AOPA Turbine Pilot Magazine - February 2022 - 26

FLIGHT MD
Wasted time
A simple explanation can prevent a lot
of heartache
BY DR. BRENT BLUE
I WAS SENT a copy of the FAA Aerospace Medical Certification
Division's letter to a pilot who had a " partial finger amputation "
reported since his last medical. The AMCD listed two paragraphs
of requests that ranged from copies of surgical records to a disability
evaluation by an orthopedic specialist. All this for a " partial
finger amputation. "
I wrote an email to Dr. Susan Northrup, the federal air surgeon
for the FAA, incensed by this apparent overreaction. Well, not so
quick. Northrup investigated the file and found that although the
pilot noted the injury on his medical, his aviation medical examiner
(AME) did not comment on it. This major screw-up by the
AME cost the airman and the FAA unnecessary time and expense.
A partial finger amputation is usually not a significant factor
for flying an aircraft. However, if the thumb is the affected finger,
it may be. The thumb is critical for opposition in the hand
which can affect the ability to control certain aspects of an aircraft.
It is not unreasonable for the FAA to want to know about
the injury. However, since the AME did not explain the injury
or comment on any possible disability, the airman was subject to
unnecessary questioning and the FAA wasted its time. Had the
AME just stated something like " amputation of distal phalanx
of index finger of non-dominant hand with no disability, injury
from using unfamiliar table saw, " the issue would have been over.
Unfortunately, this is not a one-off problem. Many times, simple
explanations by the AME of issues on a pilot's medical form can
prevent follow-up questions from the FAA about medical status.
For instance, if a pilot checks that he has allergies, does the pilot
take medication not listed on the form? If he takes a medication,
is it " approved " (non-sedating)? If the pilot checks the allergy box
and the AME does not comment, the FAA will ask for clarification.
Another common problem that drives the FAA crazy (and me
when I hear about it) is when a pilot's medical is deferred unnecessarily.
Currently there are
20 conditions AMEs can
issue (CACIs) a medical certificate
for that do not require
special issuance or approval
from the FAA. CACIs range
from asthma to testicular cancer
and the pilot just needs to
DR. BRENT BLUE is
a senior AME based in
Jackson Hole, Wyoming. He
flies a Noorduyn Norseman
and a Cessna 185 out of
Driggs-Reed Memorial
Airport (DIJ) in Idaho.
26
AOPA PILOT / February 2022
provide documentation to the AME that is listed on the FAA website.
If the listed criteria are met, the AME can issue the medical
on the spot. If the AME is not paying attention, misses that the
pilot's condition is a CACI, and sends in the medical as a deferral,
all involved lose in the process.
Although mistakes like this happen more frequently with AMEs
who do a minimal number of exams per year, missteps can happen
to anyone. AMEs are required to undergo recurrent training every
three years but remembering the intricacies of pilot medical applications
may not be top priority in a busy medical practice.
For the pilot, knowledge helps and if a condition arises
between medicals that may be an issue for the FAA, knowing
if it is a CACI may help " remind " the AME the medical can be
issued. The FAA's Guide for Aviation Medical Examiners, which
has all the rules, is available to everyone online.
A gentle statement to the AME to make sure and comment on
benign conditions like a " partial finger amputation " could help
prevent problems created by omitting simple data on the medical
form. If the AME is unsure of what to document or to defer,
asking him to call the regional flight surgeon or the Oklahoma
City main office can provide clarity.
Performance data is kept on every AME, including information
like medicals issued that should not have been and medicals
deferred that could have been granted. AMEs have access to their
records online. The regional flight surgeons are responsible for
AME performance in their regions and if multiple or recurrent
mistakes are made, the regional flight surgeon may recommend
revocation of an AME's designation. Revocation does not happen
often, but it does happen. brentblue@wyoming.com
Pilots have asked about FAA medical implications of using
CPAP in an aircraft below 12,500 feet msl ( " Flight MD: CPAP
in Aircraft, " December AOPA Pilot). This technique is not
treating a disease or pathological condition. It is a method to
reduce fatigue and is no different than using sunglasses to
prevent headaches and eye fatigue. In my opinion, it would
not be necessary to report to the FAA, just like not reporting
the use of sunglasses. -BB
AOPA Turbine Pilot Magazine - February 2022

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