ON THE PATH TO FAA MEDICAL CERTIFICATION REFORM
Article appeared in Flying Magazine July, 2018 by Martha King
When John came to in the hospital a number of years ago after a lapse of consciousness, you will appreciate that the very first concern he expressed was for his aviation medical certificate. Perhaps the most significant and deeply personal touchpoint with the FAA for every pilot is the medical certification process. To a pilot, the ability to fly is a profoundly important part of their very being.
FAA medical certificates are issued by the Aerospace Medical Certification Division (AMCD) in Oklahoma City. It is a part of the Civil Aerospace Medical Institute (CAMI). John and I recently had the opportunity to tour CAMI and we found everyone to be knowledgeable professionals committed to their mission “…to assure civil aerospace safety…”
Considering the extreme importance to the pilot of their medical certificate, and the virtually unlimited power that the FAA’s aeromedical folks have over the very soul of the pilot, you would think they would bend over backwards to convey a sense of great care to the pilot.
But as truly dedicated as the folks at CAMI are, that sense of care hasn’t been evident to many pilots. When John had his medical certificate denied, many related their own medical certification experiences to us. To a person they reported that the FAA’s approach to certification felt heavy-handed and adversarial rather than helpful. In particular they felt that the letters they received were cold and mean-spirited legal documents lacking in kindness or empathy.
A pilot who has followed the rules and reported a doctor visit revealing some medical imperfection often feels unfairly treated. Many who have disclosed very intimate and personal information feel the FAA doesn’t appreciate that the pilot voluntarily submitted the very information the FAA is now using against them. It does not appear to them that the FAA has their interest at heart and is trying to help them. Indeed, they often feel that the FAA themselves doesn’t play by fair rules.
Rather than helping them get over a hurdle to “yes,” pilots often feel the approach appears to be to throw new hurdles in the path of applicants. Pilots attempting to obtain special issuances frequently feel trapped in an involuntary game of Whack-A-Mole. Demands are made for numerous tests that the specialist treating the patient often feels are irrelevant—and sometimes unnecessarily risky. After the demands have been met and satisfied, new demands are made.
Meanwhile, while this game is being played, it not uncommon for the pilot to be deprived of their medical certificate, and often their livelihood, for many months. After the certificate has been received, when the next application for renewal is made, it is not unusual for a demand that was previously satisfied to resurface, starting the process all over again.
It is easy to understand how this lack of trust, among other things, caused the hard push in Congress to allow pilots to fly light sport aircraft with what is known as a “driver’s-license medical.” It also led to third-class medical reform in Congress, which culminated in what is known as BasicMed.
Why haven’t the dedicated people at CAMI retained the support of the aviation community? As counter-intuitive as it is, the problem begins with their mission “…to assure civil aerospace safety…” What could possibly be wrong with that mission? Who can complain about the assurance of safety?
Well, to assure absolute safety would mean we ground every pilot. The reality is that the management of safety is a tradeoff. There is a balance between protecting the public and helping even medically imperfect pilots retain their privilege to fly. What we really mean when we talk about safety is that we want to strike the right balance. This is a very difficult concept because there’s no bright line between ‘too risky’ and ‘safe enough.’ Adding “helping pilots keep flying” to their mission statement would change everything. Suddenly pilots would become “customers” that they are serving.
Right now these dedicated, well-intentioned people are trapped in a dysfunctional culture that has caused the loss of trust of the aviation community and even the disapproval of Congress. It cries out for leadership to change that culture into one that conveys their respect for pilots and the desire to serve them as customers.
Of course it would be dramatic change for the FAA to consider pilots as “customers” rather than as people they regulate. However, the California DMV has done it. It used to be a classic example of a dysfunctional government agency that everyone loved to hate. Now, after an amazing cultural reform, they do a wonderful job of conveying their respect for you and their desire to help you.
