Medical Briefing: Grounded?
A letter from the FAA doesn't have to keep you earthbound.
If you receive a letter like this, it's important to understand that you have not been denied. When your aviation medical examiner (AME) performs your flight physical, he or she has three options, issue a medical certificate, deny it, or defer it.
We AMEs only deny medical certificates when pilots have an obvious disqualifying defect. The problem might be a stroke, uncontrolled epilepsy, or a psychotic disorder. But there are many other medical conditions that might place you in a gray area. When the AME has sufficient information, he may elect to issue the medical certificate, then send it on to the FAA for final approval.
Some AMEs choose to defer issuing the certificate instead, and send the medical certificate and supporting medical information to the FAA for a decision. AMEs should attempt to secure appropriate documentation from the airman before the application is sent on to the FAA. In cases without supporting information, the AME has no choice but to forward your application to the FAA and let them demand the additional information.
AMEs handle pilot medical certification on a case-by-case basis. Some AMEs rarely encounter a pilot with a problem that would affect a medical certificate, so they defer anything that they consider unusual. You should know that there are about 6,000 physicians in the United States who serve as AMEs, but on average, 98 percent see 20 or fewer pilots per year. Most AMEs are pilots and offer aviation medical certification exams more as a public service, and a way to stay active in flying themselves, than as a primary practice area. Only a few see more than 100 pilots a year, and perhaps only five or six AMEs actually specialize in examining pilots who need major evaluations in order to return to flying. When an AME issues a medical certificate to a pilot, he is in effect saying that the pilot's health status does not represent a threat to flight safety, the pilot's personal health, or the safety of the public. I like to boil this down to a simple question: Would I want this pilot flying an airplane over my child's school? If I can answer "yes" to that question, then I issue the certificate.
I also avoid denying medical certificates. I believe my role is that of an advocate for the pilot. Even if I have an applicant with a serious health problem, I will defer issuing the certificate and let the FAA deny it. After all, they are the regulators, and they are entitled to wear the black hat. If a pilot wants to attempt to retain his medical certificate, it is my job to try to help him. The FAA authorizes medical certification for 99.99 percent of all applicants. Of those who are denied, 90 percent fail to cooperate with their AMEs and provide the additional medical evaluation requested. Out of more than 600,000 pilots in the United States in 1997, only 166 pilots who held either a first- or second-class medical were denied their certificates. However, a full 2,620 pilots received a letter of denial and did not respond at all; they just quit.
If you are trying to decide whether to fight for your medical, keep in mind that the additional work your AME may do to help you retain your medical certificate may be at little or no extra cost. For example, I do not charge any more for a complicated physical exam, which requires extensive work, than I do for a simple student examination where everything is absolutely normal.
One of my good friends and colleagues was the AME in a recent and famous airshow pilot's case. This doctor spent more than $2,000 of his own money in long-distance phone calls to the FAA and other agencies before he finally helped get back that pilot's medical certificate. This for a total income of $70 for the original examination. That?s not a very good economic balance if you want to stay in business, but as I noted, most AMEs do this because we love flying and it is a public service.
The physicians at the Civil Aeromedical Institute in Oklahoma City are all aviators themselves and strongly support aviation safety. They are happy to work with an AME to certify an aviator who can be demonstrated to be safe while piloting an aircraft.
So what happens to your aviation medical certificate if you develop a medical problem? Let's say your medical certificate is still good for a year, but you recently developed a medical condition that could affect continued certification. It happens to almost 5 percent of pilots over age 45 and 10 percent of pilots over age 60. They develop a significant medical problem, not just a cold, or even pneumonia, or a broken arm, but a serious health problem such as high blood pressure, ulcers, maybe even a detached retina. As an aviator, what should you do?
Just because you have a medical certificate that may be valid for another year or so, you are not free to exercise your privileges as an airman. Federal Aviation Regulation 67.413 requires that aviators with medical problems in effect ground themselves. You must notify the FAA at the time of your next scheduled medical examination or when you seek recertification clearance after the medical condition has been resolved. This does not include an alcohol-related motor vehicle conviction. What constitutes a reportable medical condition? Significant health problems that require you to visit a physician need to be considered. You may be temporarily incapacitated and started on medications or a treatment program. If so, you are obliged to ground yourself. An ear infection requiring antibiotics means refraining from piloting an aircraft during the course of the infection, but it does not mean formally grounding yourself and reporting the condition to the FAA. An ear infection is a minor problem. Major problems are different. Nobody is going to fly when they are hospitalized with a heart attack or collapsed lung. But once you're out of the hospital, and the condition is resolved, you probably feel fit and ready to go flying. However, you still have to contend with the FARs. This means reporting yourself and your medical condition.
The first order of business is to contact an AME. You must be totally honest. Concealing a medical condition is not only foolish but may be criminal. If you are involved in an accident later, you could be held responsible for concealing your medical condition. While the FAA is truly happy to help you evaluate and prove that you are safe to fly with a well-controlled problem, the agency's physicians are unlikely to certify a pilot who has a record of previously falsifying and concealing a serious medical condition. Here?s an example of someone who had to contend with recertification. A 35-year-old corporate pilot was struck in the eye while playing racquetball, he had foolishly not worn eye protection. Afterwards he noticed his vision becoming blurry, and then he lost sight completely in the injured eye. He was found to have a retinal detachment, the lining on the inside of the eye had literally peeled off. Surprisingly, this is a relatively easy problem to correct with surgery. The pilot believed that his career was over and he would never achieve his goal of flying for a major airline. However, working with his eye surgeon, I was able to document that the surgery had been successful and that his vision had been restored. He experienced only a very small loss of peripheral vision, less than 10 percent, which is not considered a significant amount. The repair was stable, and there was no chance of a second occurrence either in the injured eye or in the other eye. We presented this documentation to the FAA with a recommendation that this pilot be granted a second-class medical certificate for one year. At the end of that time he could be considered for a first-class certificate. Without batting an eyelash, the FAA approved, and the young man is back flying business jets. It really can be that simple.
Procedurally, we must document the medical condition and demonstrate that it has been controlled by the treating physician, who is usually not the AME. The AME and the treating physician work together. Our goal is to demonstrate that the aviator's medical problem is controlled and does not represent a threat to his personal health or the health of the public.
Advances in medical science as well as a major change in the FAA medical department's position over the past 25 years has enabled many affected pilots to return to flying. Pilots who have suffered from conditions including sinus problems, mild emphysema, high blood pressure, a heart attack or cardiac bypass surgery, ulcers, and, just recently, insulin-dependent diabetes mellitus, have been safely returned to flying.
To be sure, the FAA very carefully tracks all pilots who return to flying with medical problems, and statistics show that the accident rate, which is our real concern, is no higher for pilots with medical conditions than for those without.
Analyzing aircraft accidents is what led the FAA to begin to carefully scrutinize driving records. It turns out that a pilot with three or more alcohol-related driving convictions is six times more likely than other pilots to be involved in a fatal aviation accident.
If you develop a major medical problem, contact your AME and ask for advice. If your AME is uncertain as to the exact procedure to follow in your case, he or she can get guidance from the FAA regional flight surgeon or by contacting the Civil Aeromedical Institute.
Another excellent source of information is the AOPA medical certification department. AOPA members can reach a medical certification expert by calling 800/AOPA-USA. Information also is available at AOPA's Web site or on AOPA's 24-hour fax-on-demand service (800/462-8329).
