OT: NYC Train Victims Sue Engineers Dx?

Among other things, the medical reports said that a post-crash sleep evaluation showed that Rockefeller experienced 52.5 to 67.5 episodes an hour while sleeping in which his airflow was disrupted for at least 10 seconds.

Read more: http://www.latimes.com/nation/nationnow ... z2ypCjpc54

Rockefeller was examined by a sleep expert after the crash and found to have a fatigue-inducing sleep disorder because of his age and excessive weight. Rockefeller, who is 5-feet-11 and 261 pounds [BMI=35], and was 46 at the time of the crash, had “severe obstructive sleep apnea,” an expert concluded, according to the NTSB documents.

Read more: http://www.nydailynews.com/new-york/met ... z2ypGeIpWA

According to the National Transportation Safety Board, William Rockefeller, the engineer at the controls of the Metro-North commuter train that derailed in the Bronx, had the sleep disorder at the time of the accident, and it had not previously been diagnosed.[1]

[1] http://www.sleepdt.com/nyc-train-driver ... eep-apnea/

Thanks todzo. I missed the follow on reporting.

JDS74 wrote:Thanks todzo. I missed the follow on reporting.

Yes the more I look into this the more it looks like the doctors had everything they needed to send the guy for a sleep test and simply missed it.

Scary thing!!!!

With doctors still missing OSA some 80% of the time, with some 20 million people out there with OSA, it is hard to feel safe on the roads.

Todzo wrote:

JDS74 wrote:Thanks todzo. I missed the follow on reporting.

Yes the more I look into this the more it looks like the doctors had everything they needed to send the guy for a sleep test and simply missed it.

Scary thing!!!!

With doctors still missing OSA some 80% of the time, with some 20 million people out there with OSA, it is hard to feel safe on the roads.

One of teh reasons I changed doctors is that my long time doctor (who I liked) never asked about my sleep or anything related to sleep apnea. Here I was with high blood pressure in my early 30s, continuing to go higher, medicated at 37, several increases to medication, still too high. And to make things worse, the same doctor was also seeing my mom who had been diagnosed with sleep apnea 20 years earlier. She knew that. She knew I was a night owl. But she never asked me how much sleep I got, how I felt, or if I had any sleep issues. I knew I snored. I knew I had sleep apnea. What I didn't know was that it was more than just not getting enough sleep. If she had asked me, I would have answered honestly. But she never asked.

I don't know why, but doctors just don't seem to think of this as a big deal, or something they should at the very least, ask every patient about.

zoocrewphoto wrote:

Todzo wrote:

JDS74 wrote:Thanks todzo. I missed the follow on reporting.

Yes the more I look into this the more it looks like the doctors had everything they needed to send the guy for a sleep test and simply missed it.

Scary thing!!!!

With doctors still missing OSA some 80% of the time, with some 20 million people out there with OSA, it is hard to feel safe on the roads.

One of teh reasons I changed doctors is that my long time doctor (who I liked) never asked about my sleep or anything related to sleep apnea. Here I was with high blood pressure in my early 30s, continuing to go higher, medicated at 37, several increases to medication, still too high. And to make things worse, the same doctor was also seeing my mom who had been diagnosed with sleep apnea 20 years earlier. She knew that. She knew I was a night owl. But she never asked me how much sleep I got, how I felt, or if I had any sleep issues. I knew I snored. I knew I had sleep apnea. What I didn't know was that it was more than just not getting enough sleep. If she had asked me, I would have answered honestly. But she never asked.

I don't know why, but doctors just don't seem to think of this as a big deal, or something they should at the very least, ask every patient about.

Well I do think that doctors kind of like to not have bad endings with patients. Lets say he gets you a sleep test, then a CPAP. Follows the normal way of doing things (not looking at data regularly, not finding problems as they crop up, etc...). There is a good chance (probably between 30% and 50%) that within a year you would have stopped using CPAP, would be angry as can be at him, and would find another doctor in the process all the while talking down his practice in the mean times.

Simply I can see how a doctor would rather find something else if they could rather than Sleep Apnea because the current treatments that we have for it so often do not go well or work out well.

zoocrewphoto -

One of teh reasons I changed doctors is that my long time doctor (who I liked) never asked about my sleep or anything related to sleep apnea. Here I was with high blood pressure in my early 30s, continuing to go higher, medicated at 37, several increases to medication, still too high. And to make things worse, the same doctor was also seeing my mom who had been diagnosed with sleep apnea 20 years earlier. She knew that. She knew I was a night owl. But she never asked me how much sleep I got, how I felt, or if I had any sleep issues. I knew I snored. I knew I had sleep apnea. What I didn't know was that it was more than just not getting enough sleep. If she had asked me, I would have answered honestly. But she never asked.

