HGV driver with OSA who refuses disclosure to his employer
A 44-year-old category C+E lorry driver attends for a medical after his GP diagnosed obstructive sleep apnoea (AHI 28) and started CPAP. He feels much better, his Epworth score is 6, and he has 100% CPAP compliance at 90 days. He does not want his employer told because he fears losing his job and has asked you not to disclose. His contract requires him to declare any condition affecting driving, and he has already told his line manager he has 'sleep issues'. You are the occupational physician for the haulage company. He has had no road traffic collisions and no daytime sleepiness now.
1. What are your professional and legal obligations regarding disclosure to his employer?
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- Start from confidentiality: you should not disclose clinical information to his employer without his consent. Explain clearly why the information is relevant to safety-critical work and to his own contractual duty to declare.
- Explore his fears: dismissal risk is often overstated, and untreated or poorly controlled OSA is the greater risk to his licence and employment. Offer to support a managed disclosure.
- If he consents, disclose the minimum necessary: diagnosis, treatment status, compliance and fitness advice, not the full clinical record.
- If he refuses, you must not collude in a false declaration. Explain that you may need to act in the public interest if he continues to drive against advice or if his condition is uncontrolled. Before any disclosure without consent, warn him, document your reasoning, and seek advice from your defence body or the GMC's confidential helpline.
- The employer's contract and the DVLA group 2 standards both create obligations on the driver; your role is to advise, not to enforce the contract.
2. Assuming he consents, what fitness-for-work advice would you give and on what terms?
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- DVLA group 2 standards require a specialist assessment and evidence of control. With CPAP, confirmed compliance (usually machine-recorded usage) and good symptom control, he may be certified fit, but certification should be time-limited, for example 12 months, with review.
- Obtain a specialist report confirming the diagnosis, AHI, treatment compliance and absence of excessive daytime sleepiness. An Epworth score of 6 is reassuring but not sufficient alone; ask about sleepiness while driving and any near-misses.
- Advise him to report any return of daytime sleepiness immediately and to stop driving if sleepy. Advise the employer (with consent) of any restriction on shift length or night driving if clinically indicated.
- Document the advice, the review date and the information given to the driver about his duty to inform DVLA if his condition changes.
3. What would you do if he refuses consent and says he will keep driving?
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- Reiterate that you cannot provide a fitness certificate that conceals a relevant condition, and that driving while sleepy is a danger to him and others.
- Explain the limits of confidentiality: if he continues to drive contrary to advice, disclosure to the employer and/or DVLA may be justified in the public interest. Tell him what you propose to do before you do it.
- Document the discussion, his decision and your reasoning. Seek advice from your medical defence organisation or the GMC.
- If you do disclose, disclose only what is necessary: that he has a diagnosis relevant to driving and that you have advised him not to drive until assessed, not his full medical history.
- Continue to offer support and a route back to fitness, so that disclosure is not framed as a punitive act.