Medical Reform

[EricJ]

3 hours ago, Marauder said:

That's 1% of the active pilot population. My guess there may be some who have come out of medical retirement to join these ranks of people.
 

 

I've met one like that already. 

I expect to make use of it when my current medical reaches expiration. 

[chrisk]

15 minutes ago, Tom said:

The existence of a medical condition that would prohibit being issued a 3rd class medical is de facto evidence of the presence of a medical condition that the government believes "could interfere with the ability to operate an aircraft."

Should anyone fly under BasicMed and God forbid have an accident, and anybody sues claiming medical impairment, any AME or aeromed doc (subpoenaed or hired gun) can testify that the preceding sentence is correct and the BasicMed doc will be toast.

BasicMed isn't like a scuba or school physical.  Try walking into any doctor's office and telling them that you have diabetes and high blood pressure and are looking to get a pre-operative clearance for bilateral hip replacement--and the clearance is to state that you have no medical conditions that, as currently treated, poses a risk to a successful surgery.  See what kind of response that engenders.  It's morally questionable to take advantage of a physician's ignorance on this new subject (BasicMed) that is fraught with genuine risk.

To answer the blood pressure question:  
-If your top blood pressure number is still over 155 after three checks during the same first visit to the AME, then you have other problems besides just a bad morning
-No visits required to your primary doc
-No letters required from your primary doc
-No letters to required to go to FAA
-Assuming you didn't receive a 3rd class on the first visit, you should walk out the door of the AME's office with a 3rd class at a visit seven days later

On a related note, this aviation insurance agent states that "some companies" will not accept BasicMed for "older pilots."

The bottom line is that the 3rd class needs to go. 

From personal experience, it was a work event, not a divorce lawyer, a few cups of coffee, and a traffic jam.  I was referred to OKC.  It took 3 visits to my regular doctors office and two letters from doctors stating I had no history of high blood pressure and that I had normal blood pressure on the 3 follow up visits.  It took about a month to get a medical.  Since then I have had two other medicals, no blood pressure medication, and passed with no issues.

I'm also failing to understand the risk for the physician.  The physician is stating: 

 

"I certify that I discussed all items on this checklist with the individual during my examination, discussed any medications the individual is taking that could interfere with their ability to safely operate an aircraft or motor vehicle, and performed an examination that included all of the items on this checklist. I certify that I am not aware of any medical condition that, as presently treated, could interfere with the individual's ability to safely operate an aircraft."

 

The physician is not an expert in the operation of aircraft.  And one could even argue he is not an expert in the operational requirements of a motor vehicle.  The physician is stating the lack of awareness of a condition that could interfere with the operation of an aircraft.  He is explicitly not stating the individual is medically certified to be free of a condition which could interfere with the individuals ability to safely operate an aircraft or motor vehicle.   So, in this case, ignorance is bliss.

[EricJ]

Just now, chrisk said:

I'm also failing to understand the risk for the physician.  The physician is stating: 

"I certify that I discussed all items on this checklist with the individual during my examination, discussed any medications the individual is taking that could interfere with their ability to safely operate an aircraft or motor vehicle, and performed an examination that included all of the items on this checklist. I certify that I am not aware of any medical condition that, as presently treated, could interfere with the individual's ability to safely operate an aircraft."

The physician is not an expert in the operation of aircraft.  And one could even argue he is not an expert in the operational requirements of a motor vehicle.  The physician is stating the lack of awareness of a condition that could interfere with the operation of an aircraft.  He is explicitly not stating the individual is medically certified to be free of a condition which could interfere with the individuals ability to safely operate an aircraft or motor vehicle.   So, in this case, ignorance is bliss.

I think the speculation on risks to physicians is just speculation.   There's no way to know until the system is tested.  It reminds me of advice from the patent attorneys at a company I used to work for, "It's not really a patent until a judge says it's a patent."

That said, it seems to me the risk is being overblown.