I don't know why, but doctors just don't seem to think of this as a big deal, or something they should at the very least, ask every patient about.

Well I do think that doctors kind of like to not have bad endings with patients. Lets say he gets you a sleep test, then a CPAP. Follows the normal way of doing things (not looking at data regularly, not finding problems as they crop up, etc...). There is a good chance (probably between 30% and 50%) that within a year you would have stopped using CPAP, would be angry as can be at him, and would find another doctor in the process all the while talking down his practice in the mean times. Simply I can see how a doctor would rather find something else if they could rather than Sleep Apnea because the current treatments that we have for it so often do not go well or work out well.

With all due respect Todzo, you are giving alot of primary care doctors way too much credit as my guess is many of them have no idea what the success rate is for cpap usage. And many doctors are still quite clueless about the role sleep plays in disorders like high blood pressure as obviously what occurred with zoocrew's doctor. Conventional medicine doesn't teach them to look at the underlying issues as even the failure of 3 blood pressure meds wasn't tipping this doctor off that something else was awry.

49er

It is a shame that reporters do not seek out successful cpap users, instead of settling for the sick, angry failures.
It is an even bigger shame that failure is not aggressively avoided by better support from the professional end,
who already claim it as their territory, then treat it as a cash cow, "phoning in" what should be their responsibility.

Throwing in my two cents:

I don't see how you can sue the engineer's doctor(s) in this case. The engineer's last routine physical was way back in May 2011 (http://www.sleepdt.com/nyc-train-driver ... eep-apnea/) and his last trip to the doc for any reason was in May 2013, although what triggered the May 2013 visit was not published.

The point being: If the guy is not coming in for routine physicals each year, chances are he's not asking the doc about any sleep problems. And so far nothing has been published (for obvious reasons) about whether the guy ever complained about his sleep to his PCP or the PCP ever recommended a sleep test or not regardless of whether the engineer complained of sleep issues.

And whether we want to admit it or not, testing for sleep apnea is NOT routine and it's NOT cheap or easy. Even with the push to make PCPs more aware of sleep apnea and its consequences and even with the STOP BANG questionaire, the fact is if a PCP tells a patient "I think you have OSA and you need a sleep test", it's the patient's responsibility to follow up and get the dang test done. And many people simply won't go for a sleep test even it is recommended by their PCP. And they'll cite COST and INCONVENIENCE as the main reasons, when in reality they simply don't want to contemplate the possibility of having to use a CPAP for the rest of their life. So for all we know, the engineer may have been in deep denial about the possibility that he might have had sleep apnea and he would not have gone in for a sleep test even if the PCP had suggested it to him multiple times.

Now it could be argued that train operators should have to meet the same kind of health standards that professional truck drivers and others with CDL have to. But if the guy's last physical was in May 2011, then obviously his employer has not required even a basic physical exam each year. In that case, the party at fault is NOT the guy's doctor, but rather the idiots at the company who (in standard pennywise and pound foolish fashion) don't require a full physical each year with a mandatory sleep test for employees who on paper are at high risk of having or developing OSA.

And finally I have another question for folks to ponder: Suppose the guy's problem had turned out to be a medical problem other than OSA. Suppose, for example, that the guy had a TIA that led to the crash, but that back in May 2013 his blood pressure had checked out as "not great, but ok" and no follow-up work on treating high blood pressure was recommended because his blood pressure was "not great, but ok" back in May 2011 as well. Would folks be so quick to jump on "let's blame the PCP" bandwagon in that case? Or what if the guy was a type I diabetic who used insulin, but was struggling with getting the dose right at times, and his blood sugar simply dropped too low and that caused him to black out? Would the blame fall on the doc or the engineer in that case?

My question is what are the Govt regs for medical examinations? I don't know the answer to this one, but I find it hard to imagine some form of medical examination is not required.

I know that DOT has regulations for exams and, unfortunately only just recently, have required examiners to be certified and have provided guidelines for potential sleep disorders including height/weight, BMI, and neck circumference.

