AOPA Turbine Pilot Magazine - April 2021 - 28

FLIGHT MD

John's medical

BY DR. BRENT BLUE

Are FAA requirements successful or irrelevant?
JOHN'S WIFE CALLED ME to let me know he was admitted to the hospital for terminal care. He had cancer,
which had spread, and the situation was hopeless.
John had a special issuance (SI) of his third class medical for a distant problem with addiction. She literally
begged me to call him to tell him his special issuance
was still OK because he was so concerned about his
flying status even in his dire situation.
It is difficult for nonpilots to understand the importance to a pilot of being able to fly. The only thing that
might come close to the nonpilot is losing one's automobile driver's license. Flying is more than a privilege
granted to us by the FAA after passing written and

The fear of losing one's medical is an
overriding concern when pilots come
in for their exam. Every pilot's worry is
they may be one exam away from being
grounded.

DR. BRENT BLUE is
a senior aviation
medical examiner
and an airline
transport pilot. He
has recently become
the proud owner
of a Noorduyn
Norseman based at
Driggs, Idaho (DIJ).

28 | AOPA PILOT April 2021

piloting performance tests. It is a license of independence and freedom.
Everyone wants to be honest on their medical
8500 form and everyone wants to be safe. However,
pilots may be tempted not to be totally honest on the
pilot medical form. If there is a positive answer on the
8500, many of the FAA requirements can be logistically daunting, expensive, and time consuming. The
fear of losing one's medical is an overriding concern
when pilots come in for their exam. Every pilot's worry
is they may be one exam away from being grounded.
When I started as an aviation medical examiner
(AME), the only medical condition you could fly with
was high blood pressure on one of five medications.
The FAA has modified the medical requirements dramatically over the years, and now you can fly with
a range of conditions from heart disease to cancer.
Notably, the fatal accident rate has dropped by 50 percent (relative to total GA hours flown) during this same
period. How has the accident rate gone down given
the FAA has loosened the medical qualification rules
and more pilots are flying with previously forbidden
medical conditions?

I asked this question of the federal air surgeon at
EAA AirVenture a few years ago, and he said the FAA
" mitigates the risk. " I asked what that meant, and he
said the FAA requires more testing for these medically
affected pilots. However, since by the FAA's own numbers, approximately 98 percent of medical applications
are eventually granted, this makes no sense. The FAA is
requiring testing that is not medically indicated which
all but 2 percent eventually pass. These requirements,
which the pilot's local medical specialist finds unnecessary for monitoring the medical condition in this day
of modern medicine, waste a lot of time and money.
As I write this, I am taking a Zoom AME required
" refresher " course. One of the lecturers was a military
cardiologist whose attitude toward requiring testing
of pilots was to completely ignore the time and cost of
doing so. He is isolated in a military system where costs
are hidden, and troops follow orders without hesitation. This has been a pervasive problem in the FAA's
medical certification system. It is reflective of a lack of
latitude in testing requirements that ignores the opinions of the treating physician and even the AME.
Improved medical diagnostics have made many of
those aviation medicine diagnostics obsolete. When an
airman's physician, who is a top expert and has personally examined the pilot, says the pilot is safe to fly,
how can the FAA, who has not had any direct contact
with the pilot, require additional testing or turn down
the pilot's medical application?
The number of medically related aviation accidents across the board is minuscule. The FAA views
this as its success. Some view it as the agency's irrelevance, especially given that the accident statistics for
BasicMed are not significantly different from those of
third class medical holders.
Fortunately, we are seeing a sea change through new
leadership in the FAA Office of Aerospace Medicine:
leaders willing to address these issues. AOPA's newly
reconvened board of medical advisors (of which I am a
member) will be an important partner helping the FAA
understand the realities of twenty-first-century aviation
and medicine. We welcome the change.
So, what did I tell John about the validity of his special issuance medical? That is between John and me. He
has taken that conversation to his grave, as will I. AOPA
EMAIL brentblue@wyoming.com

AOPA Turbine Pilot Magazine - April 2021

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