CASA Avmed – In my opinion, a biased, intellectually dishonest regulator

[Clinton McKenzie]

CASA claims to be an evidence-based and risk-based regulator. That claim continues to be, in my opinion, demonstrably false, at least in the case of Avmed. Although one need look no further than the recent resurgence of discrimination against pilots with CVD in the face of objective evidence, my own recent and ongoing experience provides one of what I consider to be numerous signal examples of how Avmed really makes decisions.

Although there’s a lot to digest in this post, I’d suggest anyone who holds a CASA-issued medical certificate has an interest in understanding the content.

In ordinary circumstances the details of my medical circumstances would be highly sensitive and their disclosure by others without my consent would, depending on the context, potentially constitute a criminal offence. Unfortunately, the ghastly Frankenstein’s monster that is the aviation ‘safety’ regulatory regime dictates that, if I want to pursue external review of CASA’s decisions, I have almost no choice but to expose these sensitive details to public view through dissection in the decisions of the AAT or Federal Court. (All in the name of ‘safety’ of course.) I might as well disclose by choice rather than subsequent necessity.

In the interests of refining the relevant facts and issues, I won’t go into all of the background here. However, in order to address any suggestions that I’m telling only half of the story, I’m happy to forward by PM all of the background documents and for someone with the time and technical know-how to post links to them. Further, I am also happy to consent to CASA publishing anything that it says is relevant and which it could not publish but for my consent.

The story so far…

Mid last year I felt that the hearing in my right ear had deteriorated. I undertook a hearing test and my GP referred me to an ENT specialist. The ENT specialist diagnosed the cause to be noise exposure during my 20 years’ service in the ADF – I fired weapons ‘right handed’. Note that the extent of deterioration did not result in me not meeting the hearing standard for a class 2 medical certificate.

The ENT specialist nonetheless recommended that I undergo an MRI to rule out the possibility of a tumour affecting my hearing. I chose to undergo the MRI. The MRI ruled out that possibility. However, it coincidentally indicated unusual cranial blood circulation. The ENT specialist therefore recommended that I consult a neurosurgeon. This happened around November 2017.

I consulted a neurosurgeon whose advice was that there could be a range of explanations for the results of the MRI, and the most reliable way to determine the cause of the indicated results was to undergo a procedure involving an incision into an artery in my groin, the feeding of tubes up through that artery to reach near the point in the cranium where the unusual circulation appeared to exist, the introduction of contrast dyes into the circulation at the point, which dyes then enable the precise inspection of blood flows using X-rays. This is called catheter-based digital subtraction angiography.

The neurosurgeon’s advice was that there was no urgency at that point in time because: (1) there was a range of explanations for the apparent anomalies on the MRI results and (2) I had no symptoms of anything suggesting the worst case scenario.

As a matter of objective fact, I continued then to go about my ordinary life, including flying, without incident or any unusual symptoms.

It is important to pause here to note these objective facts at that point in the timeline of events. That is because CASA has subsequently ‘spun’ the circumstances so as to suggest that I was diagnosed when the MRI results were considered by the neurosurgeon. That ‘spin’ is, in my opinion, intellectually dishonest and intended primarily to cast my decisions in a bad light. CASA also seems to me, either as a consequence of incompetence or intellectual dishonesty, to have incorrectly confused cranial circulation with brain circulation. My specialist explained the difference (and explained to me why CASA is not qualified to express an opinion on the matter).

I underwent the catheter-based digital subtraction angiography. The opinion of my neurosurgeon and radiologist was that the results indicated I had an arteriovenous fistula, Gognard Type IV. A fistula is, in layman’s terms, a ‘short circuit’ between arterial blood flow and venous blood flow – hence “arteriovenous”. “Gognard Type IV” = bad. When I understood the implications of this opinion, I ‘grounded’ myself.

It is again important to pause here to note that the diagnosis was merely an opinion, albeit an opinion of specialists whose competence I trust. The reason this is important is that although CASA now treats the diagnosis of these specialists as being an objective truth, notwithstanding that it was, as a matter of objective fact, merely the expression of an opinion, CASA now rejects the same specialists’ opinions as to the ongoing success of the procedure those specialists carried out to deal with the diagnosed condition. In short, CASA treats the specialists’ opinions as objective truths when they are against my interests, but rejects the same specialists’ opinions when they are in my interests. This approach is, in my opinion, biased and intellectually dishonest.

When the question of the diagnosis came up at a recent hearing in the AAT – more of this later – I said that the question whether the diagnosis of the specialists was accurate was an open one – that is, it remains to be argued and determined whether it was accurate. This was a potentially inconvenient prospect for CASA, because it might result in the risks not being quite so dire as CASA’s decision-maker suggested.

The reason the accuracy of the diagnosis was (and remains) an inconvenient prospect for CASA is that the unassailably objective fact is that I have not suffered any of the dire consequences that were supposed to be highly probable long-term consequences of the condition with which I was diagnosed. However, not for CASA the objectivity of considering the possibility that the original diagnosis – remember, it was just the opinion of specialists – might have ‘overdiagnosed’ the condition.

Rather, CASA’s lawyer merely asserted, from the bar table, that the preponderance of medical opinion was to the effect that my condition was likely to have arisen recently rather than have been congenital. CASA’s lawyer’s assertion is not entirely consistent with what I’ve been advised. I will leave CASA’s lawyer to decide whether, on reflection, good conscience and professional judgment would result in him making the same assertion from the bar table again in similar circumstances. Although it may be that he has medical qualifications of which I am not aware, he certainly conceded that the material headed “Relevant Medical Literature” in the delegate’s letter is not a compendium of all of that literature. (More of the decision-maker’s selective “Relevant Medical Literature” later.)

Back to the timeline of events: I consented to undergo the procedure that my specialists recommended to deal with the fistula. That procedure happened on 23 August 2018. In simple terms, the procedure stuck a plug in the short circuit. The opinion of my specialists, based on (1) their first hand observation of the effect the plug had on the circulation at the time, and (2) their specialist knowledge of how like procedures have progressed in the circumstances of like patients, is that the procedure was a success. (And just to jump forward temporarily: A dynamic CT angiogram conducted on 6 November 2018 confirmed their view.)

I was discharged from hospital as expected on 25 August 2018 and returned to normal activities in the following week. On 26 August I informed CASA of the fact that I had undergone the procedure and that, although I thought it was unnecessary, I understood why CASA would then suspend my medical certificate until satisfied I was fit to fly. The reason I waited until then was: (1) I had already grounded myself and (2) if the main risks of the procedure eventuated – death or stroke – I wouldn’t be returning to flying anyway.

I attended a follow-up consultation with the specialist in September and, other than a post-anaesthetic period of caution which had then passed, the specialist expressed no concerns. I returned to flying.

For the record: I continue not to be dead. Nor have I suffered a stroke or any other post-procedure complications.

Acting with all the urgency of a startled 3-toed sloth, CASA suspended my medical certificate on 16 October 2018. The suspension letter said, among other things: “Please be advised, CASA is unable to make a risk assessment for your fitness to return to flying until 12 months has elapsed following your embolisation procedure.” This was, effectively, a cancellation of my medical certificate, because it expires in mid-January 2019.

By letter dated 19 October 2018 my specialist said:

CASA’s approach would seem a little heavy handed – consistent with their past history, but disappointing nonetheless. …

My professional opinion is that I do not consider you a risk of incapacitation now that the lesion has been treated. I would consider you safe to fly for daytime VFR PPL flying. I would not consider you fit for a class 1 medical or professional flying for a longer period, however.

… Having discussed the situation with Dr [X, radiologist], he agrees.

One amusing though disappointing aspect of my discussions with CASA’s lawyer at the recent AAT stay hearing was that he was at pains to point out that the specialist had qualified the word “heavy-handed” with the phrase “a little”. I suggested that the specialist may have intended some irony – analogous to the intent of the phrase ‘a little bit pregnant’. Certainly my specialist and other medical professionals use ‘a little stronger’ language when expressing views, in private, about CASA Avmed’s competence.

I note also that CASA seized upon the specialist’s opinion about my not meeting the class 1 standard as being relevant to my not meeting the class 2 standard. Setting aside the obvious point that I don’t need to or want to meet the class 1 medical standard, this is yet another example of CASA relying on my specialists’ opinion as an objective truth only when it is unfavourable to me.

Another amusing though disappointing aspect of CASA’s behaviour is the various weasel-worded attempts to paper over what is – to me at least – the patent legal errors in CASA’s statement: Please be advised, CASA is unable to make a risk assessment for your fitness to return to flying until 12 months has elapsed following your embolisation procedure.

Taken at face value, the statement means that CASA Avmed has a policy that dictates the outcome in all cases during the period 12 months after a procedure, despite what evidence in individual cases and the risks arising from individual cases might suggest during the 12 month period.

In a letter to the AAT of 26 October 2018 CASA’s lawyer said:

It should be noted that the Applicant can at any time submit further medical evidence in support of his contention that he is currently fit to fly and that will be reviewed by Avmed.

The above is an example of numerous pieces of exquisite ambiguity in CASA’s correspondence in this matter. It goes without saying that anyone can submit anything s/he likes to CASA at any time. The question as to when and whether CASA will consider and change its mind on the basis of submitted material is an entirely different matter.

Accordingly, I emailed a letter dated 30 October 2018 to CASA in which I made a request to CASA’s lawyer in these terms, with my underlining:

I request that the delegate confirm, in writing, whether or not s/he will consider and review the substance of medical evidence submitted to CASA, and make actual risk assessments from time-to-time based on that evidence, during the specified 12 month period.

CASA’s lawyer called me on the morning of 31 October 2018. As a consequence of the importance of the content of that call, I emailed him a letter dated 31 October 2018 setting out my understanding of the substance of the conversation. I noted during the conversation that I was dubious of conversations the content of which a party was not prepared to confirm in writing.

In my emailed letter dated 31 October 2018 I requested, among other things, that CASA’s lawyer let me know if any of the content was materially incomplete or inaccurate and, if so, in what way. I also requested, among other things, that he seek instructions and let me know CASA’s position on the following question:

Is Avmed’s present position that the results of a CT scan now could potentially convince Avmed of my compliance with the class 2 medical standard, at least to conduct day VFR operations?

The answer to that was given on 7 November: [A] simple CT scan I am informed may be unable to provide sufficient detail for future assessment purposes.

Here’s what I say is CASA Avmed’s actual current position: CASA Avmed is not going to change its assessment before 12 months has elapsed, irrespective of what material is put before CASA. The decision-maker meant what he said. That position is, at least, honest, even if manifesting errors of law. CASA’s attempt to paper over that position is, in my opinion, intellectually dishonest.

The person who decided to suspend my medical certificate has no specialist qualifications in the matters relevant to the condition with which I was diagnosed nor the risks arising from the treatment of it. His decision letter annexes material that is headed “Relevant Medical Literature”. The letter does not say who decided on the relevance of the material. However, it is manifestly clear that it is not a compendium of all medical literature relevant to my circumstances – a point that CASA’s lawyer and the decision-maker had little choice but to concede during discussions prior to the AAT stay hearing.

