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Jim Hall's Speech at the Sleep Apnea Conference

Baltimore, MD
November 8th, 2011


            Thank you for that wonderful introduction.

            For political animals like me, this time of year often gets my blood running because early November means one thing to me, election day.  I am reminded that I came to Washington four decades ago to work for a man I greatly admired, Senator Al Gore, Sr.  I am forever grateful to him because when he brought me here, it began a long career for me in public service.

            While I’ve had several positions in our government, I will probably most cherish my years as Chairman of the National Transportation Safety Board.  For about seven years, I oversaw one of the crown jewels of the federal government.  With no regulatory authority, the NTSB has for almost 45 years investigated transportation accidents in all modes, calling it as it saw it, not assigning blame per se but finding the root causes of tragedies and making recommendations to prevent them from happening again.  I will never forget standing amid the wreckage of TWA flight 800 brought up from the bottom of the ocean, or arriving at a small community that had been evacuated because of a smoldering rail tank car, or speaking to family members who wondered what could have happened to take their loved ones from them.

            The greatest frustration I felt in that job was seeing accidents that didn’t have to happen, if only regulators or transportation companies had followed through on those recommendations.  How many train collisions did I see that could have been prevented by Positive Train Control?  How many small plane pilots died because they flew into instrument conditions for which they weren’t prepared?

            Similarly, this is how it has been with fatigue, and with one of the most ignored causes of fatigue -- Obstructive Sleep Apnea (OSA).  It had taken too long for the transportation industry to give more than just lip service to the issue of operator fatigue.  Years before I came to the NTSB, in 1989, the Safety Board issued a comprehensive series of recommendations to the Department of Transportation, calling on it to revamp its operator fatigue regulations based on the current state of scientific knowledge.  Some of the rules at the time were more than 60 years old.

            Ten years later, while I was Chairman I directed the agency to revisit the issue with a companion series of recommendations to DOT, in which we concluded that little had been accomplished in the past decade.

            During my time there, the NTSB began zeroing in on a particular subset of fatigue inducing factors -- OSA -- thanks in large part to the work of one of today’s panel moderators, Dr. Mitch Garber.

            No mode of transportation was immune.  In 1995, the cruise ship Star Princess ran aground on a well-known, well-marked and well-charted rock in Alaska.  The ship’s pilot was found to have multiple risk factors for OSA and, in fact, was subsequently diagnosed with the disorder.  In my last year at the Board, 2000, we saw at least two major accidents that were traced to OSA -- a tractor-trailer crash in Tennessee and a light rail collision in Maryland.

            And in the years since I’ve left, we have continued to see accidents and incidents where the operator suffered from OSA -- usually undiagnosed.  I’m sure we all remember the two pilots who fell asleep in 2008 flying a regional jet from one Hawaiian island to another; when they awoke they were out over the Pacific Ocean and fortunately had enough fuel to return to their destination.  There was the tragic motorcoach accident in Atlanta in 2007 that killed members of a college baseball team, and another in Utah the following year that killed more than a dozen passengers, and yet another the year after that in Oklahoma that killed 10 motorists.  In these and other cases, the operators exhibited high risk factors for OSA but were usually not even screened for the condition. 

            By the way, immediately after my remarks this morning, we will be given a presentation on that tragic Miami, Oklahoma crash, one of the worst highway crashes in that state’s history. 

            Ladies and gentlemen, there is no controversy about the role OSA plays in fatigue.  It is estimated that 12 to 18 million American adults have OSA.  However, at least one respected study says that 28 percent of U.S. adults have some level of the condition, so that number is surely higher.  Many don’t know they suffer from the disorder, nor do they realize that they are constantly in a fatigued state.  It is imperative that those who choose to work in transportation be screened for OSA, but equally important that palliative steps be available to those found with OSA so that they can continue to pursue their careers.  We do not want to prevent millions of Americans from working in transportation if they wish because they have OSA.  In fact, if that is all someone with OSA has to look forward to -- dismissal -- then he or she will attempt to avoid detection, placing all in their vehicle or aircraft or vessel or train in jeopardy.

            Regulators have been slow to act, and while there is some good news, I continue to see the usual roadblocks to regulatory progress that I saw during my years at the NTSB.  Many people don’t realize that, while a transportation operator might travel hundreds or even thousands of miles in a day, the act of operating a vehicle is a sedentary occupation and promotes the kind of risk factors that lead to OSA.  The NTSB recognized this when it recommended a few years ago that regulators develop programs to identify high-risk operators and ensure they are properly treated before given clearance to operate.  Also, education programs are needed in all modes of transportation.  Although reaction from regulators has not been totally encouraging, the outlook is improving.

            For example:

  The Federal Motor Carrier Safety Administration has established an education program and has procedures for licensing drivers diagnosed with OSA, but still has no guidance about identifying non-diagnosed commercial drivers who are nevertheless at high risk for the condition.

  The Federal Aviation Administration does not yet screen pilots for the presence of the disorder.

  The Federal Transit Administration has no uniform medical standards for transit operators; each local operator or contractor applies whatever standards it believes appropriate.  But on this point, I am happy to say that we will be hearing during this conference from the Massachusetts Bay Transportation Authority on an aggressive medical, fatigue and OSA program it has developed.

  Finally, the U.S. Coast Guard does not have questions on its medical form that would lead to diagnoses of OSA.

            I will say that FMCSA has an excellent web site dealing with OSA.  While other DOT agencies would do well to emulate it, I am eagerly awaiting the presentation during this conference on the FRA/Volpe Center-developed sleep apnea educational website that holds great promise. 

            This so-far uneven record has provided the impetus for this extraordinary conference.  Over the next two days, we will be hearing from the nation’s authorities on the underlying medical properties of OSA and possible ways to mitigate the condition, and will zero in on how to deal with this extensive disorder in our transportation industry.

            For the sake of all of us who use our transportation system, we must identify any operators at risk for OSA.  For the sake of the many who operate commercial vehicles, we must identify ways to treat the disorder so they can continue in their chosen profession.  OSA must be pulled out of the shadows so that those who have it will willingly report it and treat it and get on with their lives.

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