Seeking medical cert help!!

[PeterNSteinmetz]

To some degree this whole area is akin to arguing about how many angels can stand on the head of a pin. Once a regulation is enacted it exists and must be recognized.

The point regarding what we have to practically comply with is a good one. Nonetheless, I think it can be fruitful to consider how things might be improved -- that is how the world gets better.

I don't agree with the argument about angels. Those are imaginary beings so any such discussion is inherently not going to be based on reality. I think we can at least ask that what the government is doing be based on actual facts and be well grounded. Particularly since what the government does with regulation inherently is forcing some people to do something they might otherwise not want to do.

I would agree that unfortunately much of our current regulatory structure is not well based on facts or good policy. I would also agree that it is very difficult to change. But some of us like to keep trying for rationality, despite that fact.

 

[PeterNSteinmetz]

Finally, I will once again reiterate my offer. If participants are interested in better understanding this issue, versus just spouting opinions, I am willing to help with a re-analysis of an expanded version of this dataset, including controlling for some possible confounds. Might actually be publishable. I contacted the author but he says the prior dataset may not be available electronically, so it would be some work to regather the information from the NTSB reports. I am not going to do that myself as I already have other side projects. But if others want to help with the data gathering aspects, I am happy to do a share of the work.

 

[PeterNSteinmetz]

Okay, fine. The answer to your question is "yes":
https://www.ntsb.gov/safety/safety-studies/Documents/SS1401.pdf

However, the end of the very paragraph quoted states "It is NOT currently possible to compare the safety of medically certificated pilots with those flying under the Sport Pilot and Light Sport Aircraft Rule because there is limited information about the number and flight activity of pilots without medical certificates." (emphasis added)

That would seem to indicate that the authors themselves do not think that study goes directly to the proposition being discussed here, i.e. that FAA aeromedical certification improves the safety of flight, and that they do not believe it is "a pretty definitive answer". I can see why they included that caution in the original report because the implications of people flying without a medical being more likely to have been using drugs when involved in a fatal than people with a medical are not immediately clear to me in terms of the proposition.

It is selective quotation when a portion of a document contradicting the assertion of the speaker is omitted, particularly when it is right there.

 

[PeterNSteinmetz]

Here's an even more fascinating study:
...
So 92% of the AMEs surveyed had 1 or 0 fatalities over a 10-year period, and one guy had 25. He either had some seriously bad luck, was someone who dealt with extremely tricky cases (and should promptly be removed from such duties), or he was the AME that all the pilots with otherwise disqualifying conditions could go to and get a medical with a wink and a nod.

Interesting study yes. But fairly peripheral to the proposition being discussed. Have a look at figure 2 in that report. It shows there is a distribution of fatality crash rates amongst AMEs with outliers on both high and low crash rates. There is always going to be some AME who is the most outlying. But there is a distribution there so this is not just a single datapoint on the more fatalities side.

What the data in this paper showed is that there is such a distribution in the likelihood of fatalities by AME. I would not find that result surprising. People differ in the care and detail with which they apply a set of rules. Pulling out the single datapoint at the tail on one side and contrasting it with the middle range only, omitting the relatively continuous nature of this distribution is a form of fairly selective citation to the data.

Quite a speculative leap to assert that this means both that pilots with disqualifying medical conditions are going to a specific subset of AMEs with looser criteria AND that those disqualifying conditions then resulted in the fatalities.

I truly do applaud taking the time to do the searches and find some of the data which may bear on this questions. Many kudos. Thanks for pulling them out.

Interpreting such data with some level of scientific objectivity often takes a fair amount of time and an attempt to consider all the data and all of the paper in their appropriate balance. I think these deserve more scrutiny and thought. Based on a brief review, I certainly would not conclude they demonstrate that FAA medical certification improves the safety of flight.

The authors themselves appear to share some of this reservation. While the discussion in this paper is fairly long and sort of mushes around on both sides of the issue, it does state "However, further study is needed to determine what role, if any, the medical certification process played. The procedure used in this study was able to identify a small group of AMEs with atypical high fatality rate per exam; however, the significance is yet to be determined." This strongly suggests the authors themselves do not think that ""the answer is patently obvious".

If you want to continue the discussion of objective interpretation of these papers, I am happy to do so and explore how they bear on the proposition being debated here. However, I will ask that the personal attacks and assumptions of some sort of malicious motive come to an end. May I suggest another way of looking at it? That when people with different perspectives look at data it can lead to honest differences of opinion about the meaning of that data. The best and most useful way for such people to have a discussion is to focus on the data and the arguments themselves, leaving aside any differences in personal characteristics. I appreciate the effort to bring up these other datasets and interpretations. I hope they can continue in a civil manner.