[Tom]

18 minutes ago, chrisk said:

I'm also failing to understand the risk for the physician.  The physician is stating: "I certify that.........<snip>.....  I am not aware of any medical condition that, as presently treated, could interfere with the individual's ability to safely operate an aircraft."

The physician is not an expert in the operation of aircraft.  And one could even argue he is not an expert in the operational requirements of a motor vehicle.  The physician is stating the lack of awareness of a condition that could interfere with the operation of an aircraft.  He is explicitly not stating the individual is medically certified to be free of a condition which could interfere with the individuals ability to safely operate an aircraft or motor vehicle.   So, in this case, ignorance is bliss.

Respectfully, here is what I think that you are missing:  in the medical world, there are physicians who are experts in aviation medicine who have developed and practice by a specific set of medical standards.  They have their own specialty--aerospace medicine--and their own board certification standards.  If you are a family doctor and you want to play cardiologist for a patient with an unusual rhythm problem, you can do so.  But if the patient has a bad outcome, and the medical record shows that you did not provide the same care that the average cardiologist would provide, then you cannot claim "ignorance" as a malpractice defense. 

I can appreciate that a non-physician pilot may not see much difference between flying and driving, but there is no comparing physician responsibilities in the two activities.  For example:

-physicians may approve of people with dementia to drive cars on the road

-AMEs cannot allow a pilot applicant with psoriasis(!) to fly without relatively extensive medical review

13 minutes ago, EricJ said:

I think the speculation on risks to physicians is just speculation.   There's no way to know until the system is tested.  It reminds me of advice from the patent attorneys at a company I used to work for, "It's not really a patent until a judge says it's a patent."

True.  But one doesn't have to go to hell to know that it's hot there.

26 minutes ago, EricJ said:

That said, it seems to me the risk is being overblown.

And to me, it is a moral hazard issue.

[chrisk]

24 minutes ago, Tom said:

Respectfully, here is what I think that you are missing:  in the medical world, there are physicians who are experts in aviation medicine who have developed and practice by a specific set of medical standards.  They have their own specialty--aerospace medicine--and their own board certification standards.  If you are a family doctor and you want to play cardiologist for a patient with an unusual rhythm problem, you can do so.  But if the patient has a bad outcome, and the medical record shows that you did not provide the same care that the average cardiologist would provide, then you cannot claim "ignorance" as a malpractice defense.

I still see a difference with your example.  In your example, the family physician is attempting to treat a condition they are not familiar with. (i.e. holding themselves out to be competent for treating that particular condition)  Extending this example to the basic medical requirement, it would be a statement from the family physician that he has no knowledge that an unusual heart rhythm could impact the safety of of someone operating an aircraft.  --He is after all not a cardiologist or an expert in aviation medicine, and there are many folks that have minor changes in heart rythm that do not require medical treatment.   And if he want to cover his butt, he might recommend, on the same form which the pilot retains for his records, that the patient should seek the advice of a competent cardiologist and aero-medical specialist.. 

[wrench]

Just a thought, what if we share with our members which Doctors have already done or will do the BasicMed that we know of, and maybe include a location and name? Mine has not confirmed to me one way or the other yet.

Probably to early but is there a data base somewhere anyone knows of?

[mooniac15u]

9 hours ago, steingar said:

Last I checked over 4000 pilots had switched to Basic Med in the first week alone.  Given that there's only about 400,000 pilots in the US, that's a huge number.

Nothing makes naysayers madder than success. 

[mooniac15u]

[DonMuncy]

I'm not sure there are too many outright naysayers.

For those (most of us) who thought we were going to be able to fly on a driver's license, it is a terrible disappointment.

For some pilots, it is a good deal.

For others of us, there is little in it that seems attractive to us. And with changes in our circumstances we may rethink our position.

So, all told, there is some good here, just not as much as we hoped.

[Marauder]

I'm not sure there are too many outright naysayers.
For those (most of us) who thought we were going to be able to fly on a driver's license, it is a terrible disappointment.
For some pilots, it is a good deal.
For others of us, there is little in it that seems attractive to us. And with changes in our circumstances we may rethink our position.
So, all told, there is some good here, just not as much as we hoped.

