ADD medication denial

[flipside]

Hi,

I was gigged on the medical by being on an ADD medication. Since I was on the medication for a single reason which was no longer relevant (marriage) I (with the prescribing doctor's agreement) went off of it.

That was almost two years ago.

I did a psych eval, in which the FAA was both most unhelpful and disorganized. They then sent those results to a reviewing third party psychiatrist who both cherry picked the results and made several serious errors of fact in the review. One of the biggest of these was that I was ever diagnosed with ADD: I was not, am not and have the documentation to prove it. Others are related to psychiatrists reviewing psychological tests in which they have never been trained.

I've taken the intervening period of time to collect and develop the materials to show that (1) I was never diagnosed, and (2) I do not currently have ADD. I don't have any other medical issues and my primary flight instructor has endorsed me in writing.

So my question is what's next? Sending them blindly to the FAA obviously is not the correct answer: they are in a default deny position and will happily maintain it. I have all but one piece of documentation: a letter explaining why I was referred for assessment at all, that should be available shortly.

 

[Jim Logajan]

First of all, YOU SURE WERE diagnosed. Any phsyciian who gives you an Rx for Ritalin class meds has ONLY one diagnosis that supports that Rx or he's in jail.

I'm sincerely confused - I thought off-label prescriptions by a doctor was legal? What law would the doctor be violating in this case without making an ADD diagnosis?

 

[Jim Logajan]

For the amphetamines, that is the common ONE EXCEPTION. There have been state board actions in I think 30 states against physicians who were supplying amphetamines outside of legimate uses....

I see, thanks. I was thinking only of the federal level. But if what I found is correct and I'm interpreting it correctly, state restrictions are variable enough that it seems possible the OP could have legally been prescribed amphetamines for something other than ADD. The following web page seems to contain summaries of the state laws concerning prescriptions of controlled substances:

http://www.medscape.com/resource/pain/opioid-policies

 

[Jim Logajan]

Amphetamines are NOT opoids, Jim.

I know, in fact I double-checked that before posting the link (I couldn't figure out why amphetamines appeared on that page.) But while they used the word opoids in the title and the URL, that page states that "The following is a summary of significant state laws involved with prescribing controlled substances for the physician." So state laws covering Schedule II drugs appear to be included.

I actually found it while searching for state laws regarding amphetamine prescriptions, which are included by name in a few places.

 

[Jim Logajan]

Um. You're kinda like that pilot who says, "there's no law preventing it so I can do it!"

This all doesn't work at the level of LAW. It's at the level of physician to physician review, doctor. Goodnight, Dr. Logajan. Get some sleep.

You used the word jail, sir. I wanted to know why. Now I know what you really meant. (You appear to be the one up late; I'm west coast. My wife's mother lives in Wasburn, not too far from Peoria; sounds wet there, so stay dry!)

I have tried to avoid any pretense of expertise. To be clear, there has been no attempt on my part to engage in debate, just clarification, but I realize now it can appear like I'm debating when I'm merely explaining my understanding. I like facts and appreciate them when you share them (even when they are delivered in a needlessly surly manner.) If there is no possible way that the OP can have gotten a prescription without a diagnosis of ADD or physician misconduct, I wanted to understand how that could be given what I thought I knew about the law. I now know more; thanks.

P.S. What about the OP's claim he has documentation proving no ADD diagnosis; is it also proof of physician misconduct or simply not what he thinks it is?

 

[Jim Logajan]

I am at least vaguely familiar with most of those tests -- enough, at least, to understand why FAA requires them.

I probably said this before, but it is my position that FAA is not in the wrong for requiring the tests. School districts and the clinicians they hire are in the wrong for not requiring the tests before handing out ADHD diagnoses and prescribing pills. Quite frankly, I'd be all for prosecuting those jokers. They think it's a trivial thing to medicate away the futures of an entire generation of kids.

-Rich

I read the document the doctor posted; I recognize some of the tests. (The references it lists are not easy to come by - I checked.) But the document doesn't seem to answer the kind of questions I think Jeff is thinking of, such as:

How far outside the norms must an applicant be for the FAA to deny a medical? How was that threshold established? What is considered unacceptable risk and how was it established? What statistical or other observational data exist to support the answers to the above questions?

