Editorial: Elephant in the Room
By Ed Downs
First, this is an editorial, representing this writer’s anecdotal and factual experience. This writer believes there is an “elephant” in the room known to virtually all pilots, but only whispered about in private conversations. Be forewarned, this editorial contains a lot of complaining but will conclude with some positive views and suggestions.
Now, about that elephant. You know, the one sitting at the head of the table, but no one will admit is there. This elephant is an issue I have dealt with for all of my 65 years of professional flying, but it took a short news feature on the Sunday Fox Report with Jon Scott to finally bring it into focus.
The Awakening
Shamefully, this writer has been pushing a serious aviation safety problem into the background for far too many years. Broadcast on Sunday, April 30 at 5:24 p.m., a truly stand-up airline captain, Reyne O’Shaughnessy, finally said the words we have all been thinking. To paraphrase Ms. O'Shaughnessy, the greatest concern expressed by a majority of professional pilots is that the FAA Aerospace Medical Division is the greatest threat they face in the quest to secure and maintain an aviation career.
More than 25 percent of pro pilots admit to outright lying on their medical applications with another 56 percent admitting to having great concern regarding the medical process. These numbers are based upon studies done by the Journal of Occupation and Environmental Medicine with supporting confidential inputs. An AME interviewed during this short news segment went on to say that an unknown number of pilots, both pro and amateur either lie, omit information, or simply avoid medical treatment for known health issues and self-medicate.
Based upon this writer’s years of experience, having worked in two major airlines, a major aerospace company, FAR 135 charter operations, aircraft certification, flight instruction, and aircraft manufacturing, these numbers are far too low. This writer will even admit to having participated in a program to help airline pilots avoid the FAA Aerospace Medical Division’s unwarranted and capricious enforcement of rules that should have been abandoned for civilian flying at the end of WWII. Does it sound like the FAA Aerospace Medical Division is creating a healthy environment that encourages pilots to seek modern medical care? Or is it forcing pilots to avoid regulatory compliance and good medical care to keep their jobs and/or retain their investment in training and aircraft ownership?
Is Safety Really the Issue?
This writer has attended and conducted hundreds of aviation safety programs on a variety of subjects, always trying to support well-meaning regulations, even when their logic might be a bit vague. In the Flight Instructor Refresher Clinics, I conduct, a big part of the refresher training given to qualify for re-issuance of a Flight Instructor Certificate ( required every two years) deals with creating a “culture of safety” through an understanding of, and compliance with, the FAR’s. But at the end of nearly every program this writer has taught, once out of the class environment and into a social setting, the conversation almost always turns to that of “the upcoming medical.” Should I tell the FAA about the pain prescription given to me by my doctor last year when I broke my leg? What about my routine hernia surgery? My doc took me off some over-the-counter stomach meds because they were affecting my kidney numbers, is that reportable? I sometimes get up-tight with work-related stress and take an occasional prescription sleeping aid, do the Feds need to know that? Who knows a good AME, one that is on our side? The list goes on and on.
THE ELEPHANT IS IN THE ROOM! It is understood by one and all that unlike FAA Flight Standards which is most recently moving away from punitive actions towards “bringing into compliance” through extensive training resources and updated testing standards, the FAA Aerospace Medical Division is solely dedicated to preventing pilots they deem to be out of regulatory compliance with punitive, not corrective action. Instead of a “culture of safety” and regulatory compliance, the FAA Aerospace Medical Division has created a culture of outright lying, falsifying MedExpress, self-medication, or worse, no medical care at all.
The Birth of a Bureaucracy
When one looks at the FAA website pages dedicated to the FAA Aerospace Medical Division, it is impossible to not be impressed by the number of personnel involved that have a lot of letters behind their name, evidence of impressive credentials, fully capable of producing positive results. So, why is this not happening?
One must look to the history of the FAA medical exam to gain a better understanding as to how the present bureaucracy came into being. The earliest aviation pioneers had neither medical nor pilot certificates. But as the U.S. neared entry into WWI, the military took up an interest in flying, and the military tradition of wanting soldiers to be healthy when sent off to die in battle carried over to flying. Nobody was really concerned about safety, the average WWI pilot seldom lasted more than a month … but died healthy.
Aviation during the ’20s and up until 1938 was controlled at the State level, with the Federal Department of Commerce and NACA (predecessor to NASA) offering certification and medical guidance. The National Airspace system was nationalized under the Federal Government in 1938 with the creation of the Civil Aeronautics Authority (CAA). For the first time, all aviation was under one roof (hangar?). With WWII looming and America having no effective military air service, Henry H. Arnold (yep, General “Hap” Arnold) approached then-President Roosevelt with a plan to undercut the powerful isolationist politicians and create a massive pilot training program in preparation for war. But this program was “disguised” as a government plan to revitalize civil aviation, engaging universities across the country with a federally funded Civilian Pilot Training Program, the CPTP.