And don't forget, with every BasicMed exam, comes at no extra charge, a comprehensive anus exam.

[Skeyedancer]

Hi guys, I'm the poster child for who benefits from BasicMed.  I'm the friend of Orion and Marauder whose experience was referenced here.  I am truly the poster child for BasicMed.  I am 67, have been flying an average of 175 hours per year for each of the past 19 years, mostly in my 67 M20F.  Five years ago, after a sleep study, I was diagnosed with OSA and had occasional Afib.  I spent six months going through the special issuance process, and have been flying since,  I use my CPAP daily and I haven't had an incident with Afib in nearly 4 years.  Part of the deal is I have to prove use of the CPAP and have a 24 Holter annually.

My most recent Class 3 expired on Apr 30.  On May 4 I had a very detailed physical with my longtime personal physician, a non-aviation person.  She pronounced me to be her patient of the month.  Every one of my numbers have improved.  My BMI is 24.3, and I'm showing no risk factors for any potential debilitation, other than my 3 year old bout with Afib.  I have a recent clean bill and Holter from my cardiologist.  The BasicMed program will allow me to avoid the annual administrivia, and produce no additional risk to the public, so I was confident that she would sign right away.  I was so wrong.  She did not, and said she had to "research" it.

Over the past week, she has researched nearly every FAA Reg she can find, and has concluded that, if I comply with all the requirements of the last Special Issuance letter, she will sign.  I've invested a great deal of time getting to this point, so I'm going to comply.  Truthfully, if I'd just gone to my AME, I would have been flying last weekend under a Class 3.  I want to avoid the annual requirements, so it makes sense for me.  My advice to anyone who will listen is - "Shop for a physician, beginning with local AMEs."  BTW, I called AOPA for their opinion yesterday, and they tell me that the number one reason for incomeng member calls re BasicMed is this question, "My Dr refuses to sign the form, no matter what anyone says.  Can you refer me to a Dr who will?"

Jack

ps.  I know her sources refer to Medical Classification by AMEs, not BasicMed. Frankly, I'm simply not a credible source of information for her.  It's not her fault.  The industry should have published talking points and quick reference guides for physicians well in advance of the release of the rules.  Instead we released scores of eager but misguided pilots like myself onto a wellmeaning, but unsuspecting physician population.  In their shoes, I would also probably decline. Sad.

 

[carusoam]

Jack,

Thank you for sharing your situation.

Going the usual Class III SI route can take several months before the paperwork clears through Kansas.  By the time the SI comes in the mail, another year has gone by...

Doctor shopping has been going on for a long time.  It is a common discussion around the airport amongst a few of my older friends.  Like how's your day going? Who do you use for an AME?

Best regards,

-a-

[Marauder]

Hi guys, I'm the poster child for who benefits from BasicMed.  I'm the friend of Orion and Marauder whose experience was referenced here.  I am truly the poster child for BasicMed.  I am 67, have been flying an average of 175 hours per year for each of the past 19 years, mostly in my 67 M20F.  Five years ago, after a sleep study, I was diagnosed with OSA and had occasional Afib.  I spent six months going through the special issuance process, and have been flying since,  I use my CPAP daily and I haven't had an incident with Afib in nearly 4 years.  Part of the deal is I have to prove use of the CPAP and have a 24 Holter annually.
My most recent Class 3 expired on Apr 30.  On May 4 I had a very detailed physical with my longtime personal physician, a non-aviation person.  She pronounced me to be her patient of the month.  Every one of my numbers have improved.  My BMI is 24.3, and I'm showing no risk factors for any potential debilitation, other than my 3 year old bout with Afib.  I have a recent clean bill and Holter from my cardiologist.  The BasicMed program will allow me to avoid the annual administrivia, and produce no additional risk to the public, so I was confident that she would sign right away.  I was so wrong.  She did not, and said she had to "research" it.
Over the past week, she has researched nearly every FAA Reg she can find, and has concluded that, if I comply with all the requirements of the last Special Issuance letter, she will sign.  I've invested a great deal of time getting to this point, so I'm going to comply.  Truthfully, if I'd just gone to my AME, I would have been flying last weekend under a Class 3.  I want to avoid the annual requirements, so it makes sense for me.  My advice to anyone who will listen is - "Shop for a physician, beginning with local AMEs."  BTW, I called AOPA for their opinion yesterday, and they tell me that the number one reason for incomeng member calls re BasicMed is this question, "My Dr refuses to sign the form, no matter what anyone says.  Can you refer me to a Dr who will?"
Jack
ps.  I know her sources refer to Medical Classification by AMEs, not BasicMed. Frankly, I'm simply not a credible source of information for her.  It's not her fault.  The industry should have published talking points and quick reference guides for physicians well in advance of the release of the rules.  Instead we released scores of eager but misguided pilots like myself onto a wellmeaning, but unsuspecting physician population.  In their shoes, I would also probably decline. Sad.
 