The Flight Standards Division of the FAA is another example. It has established a relationship of trust with the aviation community by pursing core values such as creating a just culture, helping pilots get over hurdles to “yes,” promoting risk-based decision-making, and treating people as individuals. The trust these principles have engendered has helped to create the Airman Certification Standards (ACS), the Compliance Philosophy, easier installation of non-required safety equipment, and Part 23 reform. The result is an extraordinary balance of risk management and productivity.
The very good news is that in our conversations with the folks at CAMI, John and I learned they have made the decision to follow the spectacular example of the folks at the California DMV and the FAA’s Flight Standards Service. They intend to effectively manage the personal touchpoints with new policies and procedures that demonstrate concern for the constituencies they serve, including pilots.
They have already embarked on a program to improve their communications with pilots. Previously, their letters to pilots were largely directed by the legal department who had no conception of the damage to the relationship with the aviation community the cold, legalistic letters were causing. Now they are re-crafting their letters to display the kindness and empathy that John and I observed when we met the folks at CAMI.
They have also made the decision to actively seek out other ways to mitigate risk rather than simple denial of a certificate. For instance, in John’s case the FAA was responsive to his petition to mitigate the small risk of a repeat lapse of consciousness by requiring him to fly with another qualified pilot. This was not much of an imposition on us since most of our flying is in an airplane that requires two pilots. John is very appreciative of this solution and is very eager to see other pilots benefit from the policy.
The needed culture changes are very significant, and will be difficult to identify and implement. However, there is precedent right within the FAA. Flight Standards has reformed the way they evaluate pilots from a competency standpoint by participating with a working group for over seven years in collaboration with varied constituencies of the aviation community. The spectacularly beneficial result is the Airman Certification Standards.
At our CAMI meeting they indicated they would be eager to participate in a similar working group to help design and implement medical certification reform. This is wonderful news that will benefit the entire aviation community.
My friends in the airline industry learn VERY quickly that the best way to avoid FAA troubles is to avoid self-reporting. Of course, in the era of electronic medical records SNITCH is always lurking. So where does that lead? Avoid the doctor except for once every six months to renew the medical.
I have been medical free (and job free) for several years at this point.
Here is the issue guys. FAA Aeromedical Certification Division and their doctors dont follow medical literature or scientific facts…, They also ignore and disregard their own publish kedical protocols for being certified for specific conditions.
The people who get certified are those individual who know someone at FAA Medical, or
Those who are celebrities. Profiling its well and alive at FAA Medical Branch. These people will block your path to certification on the basis of the color of skin, politics, you name it…. it is probably the most bias agency in the US.
Its a must to contact your state local representative or Senator for help.
YOU BET; John’s battle with AMCD resonates with far too many of us pilots. I heartily agree who note that Martha’s post is important, measured, and well-written. Bravo!
This topic of medical certification vs. public risk should be all about judgment, prudence, and proportionality; concepts which routinely escape the AMCD. (Forgive me in advance; as I vent here. I’m going to use words like “beaurocrat” and “weasel” a lot, to substitute for some pithier words I’d like to use.)
I too have a dog in this fight; every single Fed-inflicted torture Martha mentions has been visited on me personally for the last half-decade or so. Further, these callous AMCD Feds have dealt out to a lot of us a heap of ADDITIONAL injustices. (I hear an “Amen” from the congregation.)
How about (not a complete list):
— Routinely violating that fundamental tenet of American jurisprudence: “Innocent until proven guilty.”…
— Losing paperwork and claiming they’d never had it…
— Demanding documentation of medical facts ALREADY FAVORABLY ESTABLISHED in the previous letter I’d just sent them…
— Routinely setting deadlines that are near impossible to meet…
— Once, arbitrarily mandating a $4,000 medical test that (after I’d moved heaven and earth, and spent my last savings to accomplish by a specified deadline) they maddeningly write back to me: “Whoops, THAT test is no longer needed, now we want XYZ…”
— In another letter, yet another faceless AMCD bureaucrat described my three minor medical issues (all of them under control and not disqualifiers) as: “A constellation of problems.” Does that not sound like unprofessional, unecessarily negative CYA hyperbole? Ummmmmm …”Three”… is not “billions” …Doc Weasel.
