Tragic Death a Result of Sleep Apnea

[Snoozin' Bluezzz]

QUESTION: Are there states where you are required to report your sleep apnea to the State Dept of Motor Vehicles (or equivalent)?

I think doctors are required to report it and it can affect your ability to get your license renewed. They're required to report epilepsy and narcolepsy also.

It can also effect whether or not you qualify for life insurance.

On one hand, we want the world to know about OSA and all it entails. On the other hand, we want to keep it under wraps so our driver's licenses will be renewed and we can get life insurance.

There is a lot of room for grayness here which, in our current litigious and contentious society might (MIGHT) make me rethink how honest I would be about such a thing if it limited my abilty to get a drivers license or insurance. If we make regulatory and insurance pariahs out of folks that have this disorder they will not seek treatment or even risk diagnosis. This disorder is treatable if folks are compliant. If they are compliant there should be no impairment beyond a normal person's impairment. My xPAP will not make me more rested and alert if 1) I don't use it and 2) I don't get enough rest in general. Numerous folks are driving impaired because they are on short sleep rations pure and simple not because of a medical condition.

I must confess that this discussion disturbs me. I don't drive drunk, I don't drive sleepy and, generally, I don't drive stupidly. If I were to have an accident I would not want the first assumption to be it was because of my OSA.

David

[MandoJohnny]

I just checked the rules in my state, Missouri. A physician is not required to report a patient who has a condition that would make driving unsafe, but he can choose to do so and if he does, he is protected from civil liability for doing so. It is completely left up to the doctor's sense of ethics whether or not to do it, but there is a hint, just a hint, that if failure to report leads to consequences, the doctor could be held liable for that. There is a form the doctor can fill out to report and it lists apnea as one of the conditions, in a category called "Disorders that Impair Consciousness."

If you get busted for having apnea, you get notified to surrender your driver's license within 10 days. (It's interesting that even though they just ID'ed you as a hazard to humanity, they go ahead and let you do what you want for the next nine days!) Then, if you want your license back, you have 30 days to submit to a state medical examination. Now ask yourself: What kind of doctor goes to work for a state medical examiner's office? Then ask yourself: Do you want that guy deciding whether your apnea is severe enough to keep you from driving, and therefore possibly keeping you from earning a living, especially when the safe bet for that doc would be to err on the side of keeping you off the street?

Bottom line: Pay your sleep doc's bills on time or he may "drop a dime" on ya!

[Severeena]

In Ohio you are required to report Narcolepsy and Sleep Apnea. I should know, because I discussed it all with my doctor and he even had to write a letter on my severity.

I am a former Buckeye.

[Guest]

MandoJohnny,

How did you go about finding your state's rules about this? I'd like to do the same for Texas, although I'd be surprised if they had rules like this.

[wading thru the muck!]

I wonder if he was also one of those "statistics" that had his CPAP in the closet, too. Kinda sounds like it.

Yea, I bet he put that non-cflex, non-heated humidifier machine and the leaky throwaway mask the DME gave him into the closet because he could not get it to work. Then it stayed there because of the non-existent DME follow-up and a Doc that didn't know anything about the equipment or the treatment.

Those are the issues, that if dealt with, would have had the best chance at preventing this tragedy.

[Wulfman]

And, on top of the things that Wader mentioned, he may have been prescribed the wrong pressure (which might lead to non-compliance or not sleeping well).....the article indicated that he hadn't been sleeping well, lately......

Police said Taddonio suffers from sleep apnea and had not been sleeping well recently or regularly using a treatment device prescribed to those who suffer from the condition.

Obviously, he wasn't monitoring his therapy with software!

Den

[MandoJohnny]

How did you go about finding your state's rules about this? I'd like to do the same for Texas, although I'd be surprised if they had rules like this.

I typed in "Missouri driver's license" on my search engine. That took me to the Missouri Department of Revenue, which is the department in Missouri that issues licenses. BTW, you can tell where Missouri's head is at. It's not the Department of Public Safety or even the Department of Transportation, it's "Revenue." Anyhow the DOR site had its own search function, where I typed in "apnea." It came right up.

I just finished a 5 month consulting assignment in Texas. Driving down there,a casual observer might be led to think that if you drive a large pickup truck in Texas, there are no laws that apply to you at all!

[MandoJohnny]

Another thing that is very unfair about these reporting laws is that everyone is different. Even when my undiagnosed, untreated apnea was at its worst, I did not have big problems driving 99% of the time, even late at night. The only time I did was when I had to do a really long car trips and then I knew that was a problem and I paced myself. I have a very decent driving record and none of the few problems I have had were even remotely sleep related. Now that I am diagnosed, I should be a much safer driver, but because I got treatment, I could get my license revoked at any time.

I don't think that's gonna happen, but I worry about truck drivers who are having wakefulness problems saying to themselves. "I not going anywhere near a sleep doc. I could lose my job!"

[Snoozin' Bluezzz]

Now I have a ethical dilemma and some cogitating to do. My medical condition is being treated, I've missed one night in the last 7 months. My symptoms were daytime fatigue not sleepiness. Only once 41 years I've been driving have I felt too sleepy to drive and I pulled over and napped. So (rhetorical question only but chime in if you wish, you will anyway) do I have an obligation to report this. I am confident that no medico has, or will. I'm less confident about the insurance but the state is not authorized to investigate based on an insurance report.

hmmmmm????