Glad you came out of your hangar Jack! Keep us posted.


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[N6758N]

8 hours ago, Marauder said:

 

Glad you came out of your hangar Jack! Keep us posted.


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Thanks Jack! I didn't know you were on MS!

[Tom]

11 hours ago, Skeyedancer said:

ps.  I know her sources refer to Medical Classification by AMEs, not BasicMed. Frankly, I'm simply not a credible source of information for her.  It's not her fault.  The industry should have published talking points and quick reference guides for physicians well in advance of the release of the rules.  Instead we released scores of eager but misguided pilots like myself onto a wellmeaning, but unsuspecting physician population.  In their shoes, I would also probably decline. Sad.

You nailed it.  Certainly I'm sympathetic to your case.  

For what it is worth, AOPA does have a webpage for physicians to review on the subject of BasicMed:

https://www.aopa.org/advocacy/pilots/medical/fit-to-fly-physician-guide

Of course the webpage states:
"Pilots, in discussion with their physician, should consult available aeromedical resources to understand potential flight hazards associated with any medications being taken, such as whether the underlying condition the medication is being taken for makes flight unsafe, or to understand side-effects that may be unnoticeable before flight but could impair the ability of a pilot to make sound decisions."

17 hours ago, chrisk said:

I still see a difference with your example.  In your example, the family physician is attempting to treat a condition they are not familiar with. (i.e. holding themselves out to be competent for treating that particular condition)  Extending this example to the basic medical requirement, it would be a statement from the family physician that he has no knowledge that an unusual heart rhythm could impact the safety of of someone operating an aircraft.  --He is after all not a cardiologist or an expert in aviation medicine, and there are many folks that have minor changes in heart rythm that do not require medical treatment.   And if he want to cover his butt, he might recommend, on the same form which the pilot retains for his records, that the patient should seek the advice of a competent cardiologist and aero-medical specialist.. 

My point is that an aeromed doc knows which rhythm issues are considered to be customarily associated with providing a serious threat to safe flight, according to aeromedicine research, and which rhythm issues are not thought to be a problem.  Like it or not, agree with it or not, the aeromed community has determined that the aviation environment is sufficiently different from the driving environment to merit different standards and rules.  Again, in a malpractice case, claiming ignorance to the science of another medical specialty with which you've dabbled in is not an effective affirmative defense.

As to creating alternative documentation in the same medical file, this runs afoul with other basic medical record principals that are actionable from the medical board, etc.  Furthermore, the BasicMed form states:

NOTICE: Whoever in any matter within the jurisdiction of any department or agency of the United States knowingly and willingly falsifies, conceals or covers up by any trick, scheme, or device a material fact, or who makes any false, fictitious or fraudulent statements or representations, or entry, may be fined up to $250,000 or imprisoned not more than 5 years, or both. (18 U.S.C Secs. 1001; 3571)

15 hours ago, mooniac15u said:

Nothing makes naysayers madder than success. 

The 3rd class still exists, doctors are saying no (a phenomenon that logic tells us will get worse with time), pilots are finding the 3rd class easier, AOPA and EAA seem to be content, and you call this success?

