dgrobs

What’s a “foible”?

Manifold

I understand. But I don't think your fight will lead to any positive reform in PCA, and I think it will harm PCA (already has). In a social club staffed with volunteers who come and go, many of which take those positions in part because it confers them with status within the club (a status they may not have in their real jobs), and who are not subject to proper vetting, there will inevitably be many instances in which these 'leaders' disrespect people. It has always been that way, and I expect that it will always be that way.

BillC3

@LuigiVampa Todd -- my offer to contribute to court costs still stands, if you decide to take that route.

I dislike bullies, I dislike bureaucrats, and I especially dislike bureaucrats who are bullies. So if you decide to take them on in court, I support you.

Matt Romanowski

Read the Financials. PCA does all of those things and has a lot of paid staff. Everyone on this page is paid https://www.pca.org/connect/national-office and there are more.

Manifold

How many of those staff are full time? How much are they paid? Shouldn't the paid PCA Executive Director be handling this matter, rather than a volunteer President?

dgrobs

Guys, foible?

Veloce Raptor

Gesundheit

LuigiVampa

I appreciate the offer but that is not the path I want to take.

As someone who has been involved in a lot of litigation over the years, both personal and business, I will state that even the importance of this matter does not trump my intense dislike of litigation.

While litigation is many times a required evil, the only people who ever truly win at the lawyers.

dgrobs

OK, so that's 2 people who don't know what a "foible" is.

Todd, it's your word, so can you please explain to my dumb ***, and Dave's even dumber ***, what a "foible" is? Dave thanks you.....

needmoregarage

I’ve heard it many times over the years and understand it to be this:


foible /foi′bəl/

noun

1. A minor weakness or failing of character.
2. The weaker section of a sword blade, from the middle to the tip.
3. A moral weakness; a failing; a weak point; a frailty.
   Similar: failingfrailty

dgrobs

That actually makes a ton of sense per the way Todd used the word in the context he did.

Appreciate the info C, thanks. (And although he won't admit it, Dave thanks you too...)

Mahler9th

[QUOTE=LuigiVampa;19602500]

1. My sleep study says I have very mild OSA and according to DOT standards this does not need to be treated. Per PCA's rules I am 100% in compliance.
2. The sleep study contains all the data and conclusions and is signed by a doctor. It is MORE than just a letter from my doctor saying I don't need a CPAP any longer. /QUOTE]


The sleep study summary I saw in an earlier post is NOT consistent with these comments/conclusions.

It clearly states that CPAP rx is prescribed, and includes recommended parameters/CPAP settings.

It does NOT say patient no longer needs CPAP-- quite the contrary.

Other therapies are listed as possible CPAP add-ons, or as an alternative to CPAP, but ONLY IF CPA is not well-tolerated.

It suggests that BMI, neck circumference, et cetera, are other health parameters that might be taken into account.

It appears to have been "signed" by HCP(s). Not sure if any of those folks are the OP's primary care physician, which PCA CR might conclude is a shortcoming.

"A doctor" may NOT be the same as "THE doctor."



As far as I can tell, there is NO "DOT standard."

In the trucking industry, there are certified/authorized medical examiners that have guidelines to follow, and plenty of leeway for individual health situations. And even in the trucking industry, these topics appear somewhat unsettled.

I have previously posted a link to recommendations from an "expert panel," on this topic.

Here is a random link to some other perspective that can help folks understand that even in trucking, there is some murkiness:

https://glidewelldental.com/company/...leep-apnea-osa

Here is an excerpt:

"In applying the regulations to drivers in making certification decisions, CMEs use guidance issued by the FMCSA MRB. In 2008, the FMCSA MRB began reviewing sleep apnea and issued the first of several guidance documents to medical examiners about sleep apnea. This became a political controversy within trucking due to the costs of testing and treatment. Financial or contractual arrangements between CMEs and sleep apnea testing facilities aggravated the perceived issue.

A common theme in trucking-industry news outlets and among truck drivers is that sleep apnea is a made-up condition just to rake in money from the pockets of drivers. This resulted in efforts from trucking-industry lobbying groups in 2014 to get Congress to pass Public Law 113-45. This simple statute prohibits FMCSA from issuing guidance or regulatory guidance on sleep apnea without using the formal rulemaking process. To give a dental provider of oral appliance therapy for obstructive sleep apnea a view of how well trucking lobbying efforts were on this measure, the bill was introduced to Congress during a budget shutdown, and was passed in three weeks.