Knowing that this was actually a military plan, strict physical standards (military) were set in place. In keeping with the “civilian” aspect of the CPTP, this program was managed by the new CAA, establishing flying and medical standards that have survived to this day. And there you have it, a civilian medical bureaucracy that has been with us ever since.
The bottom line, has the specter of pilots collapsing at the controls and falling from the sky, killing innocent passengers and wreaking destruction upon the earth ever been a problem needing an entire government agency to bring such havoc under control? NO!
But once a bureaucracy is formed, it never goes away, and those who serve such a bureaucracy soon lose their skills as lettered professionals, instead becoming clerks who run computer word matching programs with crude versions of AI sending out correspondence. One must keep in mind that rules are the product of a bureaucracy, not service. The more rules you have power over, the greater your budget and importance in government. The battle cry of success becomes, “I was just following the rules.” Sort of like “I was just following orders,” eh?
Is Good Medicine an FAA Priority?
Key aviation safety priorities of today do not include medical issues. To be sure, the proliferation of recreational drugs, over-the-counter medications, and “wonder cures” advertised on TV and the web have added complexity to wellness, but the FAA Aerospace Medical Division has few reasonable provisions to accommodate these new threats to safety. But, even given such 21st-century concerns, do we have pilots dropping dead at the controls? It does happen, but to the best of this writer’s knowledge, in all such rare cases, the unfortunate pilots held a valid medical certificate. Let’s leave the standards of WWII behind us and enter the 21st century.
Basic Med is now becoming the most popular form of health assurance. The exam is given by one’s personal physician, the person who knows you the best. You undergo an online medical awareness course every two years, finally employing the crazy idea that training and education are a good thing. Most medical issues are between you and your doctor, with no federal intervention.
Then there is Sport Pilot, again, no Federal medical examination. Just normal common sense personal care. How about glider flying, needed only a statement of health. Then we look to ultra-light flying, no medical, no pilot certificate, and non-certified aircraft. How are these pilots doing… dropping out of the sky? Emphatically NO!
Recent studies (published by no less than AOPA) show no difference in medical events when comparing the preceding to those holding a third-class medical certificate. Sound like the FAA Aerospace Medical Division is out of the picture… nope. The most powerful enforcement tool held by FAA Aerospace Medical is the denial or revocation of a medical certificate. Such an action prevents any operation of a certified aircraft as PIC. All new pilots must have held a “class” medical before going to Basic Med. The denial power is retained. You may not fly PIC as a Sport Pilot if you have ever received a revocation or denial of a medical certificate. Did you know that if flying under Basic Med and you experience a medical event that requires a one-time special issuance, that special issuance must be made in conjunction with a class medical, again, giving the power of denial to FAA Aerospace medical even if all medical test standards are met. It is clear that the FAA Aerospace Medical Division is an enforcement agency, and any data they receive can, and will, be used to increase their denial rate, claiming such numbers promote safety.
Examples Of FAA Bad Medicine
Before presenting some significant examples of how the FAA Aerospace Medical Division misuses your personal medical records to keep you grounded, the National Transportation Safety Board (NTSB) provided a spreadsheet exemplifying the very small percentage of medical events that pose any danger. Jess Thomas, a statistician with the NTSB, provided the spreadsheet indicating only 13 total accidents where the defining event was a medical event. “As a total that would make up less than a .001 percent of all GA accidents for the last 10 years,” Thomas said.
One Basic Med pilot (60-plus years a pro pilot) underwent serious cardiac surgery. The results were medically successful and an FAA stress test was passed, along with a third-class medical exam. All good … no! FAA Aerospace Medical acquired past medical history and did a deep dive, requiring extensive additional medical testing for an event that occurred over 70 years ago as a child. One wonders what Ph.D. thought that was needed. This pilot’s requests for clarification were not answered, and a denial was issued, ending a productive career. And yes, all your medical records are open to FAA Aerospace Medical. Even “narratives” (private conversations with your physician) can trigger demands for involved and expensive medical tests for issues not a regulatory part of class medical standards.
Recently a well-known and respected DPE underwent the Third Class medical exam that is required to serve as a DPE, even though a DPE does not serve as pilot in command of such a flight or log the flying time. Our applicant, a DPE with 22 years of administering checkrides at all levels and more than 60 years as a CFI knew he would need to be prepared for the medical exam. He read in the FAA Safety Magazine that his medical issue could be approved by the AME if he presented certain medical information. This process is known as “Conditions AMEs Can Issue (CACI).
