Where are railroad medical standards?

Written by William C. Keppen, Jr.
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Undiagnosed OSA (obstructive sleep apnea) caused MTA Metro-North’s fatal wreck at Spuyten Duyvill in December 2013.

Why don’t the railroads have comprehensive medical fitness-for-duty standards? Why does this persist, in spite of several train collisions and derailments attributed to medical issues like untreated obstructive sleep apnea (OSA)? This analysis of those questions considers the in-terests and relationships among the three primary interested parties: railroad management, railroad labor and the Federal Railroad Administration (FRA), the regulator.

It is important to note that the public that suffers the consequences of unsafe railroad operations has no real advocate, no real knowledge of existing unsafe conditions and operating practices.

I’m utilizing three words and the following definitions to posit an answer:

  • Organic: denoting a relationship among elements of something such that they fit together harmoniously as necessary parts of a whole.
  • Complicit: involved with others in an activity that is unlawful, or morally wrong.
  • Self-interest: focused on actions or activities that are advantageous to an individual or organization.

The story goes something like this: For more than 100 years, railroads were self-regulated. Each had its own medical standards and protocols for monitoring medical fitness of safety-sensitive employees, like locomotive engineers and train service personnel. Periodic medical examinations, by railroad designated physicians, were a requirement of employment. There was no FRA to regulate railroads or to impose medical standards and fitness requirements.

As other modes of transportation like commercial trucking and aviation entered the interstate transportation industry, federal regulatory agencies undertook a more proactive approach to medical fitness-for-duty. Then, in 1966, the Department of Transportation establish FRA, at which time FRA most likely considered safety issues like medical fitness, but presumably saw no need to regulate, since the railroads already had their own comprehensive medical fitness-for-duty programs.

Then, in the 1990s, with the advent of the Americans With Disabilities Act (ADA), and the Health Insurance Portability and Accountability Act (HIPAA), things changed. The freight railroads quietly discontinued long-standing comprehensive medical fitness oversight practices in favor of much leaner, less comprehensive programs. However, as a result of several train accidents, FRA regulations now require railroads to monitor vision and hearing against established standards. No other potentially debilitating medical conditions, like diabetes, high blood pressure or sleep apnea, are covered by those or other FRA regulations. A 2005 FRA funded study, “Medical Standards for Railroad Workers,” found that only one of five Class I railroads had a program for “comprehensive periodic examinations for train and engine crews.” All others rely on pre-employment, return-to-work and change-of-position examinations, only.

There is a problem with that approach for assuring medical fitness-for-duty. Railroads don’t really know if the vast majority of their train operating employees are medically fit to safely operate trains when medical fitness is not monitored,against reliable standards, on a periodic basis.

Why does the lack of comprehensive medical fitness-for-duty standards persist? It’s because, even though the National Transportation Safety Board (NTSB) has issued numerous post-accident recommendations to FRA and to individual railroads on medical fitness, FRA and most railroads have failed to act on them, as NTSB recommendations are not binding and do not require action.

It goes further. In 2004, FRA issued a Safety Advisory on medical standards to railroads, and, once again, most railroads failed to take action on the recommended measures for assuring fitness-for-duty of safety-sensitive railroad personnel. Taking the matter even further, in 2005 FRA submitted a “task request” on medical standards to the Railroad Safety Advisory Committee (RSAC) for consideration. As information, every mode of transportation has a Safety Advisory Committee (SAC) to review and consider solutions to safety problems. Keep in mind that the RSAC is composed of three primary stakeholders: railroad management, railroad labor and the regulator, FRA, along with other industry experts who may lend their expertise in finding safety problem solutions.

This is where it gets interesting, and somewhat murky. While meetings of the full RSAC are open to the public, RSAC working group meetings, where all the real work is supposed to be done, are not. I was not a member of the medical standards working group, and I was never invited to attend. So, I cannot provide intimate details of what the working group did, or failed to do.

I can, however, tell you this: The working group ruminated on this task for more than five years and failed to reach consensus, which is required to take definitive action on a task. As a result, recommendations on medical standards were never submitted to the full RSAC for a vote on adoption.

How does one explain a group of industry experts deliberating for more than five years on something as simple as medical fitness-for-duty and failing to reach consensus? Remember, every other mode of transportation in the U.S., other than railroads, has medical fitness-for-duty standards and protocols. The RSAC working group could have done something as simple as say, “Let’s just recommend adoption of the Federal Motor Carrier Safety Administration (FMCSA) medical standards and protocols.” Those standards and protocols already apply to thousands of commercial motor vehicle operators employed by the railroads. This is something I personally suggested to several members of the medical standards working group, over the course of time.

For me, the only logical explanation for failing to reach consensus on medical standards is self-interest, for railroad management and railroad labors. Even though the self-interests of management are much different from those of labor, the objective of both was the same: Forestall any actions by FRA to establish medical standards regulations for railroad personnel.

I do not believe that management and labor were directly complicit, but failure to reach consensus constitutes what I would call an “organic complicity.” By stipulating that any working group recommendation must include certain provisions that management or labor opposed, lack of consensus was virtually assured. Neither wanted medical standards, for fear that they may adversely affect their self-interests.

Time marched on with no further action by FRA—until a series of train collisions and high-speed derailments caused by medical conditions/untreated OSA prompted FRA to issue another medical safety advisory, followed by a joint FRA/FMCSA Advance Notice of Proposed Rule Making (ANPRM) on medical fitness and OSA in 2016. Then, in August 2017, approximately 16 months after the ANPRM was issued, it was withdrawn with explanations by FRA that, to be kind, lack credibility.

So, what are the public safety implications? Look at it this way: I could be a 60-year-old locomotive engineer who is five feet eight inches tall and weighs 250 pounds (Body Mass Index 38, obese) with high blood pressure, diabetes and untreated OSA. Since my employing railroad does not require periodic medical fitness examinations, and I have not been out of the workforce for an extended period of time, which would prompt a return-to-work examination, I can continue working. When I get a call to report to work, I pack my bags, report to the location where my train is waiting, climb on the controlling locomotive, release the brakes, pull the throttle out and start the journey to my objective, an away-from-home terminal. For the vast majority of trips, I, and others like me, reach that terminal in one piece. But then, there is the exception, that one trip when I fall sleep because I have untreated OSA, or I experience some other unexpected medical event that compromises my ability to safely operate the train. At that time, I’m going down the road at 50-60 mph when I run past an absolute stop signal into the face of an opposing train. This has happened, and may continue to happen, unless and until effective medical standards and fitness monitoring protocols are either adopted by the railroads themselves, or imposed by an FRA Emergency Order or regulation.

I believe the public deserves to be informed of these safety problems. I also believe it’s owed an explanation from FRA, the railroads, or both. Why do you continue to put our safety at risk by failing to act on medical standards and fitness-for-duty? Please explain.

William C. Keppen Jr., a retired BLET (Brotherhood of Locomotive Engineers and Trainmen) Vice President and third-generation locomotive engineer at BNSF and predecessors Chicago, Burlington & Quincy and Burlington Northern, is an independent transportation advocate with experience in fatigue countermeasures programs. A railroad industry veteran of almost 50 years, Keppen provides safety analyses for Confidential Close Call Reporting System (C3RS) programs in freight, commuter, and light rail transportation. Keppen was Project Coordinator for BNSF’s Fatigue Countermeasures Program, and former BLE General Chairman for the BN Northlines GCA. “I started working on human-factor-caused train accidents in 1980,” he says. “It has been a struggle. I would like to think I have made a difference, but there are still far to many human-factor-caused train ‘accidents,’ which I prefer to refer to as ‘preventable incidents.’”

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