 

[DXB]

12 hours ago, Skeyedancer said:

Hi guys, I'm the poster child for who benefits from BasicMed.  I'm the friend of Orion and Marauder whose experience was referenced here.  I am truly the poster child for BasicMed.  I am 67, have been flying an average of 175 hours per year for each of the past 19 years, mostly in my 67 M20F.  Five years ago, after a sleep study, I was diagnosed with OSA and had occasional Afib.  I spent six months going through the special issuance process, and have been flying since,  I use my CPAP daily and I haven't had an incident with Afib in nearly 4 years.  Part of the deal is I have to prove use of the CPAP and have a 24 Holter annually.

My most recent Class 3 expired on Apr 30.  On May 4 I had a very detailed physical with my longtime personal physician, a non-aviation person.  She pronounced me to be her patient of the month.  Every one of my numbers have improved.  My BMI is 24.3, and I'm showing no risk factors for any potential debilitation, other than my 3 year old bout with Afib.  I have a recent clean bill and Holter from my cardiologist.  The BasicMed program will allow me to avoid the annual administrivia, and produce no additional risk to the public, so I was confident that she would sign right away.  I was so wrong.  She did not, and said she had to "research" it.

Over the past week, she has researched nearly every FAA Reg she can find, and has concluded that, if I comply with all the requirements of the last Special Issuance letter, she will sign.  I've invested a great deal of time getting to this point, so I'm going to comply.  Truthfully, if I'd just gone to my AME, I would have been flying last weekend under a Class 3.  I want to avoid the annual requirements, so it makes sense for me.  My advice to anyone who will listen is - "Shop for a physician, beginning with local AMEs."  BTW, I called AOPA for their opinion yesterday, and they tell me that the number one reason for incomeng member calls re BasicMed is this question, "My Dr refuses to sign the form, no matter what anyone says.  Can you refer me to a Dr who will?"

Jack

ps.  I know her sources refer to Medical Classification by AMEs, not BasicMed. Frankly, I'm simply not a credible source of information for her.  It's not her fault.  The industry should have published talking points and quick reference guides for physicians well in advance of the release of the rules.  Instead we released scores of eager but misguided pilots like myself onto a wellmeaning, but unsuspecting physician population.  In their shoes, I would also probably decline. Sad.

 

This is an interesting scenario - thanks for sharing, and I certainly hope it works out well for you.  I wonder if your old AME, who already knows your situation well,  would also be willing to sign you off under Basic Med.  I asked my AME the same thing last week while renewing my 3rd class, but he was still trying to figure out how to handle requests for Basic Med in lieu of 3rd class. It's working out with your primary MD here because of your longstanding relationship, which assures her that you're not as high risk as you might look on paper and also motivates her to take the extra time and effort to figure out how to deal with the form. Someone "physician shopping" who shows up one time to get a form signed off is a very different scenario from a physician perspective.

As an aside, one of the reasons I think physicians  dislike this category of request is that it forces them into the less familiar role of balancing the interests of society with those of the patient.  It's way easier and more fun to simply try to serve the patient without other considerations.  Going to AMEs to sign off basic med may actually a good way to prevent this tension and extract potential benefits of the new regulation. With an AME, there is no ambiguity that the physician is primarily serving a regulatory role for the FAA and not necessarily there to help the pilot.  Thus AMEs would be much more comfortable from the outset in evaluating a someone under Basic Med while also understanding the potential liabilities of signing the form.  I may try to go this route again when my current two years is up.

[wrench]

I just asked my current AEM if he would do the Basicmed and he said NO. He continues to do the Class 1,2, and 3's. The reason he does not do the Basicmed is additional prohibitive (for Him) liability insurance.

[Bob_Belville]

A year or so ago when the caveats were revealed it appeared to me that continuing to get my 3rd class with my regular AME ($120=$5/month) would be preferable. I remain of that opinion though folks with different medical issues or more expensive doctors may decide otherwise.