Although I could (and eventually will) analyse the detail of the various assertions made in a ‘Statement’ of the decision maker that was submitted to the AAT, I note a couple here:28. Based on the available review of scientific literature…”

…

33. Accordingly, I consider the lack of evidence provided by the Applicant, coupled with the known high likelihood of recurrence…

The phrase “the available review of scientific literature” seems either to have mistakenly misplaced the word “available”, or to mean what it says. Either a review was done of ‘available scientific literature’ – the appropriate course to take if CASA was in fact an objective evidence and objective risk based regulator, or an “available review” was done of ‘some’ “scientific literature” – the course that appears to have been taken in my case to justify a foregone conclusion.

It seems that the opinions of specialists with first-hand knowledge of my circumstances and how other people in like circumstances have recovered from procedures is not considered by the decision-maker to be ‘evidence’ (even though their opinion as to the existence of the condition is treated as an objective truth by the same decision-maker). The “known high likelihood of recurrence” is not quantified and the knowledge seems to me to arise from the selectively quoted and misconstrued “Relevant Medical Literature” at Annex A to the decision-maker’s letter.

For example, there is text quoted from what’s headed the “Ambekar Study” and a scary table and text from under that table. However, critically important text from the actual study that contains the findings that are purportedly described in the table has been omitted from the decision maker’s letter. (Again, just to make sure I cannot be accused of making this up, the study selectively quoted in the decision-maker’s letter is titled “Long-term angiographic results of endovascular “cured” intracranial dural arteriovenous fistalas”. A whole paragraph commencing “Follow-up angiography…” is omitted from the decision-maker’s letter, yet this paragraph contains data that are fundamental to understanding the scary table and text. The decision-maker’s letter says the table is “Figure 1”. The published article refers to the table, and marks the table, as “Figure 3”.)

When I got an expert in probabilities and mathematics to look at the text of the study, the expert’s conclusion was that the table depicts the probabilities of when a recurrence of a previously treated fistula will occur, not the probabilities of a recurrence. In other words, the table does not say how likely a recurrence is, but rather, when it is likely to happen if it happens. These are two fundamentally different probabilities. CASA’s non-expert in Avmed seems to me to be confusing the two.

If CASA were in fact an objective evidence-based and objective-risk based regulator, it would do this: Ascertain – on the basis of all relevant medical literature and current specialist expertise – (1) the probabilities of recurrence or adverse consequences of the procedure I underwent, and (2) ascertain the probabilities of those adverse consequences resulting in a sudden, incapacitating disability to discharge PIC duties during day VFR operations, then (3) work out whether that risk is ‘acceptable’ by reference to the percentages that Avmed says are ‘acceptable’.

One of the more breathtaking statements made by CASA’s lawyer during the stay hearing was this: Long gone are the days when Avmed relied on the opinions of treating specialists. That would explain a great deal, including why medical professionals now say what they say about Avmed. But if CASA were honest, the statement should have gone on to say: “unless the opinions of treating specialists are adverse to the interests of certificate holders, in which case we’ll treat those opinions as objective truths”.

CASA canvassed the option of imposing a “safety pilot required” condition on my certificate. I asked for evidence of the number of pilots with that condition imposed on their certificate by CASA who have suffered sudden incapacitation, requiring the intervention of the safety pilot. There was no evidence provided to show that the condition has ever had a practical consequence in reality. However, this inconvenient truth was waved away on the basis that …. maybe pilots aren’t complying with their obligations under the law requiring reporting of sudden incapacitation of crew members. In contrast, when I suggested that the way in which people like me and others have been treated by CASA may be resulting in pilots being too scared to raise issues with doctors or concealing potentially safety-relevant information from DAMEs and CASA, the answer was that this would be against the law. Yet another example of CASA spinning circumstances to wave away potentially inconvenient truths.

The AAT has reserved its decision whether to stay CASA’s decision to suspend my medical certificate. I will let everyone know the decision and further progress in my application.

For those who’d prefer to ‘tut tut’ and claim ‘healthier than thou’ status from the sidelines, I expect you to put your medical certificate where your mouth is. You should volunteer for precautionary angiography, the results of which you’ll forward to Avmed and on the basis of which you’ll ground yourself if anything potentially anomalous is indicated. Although CASA downplays the probabilities of fistulas, to avoid an inconvenient truth, the objective evidence suggests otherwise. However, there is good news about the objective evidence of the probabilities of you having a fistula multiplied by the probabilities of you suffering debilitating in-flight consequences. The bad news is that CASA appears not to be interested in the objective facts and objective risks.

Regards and safe flying.

[Cloudee]

Clinton, that is an awesome post. I wish you every success with the appeal. The action of CASA AVMED is just the sort of thing that stops pilots from talking to their doctors, thereby creating a scenario that is detrimental to safety. I hope you’ve got the will and means to fight them all the way. Thank you for sharing this.

[josephfeatherweight]

MRIs/CAT scans/Angiograms/whatever will show up all sorts of wonderous things that we more than likely would have been blissfully unaware of until we dropped dead at age 98 - from something completely unrelated...
i sympathise with your battle and wish you the best in your appeal.
Cloudee, you are 100% correct that the current culture ENCOURAGES those in our profession to keep their mouths shut rather than seek assistance - as Cloudee said, to the detriment of safety.
Clinton, thanks for your detailed post.

[alphacentauri]

...and if you haven't opted out of a MyHealth record yet, this story should present an argument for why it might be a good idea.

You have 3 days left to do so.

[machtuk]

...and if you haven't opted out of a MyHealth record yet, this story should present an argument for why it might be a good idea.

You have 3 days left to do so.

Actually that's a good point:-) But it does show the 'them & us' mentality is widening to the point where we pilots will have zero trust in the regulator (which is pretty much already the case) & the regulator will have zero trust in pilots, nobody wins here, it's a sad case where one sector of the transport industry gets scrutinized & abused beyond belief!

[Horatio Leafblower]

Ahhh but imagine the freedom you now have to go and fly an RAAus aircraft, medically imperiled though you are. They make a V-tailed Foxbat don't they?

[Scion]

Their arrogance defies belief.
I have a Fellowship in Dentistry from the Royal College of Surgeons in Edinburgh and I cannot understand the complete arrogance of these paradentals.

[Torres]

Did CASA turn up to your AAT hearing? They didn't turn up to mine but called and said they were "busy".

CASA has practiced malfeasance to frustrate an applicant's right to review in the AAT for over 20 years, but you already knew that.

[Clinton McKenzie]

Thanks Cloudee and joseph.

Horatio: I’m not sure I have the choice, anymore. Having been diagnosed with something that I have disclosed, it may be that I’m the regulator’s plaything for the rest of my life.

Torres: It’s been around 20 years since I worked in CASA. I’ve long since grown up and moved on.

Today the reality is that I’m effectively being punished by the regulator for having tried to do the right thing. Although it may not have been the subjective intention of CASA staff to punish me, the objective reality is that I am being punished because of the way in which CASA Avmed chooses - note, the word “chooses” is very important - to administer the medical certification system. Selectively disregarding and relying on the opinions of treating specialists is a choice. Construing everything in way that highlights the worst possibilities and downplays the best possibilities is a choice. As the thread title says, this is, in my view, a biased and intellectually dishonest approach.

Avmed used to work differently, and used to be an integrated and respected part of the system of aviation safety.

Most of the pilots with whom I’ve discussed my current circumstances have asked why I was so stupid as to disclose to CASA in the first place, or so stupid as to volunteer to do the MRI. That scares me. What scares me even more is that the positive disincentive to disclosure or even to seek medical advice ‘when in doubt’ appears not to scare CASA Avmed. I assume that in their world they’re sure they’re making a positive contribution to aviation safety.

[gulliBell]

All that aside....if you were shooting weapons right handed I would have thought the initial hearing loss (that lead to your eventual predicament) would be in the left ear.

[Clinton McKenzie]

My description may be wrong. Right cheek and ear were closest to the bang stick when it went bang. Right hand on the pistol grip and right index finger on the trigger. Left hand supporting the barrel. I call that firing right handed.

[Sunfish]

Today the reality is that I’m effectively being punished by the regulator for having tried to do the right thing. Although it may not have been the subjective intention of CASA staff to punish me, the objective reality is that I am being punished because of the way in which CASA Avmed chooses - note, the word “chooses” is very important - to administer the medical certification system. Selectively disregarding and relying on the opinions of treating specialists is a choice. Construing everything in way that highlights the worst possibilities and downplays the best possibilities is a choice. As the thread title says, this is, in my view, a biased and intellectually dishonest approach.

Avmed used to work differently, and used to be an integrated and respected part of the system of aviation safety.

Most of the pilots with whom I’ve discussed my current circumstances have asked why I was so stupid as to disclose to CASA in the first place, or so stupid as to volunteer to do the MRI. That scares me. What scares me even more is that the positive disincentive to disclosure or even to seek medical advice ‘when in doubt’ appears not to scare CASA Avmed. I assume that in their world they’re sure their making a positive contribution to aviation safety.

Look at it from Avmeds point of view for a minute:

- The staff will be on rolling five year contracts which can be renewed (or not) at the whim of CASA management.

- The staff will be blamed (rightly or wrongly) if there is ANY medically attributed aviation accident or incident. They are scapegoats pure and simple.

Considering that they have a house to pay for and a family to feed, is it any wonder that they operate in personal risk minimisation mode all the time?

Clinton, the Avmed staff have nothing to loose by denying you, and everything to loose if they let you fly. Your only hope is to change that equation by pressure on CASA, making it less painful for them to let you fly.

We have a good example of this right at the moment in that the political public backlash over cuts to foodbank funding has caused the PM to reverse that decision this morning.

As for pilots not reporting possible illness, hearsay is that this has been going on for at least Ten years. The net effect of Avmeds behaviour is to increase pilot mortality because they are afraid to report conditions on account of AVmeds predictably draconian response.

[YPJT]

Two comments relayed to me by another pilot from a DAME they had been to:
1. AVMED is now being run by computers.
2. Don't tell CASA anything.

[porch monkey]

Well, I can believe 1. above is right. I got my Class 1 renewal back in 24 hrs. Never had even close to that happening before.

[Sunfish]

Computer says no.

[YPJT]

Computer says no
If you tick yes. The computer will definitely say no.

[The Wawa Zone]

Telling AVMED nothing has always been the rule, in line with the old aviation maxim: Tell no one nuffin'.

Over a decade ago the AVMED section had a chief who had the reputation of being willing to pull Class One's for anything imaginable, apparently he just had the need.
At that time I had a car accident where I was demolished from behind by an unlicensed dopehead doing 70Kmh while I was stopped at a red light while watching a large red fire engine cross in front of me with it's lights and sirens going. Out of that I got a stiff neck for 6 months and did I go to see the local doc ?
Nope, well not under my own name, I didn't, I was under no illusions about where data matching could take my tale of woe.

My advice, to paraphrase the old Darwin saying, is ...If in pain, get on the plane (to Thailand).

[Stretch06]

Two comments relayed to me by another pilot from a DAME they had been to:
1. AVMED is now being run by computers.
2. Don't tell CASA anything.

Well, I can believe 1. above is right. I got my Class 1 renewal back in 24 hrs. Never had even close to that happening before.

Two weeks ago, I had my Class one renewal emailed to me before the ECG was completed in the doctors room.

