The integrity of aeromedical regulation of pilots

[Paul Rice]

Having experienced the medical moment in my flying career I have come away with a very low opinion of the aviation medical profession / industry / and dare I say racket.

I have experienced knee jerk panic reaction resulting in many thousands of pounds of lost wages, false promises (lying), been exposed to expensive and unnecessary tests, slow processing of paperwork, weak and unacceptably slow decision making.

Procrastination, expense, and obstruction, resulting in months and months taken to resolve essentially simple problems.

I would like to take soundings of fellow pilots and seek to get a sense of how many pilots are dissatisfied with the level of aeromedical support that is available. To see if being exposed to unnecessary medical testing is widespread in the industry and what the time scales are like clearing simple problems.

I have a hunch that because of over zealous regulation, the expense, the exposure to unnecessary and expensive testing, the long time scales involved in making decisions that many pilots avoid reporting any medical issue that they can possibly hide in order to preserve cash flow and career.

Suspending a pilots medical can have massive consequences for a pilots such that it should never be the decision of one doctor acting alone in isolated practice. Just as an engineer acting alone cannot sign off certain work without it being overseen by another engineer so suspending a pilots medical should require the signature of at least two doctors and should never be done without investigation and consultation.

If the decision to suspend a medical certificate is contested a pilot subject to the suspension should have an automatic right of appeal to a Magistrate within two weeks (or a very short time frame) of the process beginning rather than appealing for reassessment by the AME's possible "mates" at the state Aeromedical section.

Any feedback with experiences would both good and bad really appreciated.

[Radgirl]

Sorry but this is just a rant. If you want to post some details I am sure you will get a lively debate, but there is nothing to say to this.

How do you know the tests are unnecessary? And how is a magistrate (who is not even legally qualified let alone medically qualified) going to decide on the risk of a particular medical issue and the need to pull a medical? Magistrates deal with criminal law!!!

The medical profession is no better or worse than any other but your brush is too broad

[Paul Rice]

The GP states testing is not necessary, the Out Patients Department at the local hospital categorically state testing is not necessary, but the AME says re-assessment for an aviation medical has no chance of happening without testing but is fortunately able to recommend three colleagues who he works with that can do the disputed test for a fee.

This looks like a horses arse, it smells like a horses arse, and I suspect without the need for a referral and expensive testing that this is probably a horses arse.

The aviation medical is suspended by a single individual who recommends colleagues who make money from the testing, and meantime street wise pilots loose confidence in the integrity of the system and keep medical concerns hidden in order to be able to make a living.

Can you spot a fault in the integrity and reliability of that system.

Majistrates do a lot of things other than criminal for example a lot of family case work and they certainly are not trained social workers but they are good at making decisions based on evidence presented. The idea of challenging a medical suspension quickly in the local Majistrates court is to stop the long term career and financial damage of an unnecessary medical suspension quickly at a local level by providing a forum for expert opinion to present opposing evidence and for that evidence to be considered openly and fairly. Aeromedical sections at Aviation Authorities are far to close to their AME's are far too powerful and were there is power there is often sadly corruption and individuals and their careers can get shafted.

You can challenge a speeding ticket if you believe you have a case to do so and so you should be able to protect your professional standing and income from a wrong medical suspension if you believe you have a case to do so.

I would be interested to see how many crew have been satisfied or disappointed by the quality, reliability, efficiency of the aero medical system.

[Radgirl]

I think you are confusing conventional care with the preventative role of the regulator.

The NHS exists to treat symptoms (plus a smattering of screening). If you are ill they provide treatment but they dont provide significant consultations or investigations purely because of a possible risk. You have provided no details but there are many instances, for example of a slightly abnormal ECG, that would not warrant conventional NHS intervention but might indicate an increased risk of incapacitation. The recommended manangement after a heart attack is not the same as the investigations the CAA will require, but they do so as they need to ensure the risk of incapacitation is minimal, whereas the NHS merely checks there is nothing that needs drugs or operations.

As it isnt NHS you have to pay. But each doctor sets his own fees, and the referrer gets no payment for referring you so I dont know what you are insinuating. The CAA decides the tests not the AME.

Still dont follow the argument about Magistrates. Any hearing would involve court costs, the costs of medical experts on both sides, the necessity of appeal to a higher court etc etc. Anyone who has been up against the CAA knows they have a bottomless purse. If you are worried about the financial costs of having your medical pulled I suggest you consider the legal costs of going to law. And the rest of us would also pay in higher fees

[wiggy]

Just an amateurs POV but offered as someone who was recently off work for some time: don't "we" tend to have to be fit in some areas of our health to a higher standard than the general public and therefore there are plenty of conditions which might not raise much of an eyebrow with the GP/local health authority, quite probably conditions they won't test for, and won't fund testing for, but which might cause justifiable concerns to an AME/the aviation regulator.