Having had problematic eye surgery over 42 years ago, he complied with the CACI requirements. The AME evaluated his condition as “complicated” and submitted it to FAA Aerospace Medical. Aerospace Medical used that voluntarily submitted information to deny the medical certificate because of his medical history. Isn’t this what criminal law calls “entrapment?” This DPE, holder of the prestigious FAA-issued Wright Brothers Master Pilot Award, has been taken out of the system. This applicant was refused a medical flight test. He continues to fly as a “non-PIC” flight instructor.
In another example, an experienced and active flight and ground instructor (over 300 students per year) experienced a medical condition that Aerospace Medical thought would impede this person’s ability to operate an airplane. The applicant requested a medical flight test (a provision provided for by the FARs) to simply prove capability. This request was denied with the terse statement “your medical condition precludes the safe performance of airman duties under any conditions that could reasonable be prescribed.” Harsh, given that this CFI continues to conduct loss of control training, the FAA “Impossible Turn” training, flight proficiency training in antique and experimental aircraft as well as insurance check-out training, all while carefully avoiding situations that require PIC authority.
Solutions?
These, and many other denials reviewed by this writer have characteristics in common. They are printed on third generation stationary, using a printer that needs a new ink cartridge, and obviously compile form pre-written phrases contained in a computer. While issued under the authority of and title bar of David M. O’Brien, MD, MPH , Manager, Aerospace Medical Certification Division, none of the denials this writer has seen are signed by Dr. O’Brien. Instead, they are signed “for “ Dr. O’Brien by and unknown persons with no title. It is the opinion of this writer that while the FAA Aerospace Medical Division is located in Oklahoma City, Dr. O’Brien manages this operation from his office at FAA HQ in Washington DC. A web search failed to disclose just where the nearly 100 employees of the Aerospace Medical Division are actually located.
The conclusion is obvious: The aviation community is not being proactively served by the Aerospace Medical Division. The word “abused” would be more appropriate. It is time we stop trying to appease this outdated bureaucracy and demand a system that encourages honesty and good health. We need a system that is based upon modern medicine, not the traditions of a military past. The following are a few thoughts to consider:
Immediately contact ASTM International (Standards Organization) and initiate the process of creating regulations that meet an industry consensus standard, for both private and commercial aviation. This process includes all concerned parties, works rapidly and has proven to be successful in a number of aviation applications.
Replace the 3rd class medical certificate with a Basic Med structure that honors the rights of medical privacy and encourages pilots to seek professional medical care without the fear of Federal retribution. This could be an excellent first step, with the present requirements for special issuance to be determined and treated by personal physicians, not bureaucrats.
To: Mr. Pete Buttigieg, Secretary of Transportation. Prioritize the needs of the FAA and National Airspace System above those of your social engineering and green agenda. After more than two years in office, you have failed to appoint a qualified FAA Administrator and now face the loss of the current Acting Administrator. Do not simply move another career bureaucrat into this important position but go to the aviation industry for a candidate who actually understands the complexity of civil aviation and the National Airspace System.
To: Dr, David M. O’Brien, Manager, Aerospace Medical Division. You are now the “Elephant in the Room.” You have the opportunity to be the “hero” in the room, a person to be cheered at EAA AirVenture’s “meet the Administrator” forum. Be prepared to announce plans to discontinue the 3rd Class medical process in favor of a Basic Med program and the formation of an ASTM Industry Consensus effort to bring aviation medicine into the 21st Century.
To: Joe and Jane Pilot: Forward this editorial view, or your comments, to the following federal offices.
Rep. Sam Graves (R-MO), Chairman of the Committee on Transportation and Infrastructure
Committee on Transportation and Infrastructure, Republican Office
U.S. House of Representatives
2165 Rayburn House Office Building
Washington, DC 20515
Phone: (202) 225-9446
(E-mail available through his website: graves.house.gov)
Rep. Garret Graves (R-LA), Chairman of The Subcommittee on Aviation
Committee on Transportation and Infrastructure, Republican Office
U.S. House of Representatives
2165 Rayburn House Office Building
Washington, DC 20515
Phone: (202) 225-9446
(E-mail available through his website: garretgraves.house.gov)
Now is the time to make our voices heard. In addition to the references above, let your local Congressional Representatives know that you wish to take responsibility for your own flying safety, including health. This writer is now making numerous congressional contacts. If the last three years have taught us anything, it is that political bureaucrats, be they local or federal, do not know how to manage health issues, often making such issues worse.
The solution… Speak out!
–Published by In Flight USA
In Flight Publishing
June 2023