[Kranz]

All that aside....if you were shooting weapons right handed I would have thought the initial hearing loss (that lead to your eventual predicament) would be in the left ear.
WTF? tencharacters

[Clinton McKenzie]

Update: Today the AAT decided not to grant the stay.

[michigan j]

Clinton, thank you for your time in putting this post up, it was very informative. I'm sorry how this worked out for you. Unfortunately, just culture does not seem to apply to Regulators.

[The Wawa Zone]

Clinton, sorry things didn't go well but use the ground time for other things that will put you ahead in other ways.
What weapons were your shooting ? Most people fired weapons right handed.

Michigan, 'just culture' ? More specifically it is arse covering - 'we'll cover our arse by making sure that your's cannot fly'.

[michigan j]

It goes beyond "cover our arse" to "shove it up yours"

[Clinton McKenzie]

These are the Tribunal’s reasons for refusing to grant the stay, with a couple of omissions noted and comments by me in square brackets:

1. This decision is about whether a decision by the Civil Aviation Safety Authority (CASA), the respondent, suspending the Class 2 medical certificate held by Mr Clinton McKenzie, the applicant, should be stayed. CASA suspended the medical certificate in a reviewable decision dated 16 October 2018. Mr McKenzie applied for review of the decision on 17 October 2018. On 21 October 2018 Mr McKenzie sought a stay order. The suspension decision prevents Mr McKenzie from flying; the effect of a stay, if granted, would be to allow him to fly pending his review being heard and determined.

2. The tribunal held a hearing on 9 November 2018. Mr McKenzie, who is legally trained, appeared in person; Mr Anthony Carter appeared in person representing the respondent. He was accompanied by Dr Sanjiv Sharma, a Senior Medical Officer with CASA. Dr Sharma gave evidence to assist the tribunal to assess some of the medical evidence.

[The hearing was about an hour and a quarter long.]

3. The tribunal had available to it the documents submitted under section 37 of the Administrative Appeals Tribunal Act 1975 (the AAT Act) (these are known as the “T- documents”); various emails and letters between applicant and respondent; medical reports; a statement by Dr Sharma with an attachment summarising medical literature; a statutory declaration by Mr McKenzie, with attachments; and submissions by both parties.

ISSUE

4. The only issue before the tribunal is whether the stay sought by Mr McKenzie should be granted.

LEGISLATIVE FRAMEWORK

5. Section 41 of the AAT Act deals with the operation of a decision that is the subject of an application for review by the tribunal. Subsection 41(1) provides that, subject to the provisions that follow, an application for review does not affect the operation of the decision for which review is sought. Subsequent subsections allow departure from that outcome. Subsection 41(2) allows the making of an order staying or otherwise affecting the operation of the decision to be reviewed, in the following terms:

“(2) The Tribunal may, on request being made by a party to a proceeding before the Tribunal (in this section referred to as the relevant proceeding), if the Tribunal is of the opinion that it is desirable to do so after taking into account the interests of any persons who may be affected by the review, make such order or orders staying or otherwise affecting the operation or implementation of the decision to which the relevant proceeding relates or a part of that decision as the Tribunal considers appropriate for the purpose of securing the effectiveness of the hearing and determination of the application for review.”

6. Subsequent subsections provide for the variation or revocation of a stay order and for interested parties to be given an opportunity to make submissions.

7. Section 31 of the Civil Aviation Act 1988 (the CA Act) provides for certain decisions under the Act or the regulations to be reviewed by this tribunal. Such decisions include suspensions of certificates, permissions, permits or licences issued under the Act or regulations and the imposition or variation of conditions, or the cancellation, suspension or variation of an authorisation contained in such instruments. Section 31A provides for automatic stay of certain decisions, where a “show cause notice” is issued under the Act or Regulations. The operation of show cause notices is limited to airworthiness matters and it is accepted that the decision under review was not subject to a show cause notice.

8. Section 98 of the CA Act provides for the making of regulations for a wide range of purposes under that Act. The Civil Aviation Safety Regulations 1998 (the Regulations) provide the main body of rules governing civil aviation operations in Australia. Part 67 of the Regulations provides for the issue and control of medical certificates. Part 67B provides for the appointment of designated aviation medical examiners (DAMEs) and designated aviation ophthalmologists. Regulations 67.150, 67.155 and 67.160 set out the requirements for three medical standards, standards 1, 2 and 3 respectively. Regulation 67.230 allows CASA to direct the holder of a medical certificate to submit to a medical examination or undergo other tests or to authorise the disclosure of information if it is necessary, in the interests of the safety of air navigation. Where CASA issues a direction for a medical examination under regulation 67.230, subregulation 67.240(1) allows CASA to suspend the person’s medical certificate pending the examination. Subregulations 67.240(4) and (5) read as follows: [omitted by me]

9. Regulation 201.004 sets out decisions under the regulations that are reviewable by this tribunal; the provision includes any decision under the Regulations suspending an authorisation otherwise than on the application of the authorisation-holder. Regulation 11.015 states that “authorisation” includes a certificate capable of being granted to a person under the Regulations.

THE FACTUAL CONTEXT

10. Mr McKenzie holds a Class 2 medical certificate issued on 4 April 2017, expiring on 30 January 2019 (a Class 2 medical certificate means that the holder meets standard 2 set in regulation 67.155 of the Regulations). Mr McKenzie also holds a private pilot licence and must hold a Class 2 medical certificate in order to be able to fly. Mr McKenzie said that he flies for pleasure and greatly values the privilege of being able to fly.

11. Mr McKenzie was troubled by sensorineural hearing loss in his right ear and in November 2017 he had an MRI to help identify a cause. No results were found relating to the hearing loss, but the neurosurgeon, Dr Peter Mews, discovered a vascular anomaly in the left frontal part of the brain (report of Dr Mews, 2 November 2017, T1 folio 8). Dr Mews noted that Mr McKenzie had no previous symptoms or history and suggested that the most likely diagnosis was a dural arteriovenous fistula (DAVF) with some other possibilities (arteriovenous malformations) also considered. He explained to Mr McKenzie that the potential diagnosis carried a risk of haemorrhage, seizure or ischaemic neurologic deficit. He recommended a cerebral angiogram as the best way to “clarify the pattern of flow and the nature of the anatomical lesion”.

12. Mr McKenzie underwent the cerebral angiogram, and a report by Dr Mews (26 April 2018, T1 folio 10) confirms an arteriovenous fistula “Cognard type IV” (I gather the Cognard name comes from a system for classifying this type of fistula). Dr Mews also suggested that this type of fistula “is associated with a malignant behaviour risk (haemorrhage, ischaemic neurologic deficit, or seizure) approaching 40% per year”. He recommended treatment, which carried with it an element of risk. A report dated 12 July 2018 (T1 folio 12) reports on a further consultation with Dr Mews. The preferred treatment modality was endovascular obliteration with liquid embolic material, although the risks of the procedure are significant.

13. A report of Dr Shivendra Lalloo, dated 24 August 2018 records the procedure, which was carried out by catheterisation and introduction of embolic fluid identified as “Onyx 18”. I gather that Dr Lalloo (described by Dr Mews in an earlier report as “the senior neuro interventional practitioner in Canberra”) carried out the procedure, assisted by Dr Mews. The procedure was regarded by the doctors as having been successful.

14. Drawing on the evidence given briefly by Dr Sharma at the hearing (for which I am grateful), it may be helpful to explain Mr McKenzie’s condition and the procedure used to treat it. The DAVF involves an anomalous connection - the fistula - between the arterial blood vessels and the venous blood vessels in the brain, with the possibility of blood from one part of the circulatory system making its way into the other. The treatment involves filling the fistula with copolymer material delivered through a very fine catheter; the copolymer material sets or hardens, closing off the connection between the two sets of blood vessels.

[My comment: As noted earlier in this thread, the advice to me is that the anomalous connection was in the cranial blood flow, not in the blood flow in the brain. Dr Sharma is not a specialist in this area.]

15. On 26 August 2018 Mr McKenzie wrote to CASA advising that he had undergone the above procedure, explaining how the diagnosis came to be made, and suggesting that the procedure had reduced his risk by treating his arteriovenous fistula (T16). He noted that he had not flown since the condition was diagnosed and said he would not fly again until he received specialist advice that he was medically fit to do so. He suggested that his medical certificate did not need to be suspended but recognised that CASA might take a different view. By letter of 28 August 2018 (T17) Dr Sharma reminded Mr McKenzie of his obligation not to fly while his capacity was impaired, and sought a report from his treating doctor.

16. Mr McKenzie’s general practitioner, Dr Hayden Henry wrote to CASA on 31 August 2018 (T19) stating that the procedure undergone by Mr McKenzie had been a success and that he was “unimpaired and symptom free” neurologically, although he had not undertaken a full neurological examination.

17. In a letter to Mr McKenzie dated 12 October 2018 (T26) CASA provided an update about an application for a medical certificate, stating that the matter had been referred to complex case management (CCM), a process CASA uses to assess more difficult medical certification issues (at this time Mr McKenzie still held a medical certificate, so it appears that the letter misstated the reasons for the assessment; in practice it related to Mr McKenzie’s fitness to retain his certificate rather than whether or not to issue a certificate). The CCM report (T27) concluded that reports should be gathered from the relevant specialists addressing questions such as the risks of recurrence of the fistula, ongoing monitoring requirements, the percentage risk of incapacitation and the long -term prognosis, and appears to have considered two options: allowing Mr McKenzie to retain his class 2 certificate with a neurological report after 12 months; and suspending his medical certificate in order to establish whether he is fit to fly through neurological assessments over the next 12 months.

18. On 16 October 2018 CASA took the decision currently before the tribunal (T3): the decision issues a direction under regulation 67.230 requiring Mr McKenzie to undergo a medical examination; and suspending his medical certificate under regulation 67.240. The reasons for the decision identified several elements of the class 2 medical standard in regulation 67.155 which CASA was not satisfied that Mr McKenzie met, as follows:

“Abnormalities, disabilities and functional capacity
2.1 Has no safety-relevant condition of any of the following kinds that produces any degree of functional incapacity or a risk of incapacitation:
a) an abnormality
b) a disability or disease
c) an injury
d) a sequela of an accident or a surgical operation
2.2 Has no physical conditions or limitations that are safety-relevant
Nervous system
2.7 Has no established medical history or clinical diagnosis of:
a) a safety-relevant disease of the nervous system; or
b) epilepsy; or
c) a disturbance of consciousness for which there is no satisfactory medical
explanation and which may recur
2.8 Is not suffering from safety-relevant effects of a head injury or neurosurgical procedure

19. The reasons also identify possible risks as including haemorrhage, venous congestion/hypertension and oedema, ischaemic neurological deficit, seizure , and procedure related risks (permanent neurologic morbidity and failure of the procedure requiring re-treatment).”

20. The direction to submit to a medical examination includes the following in bold type: “Please be advised, CASA is unable to make a risk assessment for your fitness to return to flying until 12 months has elapsed following your embolisation procedure”.

