Court Decision Supports Mandates for Sleep Apnea Treatment
The debate over mandates for sleep apnea treatment is a controversial subject among commercial drivers and advocates for personal freedom, but safety on the road is a legitimate concern. According to the American Academy of Sleep Medicine (AASM), the number of automobile accidents due to drowsy driving averages over 300,000 a year in the U.S. alone, including over 6,000 fatalities. Along with insomnia, sleep apnea is one of the most common sleep disorders in the United States, causing routine fatigue and endangering the lives of drivers every day. According to some assessments, nearly 30 million Americans have sleep apnea, and over 23 million remain untreated for the condition. Studies have also found a high prevalence of sleep apnea, particularly obstructive sleep apnea (OSA), among commercial drivers. This puts pressure on employers to ensure that their drivers are screened and treated for this highly dangerous condition. This summer, a civil case in Ohio attracted a lot of attention when the Sixth Circuit Court agreed with the company defendent, Walmart, Inc., that requiring a driver to use his CPAP device to treat his sleep apnea was not considered discrimination under the Americans with Disabilities Act. The case, Allman v. Walmart, Inc., involved a truck driver who objected to using CPAP and later claimed that his resignation over the issue was caused by the company’s unfair practices. The lawsuit was dismissed and the Sixth Circuit affirmed dismissal on appeal. In the end, the court decided that Walmart had a legitimate reason for the requirement under federal Department of Transportation rules that require healthy medical status as a condition of employment. Since the plaintiff in this case was diagnosed with sleep apnea, the mandate was in accordance with federal law. While there is some gray area in regard to treatment mandates for sleep apnea and CPAP, the bottom line is that once diagnosed for a disorder, treatment adherence is not only expected, but mandated by the company as a responsibility to its employees and other drivers on the road.
The language used by the justices in Allman v. Walmart, Inc. was quite clear. According to the court’s published statement, no “reasonable person” would agree with the plaintiff that requiring an employee to wear a CPAP machine when sleeping was discriminatory, or that it amounted to a wrongful termination. Walmart required the employee to use a CPAP device based on medical reports that he was diagnosed with sleep apnea. While federal law does not mandate sleep apnea screening for all commercial drivers, it does, however, require medical certification. This leaves screening up to the discretion of the doctor performing the physical examination. In most cases, sleep tests will be recommended when patients exhibit signs or symptoms of a sleep disorder. This can vary between doctors, but some of the most common signs are linked to obesity, fatigue, and daytime sleepiness.
Unfortunately, like some patients first introduced to PAP therapy, the plaintiff in this case, Joe Allman, failed to get used to the machine. But rather than attempting to find solutions, he looked for a second opinion on his own, an independent sleep study that did not find him to have sleep apnea. Yet in order to be recertified, Allman still had to undergo another DOT medical exam for Walmart, as well as another sleep study. This resulted in another sleep apnea diagnosis. Again, rather than looking for solutions, Allman resigned in protest. When he sued, he characterized his resignation as a wrongful termination.
The Court, both in the initial case and in the appeal, found in Walmart’s favor for two primary reasons: they found his legal arguments unfounded and his behavior contradictory to state and federal laws protecting employees from unsafe work environments. With PAP therapy’s long history of success “to alleviate the dangers of sleep apnea,” the court statements read, “nothing in the record” suggests that a mandate is discriminatory or damaging to the plaintiff. While this ruling may help in the establishment of safer roads and safer workplaces, it is unfortunate that the plaintiff did not seek a more reasonable solution to his problems. It is important to remember that CPAP compliance requires only four hours of use per night about 70 percent of the week. If there are difficulties, patients can work toward this goal by seeking alternative masks, machine types, or sleeping arrangements. In these situations, treatment follow-up and support can help patients find solutions they may not be aware of initially. In fact, few people get it perfect right from the start. The goal is improvement over time, and troubleshooting is part of the process.
Setting a Precedent
Allman v. Walmart, Inc. is important because it sets a precedent for the industry. Commercial drivers are different from other employees in that they are subject to federal Department of Transportation safety rules that require medical certification. This means that certain conditions, especially if left untreated, can result in disqualification from employment. Sleep Apnea is one of those conditions. The Federal Motor Carriers Safety Administration (FMCSA) has determined that moderate to severe sleep apnea interferes with safe driving and should be treated. In addition to health and safety risks, studies supported by the FMCSA show that untreated drivers with sleep apnea may be expected to incur thousands of dollars of additional costs per year. When PAP therapy is implemented, steering performance and reaction time are almost immediately improved, leading not only to savings for the company, but also saving lives. While this controversy may continue, this ruling provides legal support for treatment mandates in the future, giving commercial drivers with sleep apnea yet another reason to accept CPAP as a necessary treatment.
Accident Annalysis and Prevention – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3506009/
Allman v. Walmart, Inc., Circuit Case No. 2:18-cv-369 (S.D. Ohio Feb. 11, 2019)
Allman v. Walmart, Inc., Appeal No. 19-4220 (6th Cir. Jul. 30, 2020)
Casetext.com (Appellate) – https://casetext.com/case/allman-v-walmart-inc-2
Casetext.com (Circuit) – https://law.justia.com/cases/federal/district-courts/ohio/ohsdce/2:2018cv00369/212910/31/
Sleep Medicine Clinics – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3763954/