In my weak, selfish moments of thought and contemplation, I think that perception is mine alone, and only until my brain starts making good thought and logic synapses do I realize that I’m not different from anyone else who falls into the “I am human” category. The state of our minds, our homes, our country, and our planet, along with what may be a chronic dose of “post-Covid” syndrome, just results in “life getting in the way of living.”
We certainly see that in our daily interactions with pilots who are facing challenges with the FAA about their medical certification. The quote “The best government is that which governs least” has been attributed to Thomas Jefferson, with Henry David Thoreau and Ronald Reagan sharing the same sentiment, and it is something Mark Twain might have penned along the way, too. Regardless of who said or thought it, it certainly seems to be a concept that most everyone can agree with.
To bring that thought a little closer to home for pilots, I thought it appropriate this month to go back to some basics of how that part of our government, the FAA, manages the safety of the national airspace through medical certification standards and practices. We can relate to the concept of en route navigation and communication with ATC sectors, and the understanding that the airspace being “worked” by an ATC specialist “belongs” to that controller and everything that happens within that sector is his or her responsibility. The airspace is ours to share, but the FAA “owns” it and when we are flying within that airspace, someone somewhere is looking after it and everything that’s going on in it.
Likewise, the FAA Office of Aerospace Medicine (OAM) shares the responsibility of protecting the airspace by evaluating pilots who operate under a Part 67 medical and affirming that those pilots can safely operate up there. The responsibility is a shared one, too, for pilots, controllers, Aviation Medical Examiners, and the hundreds of FAA professionals within the OAM network in Washington, at the Aerospace Medical Certification Division in Oklahoma City, and at the nine FAA Regional Medical Offices around the country.
One of the most common questions we get in the Pilot Information Center centers around the differences in opinion between the “medical bureaucrats” at the FAA and pilots’ treating physicians regarding past or current medical history. It is an understandable confusion, too, because the roles of the FAA and your family doctor, or your oncologist treating non-Hodgkin’s lymphoma, the neurologist seeing you for a traumatic brain injury from a motorcycle accident, the cardiologist managing your coronary heart disease, or any of the hundreds of medical conditions that afflict the human body, are both very different and very similar.
The FAA physicians and Legal Instrument Examiners who review the thousands of medical applications and associated medical records each year are maintaining their obligation to “protect the airspace.” Their job is to assess the likelihood during the time a person’s medical certificate is in effect that the medical condition could result in an impairment or incapacitation that would compromise the safety of that airspace and the pilots and/or passengers in it, or people on the ground.
In the US, our direct health care providers are not in the business of regulating federal airspace but are responsible for providing quality health care to patients, with the constraints of their own bureaucracies looking over their shoulders, including HMOs, insurance companies, government entities like the FDA, CDC, Health and Human Services, Medicare, and Social Security. Everyone is under the gun of government oversight—we’re stuck with that. However, the diversity of the FAA’s and our health care providers’ functions creates confusion for the people caught in the middle of the morass—the pilots who need or want a medical certificate.
During a review by the FAA of an airman medical application, the need for medical records, both historical and current, is an everyday occurrence. The medical regulations refer to a “history of” medical conditions, and that history goes all the way back to the beginning of one’s life, so the reach is broad. A loss of consciousness, for example, is a big deal to the FAA, regardless of how long ago it happened. In their world, a past or current medical history is a problem until they determine that it’s not a problem. As part of their role in the safety of the airspace, such a history will usually require all the past medical records and a current evaluation to see if the problem that caused that LoC years ago is still present and could cause another event.
When the pilot then tells the doctor, “I need all my previous records, and I also need a current neurological evaluation and a heart workup too,” and the doctor says, “I can’t justify that level of workup for something that happened one time and many years ago,” the conundrum begins for the pilot.
Your doctor is there to keep you pain free and living a “normal” life; the FAA is doing a risk assessment to determine if your condition could result in a safety breakdown while you’re flying the airplane in some controller’s airspace. Two very different roles with different requirements and far different realities as to how to accomplish the objective. The FAA wants to find a way to “yes,” but the requirements are formidable, especially from a cost perspective, as much of the testing required isn’t covered by insurance and is an out-of-pocket expense to the pilot!
To the FAA’s credit, they really do try to take these factors into consideration and limit the amount of information needed to make a decision. Sometimes it just takes a lot of information, and time, to get to the “yes.” An in some cases, I absolutely think they go overboard in what they ask for. They are working on making the process more “customer service oriented.” It will take time, but under the new leadership, I believe positive changes are coming. Stay tuned!