21. On 19 October 2018 Dr Mews emailed CASA (T32) asking for guidance on what CASA might need with regard to establishing that a person who had undergone DAVF treatment by endovascular techniques was now fit to hold (or retain) a class 2 medical certificate. He noted that he himself held a class 2 certificate and a private pilot licence. He said “I have advised the patient not to fly and notify his DAME to work towards medical clearance to resume his pilot privileges”. He noted that the patient (who was unnamed in the email) had no neurological symptoms and no adverse effects from the procedure. CASA’s response (also at T32), dated 22 October 2018, encouraged Dr Mews to submit all available medical information, noting that CASA might need to seek further information from the applicant.

22. On 19 October 2018 Dr Mews also wrote to Mr McKenzie (T29). In that letter he said that

a) CASA’s approach (as relayed by Mr McKenzie) “would seem a little heavy- handed”.

b) His professional opinion was that he did not consider Mr McKenzie a risk of incapacitation following the treatment of his DAVF. “I would consider you safe to fly for daytime VFR PPL flying. I would not consider you fit for a class 1 medical professional flying for a longer period, however.”

c) He had written to CASA (this is plainly a reference to the email at T32), and after receiving a response, would write a report stating his conclusion that Mr McKenzie was not at risk of incapacitation. He thought that Dr Lalloo held the same view, but both thought that CASA would require something further, such as a cerebral angiogram demonstrating no residual flow post treatment.

23. Mr McKenzie undertook further consultation with Drs Mews and Lalloo. Shortly before the hearing he provided a statutory declaration which included as an annex a report by Dr Lalloo of a CT scan (including both “limited CTB” and “dynamic CTA”), taken on 6 November 2018. In the report Dr Lalloo notes that “Limited CTB does not demonstrate any ICH [intracranial haemorrhage], left frontal infarction or hydrocephalus” and “Dynamic CTA demonstrates no evidence of residual AV shunt in the anterior cranial fossa.” The conclusion was “High quality dynamic CTA suggests no residual dural fistula”. I understand that “dynamic CTA” offers higher resolution and much more information than other forms of CT.

CONSIDERATION

24. CASA has argued that the tribunal’s jurisdiction extends to the suspension decision but not to the direction to Mr McKenzie to submit to a medical examination. That is indeed so: section 31 of the CA Act and regulation 201.004 of the regulations make it clear that the suspension decision is reviewable and the direction is not. Mr McKenzie has pointed out that an element of the decision to require a medical examination is legally somewhat dubious: the statement that CASA will be unable to take a decision until 12 months have elapsed would appear to have the effect that CASA has attempted to bind decision-makers in the future regardless of what evidence might be before them. Further, that appears to be at odds with the wording of subregulations 67.240(4) and (5), which contemplate that a person might bring forward information at any time and by so doing would oblige CASA to assess whether in those circumstances the suspension of a medical certificate should be lifted or maintained. As the direction is not reviewable, however, that is a matter for CASA.

[My comment: The “legally somewhat dubious” issue noted by the Tribunal is what CASA continues to try to paper over. It is, indeed, a “matter for CASA” which CASA has chosen deal with in a way that I consider to be utterly unconscionable. I have written to CASA, again, about this issue.]

25. Applications for a stay take on a different character depending on the legislative context of the decision under review, and even under a single piece of legislation, in the different contexts of each matter. But in the aviation safety context it is well established1 that an application for a stay comes to be considered in the light of three general considerations:
a) the applicant’s prospects of success in the substantive review;
b) any hardship that may result to those affected by the decision in the absence of a stay; and
c) the public interest in air safety.
[Footnote omitted.]

26. The above matters contribute to determining whether or not a stay is “desirable”, as specified in subsection 41(2) of the AAT Act; that subsection also requires that the stay decision is one that the tribunal considers appropriate “for the purpose of securing the effectiveness of the hearing and the determination of the application for review”. Where the denial of a stay would render the review itself nugatory, that would provide a clear basis to consider the grant of a stay.

27. Mr McKenzie argued that the reports and statements from Dr Mews and Dr Lalloo provide the basis for a decision that he is medically fit to fly under his existing class 2 medical certificate. He is therefore likely to be successful in the review process, the suspension is highly likely to be lifted, and there is no reason not to grant a stay. He noted that the condition for which he had been treated was of unknown origin, and he might have been carrying it for some time – perhaps years; thus the procedure to treat it had reduced his risk, not increased it. He accepted that denial of a stay would not cause him significant hardship, as flying is not a major source of income for him; and similarly he accepted that denial would not render the substantive hearing nugatory.

28. CASA argued that Mr McKenzie is yet to demonstrate his medical fitness to resume flying; that Dr Mews’s clearance in his letter of 19 October 2018 is qualified; that a number of the issues raised in the CCM report and in the reviewable decision are yet to be addressed; and that Mr McKenzie has not been in contact with his DAME, which would be the usual pathway to medical clearance. The evidence does not provide any assurance that the current level of risk is within the tolerances required by the class 2 standard. There is no indication that a stay would have any consequences in terms of hardship or the effectiveness of the hearing. Finally, there are significant considerations relating to public safety, including those arising under international agreements by which Australia is bound, such as the Chicago Convention.

Prospects of success

29. It is accepted that an interlocutory hearing is not the time to assess the merits of an applicant’s case in any substantive way, making findings of fact; rather the tribunal’s task in considering a stay application is to make a general assessment of the prospects of the applicant, at their highest. Making such an assessment in this matter was attended with some difficulty because of the late provision of the CT report from Dr Lalloo. This was a somewhat technical document, and I took some evidence from Dr Sharma in order to understand it better (and to understand some other technical elements in the evidence).

[My comment: If the advice given to me about where the fistula was located is correct, Dr Sharma confused rather than assisted in an understanding of that issue.]

30. It certainly seems clear that the procedure undertaken by Drs Mews and Lalloo has been very successful. Their reports make that plain. It remains the case, however, that the reports available at this point do not address all the elements raised by CASA in the CCM report and the reviewable decision; in particular, there is no expert opinion on the possibility of recurrence of the fistula; no comment on Mr McKenzie’s general prognosis beyond Dr Mews’s comment that he is not a risk of incapacity; and no overall assessment of the quantitative level of risk associated with Mr McKenzie’s post-operative condition. No DAME has been involved to this point, and although Mr McKenzie is no doubt right when he says that a decision by a DAME will be essentially guided by the expert opinion of the relevant specialists, it is nevertheless the case that a DAME will be the person who takes an overall perspective and ensures that all relevant considerations have been taken into account. There is no indication, for example, that Dr Mews gave consideration to all the relevant aspects of regulation 67.155 when he provided the assurance that there was no risk of incapacity.

31. If Mr McKenzie can gather all the relevant medical evidence – including presumably detailed reports and records from Drs Mews and Lalloo – it seems possible that he could be successful at a hearing. But on the material currently available to me I cannot conclude that that is the most likely outcome. On the material presently available to me it is my view that Mr McKenzie’s prospects are not nearly as good as he asserts.

Hardship and the effectiveness of the hearing

32. I have no reason to conclude that Mr McKenzie would be caused financial hardship by denial of a stay. He did not make any case in that direction; rather he said that he flew for the joy of it. Denial of a stay might cause him emotional hardship, but nothing beyond that. And he conceded that refusal of a stay would not render a hearing nugatory.

[I am disappointed that so little weight is attributed to the value of an individual’s recreational activities. However, there is not much I can do about that.]

Public safety

33. Mr McKenzie made various arguments about the comparative risks to himself and others of flying his small aircraft and driving a car. Most of these comments are irrelevant for my purpose, which is limited regarding aviation safety matters to the question of whether Mr McKenzie meets the standard set in regulation 67.155; comparisons with other activities have no bearing on that question. The public safety aspect of the stay decision is clearly caught up in the question of medical fitness and therefore with the prospects of success of the application for review. But Mr McKenzie is not flying commercially, although he does take passengers with him and there are the risks to public safety of others on the ground should an accident occur. These risks are not to be lightly dismissed. Managing them is part of CASA’s core role: see section 3A of the CA Act; McPherson v Civil Aviation Authority (1991) 22 ALD 754; Griffiths, Grif-Air Helicopters Pty Ltd and Civil Aviation Authority [1993] AATA 274.

[Ironically, these public safety risks are never quantified by CASA. As with much of the aviation regulatory system, it’s sadly left to intuition tainted by cognitive bias. I stress I’m not criticising the Tribunal on this point. It’s just a natural human tendency. But that’s precisely my point. ]

34. Mr McKenzie is not the only party to have raised irrelevant arguments in this matter. CASA has pointed out that Dr Mews has said that Mr McKenzie would not meet the standard for a class 1 licence. That is so, but it is not relevant to whether he meets a class 2 standard. It is to be expected that there will be a subset of class 2 licence holders who would not meet the class 1 standard. Mr Carter also dwelt on the 40% annual risk identified by Dr Mews before the procedure was undertaken. That was indeed very high, but it is the risk following completion of the procedure that is determinative in this matter. If the condition recurs, the risk would presumably depend on the particular form and severity it takes.

[And there is no acknowledgement that the original diagnosis might not be an objective truth. It is, after all, just an opinion.]

35. The international agreements governing air safety were given some emphasis by Mr Carter; but the usual course is that such agreements are given effect by incorporation of relevant provisions into municipal law. I have arrived at my decision by following the legislation, the authorities and the facts of the matter. I have not taken separate account of international agreements.

Other considerations

36. Mr McKenzie’s current medical certificate expires on 30 January 2019. The period in which a stay could operate is therefore short, and that limits its utility, which militates against the grant of a stay. At that time Mr McKenzie would need to apply for a new certificate, and the matter would come before CASA for decision once more. Any decision adverse to Mr McKenzie would be open to appeal to this tribunal.

37. The parties have raised the possibility that a stay might be granted with conditions, for example, that Mr McKenzie’s flying might be limited to daylight hours or that he might only fly passengers who have given consent after being informed of his medical history. There was discussion of these matters at the hearing. An outcome along those lines would clearly be second best for Mr McKenzie, but would allow him to keep flying. CASA appeared to put forward such an option only where for other reasons I might be inclined to grant a stay. As I am not so inclined, I have not considered the advantages and disadvantages of those options at any level of detail.

CONCLUSION

38. I regard Mr McKenzie’s prospects of success as uncertain, the refusal of a stay would not cause him hardship or prevent an effective hearing, there are real questions of public safety, and the utility of a stay is limited. Taking all the above matters into consideration, I refuse the application to stay the decision under review.

[Clinton McKenzie]

This is the text of a letter I sent by email to CASA on 14 November to try again to pin CASA down on the “legally somewhat dubious” issue noted by the Tribunal in its reasons for denying my application for a stay:

CT SCAN RESULTS

You might recall that in my email letter to you of 31 October 2018 I requested that you seek instructions and let me know Avmed’s position on the following question:

Is Avmed’s present position that the results of a CT scan performed now could potentially convince Avmed of my compliance with the class 2 medical standard, at least to conduct day VFR operations?

You might also recall that I underwent a high quality dynamic CT scan on 6 November 2018, and provided to your client and the Tribunal a copy of Dr [x’s] report on the scan as an attachment to my statutory declaration dated 8 November 2018.

By email 7 November 2018 you said, among other things:

[A] simple CT scan I am informed may be unable to provide sufficient detail for future assessment purposes.

Your response raises two issues in the context of the scan I underwent on 6 November 2018 and CASA’s position on the results:

(1) Whether the scan I underwent does provide sufficient detail for assessment purposes, given that, based on advice I have been given, the scan was not “a simple CT scan”.

