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Henry,  <o:p></o:p> I do not understand why you conclude that the remedy will be for the employee to self-diagnose and treat himself.  That is far from how I interpret it.  Here is how the FRA will fix the problem: <pre> <o:p></o:p></pre> <pre> <o:p></o:p></pre> <pre> <o:p></o:p></pre> Recommended Actions  <o:p></o:p>     Therefore, FRA recommends that railroads and representatives of employees, working together, take the following actions to promote the fitness of employees in safety-sensitive positions:     (1) Establish training and educational programs to inform employees of the potential for performance impairment as a result of fatigue, sleep loss, sleep deprivation, inadequate sleep quality, and working at odd hours, and document when employees have received the training. Incorporate elements that encourage self-assessment, peer-to-peer communication, and co-worker identification accompanied by policies consistent with these recommendations.     (2) Ensure that employees' medical examinations include assessment and screening for possible sleep disorders and other associated medical conditions (including use of appropriate checklists and records). Develop standardized screening tools, or a good practices guide, for the diagnosis, referral and treatment of sleep disorders (especially sleep apnea) and other related medical conditions to be used by company paid or recommended physicians during routine medical examinations; and provide an appropriate list of certified sleep disorder centers and related specialists for referral when necessary.     (3) Develop and implement rules that request employees in safety- sensitive positions to voluntarily report any sleep disorder that could incapacitate, or seriously impair, their performance.     (4) Develop and implement policies such that, when a railroad becomes aware that an employee in a safety-sensitive position has an incapacitating or performance-impairing medical condition related to sleep, the railroad prohibits that employee from performing any safety- sensitive duties until that medical condition appropriately responds to treatment.     (5) Implement policies, procedures, and any necessary agreements to--     (a) Promote self-reporting of sleep-related medical conditions by protecting the medical confidentiality of that information and protecting the employment relationship, provided that the employee complies with the recommended course of treatment;     (b) Encourage employees with diagnosed sleep disorders to participate in recommended evaluation and treatment; and     (c) Establish dispute resolution mechanisms that rapidly resolve any issues regarding the current fitness of employees who have reported sleep-related medical conditions and have cooperated in evaluation and prescribed treatment.     FRA acknowledges that some of the above recommendations may have already been institutionalized in one form or another by various segments of the industry; in this case, FRA suggests a review of current policies and procedures for relevancy.     FRA believes that the recommendations set forth above, if implemented by industry parties, could advance the successful management of sleep disorders. Taken together with the results of FRA's broader study of potentially impairing medical conditions, lessons learned could provide a sound foundation for more formal action by industry, government, or both.  <o:p></o:p>  <o:p></o:p>
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