— Inhumanly letting us all stew for soul-crushing weeks, sometimes months, wondering if we could ever again practice our beloved, decades-invested flying profession or avocation…
— Perpetually ignoring the clear, unequivocal letters of recommendation I’d gotten from multiple accomplished physicians; medical experts who had ACTUALLY CAREFULLY EXAMINED AND TESTED ME! …and who had (bless them) unanimously stuck their necks out to endorse in writing my return to flying…
Finally –just this Oct. 27, 2018– from behind the impregnable walls of this beaurocratic Fed clown-posse, I received yet another heinous AMCD epistle, this one informing me (paraphrasing here): “Your 2nd Class will hereby expire at the end of Nov 2018.” Instead of the April 2019 expiration of the one currently in my wallet.
Furthermore, I had just “60 days (do the math) to get into AMCD’s hands the (absolutely trivial) info we now demand.” And they wonder why our collective BP’s are mildly elevated?
Obviously the big red “NO” stamp on the AMCD’s desk best protects their own hides, and is a lot easier to use than the little green “YES” stamp. Indeed those of us have endured needless persecution at the hands of these self-serving thugs wish mightily to see realistic reform.
Something along the lines of the “New Compliance Philosphy” the FAA claims to be using since 2015 sounds nice; and Martha is understandably very diplomatic in her article. But those on the hurting end of these malevolent lawn-darts from OK City know how much anger and distrust these unnamed, execrable AMCD ‘public servants’ have provoked.
As for me, I call for Nuremberg Trials for the %#$@. “I vas only followink orders” would not be acceptable. In my calmer moods I visualize a pissed-off, crusty old Alabama cropduster dragging them into the courtroom with a Piper nosewheel towbar clamping their ears.
While I’m SLIGHTLY encouraged by what I read about the King’s visit to CAMI… as of the last week of Oct 2018 I ain’t seeing this new attitude at all.
…and I suppose my “severely-chapped posterior” is now one more thing I’m obliged to report to my AME.
These discussions are long overdue among the pilots who have been screwed by the FAA medical establishment. I have my own incredible story which I will post when I have time to spare soon. In a nut shell, have been waiting 27 months since I appealed a denial for a 3rd class medical. The journey has taking me from the AME to OK City to my local Flight Surgeon back to OK City then to the big dog Federal Air Surgeon, 800 Independence Ave, Washington DC, . . And just received a certified letter saying my case has been referred to a highly specialized consultant for review. . . How’s that frost you? ? . . . I have non-sustained ventricular tachycardia with is completely under control with Toprol XL. No events of any kind for two years, and never in my lifetime has there ever been Syncope, EVER ! ! . . So, 5 days a week M – F, I get into my 5000 Lb car and drive past an elementary school zone near my house, young children darting out in front of me occasionally, never over 20 mph nice an legal, children waving at me as if I were taxing my C182, on my way to have decaf coffee with my partners in crime. . . So here I be with clipped Wings wondering just how this will all come to a head, going on with my all to pathetic life waiting for a highly perplexed FAA Medical Establishment do what they do best, protect the public. . . Protect the Public ? ? . . .
Check out the following link and see just how they do this
Having an overzealous federal bureaucracy policing private aviation medicals is grossly out of proportion to the risks they oversee. How many persons die due to aviation medical incapacity per year?
It’s tiny. Outright collapse in flight is extremely rare, numbers that can be counted on your fingers.
Impairment in flight while higher, is still extremely low, as a cause of lost life. Usually it is a lack of judgement, mechanical failure, weather, use of alcohol or drugs, lack of training, and just bad luck that causes accidents. Medical incapacity, as a cause, is extremely rare, even as documented in the NTSB accident reports.