Objective scientific justification for the criteria and process being used may not be possible for neuropsychological problems, but that doesn't mean the FAA shouldn't try to produce that justification - or at least explain why it can't produce it but that it still needs to perform those evaluations to the best of their abilities.

(FAA medicals appear to exist based on the general proposition that if an individual becomes a member of a group that has a higher probability of causing harm to others while engaged in an activity, then that individual can be banned from that activity. That general proposition is one that can lead to obvious impairments to even the most innocuous individual liberty.)

 

[Jim Logajan]

So class, how did I do?

Very nice and informative; I appreciated the details and the time spent. I have placed "Aeromedical Psychology" by Kennedy and Kay into my Amazon wish list; I may buy it when it is published at the end of July.

I'd be curious to know what FAA documents or other texts you referred to (mentally or physically) while you composed those example scenarios.

 

[Jim Logajan]

It is there, and if you are a doctor you can understand it. For example, look at these TWO protocols. I have no problem knowing which one they want, and folks are always saying, "why the expesnive one?". To know that, you have to understand the array of conditions being evaluated.... That is because they have NO ZERO ZILCH NADA obligation to educate the public to the level of a physician, and aeromedical has said so, and they don't have the resources to do so.

So? When the FAA proposed ADS-B in this NPRM, the FAA had no obligation to educate the public about electronics and radio communication standards either, but they were obligated to publish the relevant technical standards so those members of the public who were trained in the appropriate fields could provide feedback. The ADS-B NPRM referenced a highly technical document over 1000 pages that any idiot could have tried reading and commenting on during the comment period. Sure, you could look it over and say "Dammit Jim, I'm a doctor, not a radio communications engineer!" but the NPRM process would have allowed you to seek help from an expert who wasn't on the payroll of the FAA so you could understand it and then comment on it intelligently!

Also, with ADS-B the FAA was required to issue an Initial Regulatory Flexibility Analysis (guide here) like this revised one for ADS-B that attempts to quantify the affect any proposed rule change has on the economics of small entities.

There may be an informal feedback mechanism to aeromedical, but is there any formal mechanism equivalent to the NPRM process? My complaint is that there doesn't appear to be one, but changes to medical standards sure by god do impact the common airman since they have all the force of regulations.

For example, look at this requrements sheet. It's pretty plain what needed. I'm sure glad some participants here recognize the names of some of these tests....

(The MMPI test and its variants is rather famous, or infamous, even to people like me who otherwise had no interest in such things.)

As to the two spec sheets - neither one contains any quantified (or other) justification for the risk assessment claim made at the very top of each:

• "Mental disorders, as well as the medications used for treatment, may produce symptoms or behavior that would make an airman unsafe to perform pilot duties."
• "Attention-Deficit/Hyperactivity Disorder (ADHD), formerly Attention Deficit Disorder (ADD), and medications used for treatment may produce cognitive deficits that would make an airman unsafe to perform pilot duties."

For example - based on what you haven't said, it seems there is currently no legal mechanism stopping aeromedical from suddenly and unilaterally making the ingestion of any amount of Ibuprofen cause for grounding unless one gets a SI - and their spec sheet and justification could be as simple as this:

• "Taking Ibuprofen may produce an increase risk of heart attack that would make an airman unsafe to perform pilot duties."

Without public disclosure of how they quantified that risk and what level of risk they were using as a threshold for enactment of that regulation-by-medical-proxy, they could (and probably have) created lame-brain special issuance criteria.

Your attacks on our lack of medical expertise is absolutely irrelevant - all I want is for aeromedical to publish its justifications and determination criteria for public critique. (For example, the main reference in those two specs is a book that wont be published for another 3 months!) Pilots like me don't need medical expertise so long as we know where we can borrow or hire it (so we can respond and hopefully change the what aeromedical decides.) There are doctors who are also pilots who have the needed expertise that affected pilots could hire as experts, who then could intelligently contest aeromedical's decisions during the justification and spec writing phase if only aeromedical could be made to follow modern regulatory practice. All the evidence shown so far indicates they operate carte blanche.