Our national regulators website has lots of info on disqualifying conditions and test required, does yours do similar?

As to the recommendations.I assume despite your AME's thoughts on who to go to you are actually free to "source" the tests elsewhere?

[Paul Rice]

A very good point we can of course go to any source to have the testing completed. I went to my GP to enquire about an alternative service provider and he said that he could arrange for a private referral to get a report written and by doing this he could control what is written and get me back on line.

Now call me very old fashioned but would integrity, ethics, safety and basic honesty not simply require a simple report stating the actual findings be more appropriate as opposed to a bent report drafted to achieve an effect.

The AME says in his notes to use his recommended people for the testing as they are able to write the report in the format required by the Aeromedical section. Old boys network in full gravy train mode.

What is worse about the entire scam is that there is nothing in the symptoms that I have reported that would indicate that there was any sort of problem relevant to what they wanted to test.

Thats why I want a right of appeal at the local magistrates court in which an honest Doctor if one could be found and an honest Solicitor with a 30 minute hearing would have me back at work by the afternoon. A right of appeal outside of the aeromedical world would prevent any abuse of power taking place.

Now a month and a bit later, £7000 the lighter in lost wages and medical fees and I am still waiting for the Aeromedical section to consider the position. Remember there these boys and girls only turn up in the office two days a week so not expecting anything to happen anytime soon.

If an engineer grounded an aeroplane and carried out irrelevant tests his services would be dispensed with. Why can a pilot be grounded and subjected to irrelevant tests and the scab lifters be allowed to get away with it. Oh because they close ranks have power to abuse and can.

[Fostex]

Occupational health (which AMEs practise) has never been a very dynamic or sought after field of medicine...

And it is not pilots who feel it's wrath. My wife (anaesthetist) suffers from a benign essential tremor and had her speciality training put on hold by a particular clown of an occupational health consultant until additional opinions were sought and the threat of legal action issued.

But I do think it is unfair to describe the medical profession as an old boys club. Get another opinion and build your case, decisions are made on evidence and expert opinions. Unfortunately however that is something that will take time.

[Radgirl]

Paul

We still have no details but you seem to be slating the medical profession (AND the legal profession!!!!) for trying to help. I do not believe the GP suggested he would nobble the report. However a GP in referring to a consultant can properly place emphasis on the relevant issues - the fact that your livelihood is at risk, the fact that the chest pain occurred after a night in a curry house, the fact that the CAA needs everything in black and white not as the usual differential diagnosis. Equally your AME is bang on in stating that the report has to be in the correct format. Why is that a gravy train? We spend years training doctors to write reports for the Courts; they arent bent but need to provide the data in the right way.

We all sympathize with your predicament but slating off those trying to help is digging a hole. Let them help you, and post specifics here - you might get some helpful advice from the bent greedy doctors..

[Paul Rice]

The medical profession as a whole is brilliant lots a highly educated professional men and women doing their absolute best to look after people often with public service and concern for other peoples welfare at the core of what they do and stand for. On the other hand in every profession there are bad apples. The biggest mass murderer in UK criminal history was a friendly highly regarded and trusted GP.

I have no doubt whatsoever that my GP is bent. His response to to considering that I might have angina was to say there were two ways to play it and one way was to quote look the other way as a he does with many lorry drivers on his books so I have no doubt that his offer to manipulate a private referral was exactly that. Sorry to say it but it is well below the standards of integrity that I would expect of any professional person.

Notwithstanding that there was nothing about my symptoms that would suggest angina.

Now in respect of the Aeromedical Regulatory community I am sure that there are many exceptional individuals there doing great work to help people, and perhaps many entered into this line of work with deep medical knowledge combined with a passion for aviation. However there are some who see being an AME as a nice little earner a sleepy back water away from the need to practice medicine and simply a nice way to see a list of fit, relatively healthy, relative young people who are not going to disclose any health problems for fear of loosing their job.

As soon as a simple problem is disclosed then the system brakes down and there seems to be no judgement exercised, an anxious reach to study some outdated only partially understood AMC s and a career gets flushed down the toilet. A pilot without a medical certificate is no longer a pilot and there has to be a line of defence to prevent a single individual taking away another persons job because the make a mistake.

I think they only way to proceed is sadly to appoint a lawyer and sue the Aeromedical section for loss of earnings what a shame there are no sensible checks and balances in the system.

[parkfell]

Might your current plight be connected to your post February 2016 ~ medical suspended due to a PE ?
The process to regain your medical is clearly laid down. A consultant well versed in CAA matters is clearly the way to proceed.
An OML on your class one can also translate into an unrestricted class 2 which is what is required for PPL flying instructor.