To see how out of proportion the policing vs risk is, note that there are less than 400 deaths per year in all of general aviation. Medical incapacity as a cause of those, insofar as it can be proven, is a very small part of that. Say 10%, then that would be 40 deaths per year, literally about the number dying from lightning strikes or falling out of bed. Do we need a federal bureaucracy to oversee those number and ridiculously low risk level? Compare the total death rate of 400 per year with other activities. Motorcycle, boating, driving, bicycles, all have higher, and in some cases, far higher rates of deaths, yet have no bureaucratic medical requirements beyond a simple license. The FAA medical establishment behaves as all government bureaucracies do, expand their power, clumsily interfere in the lives of their subjects, Justify their existence by accretion of more and more rules. When you consider the out-of-proportion aspects of risk vs oversight, it is an absurd mismatch.
We should refrain from the silly thought that “if just one life is saved, it is worth it”. If we lived by that, we wouldnt do anything. That’s where the notion of reasonable balance between risk and safety enter the argument.
Great article! Don’t see any movement from CAMI….I’m a DPE, why do I even really need a medical? FAR 61.23 (iv) When performing the duties as an Examiner in an aircraft when administering a practical test or proficiency check for an airman certificate, rating, or authorization. Is the only reason? How would/could the community be served if this were to include BasicMed?
CACI’s in my humble opinion should be expanded. The AME needs to be more involved as DPE’s are for certificate issuing so should AME’s!
Keep up the good work!
I am a 74 year old commercial pilot with over 8,500 flight hours who disclosed at my last Class 2 Medical that I had early stage (2 pills a day) Parkinson’s. My medical was declined and I was informed by my DME that I had no hope of flying again. Other than moving a bit slower than I used too, I still do most things normally, but the DME offered no encouragement and actually discouraged any attempt. Have a heart problem and be back flying in six months. I agree Medical reform is need, but I don’t hold much hope for my problem.
Martha, what a timely article for me to read. I have just gathered together the paperwork (about an inch thick) to send to the CAMI to request reinstatement of my class three medical certificate. I lost it to an onset of Atrial Fibrillation which was discovered by both my DMV medical examiner ( I have a Class B Commercial Drivers License in CA) and my AME during my airman medical exam. I have carefully put the paperwork in chronological order and will be submitting the sheaf of paperwork tomorrow. I pray that the folks at the CAMI will process it quickly and allow me to have my medical certification reinstated. I received the “legalese threatening” letters referred to above. As I said I am just writing my cover letter for all of this. Thanks for your article. I is encouraging to read that they are committing to work with folks to get a more customer friendly atmosphere at CAMI.
Peter I have a similar afib issue – did you get your medical back?
I recently re-read the story of how Bob Hoover’s medical, and his licenses were revoked on an ’emergency’ basis. Despite complying with all of the FAA’s demands Mr. Hoover’s medical and pilots certificates were not restored for years… long after he had passed multiple 1st Class medicals & earned Australian pilot certificates equivalent to his revoked US certificates under nearly identical Aussie requirements — all with no problem.
It’s saddening to me that the FAA has become an impersonal bureaucracy that grinds well meaning people down, rather than supports them. I am very hopeful that Basic Med and the new FAA enforcement philosophy may change this. Until the success of these much needed new approaches are assured, I fear that Bob Eicholz’s concerns will continue to drive at least some pilots away from necessary medical care that would both lengthen their lives and lessen very real safety of flight issues related to in flight pilot incapacitation.
Thanks Martha, for your excellent article.
Thank you, Martha. Well written. But I have to agree with the comments above that say that improvements are not being seen in the field. I have been flying for over fifty years and currently have some issues to be resolved. Thus far, all I have gotten from the FAA is their stupid legal crap and demands for procedures and requests to repeat what has already been done. I applaud any effort for the FAA to try to help us when we need help, but being completely honest has been a big, black hole for me.