These requirements may not have been in effect in 2011, but I know just from driving a vanpool to work that I have had to provide documentation for my sleep apnea during my exams.

There could be a couple of problems that arise out of the investigation...

if a medical certificate was required and signed off by the doctor, did the doctor perform an adequate examination? If he signed off on the certificate he may be liable more so than if he was just PCP.

Was NY Metro compliant in ensuring the examinations were current?

Were there any signs of a sleep disorder prior to the accident? The last one could probably be uncovered through interviews if Rockefeller had been complaining of always being tired. If so, it will probably surface. If he knew he was tired and did nothing then he could be found negligent.

Interesting side note... I wonder how many people view him more negatively merely because he happens to have the last name of Rockefeller.

John

robysue wrote:Throwing in my two cents:

I don't see how you can sue the engineer's doctor(s) in this case. The engineer's last routine physical was way back in May 2011 (http://www.sleepdt.com/nyc-train-driver ... eep-apnea/) and his last trip to the doc for any reason was in May 2013, although what triggered the May 2013 visit was not published.

The point being: If the guy is not coming in for routine physicals each year, chances are he's not asking the doc about any sleep problems. And so far nothing has been published (for obvious reasons) about whether the guy ever complained about his sleep to his PCP or the PCP ever recommended a sleep test or not regardless of whether the engineer complained of sleep issues.

And whether we want to admit it or not, testing for sleep apnea is NOT routine

Since they still miss Sleep Apnea some 80% of the time one can argue that it should be more routine.

robysue wrote: and it's NOT cheap or easy.

I really put these things in the “screening” category but there is even a chip which you wear on your nose/lip that records breathing and pulse oximetry and is even reusable if you wish. There are many pretty well “cheap and easy” home test devices. I think more “screening” should be and easily could be done!!!

robysue wrote: Even with the push to make PCPs more aware of sleep apnea and its consequences and even with the STOP BANG questionaire, the fact is if a PCP tells a patient "I think you have OSA and you need a sleep test", it's the patient's responsibility to follow up and get the dang test done. And many people simply won't go for a sleep test even it is recommended by their PCP.

I think the word “criminality” would have been used in regard to the engineer in this case if that had happened.

robysue wrote: And they'll cite COST and INCONVENIENCE as the main reasons, when in reality they simply don't want to contemplate the possibility of having to use a CPAP for the rest of their life.

Is it possible that the fear of CPAP often comes from knowing others who have had a bad experiance?!

robysue wrote: So for all we know, the engineer may have been in deep denial about the possibility that he might have had sleep apnea and he would not have gone in for a sleep test even if the PCP had suggested it to him multiple times.

Considering his responsibilities, that would be criminal.

robysue wrote:Now it could be argued that train operators should have to meet the same kind of health standards that professional truck drivers and others with CDL have to.

More people and property are at risk per incident so the standards should be higher!

robysue wrote: But if the guy's last physical was in May 2011, then obviously his employer has not required even a basic physical exam each year. In that case, the party at fault is NOT the guy's doctor, but rather the idiots at the company who (in standard pennywise and pound foolish fashion) don't require a full physical each year with a mandatory sleep test for employees who on paper are at high risk of having or developing OSA.

And finally I have another question for folks to ponder: Suppose the guy's problem had turned out to be a medical problem other than OSA. Suppose, for example, that the guy had a TIA that led to the crash, but that back in May 2013 his blood pressure had checked out as "not great, but ok" and no follow-up work on treating high blood pressure was recommended because his blood pressure was "not great, but ok" back in May 2011 as well. Would folks be so quick to jump on "let's blame the PCP" bandwagon in that case? Or what if the guy was a type I diabetic who used insulin, but was struggling with getting the dose right at times, and his blood sugar simply dropped too low and that caused him to black out? Would the blame fall on the doc or the engineer in that case?

Very much apples compared to bricks. One glance it all it took me to see the obesity and large neck. The indicators are clear and very observable!!! Obesity + Large Neck = Sleep test - for CDL and the train engineer has a higher responsibility level!!!

Overnight oximetry, at home, could be useful--at least as a more affordable screening procedure.
It could be required of all applicants for CDL or train operator permits--not just the hefty guys with big necks.

chunkyfrog wrote:Overnight oximetry, at home, could be useful--at least as a more affordable screening procedure.
It could be required of all applicants for CDL or train operator permits--not just the hefty guys with big necks.

The test also includes air flow data as well.

Not a bad idea!!!