(2) When will Avmed do assessments of and make a decisions on material put before it.

On the first issue, you might recall that during the hearing on 9 November 2018 I provided to the Tribunal and your client a copy of the first page of a review article setting out what dynamic CT scans do in comparison with other forms of angiography. I hope that Avmed has conferred or will confer with experts to ascertain whether the results of the kind of scan I underwent are sufficient for assessment purposes. For your convenience, I attach a copy of the first page of the review article as well as a copy of Dr [x’s] report of the high quality dynamic CT scan carried out on 6 November 2018.

I therefore request that you seek instructions and let me know whether Avmed considers the results of that kind of scan are sufficient for assessment purposes at all, even if not, in Avmed’s opinion, determinative at this point in time.

On the second issue, there continues to be imprecision about what is, in my view, a simple and reasonable request. I reiterate that request from my letter dated 30 October 2018:

I request that the delegate confirm, in writing, whether or not s/he will consider and review the substance of medical evidence submitted to CASA, and make actual risk assessments from time-to-time based on that evidence, during the specified 12 month period [following the date of the emoblisation procedure].

The continued imprecision around this issue strongly suggests to me that the delegate meant what was said, in bold, in the decision letter:

Please be advised, CASA is unable to make a risk assessment of your fitness to return to flying until 12 months has elapsed following your embolisation procedure.

If the truth is that Avmed meant and continues to mean what is said in the decision letter, and simply refuses to do an assessment or contemplate changing its opinion until 12 months have elapsed following the procedure, could you please just confirm that. I realise that the truth may be inconvenient for CASA, but that is a problem of CASA’s own making.

It would in my view be utterly unconscionable for CASA to maintain the pretence that material I submit will be considered objectively by and potentially alter Avmed’s opinion of my fitness before 12 months have elapsed following the embolisation procedure, if as a matter of fact Avmed meant and continues to mean what it said in the decision letter.

Regards

[The Wawa Zone]

Is their '12 months' based on some precedent or standard, however derived, or is it an arbitrary number that could be subject to some further judicial review of administrative action ?

[Sunfish]

it will be based on the assumption that if nothing has happened in 12 months then nothing is going to happen in future.

[QFF]

Yes, but why 12 months? Why not 6 or 13 or even 2 months?

[mullokintyre]

Yes, but why 12 months? Why not 6 or 13 or even 2 months?

Because the F@#$WIT who made this decision retires in 12 months, so its longer his/her/its problem.
Mick

[Clinton McKenzie]

Some good questions there. In the outback at the moment with only intermittent interweb. Will respond more fully in the next couple of days.

[Sunfish]

look at it from the Avmed staff point of view; there is no “‘upside” for them in letting you fly. There is plenty of downside. They will automatically be blamed for letting you fly if you have an accident.

Their only defence is relying on the AAT and multiple specialists reports to diffuse the responsibility of letting you fly; such that they cannot be blamed.

They are on contracts so the easiest and safest thing for them is to say “no” to you.

This cannot change until the political pain of letting us fly freely is less than the political pain from preventing us from flying. We need (as I keep saying like a broken record) to create a lobbying body that is capable of inflicting great political pain on selected political targets. AOPA USA has such an attack dog. We need one too.

Unfortunately our potential attack dog was slipped a bait by the government and is no more.

[swh]

Sounds like they are treating you as if you had Acoustic Neuroma. The UK CAA has some good guidelines which many AVMED doctors follow.

eg ENT

https://www.caa.co.uk/Aeromedical-Examiners/Medical-standards/Pilots-(EASA)/Conditions/Otorhinolaryngology/Otorhinolaryngology-guidance-material-GM/

[Horatio Leafblower]

Sunfish
Unfortunately our potential attack dog was slipped a bait by the government and is no more.

Care to expand on that?

[Sunfish]

HL, expanded voluminously previously. AOPA USA has an affiliated PAC that keeps the FAA honest. We don’t.

[Aussie Bob]

I am so sorry to read all this Clinton. For a private pilot there should be only two considerations when issuing a medical:
Is the pilot likely to die or become incapacitated at the controls?
Is the pilot a suicide risk?
It would seem in this age of stifling bureaucratic intervention that simplicity is never a consideration. Folk, in particular Australians are more at home offering restriction,writing legislation and being afraid of litigation. The phrase “arse covering” is on everyone’s lips, even in this very thread but the statement in truth is corrected simply by wearing trousers.

The solution of course is civil disobedience on a grand scale but bureaucracy has covered its own arse here by keeping the majority of Australians a pay check or two away from bankruptcy and keeping the disinterest in and disenfranchisement with politics alive. It is no longer possible to even keep the bastards remotely honest. Getting a politician to take an interest in a personal case like Clinton’s was once possible, now it is a thing of the past.

On my travels around this country I occasionally come across folk without medical and/or current flight reviews and even operating aircraft without current maintenance releases. I don’t really need to ponder why this is happening.

[Sunfish]

the root of the problem is that public servants are now employed on renewable short term contracts. there is no more “full and frank advice” to be had, all you get is arse covering.

[Horatio Leafblower]

HL, expanded voluminously previously. AOPA USA has an affiliated PAC that keeps the FAA honest. We don’t.


OK I wanted to understand who you thought was the watchdog and who had been slipped the bait. I even had to do my own research and spend 10 seconds Googling what a PAC is. Now I am slightly better informed:
AOPA Political Action Committee (https://www.aopa.org/advocacy/take-action/political-action-committee)

AOPA PAC is an integral part of AOPA's efforts to promote the legislative and political interests of all aircraft owners and pilots. AOPA PAC is an independent fund of voluntary, personal contributions. The fund is strictly regulated by the Federal Election Commission and is used by political candidates to defray campaign costs. AOPA PAC is a completely non-partisan entity. Its primary goal is to elect a pro-general aviation majority in Congress.Under federal law, AOPA is prohibited from giving dues money to candidates for federal office. Therefore, AOPA PAC has been created to identify and contribute money to qualified candidates who weigh the interests of general aviation when considering legislation. In addition to our proven friends in Congress, AOPA PAC works to cultivate new members and candidates who are supportive of the industry.Seems like a good thing to me.

[Sunfish]

That is exactly what we need,, and there is a aFederal election next year.

[Horatio Leafblower]

That is exactly what we need,, and there is a a Federal election next year.

Sunfish has exceeded their stored private messages quota and cannot accept further messages until they clear some space.

[Sunfish]

fixed............

[Clinton McKenzie]

Is their '12 months' based on some precedent or standard, however derived, or is it an arbitrary number that could be subject to some further judicial review of administrative action ?The refusal, outright, to do any assessment during the 12 month period is, in my view, a manifestation of a couple of errors of law in the delegate’s decision that are easily demonstrated. However, for reasons I’ll explain, there’s little practical point in applying to the Federal Court for orders to the effect that the delegate should comply with the law.

Unsurprisingly - except perhaps for Avmed - delegates are supposed to exercise their powers on the basis of the specific circumstances relevant to the particular case in question. The potential risks of a medical condition posed to and by a day VFR pilot are not the same as the the potential risks of the same medical condition posed to and by an IFR-rated aerobatic-rated pilot who does single pilot IFR as a day job. (Note: the phrase “to and by” the pilot is important.). Further, delegates are not supposed to be dictated to by policy or administrative rule.

Accordingly, one of the numerous circumstances that the ADJR Act says is an improper exercise of power is:[A]n exercise of a discretionary power in accordance with a rule or policy without regard to the merits of the particular case.It’s obvious to me that Avmed has a policy simply to refuse to assess and make any decision on any evidence during the 12 months following the procedure I underwent. (Avmed has ‘form’ on making decisions under the dictation of policy. At one level this is not surprising, because Avmed does not have specialist expertise in the subject matter. )

The refusal is also, in my view, contrary to CASR 67.240(4), which says: (4) If:

(a) CASA suspends a medical certificate; and

(b) the holder of the certificate submits to an examination or test directed by CASA, or authorises the disclosure of information to CASA; and

(c) the examination, test or information shows that:

(i) the holder meets the relevant medical standard; and

(ii) the continued holding of the certificate by the holder will not adversely affect the safety of air navigation;

CASA must:

(d) end the suspension; and

(e) tell the holder in writing that the suspension has ended.If the delegate’s letter is taken at face value, the outcome is that the delegate is simply going to refuse to change his mind during the 12 month period. I can only continue to assume the delegate meant what he said, because he steadfastly refuses to provide written confirmation that he will make assessments of evidence I submit and potentially form a different view during the 12 month period.

Why wouldn’t I go to the Federal Court and get this stuff tested, when my ‘day job’ is administrative law litigation and I’m am able to afford it? Because there is no practical point. If I’m correct, all that will happen is that CASA will be directed to assess during the 12 month period. I already know what CASA’s assessment will be - there is little-to-no chance that Avmed could approach the assessment in an objective, unbiased way.

Where does the 1 year come from? I’m guessing it’s from the graph in the Ambekar study that’s selectively quoted in the selected ‘Relevant Medical Literature’ annexed to the delegate’s statement to the AAT.

Let’s assume the material gathered by the delegate is a complete compendium of relevant studies. (A patently invalid assumption.). Let us also assume that no findings of any study have ever been subsequently proved wrong or inaccurate. (Another patently invalid assumption. My favourite study is “Why Most Published Research Findings Are False” by John P. A. Ioannidis.)

Even given those assumptions, Avmed mixes up the different probabilities described in the Ambekar study. There are the probabilities of when a recurrence of a previously treated fistula will occur - usually during the year following the treatment. But those are not the probabilities of it occurring.

As I’ve said earlier, if Avmed walked the talk, it would be assessing the probabilities of recurrence. It would also be assessing the probabilities of the recurrence causing sudden incapacitation. If Avmed understood how the relevant probabilities work, it would know that the first times the second equals a very remote probability.

In my case, I’ve already had a high quality dynamic CT scan over 2 months post the treatment, which is already past the 80% point on the Ambekar graph, confirming the ongoing effectiveness of the treatment. But given Avmed’s current position, Avmed would view the images from that scan like a dog watching television.

[Clinton McKenzie]

Over a decade ago the AVMED section had a chief who had the reputation of being willing to pull Class One's for anything imaginable, apparently he just had the need.That might have been erstwhile PMO Pooshan Navathe. Many careers and life’s passions were destroyed under his watch. It was he who returned Australia to the dark ages on the CVD issue. All in the name of ‘safety’ of course.

My favourite comment on Navathe was made by Deputy President Hack SC (in this AAT decision Bolton and Civil Aviation Safety Authority [2013] AATA 941 (23 December 2013) (http://www.austlii.edu.au/cgi-bin/sinodisp/au/cases/cth/AATA/2013/941.html?stem=0&synonyms=0&query=Civil%20Aviation%20Safety%20Authority)):Dr Navathe’s witness statement concluded [in terms quoted by the AAT].Despite the fact that the statement does contain the declaration of duty required by the Guidelines it could not be plainer that Dr Navathe is an advocate for his own decision. I do not propose to have any regard to his opinions. For the future I would trust that CASA’s Legal Branch would exercise independent judgement in deciding what witnesses ought be relied upon and the content of their statements. They ought, obviously enough, be confined to matters that are relevant and witnesses ought be those who can truly provide an independent opinion.The delegate who decided to suspend my medical certificate is Dr Sharma.

