Mahler9th

42k posts?

Mahler9th

Let me emphasize what the expert panel stated:

"An individual with a diagnosis of obstructive sleep apnea may be certified to drive a CMV if that individual meets the following criteria:

Has untreated obstructive sleep apnea with an AHI ≤ 20, AND

Has no daytime sleepiness."

"...based on demonstrating satisfactory compliance with therapy."

What then remains is a definition of "demonstrating satisfactory compliance with therapy."

peterp

The discussion is already very, very, very long on this topic -- why are you expanding it into unrelated topics of state/nation/local jurisdiction?????

This is so much detail in your posts that they are unreadable, and it's unrelated to the specific topic of this thread.

The ONLY thing that matters from the PCA perspective is how things would play out in court. That's it. That's the only way to think about it if you want to know what the PCA will and will not do, and what the PCA should and should not do.

I've already stated very specifically how it would play out in court. If you think something different would happen in court with the doctor saying it was okay to race without using CPAP, spell out what you think would happen, instead of just saying I'm wrong.

AHI is irrelevant -- people are only prescribed CPAP and choose to follow through on getting it if they need it -- and that's why PCA wants confirmation of use when it has been prescribed. The legal liability equation is the same guy who needs CPAP with CPAP versus the same guy without CPAP. It's apples versus apples -- the same apple -- and the latter is inferior to the former. It's a conscious choice to be impaired (regardless of the degree) in a situation that already has significant safety risks, which is why it will get destroyed in court to not use CPAP.

T&T Racing

​​​​​​You can question doctors. The lesson learned is not PCA medical staff.

Matt Lane

This thread is leaving me breathless

winders

Just shut the f**k up! Jeez....

Mahler9th

State how things would play out in court? You mean a bench trial or jury trial?

Yikes.

100% in this context?

No.

Even in the world of commercial trucking, this is a complex topic, and there are nuances.

Risk is complex.

There are racing sanctioning bodies that only require a valid driver's license.

Nowanker

Might be expired....

Mahler9th

LOL...

I am reminded...

I joined PCA in 1987. Bob Akin was the guest speaker in one of my first meetings. I think it was my first. If I recall correctly, there were less than 40 of us.

In another meeting early on, folks showed up with helmets and racing gloves. They kept talking about "going to Malibu." I did not know whatthey were talking about so I asked. They said... join us. So I did. We had to drive a bit to get there, and I had to use the helmets provided by Malibu.

It was fun.

I think my 3rd or 4th PCA activity was DE at LRP in '88. I had a female instructor who was outstanding.

Blast from the past Nowanker! I disposed of my Malibu license just last year.

I visited Malibi many times in RWC, and a few times in other cities on biz travel.

I always made sure to check with staff about engines and tires and tried to get the best of both before and during driving.

Zhao

Nice, I have a malibu license too somewhere in a box from that era.

peterp

Yes, I agree, it can be complex. But not really in this situation. The doctor saying it's ok to race without CPAP is not substantially different than him saying it's okay to race with a pacemaker that has an expired battery, or somebody with serious vision issues racing without glasses. None of those things is guaranteed cause an accident, but if there is an incident, the doctor who advocated for the less safe option (e.g. racing without CPAP, or with a dead pacemaker battery, or a severely vision-impaired person) will, at the very least, not look good. Same with a non-medical PCA executive who overruled the doctor.

I definitely agree that, at that point, they would dive into the details of the data to see if there is a chance they can prove the condition was so mild that it wasn't an issue. That might give them an "out" if it happens to be extremely mild (which I don't think is typical if you have a CPAP machine). If it is even slightly a gray area that failure to use CPAP had any role in the accident happening, the PCA is going to lose because they advocated for the less safe scenario for a situation that was easily preventable. Why would the PCA open themselves up to that potential risk?

