AOPA Pilot Magazine - April 2024 - 24

FLIGHT MD
A better way
Why not issue temporary medical certificates?
BY DR. BRENT BLUE
BRUCE LANDSBERG, vice chairman of the NTSB, made a critical
point during the NTSB aviation safety summit " Navigating Mental
Health in Aviation. " To paraphrase, he said, " If the FAA gives pilots
60 days to respond to their request for records, then the FAA should
only have 60 days to make their medical certificate decisions. "
This will never happen, and the FAA will never have enough
staff in its medical department to expediently evaluate pilot medical
certificate issues given the sheer volume of applications. The
problem is the FAA has been unwilling to make the necessary
changes to fix the delays that are caused by self-imposed criteria,
particularly in the mental health area. (For an excellent discussion
of the aviation mental health issues and the FAA, see the NTSB
summit on the NTSB YouTube channel, @NTSBgov.)
Let me make some suggestions that could be implemented
quickly by government standards. First, since the FAA states that
99.9 percent of medicals are eventually approved (this number
does not count pilots who give up during the process or abandon it
before starting), how about giving pilots " temporary " medical certificates
during the FAA's protracted review? This stops penalizing
the pilot for the FAA's arduous, time-consuming deliberations. Of
course, the obvious question is if 99.9 percent of certificates are
eventually approved, from a statistical point of view, what purpose
is the process at all?
Another area is trust. The FAA needs to trust aviation medical
examiners and local health care providers to determine if a pilot is
safe to fly. The FAA has so little trust in its AMEs that the agency
has sent surveys to pilots after their medical examinations with
questions like, " Did the AME personally do your exam? " and " Did
the AME look in your ears? "
The FAA standards for pilot medicals are based on medical
qualifications that were developed when most AMEs were in
grade school. Medicine has not only changed dramatically, but
also our ability to evaluate patients is beyond what I could have
dreamt about in medical school during the last century.
Heart disease is the classic example of the FAA's arrogant
evaluation process. If a pilot has a minor heart attack-such as an
inferior myocardial infarction-and has a stent placed, the FAA
will require a cardiovascular evaluation, a stress ECG, and all the
hospital records. If the pilot is applying for first or second class
medical, they may be asked for a nuclear stress test and airline
pilots may be required to have a follow-up catheterization. A pilot
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AOPA PILOT / April 2024
could have a cardiovascular evaluation done by a world-famous
cardiologist at a major medical institution like the Cleveland
Clinic, which states the pilot is fit to fly but the FAA will still
require additional testing. Many times, the cardiologist will specifically
state the additional testing is not indicated. However, the
FAA uses a cardiology panel that has never seen the pilot, and uses
a checklist of required tests, to judge whether the pilot is fit to fly.
According to the federal air surgeon, almost 30 percent of
pilots flying under BasicMed had a special issuance at their last
medical. Decisions on whether they are fit to fly are made by any
state licensed physician based on the physician's professional
opinion, not FAA criteria. Since the accident rate for BasicMed
pilots is the same as third class medical pilots, it illuminates the
lack of value in the FAA's requirements.
The FAA has made some improvements like the CACI
program-Conditions AME Can Issue. But look at a CACI like
hypothyroidism. The CACI requirements for the pilot to bring in
are not too bad. The pilot must bring in the treating physician's
clinical note done for a visit within 90 days of the AME exam
and a lab test within the last year. Even though most hypothyroid
patients are stable on the same dose of medication for years, the
FAA thinks that pilots need a recent office visit and annual blood
work. That means the FAA is determining the medical standard of
care. Sure, hypothyroidism could theoretically cause an accident,
but an aircraft could theoretically be hit by a meteor. Why not let
the AME decide if the pilot is safe to fly?
The FAA evaluation of mental health issues is so complicated,
expensive, time consuming, without transparent criteria, and
without proven validity, pilots hide mental conditions and/or avoid
mental health care whether it is counseling or medication. The
FAA has started an aviation rule-making process to look at mental
health specifically but changes, if any, will take years.
Every pilot determines whether they are safe to fly prior
to each flight. Given the 0.5 percent medically related accident
rate, pilots and AMEs should have earned the trust of
the FAA. Trusting AMEs to make decisions locally will reduce
workload and maybe,
someday, the FAA can
make decisions within
60 days.
brent@brentblue.com
DR. BRENT BLUE is a HIMS
certified senior AME, practicing
at the Driggs, Idaho, airport (DIJ)
just west of Jackson Hole.
AOPA Pilot Magazine - April 2024

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