Thank you Martha! Sorry to hear others have had the nightmare I have had with CAMI. Developed atrial fibrillation and they put up every road block they could. I am in a small subset of a fib patients whose heart doesn’t race, just irregular. Live a normal life, in fact run or bike daily. Half marathons, bike ride across Iowa no problem. Letters from board certified cardiologists and electrophysiologists who have examined me and state no increased risks for this guy. This year I have one pause greater than 3 seconds on my Holter, a disqualifier for them. So based on my past dealings with these cold hearted people, I went to basic med rather than risk my ability to fly all together. Worst part is I have to sell my beautiful Baron because it’s more than 6000#. All because some guy wields his power with his “denied “ stamp irregardless of medical facts and support from medical professionals who treat me.
As frustrating as all this is, there is a time when old people should give up driving (hard thing for drivers to face). There is also a time for pilots to give up flying. Giving up flying comes sooner than giving up driving. Want the truth–Go to your cardiologist and ask him if you should subject your heart to 2 or 3 G’s in an airplane.
After a great lifetime of flying, I am happy to say “Been there, done that, and got the T-shirt– and I am still alive to share the stories.
I hear what you are saying, but there are other ways for older pilots to fly. I’m not saying I’m old, but have let my license lapse and go up with a CFI. I realize that there’s a huge difference between what you can do when you’re 30 and 60. I also admit that I enjoy flying more with another proficient pilot by my side. So, keep flying. Just take another pilot with you.
Common sense must prevail. FAA is understaffed. Should decisions to AMEs.
I second Bob Eicholz’ sentiment in the first comment: “What a great letter, Martha.”.
Your effort is very much appreciated, thank you.
While I have never encountered any medical certificate issues in many decades of flying, I encountered the medical certification horror stories with some regularity.
Your letter supports the reform movement and I thank you for your initiative.
Keep up the good work!
I have experienced exactly this same problem with CAMI. My medical was delayed last July and the reasons given were approved in July of 2016, and July 2017. My AME approved me in July of 2018 but was not allowed to issue my medical. I satisfied all the requirements of my Special Issuance Medical
It was later denied based on the exact same conditions that were approved as described above. Facts have been provided, supporting tests have been provided, and all of this seems to be ignored by the FAA Medical Folks and they have denied my medical. I have appealed their decision and still waiting for their decision. I am a very active DPE in South Florida doing over 200 Practical Tests each year. Grounding me has created a lot of problems in an environment where the scheduling of Practical Test often is months out. A change in direction would be very welcome from the Medical side of the FAA but so far I haven’t seen this at all.
I lost my medical, commercial, and flight instructors for ” lying on the application” under the threat of a $1347.00 per day fine until I delivered my certificants
This is one beautifully written piece. Thank you. As a 58-year-old pilot, these issues hit pretty close to home.
What a great letter, Martha.
To add a key point: the current FAA policies INCREASE RISK by discouraging pilots from seeking medical attention. Why? Simple – Simply raising an issue can ground us unnecessarily.
That chest pain? Ignore it, because seeing a doctor could ground you for potential heart issues. Feeling depressed and overwhelmed? Suck it up, because a depression diagnosis could ground you. Overweight and feeling a lack of energy? Have some more coffee, because anything that hints at sleep apnea could ground you.
Granted, we all want safety. But a policy that discourages us from seeking medical attention does the opposite: it increases risk.
As one who was the subject of FAA’s scrutiny over a non-issue, I sympathize. I spent untold hours and money to overcome series of minor headaches 5 years ago that went away and never came back. My doctor had to retrieve old files long archived. It wasn’t enough for him to say it is and was a non-issue.
Hopefully an open dialogue will lead to a better system. There’s no one better than you and John to lead us through this mess! Let me know if I can help.