Article and photos by James Campagna

Fabiola Bittar de Kroon waited on the crowded platform at New Jersey Transit’s Hoboken terminal on the morning of Sept. 29, 2016. The 34-year-old Brazilian had just dropped her 18-month-old daughter at day care before heading to the station. She would never return to pick her up.

Shortly before 9 a.m., New Jersey Transit train 1614 ran into the station’s bumping blocks at the end of the line, causing 114 injuries and de Kroon, the sole fatality, her life. Although the engineer had passed the mandatory medical screening two months before the accident, the National Transportation Safety Board’s accident report said he had an undiagnosed condition of severe Obstructive Sleep Apnea, or OSA, and that it was a primary cause of the fatal accident.

Sleep apnea causes a collapse of the airways while asleep, interrupting the sleep cycle and causing daytime fatigue. No federal regulations address sleep apnea in locomotive engineers, nor were they included in NJT’s medical screening at the time of the accident.

The Federal Motor Carrier Safety Administration is tasked with creating and implementing safety regulations for the nation’s rail systems and roadways. In late 2016, Dr. Gina Pervall, the chair of the agency’s Medical Review Board,  submitted a series of recommendations for sleep apnea screening in commercial motor vehicle operators.

The agency’s report, “Evaluation of Safety Sensitive Personnel for Moderate-to-Severe Obstructive Sleep Apnea,” explains, “Undiagnosed or inadequately treated moderate to severe OSA can cause unintended sleep episodes and resulting deficits in attention, concentration, situational awareness, and memory, thus reducing the capacity to safely respond to hazards when performing safety sensitive duties.”

A former train engineer with the Port Authority Trans-Hudson system, Erik Garces, 48, said: “They’re not proactive about things like that. They only respond to something usually after there’s a terrible accident.”

In August 2017, before the relevant federal agencies could implement the Medical Review Board’s recommendations, the Trump administration withdrew them. Many Democratic lawmakers, including Senate Minority Leader Charles Schumer of New York and Senator Cory Booker of New Jersey, voiced disappointment,  claiming the administration was ignoring science and putting the public at risk.

The bipartisan divide has left the nation’s rail systems with federal regulations largely unchanged since 2000. Senators Booker and Schumer have proposed legislation to address these concerns­­­ but face steep opposition from a Republican White House and Congress.

Under current regulations, a commercial vehicle operator may continue to work if he or she “has no established medical history or clinical diagnosis of a respiratory dysfunction likely to interfere with his/her ability to control and drive a commercial motor vehicle safely.”

Local transit agencies, like the Metropolitan Transportation Authority, have recently begun testing for sleep apnea as part of their medical screening. The pressure has increased with each fatal accident, including the NJT Hoboken crash, the 2013 Metro-North train derailment and a 2009 tractor-trailer accident in Miami that killed 10 people in six vehicles. In each case, the NTSB determined that fatigue or incapacitation caused by sleep apnea was a primary factor in each case. In April 2017, both the MTA and NJT ordered sleep apnea guidelines be included in the medical screenings for all safety-sensitive employees. Previously, NJT did not address sleep apnea specifically. The MTA has included a sleep apnea questionnaire in its screening process since 2013.

With more than 30 years in the industry, Garces, the former engineer, said he has witnessed the slow pace of federal oversight first-hand. As an engineer for PATH  from 2002 to 2004, he underwent mandatory medical screening to qualify for service. But the primary goals of the medical exams, he thought, were to assess conditions like heart disease and diabetes. “They really don’t care whether or not you get enough sleep,” he said. “They really don’t care whether you get enough time off. They only care about how fast they can get you back into the cab.”

Garces said that sleep apnea “is a problem and I think some of the local railroads are doing a good job of addressing it, making sure everyone is medically tested. And those people who have an issue have the proper treatment.”

Schumer has long supported stronger federal regulations and medical screening requirements for all commercial vehicle operators and has pushed for completion of Positive Train Control systems, or PTC, on all passenger trains. The technology can slow and stop a train if the engineer becomes incapacitated. The most recent progress report from the MTA said completion of a PTC system was about half-done, despite what Schumer’s office said was nearly a decade of preparation time.

An MTA spokesman, Aaron Donovan, responded, “Safety is always the agency’s top priority. Despite Senator Schumer’s statements to the press the MTA will be in full federal compliance by the Dec. 31, 2018 deadline.

The recommendations made by the federal Medical Review Board included the measures recently implemented by the MTA and NJT.  They would also have set standards for diagnosing sleep apnea and effective treatment requirements to maintain active employment status.

Common treatment options include a C-PAP device, involving a mask worn at night and forced air that maintains an open airway, and surgery to widen the airway. Vehicle operators would be disqualified from driving if they were not in compliance with effective treatment requirements, if they were involved in a sleep-related crash or if they have admitted fatigue or sleepiness on the job. Those receiving effective treatment for the disorder would be conditionally certified to work on a yearly basis with additional medical reviews required.

Meanwhile, the Trump administration said in August it was conferring with the industries themselves and other “interested parties.”

Fabiola Bittar de Kroon’s husband, Adrianus, and their daughter, Julia, took her home to Santos, Brazil, to be buried and decided to relocate to Brazil to be closer to the de Kroon family.

The fate of Senators Schumer and Booker’s proposed legislation is uncertain.