 

[PeterNSteinmetz]

Yes, the Canfield et al 2016 study examined the rate of fatalities per FAA physical exam broken down by AMEs. There was a distribution of this rate. There are a number of other interesting items in that paper in terms of the proposition being discussed which I am reviewing in a bit more detail.

 

[PeterNSteinmetz]

So I guess it comes down to being in that part of the continuum wherein one is crazy enough to want to do it, but not so crazy that they can't do it.

A lot of reasons people like to fly and a good point about risk-benefit tradeoffs.

In general there is of course no way to objectively say what is more valuable or “worth it” for someone else. Values are personal.

What one can try to do is decide is when someone’s actions have or imminently will endanger others. I have argued at length here that our current aeromedical regulations fail to improve the safety of flight, or more precisely, that there is no good evidence that they do so.

And I would argue that without clear evidence that they do so, we shouldn’t try and prevent others from pursuing their passions, whatever those might be.

 

[PeterNSteinmetz]

still brings us much closer to that reality than we were 3 years ago. Yes, it does require that a physician examine you and determine that you are safe to fly,.

Of course there is the bigger initial hurdle which is a large variance from that philosophy - the requirement for the initial 3rd class. Which then brings up all the “have you ever in your life” questions.

And then the fact that if you fill out the medical app and are denied you can’t fly LSA whereas if you didn’t do so, so still can snafu.

Agreed it is a big improvement, hopefully more improvements can still be made.

 

[PeterNSteinmetz]

Either that, or they have a doctor with a lot of misconceptions, misgivings, and unfounded fears about aviation and BasicMed. I agree with your opinion completely.

I think Dr. Chien actually had made a fairly good case that signing off on BasicMed is really outside the scope of most physician’s practice and will leave them open to substantial liability. Lucky for pilots most Drs don’t see it that way but there may be a case on it some day.

 

[PeterNSteinmetz]

What I'd like to know is this: Have physicians been getting sued for BasicMed signoffs yet, and if so, what percentage of the suits have been successful?

My understanding is there has been no case yet.

Would presumably require a BasicMed pilot to have a significant accident with a large loss that was arguably due to medical incapacitation.

 

[PeterNSteinmetz]

If that were the case, they wouldn’t be signing off on workplace physicals, drug testing, or the kiddies to play sports.

Is the liability really any higher than signing off a kid to play football who drops dead of a heart condition on the field?

Other than the “ooh scary airplanes!” part, that is?

I suspect the Docs who won’t do it are concerned about two things. Their liability insurance only covers things within their scope of practice. Secondly the airline business is much more litigious with larger potential awards than a high school sports physical.

 

[PeterNSteinmetz]

Second...I doubt very many airline pilots are flying on BasicMed...

You’re right. Of course I meant aviation business.

 

[PeterNSteinmetz]

Not even really flying on business for the most part.

Right. I just meant anything to do with aviation generally has greater potential liability than a high school sports physical. More expensive equipment, more possible damage to others, etc. Accidents involving aviation often involve a lot of expensive lawsuits.

 

[PeterNSteinmetz]

Not really. Seen any light GA accidents hit any school busses full of children and nuns? It’s an OWT.

But who does the physicals for the truck drivers? And is doing so explicitly in their scope of practice? Or is it somehow mentioned explicitly in their insurance? I don’t know the answers but my understanding is that that will be the functional question for insurance liability.

 

[PeterNSteinmetz]

Well considering there’s an RV parked at a local truck stop that says “DOT physicals” I’m going to take a guess they aren’t buying high end liability coverage. LOL.

Probably not. The question here is, are the doctors providing those exposed to liability for accidents in the trucks arguably caused by their failure to correctly perform them?

There are several ways they might be shielded from that.

1. By statute. The laws requiring these physicals may explicitly shield the physicians from liability.

2. Scope of practice. Providing DOT physicals may be explicitly listed in the scope of practice which the practitioners are licensed for and consequently their normal malpractice insurance may cover it.

3. Explicit insurance. The malpractice insurance carried by the practitioners may explicitly list DOT physicals as one of the items covered.

I don’t know if any of these apply for DOT physicals. However, my understanding is that the problem with the Basic Med exams is that none of the above mechanisms of shielding liability applies to those exams.

It is possible I suppose that none apply either to the DOT physicals and people just don’t worry about it in that case but some doctors do in the case of aviation due to prejudice, unfamiliarity, etc, but that is not what I have heard from thoughtful people.