David

State of Illinois - Secretary of State

Notifying Our Office

By law, you are required to file a Medical Report Form, completed by your physician, if:

1. you have any medical or mental condition which could result in a loss of consciousness or any loss of ability to safely drive a vehicle, or
2. you take any medications that may impair your ability to drive.

Each time you renew your Driver's License you must also resubmit the form.

It is your legal responsibility to notify our office within 10 days of becoming aware of any of these conditions. Failure to do so may lead to the cancellation of your driver's license and driving privileges.

Notification must be sent in writing to:

Final Medical Report
If the particular medical condition no longer exists, you must still submit a final Medical Report Form completed by your physician indicating the condition no longer exists, in order to be removed from the follow-up program with this office. This Medical Report Form must be sent to:

Worried About the Ability of Another Driver?

In order to protect the rights of all persons, the Secretary of State's office is only authorized to investigate potential medical conditions when reported to us by a licensed physician, member of law enforcement, or member of the judicial system.

If you have a friend or relative whom you feel could jeopardize traffic safety as the result of a medical condition, you should contact the individual's doctor or a police officer and request that they ask our office to investigate.

Options available are partial or complete re-testing, restrictions to driving privileges or complete cancellation of driving privileges.

[Snoozing Gonzo]

I am a much more alert driver than I was before my OSA diagnosis - especially on long trips. That is not just because of treatment but also because I am more in tune with what tiredness is and at what level it could affect my abilities. However, if I was in a wreck last December due to diminshed reactions, it probably would not have made much of a ripple. If I were in a wreck today would the automatic reaction would be to blame it on OSA even if it is being successfully treated? I have a problem with the concept that official identification of those with OSA or being treated would somehow make the streets safter when IMO the real danger is from the large group that are not treated. Hopefully the person who has chosen to ignore his or her condition while continuing to driving is the aberation as it appears to be for diabetics for example.

[NightHawkeye]

Hmm . . ., I'm thinking this all adds up to one very good reason for xPAP machines to available without a prescription. After all, once apnea is treated, the driving problem is non-existent.

Sure seems like the best solution for society as a whole. Of course, smarter folks than me may see things differently.

Regards,
Bill

[BetterBreathinBob]

The state of New Jersey considers it a crime if you fall asleep and kill someone while driving. I believe it's called Megans Law, named after a teen who was killed by a person sleeping behind the wheel.

While hooking up my patients in the lab where I work, many folks tell me that they've dosed off behind the wheel.

This is real and happening all the time. Education about good sleep is vitual to our and everyone's communities.


Bob

[krousseau]

That sounds like a good idea to me.

Several other thoughts;
Regardless of the reasons for noncompliance-poor fit of mask, wrong pressure, no humidifier-this person got behind the wheel of a car impaired and he knew it. I agree that while the people who provided his treatment will never have to take responsibility for what they did or did not do-he made the final decision-and someone else paid the ultimate price for it and I hope that he accepts 100% responsibility for that decision.

Truck drivers, bus drivers, airline pilots etc could be in a special category and could be provided job retraining, guaranteed employment, disability insurance in the event they develop a sleep disorder.

Your monitoring software could be very useful in the event of a car accident. When I decided to wear a Medic Alert-I knew I also had to get the card reader and softwear to show compliance with, and effectiveness of treatment. And to not drive after a night of less than 6 hr of good sleep.

[MandoJohnny]

State of Illinois - Secretary of State

Notifying Our Office

By law, you are required to file a Medical Report Form, completed by your physician, if:

1. you have any medical or mental condition which could result in a loss of consciousness or any loss of ability to safely drive a vehicle, or

2. you take any medications that may impair your ability to drive.

This is what I call a stupid "save me from myself" law. If you are responsible enough to report that to the state, wouldn't you also be responsible enough to make sure you don't drive not drive in an impaired condition? Also, the law makes you go to a doctor to ask him to fill out a form that will get your license revoked. Yeah, that's a great deal! Why don't we demand that criminals go get a lawyer to sign a form saying they are guilty? Oh, but that would be unconstitutional!

Also my guess is that 80% of the people in Illinois have, at some time, done either #1 or #2 or both at some time or another. Have they every had a cold? The flu? Have they ever taken OTC medications for it and driven cars? Do they rush to the doctor to submit forms every time? It's whacky. Also I hate that invitiation to "turn in your friends." Hitler was big on that.

Drivers have to be responsible, and be held responsible, for controlling thier own vehicles, not the state, not their doctors and not thier family and friends. And they should never use apnea as an excuse for not being responsible, because it's not the apnea, it's not the DME or the equipment, it's that you know when you're potentially sleepy and you just shouldn't drive then. I think the fact that these laws create a deterrent to getting diagnosed and treated far outweigh thier value.

I agree about not requiring a prescription for an XPAP, although that would mean that insurance won't cover it anymore. I can't figure out why you need a prescription anyway. Has anyone "OD'ed on CPAP?"

I can see the movie scene now: Dirty Harry shows up to a bloody death scene and says, "Damn CPAP junkies! This idiot cranked it to 20 and blew his head clean off!"

[friendly guest]

This is just one link. Type Maggies Law into the search engine for pages of reading on the subject of drowsy driving

http://www.sleepfoundation.org/hottopic ... =10&id=247