pressure reading of 120/60.

“My blood pressure could have been a little higher, because she (the certified medical examiner) really had me wound up,” McMillen said. “But I can’t gain 30 pounds and then lose 30 pounds in a few days.”

In order to remain compliant, McMillen continues to be required to wear the CPAP at least four hours a night on most days. This is even though McMillen claims the CPAP has caused him to have trouble sleeping for the first time in his life.

“The FMCSA is trying to make it safe out there, but they’re just making it worse,” McMillen said. “I know there are some people who need this, but I have trouble sleeping with it.”

A case of discrimination?

Barbara Beal, an OOIDA member from Florida, also experienced problems with her certified medical examiner after a mild sleep apnea diagnosis.

Beal, who said she hadn’t experienced any sleep problems or had an at-fault accident in 25 years, believes her certified medical examiner targeted her for a sleep study simply because of her weight and neck size.

“I have 25 years of truck driving experience, and I’ve never had an accident that was my fault,” she said. “I understand that there are people out there who have problems with sleep apnea. But I feel like I’m being discriminated against because of my weight. My daughter is 125 pounds and snores like a freight train. But she wouldn’t be asked to be tested, because she’s skinny and has a small neck. Why discriminate against me?”

Beal said the sleep study determined she had an AHI of 9-10, which still registers as mild sleep apnea and does not require the use of a CPAP.

But just as in McMillen’s case, the certified medical examiner told Beal the use of a CPAP machine would be required in order for her to receive her medical card.

Beal said the cost of the study, machine and treatment was up to $3,500. Additionally, she said she lost a considerable amount of money because of time off the road for screenings.

“If you count all of the lost work, this has cost me $20,000 if not a little more,” she said.

Also like McMillen, Beal said the machine was a detriment to her health rather than a benefit.

“I could sleep all through the night until I got the machine,” she said. “After I started the CPAP, I no longer had dreams or entered REM sleep. My certified medical examiner said I had to keep using the machine and that I just wasn’t using it right and that I just had to get used to it. I asked him why I didn’t dream or get REM sleep any more, and he didn’t have an answer for me.”

Beal eventually did a home study with Phoenix Sleep Solutions and has been set up with a new certified medical examiner. She is no longer required to use a CPAP.

While most drivers haven’t experienced the extreme stories like McMillen and Beal, many more have dealt with the inefficiency of the system.

An inefficient system

David Becker, an OOIDA life member from Georgia, said he recently was charged about $80 by his certified medical examiner for an A1C diabetes test even though he had already taken the test from his family physician just two days earlier.

“A DOT physical used to cost me $45,” Becker said. “This one cost me $190 just because I have to duplicate this stuff. It’s absurd that you have to go to another doctor than your regular doctor who knows about your health and medical history.

“I used to be able to get a two-year medical card. I’m basically paying eight times more for my DOT physical than I used to. It’s four times more expensive than it used to be, and I have to do it twice as often as I had to a couple of years ago. I wouldn’t mind if it accomplished something, but it doesn’t.”

What can you do?

Scott Grenerth, OOIDA’s director of regulatory affairs, said preparation can play a big role in avoiding problems with the medical certification process.

“Don’t wait until it’s too late and be prepared,” Grenerth said. “Allow enough time for the unexpected, just like a driver would when they’re planning their trip for the day. Try to be relaxed. Get a good night’s rest the day before the physical. Don’t overlook the basic things.”

The OOIDA website also provides a link to the registry of certified medical examiners and offers a list of reviews on the doctors.

If a driver believes they have been wronged in the medical certification process, Grenerth suggests they call OOIDA.

“The first thing you should do is call OOIDA,” Grenerth said. “That’s why you’re a member. That’s why we exist, to help in situations like this. That’s what our business services department is here to do. Unfortunately, they are all too familiar with this topic. The first thing they’ll tell you to do is to get that second opinion if you can. They will try to find you a medical examiner who is most likely to give you a fair evaluation based on our experiences.”

The problem is that a second opinion is often not an option for a driver who is leased to a carrier that sends them to a specific doctor.

If all else fails, the FMCSA does have a system in place for the resolution of conflicts in the medical evaluation. The catch is that once a resolution of conflict application is submitted, the driver is disqualified until a determination is made.

“If you go through that process, you are giving up your ability to drive for an undetermined amount of time,” Grenerth said. “That’s how you resolve a conflict? You’re guilty until proven innocent in this system.”

Grenerth said the unfortunate thing is that the certified medical examiner holds all the power.

“It’s like the wild west out there,” he said. “The person who is doing the exam holds all the power. As long as they hold that authority, they have the gun and they’re the sheriff in town.”

Beal says she tells other drivers to get all the information in hand before they go in for their physical.

“Educate yourself before you go in there. Find out what the FMCSA requires, and find out what your company requires.”