I don't fault AOPA, EAA, et al for trying to make the process easier. Compromise is a way of life in Washington and the compromises that apparently were necessary to get this thing passed have made the sausage a lot less than delicious.

[Skeyedancer]

Interestingly, my Doc has been looking at all the FAA publications to see any verbiage that BasicMed actually replaces the AME guidelines.  There is no such clarity.  I also searched the FAA sites, and found a comprehensive FAQ document on BasicMed, that specifically said that advising non-AME doctors was out of the scope of responsibility of the FAA, and that they would decline to respond to questions for further guidance.  The FAA maintains that their scope is only to provide guidelines to AMEs regarding Medical classifications and Special Issuances.

Fortunately for me, I have complied with the annual SI requirements, so I'm hopeful that I'll have a positive outcome - eventually.  Had I been hired as the project manager for the BasicMed program, I would have developed a comprehensive communication plan targeting these new docs, and probably would have blanketed the GP community with guidelines and guidance that would have prepared them for the May 1 onslaught.  I'm confident that this will sort itself out, but it could take years before there is a general comfort level in the medical community.

[Marauder]

Interestingly, my Doc has been looking at all the FAA publications to see any verbiage that BasicMed actually replaces the AME guidelines.  There is no such clarity.  I also searched the FAA sites, and found a comprehensive FAQ document on BasicMed, that specifically said that advising non-AME doctors was out of the scope of responsibility of the FAA, and that they would decline to respond to questions for further guidance.  The FAA maintains that their scope is only to provide guidelines to AMEs regarding Medical classifications and Special Issuances.
Fortunately for me, I have complied with the annual SI requirements, so I'm hopeful that I'll have a positive outcome - eventually.  Had I been hired as the project manager for the BasicMed program, I would have developed a comprehensive communication plan targeting these new docs, and probably would have blanketed the GP community with guidelines and guidance that would have prepared them for the May 1 onslaught.  I'm confident that this will sort itself out, but it could take years before there is a general comfort level in the medical community.

So, how does this impact your medical?


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[Skeyedancer]

Chris,

So DrG said that if I complied with the SI requirements, then she would sign me off.  Essentially the SI requirements are that I need to get a 24 hr Holter and Cardiologist's opinion annually (done Jan 2017) and have the Medical Device company download and print a 12 month CPAP usage report.  That will be done tomorrow.  Should have been today, but after the 40 mile drive to Trooper, we discovered that my CPAP card was corrupt, so I've installed a new one, and tomorrow morning will be making the 80 mile round trip again.  (Ugh)

I'm hopeful that after I provide the CPAP report, she'll sign the form.

[Skeyedancer]

FAA Briefing on BasicMed at N57

All, the FAA will be providing a briefing on BasicMed at New Garden Airport (N57), near Wilmington, DE, on Saturday, July 15, 2017.  The event will be from 10:00-14:00, and will also have a session addressing CFIs and CFIIs.  I expect this to be a well attended event, given the demographics of the pilot population at N57.  I will attend and will offer my story.  Not sure if this is part of the Wings Program, but pencil mark your calendars and I'll provide updates as the date gets closer.

'

[tony]

16 hours ago, Bob_Belville said:

I don't fault AOPA, EAA, et al for trying to make the process easier. Compromise is a way of life in Washington and the compromises that apparently were necessary to get this thing passed have made the sausage a lot less than delicious.

Bob,  when the AOPA started down this road it was sold to the membership as an exemption to 14 cfr 61.23 (remember the drivers license medical) but we ended up with an ELOS.  I understand about compromise but when the AOPA declared victory and just let the issue drop without continuing to pursue the exemption, they lost me as a member.

[Marauder]

when the AOPA declared victory and just let the issue drop without continuing to pursue the exemption, they lost me as a member.

If they only put as much vigor into this effort as they have been to get me to renew my membership.



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[aviatoreb]

22 minutes ago, Marauder said:

 

If they only put as much vigor into this effort as they have been to get me to renew my membership.



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I know!

With the amount of junk mail they send me, both in my email box and in my US postal box, that alone makes me want to stop supporting to make the annoyance stop.