The legal side of sleep medicine

Nancy A. Collop, MD, FCCP
Nancy A. Collop, MD, FCCP

Sleep medicine has implications beyond the patient and his or her family. Legal implications can affect the patient, the patient’s employer, and even the clinician.

“As the provider, you need to document in the medical record what you talk about with your patient,” said Nancy A. Collop, MD, FCCP, professor of pulmonary, allergy, critical care medicine, and neurology and director of the Emory Sleep Center at Emory University School of Medicine. “You have to protect yourself and your patient and their family.”

Dr. Collop led an interactive discussion exploring the legal aspects of sleep medicine on Tuesday morning as part of a Meet the Professor session. The complexities of polysomnography are clear and concise compared to the potential legal complications, she said.

Sleep, or lack of sleep, is a major issue in a number of industries, particularly those involving truck drivers, bus drivers, train engineers, pilots, and other commercial transportation workers. There are few federal standards regarding sleep and sleep testing, and state provisions vary dramatically.

“When the law looks at a crime, there are two factors to consider,” Dr. Collop said. “There has to be a criminal act, and there has to be criminal intent. The act alone does not make a crime without intent, which makes situations very blurry.”

Many states require commercial drivers to undergo regular medical checkups as a part of their commercial licensing procedure. Fatigue, lack of sleep, and sleep apnea are often addressed as medical issues.

New Jersey is one of the few states in which knowingly fatigued drivers who cause a fatality can be prosecuted for vehicular homicide. Known as Maggie’s Law, the statute was named after a 20-year-old woman who was killed by a sleeping driver.

Dr. Collop noted that a recent safety study by the American Automobile Association using cameras to record drivers behind the wheel found that about 10% of accidents are due to drowsy driving. But few police officers are trained to assess drivers for drowsiness, and there are no legally validated roadside tests for drowsiness as there are for alcohol levels.

Commercial truck drivers who work for a large transportation company are less likely to have sleep issues than independent drivers, she noted.

Some larger employers have found a financial benefit in establishing and enforcing sleep guidelines, including medical intervention for sleep apnea.

“Some companies manage sleep aggressively,” Dr. Collop said. “Their health care costs go down, they have fewer hospitalizations, lower drug costs, healthier employees. And, they have fewer accidents.”

Night workers are another group at risk for sleep disorders. Not only are they ignoring the usual light-dark sleep and activity cues, they are often underslept and have more disturbed sleep, as other individuals in their household keep different schedules.

Uber and Lyft drivers are an emerging at-risk population. Driving is a second job for many and their driving is concentrated during evening and morning hours when traffic accident rates are highest.

“As long as you document your process, you should be well covered,” Dr. Collop said. “Documentation is incredibly important.”