In 2016, the FMCSA, working with the Federal Rail Authority (FRA), began joint rulemaking on sleep apnea in compliance with 113-45. FMCSA and FRA held a series of listening sessions — aka public hearings — to gather information and comments.

In August 2017, they withdrew the rulemaking, citing that the current safety programs are the appropriate avenues to address sleep apnea. This political and regulatory “kicking the can down the road” on sleep apnea has created the “no-rule rules.” There is no specific guidance or regulatory guidance for a CME or sleep medicine provider to use and follow.

Drivers often argue that there is no regulation requiring them to get tested or receive any form of treatment for sleep apnea. They are correct.

The question of whether to issue a DOT medical card is solely based on the best expert medical opinion of the CME. The CME may or may not choose to use existing guidance documents. As the level of experience and training among CMEs varies widely, a CME may be an M.D., D.O., N.P., P.A., or D.C. The level of sleep apnea training given to doctors of chiropractic varies greatly from the other medical certifications able to take the NRCME certification exam."

Here is another excerpt:

"Having the M.D. chart state that “this patient does not have sleep apnea to the severity that it would interfere with their ability to drive a commercial motor vehicle in interstate commerce,” or something to that effect, is important."


I understand that folks might believe that many aspects in medicine/healthcare are "black and white." Often they are not.

In this case, the single study result indicates that CPAP is the recommended therapy. This is apparently NOT solely based on AHI score.

If PCA CR has concluded that the disclosure of OSA dx with a resulting CPAP rx from HCP(s), triggers or even may trigger a requirement for rx compliance data, they should state so, and thoroughly describe the data so that candidates can comply in a proactive fashion.

It seems that in trucking, there is no "standard," and examiners have discretion.

If this is likewise true for PCA CR, they should state so.

NaroEscape

There are a lot of full time staff in PCA. Way more than you would think that get paid a lot of money. I have no problem with any of it as long as the budget supports it. The BUSINESS of PCA takes a small army to run correctly. There are full time paid employees on the CR staff (not the chair, stewards, scruts, timing, etc), full time staff to publish Pano, and more.

LuigiVampa

[QUOTE=Mahler9th;19602986]

Quote:

Originally Posted by LuigiVampa

1. My sleep study says I have very mild OSA and according to DOT standards this does not need to be treated. Per PCA's rules I am 100% in compliance.
2. The sleep study contains all the data and conclusions and is signed by a doctor. It is MORE than just a letter from my doctor saying I don't need a CPAP any longer. /QUOTE]

If you must know I have been getting a rash under my nose, to the point where the skin is rubbed raw, so CPAP is not being well tolerated.

You need to do more research in re DOT trucking standard. While examiners have discretion there is no need for CPAP when it is mild, only moderate or severe. I used to be severe. I think it I lose another ten pounds I will have no OSA.

What do you mean by "A doctor" may NOT be the same as "THE doctor"? That's ridiculous. If you go to a specialist, which I did, that is the best doctor for the diagnosis. On what basis can you disagree with point number 2?! Ridiculous.

The facts never mattered and they matter even less now. PCA just wants to say "wah, I don't wanna play with Todd anymore!"

I appreciate the fact that you have appointed yourself to be the contrarian here but you are engaging in just as much mental gymnastics as PCA.

Mahler9th

[QUOTE=LuigiVampa;19602995]

Now you are just being a J**K.

You posted a sleep test result that clearly states that the reporting HCP has prescribed CPAP rx, and the parameters.

It does NOT say that you no longer need CPAP.

It reports a neck circumference > 17 and a BMI score as well.

There are all kinds of masks (which are medical devices) and all kinds of accessory products one can buy on Amazon to deal with things like "rashes" or skin irritations from CPAP rx.

I have pointed out that even in trucking, things are NOT so simple.

So one natural inference is that PCA CR could not possibly rely on a "DOT standard" since none exists.

And to be more clear, there is not even a DOT standard for what to do when it comes to requiring "proof" of rx compliance.

A (large?) number of folks in management positions at PCA and PCA CR might not understand the details about OSA and trucking. They may simply feel that they should not bother trying if candidates are nearly 100% compliant in providing data of some sort when demanded.

If that is so, it would seem to me that that as soon as even just one candidate points out issues, they would rethink.

The OP has done so.