If they never had the rule -- they would not have the risk. Since they do have the rule, and apparently have had it for many years, they have significant risk in not following their own rule. It's not debatable that not preventing the preventable opens you up to liability, especially when preventing it has been spelled out in your own rules for years. The horse is out of the barn on the rule for this year -- the only chance would be to advocate for changing the rules next year (which honestly seems unlikely given what has transpired).

peterp

Malibu Grand Prix rocked!! Used to love that place. I think it was something like $4 in 1980 dollars a lap -- which was a lot back then when I was in high school, but worth every penny.

Is there anything like that that exists today? I think they used 440cc Chaparral? two-strokes.

Manifold

... but it would be very difficult, or impossible, to show, if an incident occurred, that OSA was a significant contributing factor. The driver could just say that he made a driving error because he was pushing too hard, and that OSA has never been a problem for his driving on the road and getting through daily life. There's no possibility that someone who has OSA is going to fall asleep while driving on the track, so you won't be able to link sleepiness to the incident. The only way to show that OSA generally adversely impacts driving on the track and increases risk by any amount is to do a proper study; that study would be difficult to do, and would still not establish that OSA was a contributing factor to an incident in a particular case.

The best that PCA can say in defense of their policy is something like "it's possible that OSA may increase risk of an incident on track, so we want to play it safe and verify that people who've been prescribed a CPAP to treat their OSA are generally using it and it's helping them." But since there's no strong evidence that OSA increases risk in the context of driving on the race track, PCA may be increasing their liability by delving into the specifics of someone's OSA, and the person's use and effectiveness of CPAP, and making a medical judgement about those things. PCA would take on less liability if they simply accepted the personal doctor's medical clearance of the candidate to race.

Mahler9th

No.

This thread has NOTHING to do with "racing without CPAP."

My hypothesis is that some PCA volunteer executives are indemnified by PCA through policies, and that indemnification is not absolute. Nor does it preclude them from "overruling" a physician.

PCA has not made it clear what aspects of trucking industry "standards" are required, if any. I have seen nothing in writing on this from PCA.

Furthermore, it seems that the trucking industry policies and practices have some leeway for DOT medical examiners... for example it seems they can "pass" a trucker with a new diagnosis of OSA and an admission that CPAP rx was prescribed with only a week of data. It seems that a handbook ("MEH") was put forward for these docs, but it may have been pulled back because it is not fully clear what should be done due to lack of specific studies on OSA, CPAP rx and trucking safety.

It also seems clear that these docs may or perhaps must look at other factors, like BMI as they make their determinations.

Preventable? That is not how human physiology, medicine or our legal system works. They are all far more complex than that.

Gray area?

PCA is going to lose automatically?

Well, I don't think so.

Look, in this case, all we have been told is an ACTIVE license was revoked and will not be reinstated until some data is provided. We have been told that three (3) days was not sufficient.

We have been told that a trucking standard has been mentioned.

What I found with modest effort was a "standard" of at least 4 hours of usage for 70% of days during a ninety day period. And that the data cannot be more than 30 days old.

But I have not heard that from PCA.

Even in the trucking industry, things may not be clear. See, for example:

https://www.truckingtruth.com/trucke...-30-or-90-days

In this example, the person states: "My problem is that I sometimes go to bed and play on my phone and then fall asleep. I’ll wake up around 3 or 4am and put it on, but by then it’s too late to get the 4 hours."

The CPAP user in my household does this from time to time. It does NOT automatically mean that user is compromised the next day or days.

OSA is a chronic condition.

Severe OSA is a huge deal.

See for example:

https://aasm.org/economic-burden-of-...150b-per-year/

Optimal ongoing CPAP therapy can help make some of the sequella less likely.

But it does not "prevent" the sequella.

And by the way:

Prescribing guidance for CPAP therapy is not an "absolute" from the standpoint of AHI. So you can have a less than moderate case of OSA and be prescribed a machine.

My hypothesis is that companies that make and sell CPAP machines engage lobbyists (ask me why this is relevant in trucking).

I almost went to work for one such company.

DiBs820

Are you sure its not OSA?