Establishing someones basic medical fitness for flight has long been a prerequisite for pilot certification. Before even going far beyond initial lessons, primary students should have obtained at least a Class III FAA medical certificate, which is a requirement before their first solo. After obtaining a certificate, the FAA essentially requires pilots to “self-certify” they are medically fit for each flight. Renewals by an Aviation Medical Examiner (AME) usually arent cumbersome or in doubt. Basically, unless something in the pilots medical history raises a red flag at the AMEs office, or the pilot confesses to a potentially disqualifying condition, obtaining and maintaining a medical certificate isnt that hard. For now, anyway. A recent report from the U.S. House of Representatives Committee on Transportation and Infrastructure found what it labeled “egregious cases of airmen lying about debilitating medical conditions on their applications for Airman Medical Certificates.” According to the report, the Department of Transportations Inspector General “found more than 3200 airmen holding current medical certificates while simultaneously receiving Social Security benefits, including those for medically disabling conditions. While the U.S. Attorneys Office ultimately prosecuted more than 40 cases, hundreds more could have been pursued if resources had not been constrained.” Some conclusions in the Committees report were based on finding inappropriate substances during accident-pilots post-mortem toxicology screens. The report went on to conclude, “Pilots with undisclosed medical conditions pose safety dangers to themselves and the public,” and recommended the FAA coordinate with disability-benefit providers while “spot-checking” application-form disclosures and ensuring “swift and meaningful consequences” for violations. At least one of the fatal accidents examined in the report certainly involved a seemingly intentional failure to disclose a potentially disqualifying medical condition. However, that particular accident also involved “failure of the horizontal situation indicator” and the “pilots failure to maintain aircraft control,” according to the NTSB. The FAAs medical certification rules are, perhaps, the most routinely violated of all aviation regulations. But mass quantities of aircraft are not falling out of the sky because of this. Similarly, the FAAs medical certification rules are long past TBO and need a major overhaul. And the populations general safety could be greatly enhanced by enacting more stringent medical standards for motorists. But its likely the Committees report will at least stimulate the FAA into stepping up its medical enforcement activities. Even so, the burden of ensuring were medically fit for flight remains squarely on the pilots shoulders. Lets discuss what can happen when we try to cut that corner. Background On May 5, 2005, at 0914 Pacific time, a Gulfstream 695A collided with terrain several hundred feet short of the approach end of Runway 12R at the North Las Vegas (Nev.) Airport (VGT). The Airline Transport pilot experienced an incapacitating event during the flight and was the only fatality. One passenger was seriously injured; the other received minor injuries. The airplane was substantially damaged. Visual conditions prevailed for the flight, which originated from VGT at 0830 with San Diego, Calif., as its intended destination. Shortly after takeoff and while level at 9700 feet, the pilot started to cough repeatedly and donned an oxygen mask. He then contacted ATC and stated the flight would return to VGT. Shortly after turning back, the pilot collapsed against the control yoke. Neither passenger was a rated pilot, although the right-seater had some glider training from 25 years earlier. Together, they managed to get the airplane back to VGT and, after three landing attempts, crash-landed short of a runway. The pilot was transported to University Medical Center Trauma but did not recover from his medical condition. An autopsy was performed on the pilot, concluding his cause of death was “arteriosclerotic cardiovascular disease.” Investigation As part of its investigation, the NTSB requested the pilots medical records were requested from the FAAs offices in Oklahoma City, Okla. The Airline Transport pilot, whose age was not stated in the NTSBs report, held a First-class medical certificate dated October 11, 2004, with the limitation that the holder shall possess glasses that correct for near vision. The pilot was issued a Statement of Demonstrated Ability Waiver (SODA) for defective color vision dated October 6, 1999, plus another SODA for the same condition dated December 2, 2004. The pilot had not reported any heart or vascular trouble on the medical examination form; however, he did report having the flu in June 2002. A routine electrocardiogram (ECG) test was performed for this exam and for previous FAA medical exams on January 23, 2003, December 5, 2001, and June 28, 1999. The Clark County Coroner reported the pilot had been battling what appeared to be a sinus infection for the previous two weeks and that his physician had “cleared” him for flight on May 2, 2005. Its not clear from the NTSBs report whether this physician was also the pilots AME. Its also not clear whether the pilot had any history of cardiovascular disease. As a consequence, its impossible to know-based solely on the NTSBs report-whether the pilot knew of his heart condition and failed to report it or whether his incapacitation caught everyone by surprise. Probable Cause The National Transportation Safety Board determined the probable cause of this accident as “The incapacitation of the pilot.” The board did not speculate on whether the pilot knew of his condition. Theres no question that aviating can place on the human body certain stresses we would not otherwise encounter, including those caused by altitude and motion. But very rarely are the stresses different from those we might otherwise experience in our everyday recreation and profession. We cant choose when and where we might suffer an incapacitating event. But, sometimes, “stuff” happens that is not of our choosing. We can choose to stay home and watch television, or we can choose to do something more exciting and rewarding, but perhaps carrying with it greater consequences. Nothing is without risk; one of a pilots challenges always is to understand and manage that risk.