Dr Sharma provided a statement to the AAT prior to the stay hearing.

That statement contained the declaration of duty required by the Guidelines.

Unsurprisingly, Dr Sharma’s statement is to the effect that his own decision was a good one.

[Clinton McKenzie]

CASA’s response to my request that the delegate confirm, in writing, whether or not he will consider and review the substance of medical evidence submitted to CASA, and make actual risk assessments from time-to-time based on that evidence, during the specified 12 month period following the date of the emoblisation procedure:

Dear Clinton,

Further to your letter of 14 November 2018 and as previously advised , you may at any time submit further material and/or reports in support of the lifting of your suspension of your Class 2 medical certificate and CASA will give timely consideration to such material as and when received. The type of material which would be of greatest assistance is as set out in the direction letter - namely opinions from Dr Lalloo and Dr Mews dealing with the specific listed issues relevant to determining ongoing certification.A reminder of what the delegate said in the decision letter:Please be advised, CASA is unable to make a risk assessment of your fitness to return to flying until 12 months has elapsed following your embolisation procedure.I think “give timely consideration” is CASA-speak for “presumptively ignore”.

[Fantome]

Why do some get their medical clearance quickly and others take months, with no explanation except a big backlog to get through? I completed Class Two renewal in May but did not get the certificate issued till 20 October. (Despite numerous phone calls.)

[Clinton McKenzie]

Based on the - quite disturbing - conversations I’ve had recently, I’m guessing you or your DAME upset Avmed’s computer program. Once you upset Avmed’s computer program, Avmed humans get involved. Once Avmed humans get involved, they feel compelled to add ‘safety’.

[Squawk7700]

At my last medical renewal I upset the avmed computer by ticking a “yes” checkbox for a very benign procedure that was signed off by Australia’s foremost orthopaedic surgeon to the stars and it took them months to renew it. I felt compelled to tell them because it felt like the right thing to do at the time, as my dame would no doubt see the scars at my next renewal.

Every time I rang them on a Friday which is what they asked me to do, they would tell me that the avmed doctors were only part time working from home and they hadn’t got to mine yet and to call again next Friday.

[On eyre]

Should’ve ignored their advice and rung on Monday, Tuesday,Wednesday and Thursday continuously ��

[The Wawa Zone]

Clinton, if you as a former CASA OLC goon and current administrative law lawyer can't get this sorted then the ordinary sick people are screwed.
That might have been erstwhile PMO Pooshan Navathe. Many careers and life’s passions were destroyed under his watch. It was he who returned Australia to the dark ages on the CVD issue. All in the name of ‘safety’ of course. No, but one who sounds much the same. 2004-ish. I had to talk to him once about blood-in-the-urine at a Class 1 med renewal and I made a point of putting everything in the context of questions that only a Doctor of his brilliance could answer, and he didn't start thinking about ways to get me to spend another $2k on tests.

[Clinton McKenzie]

I think you’ll find that Avmed now presumptively ignores the opinions of even the specialists who treat “former CASA OLC goons”. (That is unless the opinions are against the interests of the goon, in which case they’re considered by CASA to be an objective truth. CASA is at least consistent in what I consider to be a biased approach.)

Meanwhile, I underwent intravenous digital subtraction angiography on Friday. The results stated in the report: “entirely normal”.

So the timeline and specialists’ opinions are:

- treatment in August, expressed to be a success

- I’m OK to fly day VFR, stated in a letter in October

- results of dynamic CTA scan on 6 November don’t indicate anything wrong

- results of intravenous digital subtraction angiography on 30 November are “entirely normal”.

In case anyone overlooked a key point in my previous posts: My surgeon is a pilot.

Against these opinions is CASA’s non-specialist opinion based on selected (acknowledged as such by CASA) and in my view misconstrued studies.

I held a medical certificate and continued flying while I was unaware of the existence and potential consequences of a condition. The condition was then identified and treated, and the specialists who carried out the procedure say the treatment was successful, everything is “entirely normal” and I’m fit to fly day VFR. Only in the weird and whacky world of Avmed could it make sense that I should not now have a medical certificate enabling me to fly day VFR. Sure: Avmed will be able to come up with studies to show that there’s ‘some’ risk of sudden incapacitation. But I can come up with studies that show everyone’s ‘some’ risk of sudden incapacitation, just as everyone’s at ‘some’ risk of being struck by a meteorite.

And apparently it’s OK for me to drive a petrol tanker past airports and schools, in all weather conditions day and night.

I did laugh like a drain as I watched CASA on 19 November try to justify a regulatory regime in which self-certified pilots are allowed to mix it with RPT jets in G airspace but, by implication, I’m too dangerous to do so as well. I recall helping one of those pilots at a fuel bowser at a place that will remain nameless - Even with glasses he couldn’t read the instructions and keypad on the bowser.

Fortunately one of the most significantly causal contributors to aviation safety in Australia is the low density of traffic.

My primary concern in all of this is that Avmed is now, in my view, a force inimical to aviation safety.

It wasn’t so bad when all they were doing was destroying careers and life’s passions - that’s just money and personal satisfaction. At least that outcome does not have a negative impact on safety, in the sense that there would be no negative impact on safety if all Caucasian males were prohibited from flying. And it wasn’t so bad when there was a substantial increase in the number of medical conditions undisclosed to DAMEs and CASA, but dealt with ‘underground’. At least the conditions were dealt with.

However, it’s now got to the point at which some pilots are simply too scared to tell any doctor anything ‘when in doubt’, for fear of what would happen if Avmed became aware of a potential medical issue. Think of the dilemma faced by a pilot who’s considering talking to a doctor about a potential mental health issue, when the potential outcome is being ‘grounded’ or directed to undergo intrusive and expensive examinations while being presumed a potential GermanWings criminal.

There is now a material possibility that someone ‘up front’ of an aircraft is too scared to talk to a doctor about a potential medical issue, for fear of Avmed. That is not good for aviation safety.

CASA waves this away on the basis of the frequency of DAME examinations and the multi-crew environment. As always, any potential downsides of CASA Avmed’s behaviour are ‘spun’ as being justified, and inconvenient truths like single pilot IFR downplayed.

Avmed chooses - note it’s a choice - to give greater weight to any evidence of potential medical unfitness compared with any evidence to the contrary. That’s not, in my view, treating the safety of air navigation as the most important consideration. That is, in my view, bias. That’s not, in my view, objective evidence-based and objective risk-based decision-making. That is, in my view, intellectually dishonest.

[Sunfish]

As I said before, employment conditions for most public servants are such that there is zero incentive to give you the benefit of the doubt and a massive positive incentive to minimise their personal career risk be minimising your chances of flying and possibly having an accident that might be sheeted home to a medical condition. this has to change.

[Clinton McKenzie]

A conference occurred in the AAT on Monday 3 December. There is to be a conciliation conference on 1 April 2019. The date may be propitious …

About the only substantive material of interest to readers is that I obtained access to the letter sent by the CASA decision-maker seeking supposedly independent specialist advice. The content of the letter confirms for me that CASA has either forgotten or has decided simply to ignore what the AAT said in the Bolton matter. My guess is that Avmed simply chooses to ignore what the AAT said. Not for Avmed the mere bagatelle of doing things in an objective, disinterested way.

Before setting out extracts of the letter from Avmed supposedly seeking independent specialist advice, it’s worth reviewing what the AAT said in the Bolton matter, and why. The decision (here:https://www.austlii.edu.au/cgi-bin/viewdoc/au/cases/cth/AATA/2013/941.html ) says, at paragraph 24:Despite the fact that the statement [of erstwhile PMO Dr Navathe] does contain the declaration of duty required by the Guidelines [for Persons Giving Expert and Opinion Evidence] it could not be plainer that Dr Navathe is an advocate for his own decision. I do not propose to have any regard to his opinions. For the future I would trust that CASA’s Legal Branch would exercise independent judgement in deciding what witnesses ought be relied upon and the content of their statements. They ought, obviously enough, be confined to matters that are relevant and witnesses ought be those who can truly provide an independent opinion.It didn’t end there. The AAT went on to say, at 25: It is not known what documentary material was provided to [the specialist] nor is it known what was conveyed to him by Dr Navathe in the conversation on 1 November 2013. Moreover, it is highly irregular that one expert witness, who is as well the primary decision-maker, was apparently briefing another expert witness in terms not disclosed. The danger of such a practice ought to have been evident. The vice is merely compounded by the failure to make clear what information was conveyed.I find it breathtaking that the fundamental concepts underlying the AAT’s reprimands were either not obvious to Avmed and its legal advisors or simply disregarded by them in conducting the Bolton matter. At this point I tend and want to believe it was just the arrogance of Avmed in the face of legal advice to the contrary.

The underlying reason for those reprimands from Deputy President Hack SC of the AAT is that people who provide expert evidence are supposed to be independent of and disinterested in the subject matter of the decision under review. Experts are supposed to be provided with objective facts on the basis of which the experts express an objective and unbiased opinion. Dr Navathe was evidently an advocate for his own decision. Thus he was evidently not independent and the AAT therefore did not have any regard for his opinions. Further, Dr Navathe took it upon himself to engage in the “highly irregular” practice of briefing the expert in terms undisclosed.

So fast forward to my matter. As I’ve previously posted, the decision maker in my matter is Dr Sharma. Dr Sharma provided a statement to the AAT in advance of the stay hearing. That statement includes the declaration of duty required by the Guidelines. And see if you can guess if Dr Sharma’s statement was advocating for or against his own decision.

Dr Sharma wrote to a specialist on 31 October 2018, seeking a medical opinion. I have extracted key parts of the letter below (and continue to be prepared to make entire copies available to anyone on request if someone wants to post them in this thread). I will leave others to assess whether this constitutes a disinterested request for an independent expert’s opinion based on the provision of facts to the expert:OPINION SOUGHT

CASA holds ongoing certification concerns in view of the endovascular intervention for Mr McKenzie’s medical condition, the specified risks and probabilities outlined by Dr Mews and in the absence of evidence of stability of the ONYX procedure. [My notes: I again note Dr Mews’ opinions of the risks and probabilities are implicitly taken as evidence, but his opinion (and that of Dr Lalloo) as to the success of the procedure is implicitly dismissed as no evidence. Further, there is no causal connection with CASA’s concerns and my compliance or otherwise with the class 2 medical standard. CASA’s concerns are irrelevant to – or at least should be irrelevant to – the expert.]

Considering that Mr McKenzie is now only some 2 months post procedure it is also of concern as to the potential procedure-related risks viz. permanent neurologic morbidity or failure of the procedure requiring re-treatment, and the likely risks due to the medical condition itself (haemorrhage, venous congestion/intracranial hypertension, ischaemic neurological deficit or seizure). [My notes: Again, there is no causal connection with CASA’s concerns and my compliance or otherwise with the class 2 medical standard. CASA’s concerns are irrelevant. The word “only” is value-laden, as is the phrase “likely risks”. These are matters about which the expert is supposed to form an independent view.]

Mr McKenzie’s present proceedings before the Tribunal seek to review the suspension decision and potentially the need to provide further evidence as to his medical condition. [My notes: The assertion that I have a “medical condition” is merely that. It’s supposed to be up to the expert to express an independent view as to whether diagnosis X on Y date followed by procedure A on B date results in any ongoing issue months later.] He contends that the suspension is unreasonable since he has been medically fit during the 32 years of flying before the diagnosis of a pre-existing medical condition and that the recent “successful” medical procedure has reduced whatever risks arose from the DVAF. [My notes: My contentions are irrelevant to the specialist, or at least they should be. In any event, it was Drs Mews and Lalloo who expressed the opinion that the procedure was “successful”, that I am not a risk of incapacitation and that I meet the class 2 standard for day VFR.]

CASA considers such a submission to be untenable in that the issue is whether or not Mr McKenzie presently meets the Class 2 medical standard in all respects. [My notes: At least CASA got one thing right: there is only one issue. But the point is that all the other fluff is unnecessary and irrelevant to the specialist, or at least it should be.] Provided at Annex 2 are [sic] a list of identified studies of potential relevance to the matters under consideration. [My notes: More on the list later, but here you see one of the clearest manifestations of Avmed’s complete arrogance or complete misunderstanding of how independent experts are supposed to be briefed. They are not supposed to be spoon fed the decision-maker’s inexpert and selectively chosen and quoted studies that just happen to support the decision-maker’s own decision. I am completely astonished that CASA continues to do this, in the wake of the Bolton decision.]

CASA seeks your opinion (including supporting references) with respect to the following: … [There follows a list of mostly leading questions. My favourite is this one: “Do you agree with Dr Mews[sic] initial assessment of a 40% annualised malignant behaviour risk prior to treatment.” That’s not, in fact, what Dr Mews said. It’s Avmed spin.]The ‘list’ is headed “Evidence elsewhere”.

The most breathtakingly inappropriate aspect of the list is not that it’s there at all (an independent expert is supposed already to have access to reference material relevant to their expertise, based on their own judgment, otherwise they aren’t experts); it’s not so much that the list is selective; and it’s not even so much that it is mostly selective in favour of material in support of the decision-maker’s decision, when the decision-maker is briefing the ‘independent’ expert. I get it now that Avmed just blithely operates in a way that is in my view biased and intellectually-dishonest.

The most breathtakingly inappropriate aspect of the selective and selectively quoted material is that there is emphasis added by Avmed! That is, Avmed has gone through and underlined and italicised text that is not underlined or italicised in the original source documents. Presumably this is so the “independent” expert can “independently” come to the view that the underlined and italicised text in the material selectively chosen and quoted by the non-expert decision-maker who happens to be briefing the “independent” expert is – surprise, surprise – specifically relevant to and – surprise, surprise – supportive of the decision-maker’s decision.

My favourite selectively quoted text with underlining and italics in Dr Sharma’s letter to the expert that is not underlined or italicised in the original text of the source document is this:Even lesions apparently cured with embolic agents have been shown to recanalize, including potentially catastrophic bleeding. Hence, even apparently obliterated lesions with transarterial embolization should be followed with late confirmatory angiogram, after a few months, to confirm effective cure.You got that, “independent” expert? The non-independent non-specialist decision-maker wants you to independently form the view that the text selectively quoted and emphasised is specifically relevant to your “independent” opinion.

Why is that my favourite? I have now undergone a “late confirmatory angiogram, after a few months, to confirm effective cure”. The intravenous digital subtraction angiogram I underwent on 30 November confirmed effective cure of the DAVF by the procedure I underwent on 23 August. By my maths, that’s a few months. I’m advised that intravenous digital subtraction angiogram is the ‘gold standard’ scan to confirm ongoing success in cases like mine. However, I have no confidence that Avmed will consider the results of that scan (or the results of the dynamic CTA scan from 6 November) in an objective way, even assuming Avmed had expertise to do so.

[Cloudee]

Thanks Clinton, your ability to interpret this stuff so a layman like me can see what’s happening I’d amazing. Putting this out in public is gold for all of us that have to deal with these clowns.

[Horatio Leafblower]

I will leave others to assess whether this constitutes a disinterested request for an independent expert’s opinion

....he said, and then pointed out in each paragraph why this doesn't constitute a disinterested request for an independent expert's opinion! :D

Seriously though - thank you for sharing this CM it's important that as much light is shone upon CASA's conduct as possible.

[Nowluke]

Leaving aside the details of your concerns with the application of administrative process and the roles of a regulator/accrediting body. I have no skin in the game or knowledge on that front, I have no CASA connection and empathise with your frustrations. It looks like you've not had a pleasant experience.

Nevertheless, you had a flight safety relevant condition which was treated using novel (i.e. new techniques) for which a significant body of long term evidence has not been generated. Your specialist opinions did not address the specific questions required in order to make a sound risk based decision. You then further complicated the process by acting as your own medical advocate with the avmed unit. Where was your DAME or GP in this process? Further complicating this you sought out 'tests' to provide secondary proof against a negative, which can't really logically ever be done i.e. "prove it won't happen"

There's an element of fixation around 12 months being 'required' to make a decision. Without diving into a large amount of academic papers, generally, any instrumentation of your brain, its vascular sctructures and the cavity it sits in has a significant risk of generating a (new) source of future seizures (i.e. risk) and causing damage/infection/bleeding. This risk is generally realised within the first 12 months if it is to occur and the corollary is that if its occurrence rate is less than once/year then it should generally be acceptable under most aviation contexts (or have mitigations applied to make it so).

There is no evidence that can be provided in the intervening time period as there is no clinical/investigatory test able to stratify the cohort- there is generally only evidence/results of higher risk i.e. a bleed/neurological symptoms/infection etc. or immediate short term 'treatment' success. That you have normal post intervention tests is reassuring you are not at a higher risk than baseline however the condition has risks of recurrence/treatment failure/complication that no test other than the passage of time exists to prove non-occurrence. A 12 month period is somewhat arbitrary but it is the objective statistical risk standard/threshold for decision making and there is some evidence for that period roughly correlating with a period of recovery healing/rehab and then physiological stabilisation (more towards the 6-12month time period). Much argument can be had over the 1% rule and its origins/assumptions but it is what is used and sets part of the standard.

The phrasing/process in the corro out of CASA, from your position, would not be compliant with admin process law or some similar position. It doesn't strike me as particularly troublesome in providing an independent opinion. Very specific hypothesis/questions/risk scenarios/assumptions need to be addressed with rigour. Provision of a supporting or dissenting opinion (with academic clinical research/analysis to support) against these is critical in coming to a reasonable decision against a risk framework (Meta-analysis, single quality study, other cohort research and then expert opinion form the hierarchy with most weighting to the former). The absence of an opinion (against not just "fit to fly today" but time based risk and long term consequences with quality research to back it up), as would appear to have occurred with your earlier reports has led to the ambiguity/lack of probabilistic statements against the risks. I would be very surprised if any reasonable person would then afford you the 'benefit of the doubt' rather than take the conservative position.

I'd likely consider you recommendable to be fit to fly Class 2 with restrictions after 12 months from your narrative but can't offer an opinion on an incomplete picture. The other question I would ask is that why not fly under an RPL or Basic Class 2 - if you VFR day fly only for your own pleasure? The emotional effort and time to 'fight' for a principle or against perceived slights is not going to be healthy for you in the long term.

[Cloudee]

Do you really think CASA would allow someone they have medically grounded to fly the same aircraft in the same airspace with a basic class two medical? If they would allow this, surely Clinton would have been offered this alternative medical standard.

[Clinton McKenzie]

I’ll be providing a detailed response to Nowluke’s (curiously first) post, tomorrow.

[Nowluke]

Feel free, first post as I haven’t had much to contribute. As you can check though, I have been a member for a while. I’m offering a perspective from a different part of the aviation community; take whatever value you wish, discard it if you want. As I said, it’s a shame you’re not flying, it’s doubly so that communication issues have compounded your distress.

[VH-MLE]

Was that Dr Luke Sharma posting? I smell an _________ here...

[Clinton McKenzie]

Nevertheless, you had a flight safety relevant condition which was treated using novel (i.e. new techniques) for which a significant body of long term evidence has not been generated.Thanks for your opinion. I am not aware of what expertise and experience you have.

That said, I agree, based on the advice of specialists whose opinions I respect, that I did have a safety relevant condition. But note: I left out “flight”, because part of the problem with the Avmed paradigm is its self-interested insistence that aviation is ‘special’ with unique risks.

In fact, apart from the activities engaged in by fighter pilots and aerobatic pilots, there’s very little in aviation that entails some special demands on pilots, resulting in an objective justification for a special medical standard (even though pilots, wearing their own-worst-enemy hats, like to think otherwise).

Specialists with relevant, current experience disagree with your opinion that the treatment continues to be “novel” as you have defined it.

It’s an acceptable risk for me to continue to drive a car that weighs more than my aircraft and carries more people than my aircraft, on the road shared by buses full of school children a mere couple of metres away, day and night in all weather, when I’m apparently an ongoing potential neuro-circulatory time bomb. Were I to instead get into a vehicle of less weight with fewer passengers, usually kilometres from the nearest other people, apparently the risk of sudden incapacitation increases or the consequences become more catastrophic if there happens to be an air gap between the vehicle and the ground. That seems to me to be a nonsensical incongruity. However, I know why it exists - more on this later.

Your specialist opinions did not address the specific questions required in order to make a sound risk based decision. Let me fix that for you: Apparently the specialist opinions do not address the specific questions that, in Avmed’s opinion, are required in order for Avmed to make what is, in Avmed’s opinion, a sound risk based decision by Avmed.

Were it the case that:

1. any of the medical professionals with whom I’m dealing were prepared to speak in glowing terms of Avmed’s expertise and decisions, and

2. I could find any correspondence or statement in this matter that is not replete with what I consider to be biased and intellectually dishonest spin by CASA, and

3. my specialists were unwilling to express any opinion as to my current fitness to fly,

then I might take Avmed’s opinions seriously and allocate weight to them compared with specialists with first hand knowledge of my circumstances.

What I find baffling is that when my specialists express the opinion that the procedure was a success, that I am not a risk of incapacitation and meet the standard for day VFR, it seems Avmed (and you) think those opinions were expressed just for ****s and giggles, or perhaps based on disembowelling a goat and reading the entrails or by consulting an astrologer.

The objective fact is that there is no causal connection between Avmed’s opinions and levels of knowledge or ignorance on the one had and my compliance or otherwise with the medical standard on the other. Or do I have that wrong?

You then further complicated the process by acting as your own medical advocate with the avmed unit. Where was your DAME or GP in this process? Further complicating this you sought out 'tests' to provide secondary proof against a negative, which can't really logically ever be done i.e. "prove it won't happen"Bit hard to know where to start with that...

I haven’t “sought” any tests. I hate doctors (not on a personal basis), I hate hospitals (but love their work), I hate needles and I hate holes being punched in my groin so that tubes and contrast chemicals can be fed through my circulatory system.

I’ve undergone the kinds of scans that my specialists recommended I undertake, at the points in time my specialists recommended that I undertake them, in what they say is the ordinary course of follow-up tests in cases like mine. (And let me make this very clear: If it were otherwise, I would be taking action if my specialists have been ‘ordering’ scans in circumstances in which they would not ordinarily recommend them. However, I’m very confident that my specialists know what they’re doing, in my particular circumstances.)

I have no idea what you mean by “acting as [my] own medical advocate with the avmed unit”. I asked my GP and specialist to forward to Avmed whatever stuff that may be relevant to my case. My first post-procedure correspondence with Avmed was me forwarding to Avmed my GP’s letter to Avmed that I requested my GP to send Avmed, just to make sure Avmed had received it and I couldn’t be accused of withholding information from Avmed. My GP didn’t generate that letter as a consequence of sensing a disturbance in ‘the force’.

I visited my GP after the procedure. I had a follow-up visit with the specialist a few weeks after the procedure. Are you or Avmed worried that my GP and specialist failed to notice that half my face was paralysed, drool was running down my chin and I was in a wheelchair being led by a guide dog?

As to a DAME, what possible ‘value add’ could a DAME’s opinion currently be? Are you seriously suggesting that, having disregarded the specialists’ opinions, Avmed is going to do anything other than disregard the opinions of the non-specialist GP and DAME? (This was one of the fascinating things that CASA brought up at the stay hearing.)

I have repeatedly requested that the delegate confirm, in writing, that the results of scans carried out during the 12 month period post-procedure will be assessed by and potentially change the delegate’s position during the 12 month period. That request has repeatedly been denied. There’s been some sophistry in correspondence from a CASA lawyer, but the lawyer isn’t the delegate and the lawyer’s opinion does not determine the delegate’s position. For CASA to keep raising the issue of GPs and DAMEs in those circumstances is, in my view, simply disingenuous. CASA will ignore their opinions (unless, of course, they are against my interests) and GPs and DAMEs will defer to the opinions of treating specialists in any event.

There's an element of fixation around 12 months being 'required' to make a decision. Without diving into a large amount of academic papers, generally, any instrumentation of your brain, its vascular sctructures and the cavity it sits in has a significant risk of generating a (new) source of future seizures (i.e. risk) and causing damage/infection/bleeding. This risk is generally realised within the first 12 months if it is to occur and the corollary is that if its occurrence rate is less than once/year then it should generally be acceptable under most aviation contexts (or have mitigations applied to make it so).In your opinion.

And what, in your opinion, is the percentage risk of a recurrence of or new vascular abnormality, multiplied by the the percentage risk of that causing sudden incapacitation? Or is this one of the circumstances in which it’s just OK to use words like “significant” or “high”, rather than specific numbers like 1% or 2% that apparently have some magical consequence. The insistence on specificity is selective. That selective insistence is, in my view, biased and intellectually dishonest.
There is no evidence that can be provided in the intervening time period as there is no clinical/investigatory test able to stratify the cohort- there is generally only evidence/results of higher risk i.e. a bleed/neurological symptoms/infection etc. or immediate short term 'treatment' success. That you have normal post intervention tests is reassuring you are not at a higher risk than baseline however the condition has risks of recurrence/treatment failure/complication that no test other than the passage of time exists to prove non-occurrence. A 12 month period is somewhat arbitrary but it is the objective statistical risk standard/threshold for decision making and there is some evidence for that period roughly correlating with a period of recovery healing/rehab and then physiological stabilisation (more towards the 6-12month time period). Much argument can be had over the 1% rule and its origins/assumptions but it is what is used and sets part of the standard.Interesting opinions.

“There is no evidence that can be provided in the intervening period as there is no clinical/investigatory test able to stratify the cohort”. Really? There are eminent specialists in medicine and statistics who have different opinions. Or is yours an objective truth?

“Somewhat arbitrary”. Is that like being “a little bit pregnant” or “slightly heavy-handed”?

The “1% rule” is not a rule. That’s why much argument can and should be had about it. I realise that it’s a number that’s nice and simple and, therefore, compellingly attractive and easy to use to convince the AAT and others of its safety relevance. But the objective fact is that it isn’t a “rule” and there is no safety magic in it.

The phrasing/process in the corro out of CASA, from your position, would not be compliant with admin process law or some similar position.I have no idea what you meant by that.

It doesn't strike me as particularly troublesome in providing an independent opinion. Very specific hypothesis/questions/risk scenarios/assumptions need to be addressed with rigour. Provision of a supporting or dissenting opinion (with academic clinical research/analysis to support) against these is critical in coming to a reasonable decision against a risk framework (Meta-analysis, single quality study, other cohort research and then expert opinion form the hierarchy with most weighting to the former). The absence of an opinion (against not just "fit to fly today" but time based risk and long term consequences with quality research to back it up), as would appear to have occurred with your earlier reports has led to the ambiguity/lack of probabilistic statements against the risks. I would be very surprised if any reasonable person would then afford you the 'benefit of the doubt' rather than take the conservative position.And there we have it, writ large: Not an objective assessment of the risks and consequences, but bias towards the worst-case scenario, based on an appeal to the “reasonable person”.

And we know what Ace CASA always has up its sleeve: the cognitive bias of the “reasonable person” contemplating an aviation catastrophe. You should read all the relevant studies on cognitive bias. Scaring the public pays the bills.

I'd likely consider you recommendable to be fit to fly Class 2 with restrictions after 12 months from your narrative but can't offer an opinion on an incomplete picture.Not to worry: I have specialists who’ve already expressed an opinion.The other question I would ask is that why not fly under an RPL or Basic Class 2 - if you VFR day fly only for your own pleasure?Not that it’s any of your business, but the answer is: I don’t want to. I’m pretty sure I still have choices in these matters.The emotional effort and time to 'fight' for a principle or against perceived slights is not going to be healthy for you in the long term.And here we see another ghastly irony of the Avmed system, writ large.

Avmed made an administrative decision that affects my interests. I am entitled to seek review of that administrative decision, and have done so. That’s how it’s supposed to work in a representative democracy supposedly subject to the rule of law. Your dismissal of my concerns as “perceived slights” suggests to me that you might not understand how government accountability mechanisms are supposed to work, and why, (but also, coincidentally, confirms for me that you are in the medical industry).

The practical consequence of the way in which Avmed chooses to administer the medical certification system is that people can simply be ground into submission through not having the resources to fight or - and this is the ghastly irony - through the stress that is ultimately deleterious their health. What a great outcome! Caused by people who claim to be medical professionals.

Let’s see if I can summarise: We should all just cop whatever decisions Avmed makes, because to do otherwise will be bad for our health. (What’s the name of that organisation which says non-compliance with its demands could be bad for your health? The name escapes me for the moment...)

The “principle” that I am actually fighting for is aviation safety.

There are very simple ways for holders of class 1 and class 2 medical certificates to avoid all of what I’ve gone through as well as keep their medical certificates. Very simple ways.

The way in which Avmed currently chooses to administer the aviation medical certification regime encourages pilots to choose those ways. Pilots are increasingly choosing those ways.

That is bad for aviation safety because it’s bad for the health of those pilots.

That is why Avmed is now, in my view, a force inimical to aviation safety.

Think about that and your opinions, the next time you jump on a commercial aircraft. And remember: you’ll be sharing the sky with self-certified pilots.

[megan]

And remember: you’ll be sharing the sky with self-certified pilotsThat is always the case Clinton, irrespective of whatever system may be in place, unless of course we go down the Russian route where crew have a medical at the commencement of duty. You get out of bed on the day of duty and ask yourself, "am I up to it, yes or no?".

[Clinton McKenzie]

True.

I was trying to make a broader point: You’ll also be sharing the skies with pilots who might never have been near a DAME and might never have held a medical certificate.

[Nowluke]

I appreciate the passion and effort you're putting into your case, as you and others have said, you are entitled to administrative fairness and should be able to clearly understand the basis of a decision for which you disagree with and challenge it if it is incorrect. I don't want to engage in a giant point by point internet forum battle over your process, just give you some commentary from someone who has some general knowledge of an element of your problems.

To clarify on a small number of your points. All post fellowship doctors are specialists. Fellows of any specialist college and some senior trainees can undergo aviation medical training. Of that cohort some can go on to further post graduate qualifications and experience in the aerospace industry- generally, through the military and in the US or UK. There are some avenues for distance education and new courses in the Aus/NZ space recently. Australia has its own aerospace medical fellowship as well, the post nominals FACASM indicate that, earned after a number of years of study and assessment. There are very few surgeons with that dual qualification (I would say less than 10 in Aus, most of them eye, ortho and general surgery).

So when we play the game of "my opinion is better than yours" some of the weight will come from that specific expertise and as I said before, expert opinion alone is the lowest level of 'evidence' to support a decision. If there's no well designed study into your condition (and even better, a meta-analysis), in the aviation environment as well, then making a defensible decision will be hard, hence defaulting to a the general decision pathway for brain surgery/injury/interventions which does have this top level of evidence. There are even more complications when expertise on the condition, the environment and the safety system need to overlap, no one doctor is expert in all of them.

Using examples from non aviation contexts i.e. "I can drive a car so what if X" have not much relevance. The regulator is protecting the public from direct harm from aircraft crashes, protecting the industry with a perception of assisting rigorous safety management systems and setting a standard which is 'acceptable' to government, the public, industry and aircrew (in that order) Your car crashing into a pole vs shutting down an airfield or crashing into a house in western Sydney are obviously different levels of consequence (reductio ad absurdum on buses full of school children don't help you) and form part of the basis for differing standards to drive a car vs flying. Endless argument can be had over how automation and support systems have now altered what critical phases of flight is and the burden of the aviation environment on the body is little in recreational flying. Perhaps the standards will lower in the future, and they have already arguably with the introduction of the basic Class 2.

Undoubtably an unfair, or perception of an unfair, regulator will lead to lowered rates of compliance to 'protect' a privilege or avoid censure. This is not unique to aviation and applies to safety management universally. Processes and cultural changes need to be in place to avoid this as much as possible but again, universally, these do not tend to happen until after some critical failure and it is a thorny problem.

I felt I should put the previous and this here to assist the community in understanding some of the why/how in these kinds of cases, that do tend to appear each year or so. Being told you can no longer do something when you believe that it is the wrong decision is hard, it is distressing but it is not out of some systemic malice or malfeasance. It's a difficult decision (because there is no high quality evidence to support, because there are conflicting opinions from relevant subject experts and because it is in a population not flying Class 1- with the employment and industry pressures that may assist in gathering support) and no one would argue it is a perfect process.

[Sunfish]

The behaviour of Avmed appears to encourage non reporting because there is a perception that Avmed will always act in its own interests at the expense of the pilot. This encourages what the ICAO safety management manual terms latent violations of safety principles. These are things that are loose in the environment that may one day result in an accident if other defences are overcome. As such it appears that Avmed is making us less safe.

My own DAME tells me his job is to keep me flying as long as possible.

[andrewr]

It’s an acceptable risk for me to continue to drive a car that weighs more than my aircraft and carries more people than my aircraft, on the road shared by buses full of school children a mere couple of metres away, day and night in all weather, when I’m apparently an ongoing potential neuro-circulatory time bomb.

I would be careful going down that track. The Austroads medical standards say for vascular malformations of the brain treated surgically a person should not drive for 6 months - private or 12 months - commercial. Advisory only, but if I understand your description of your condition, Austroads do in fact say you should not drive.

Certainly you share the roads a lot more closely than the sky, but the obvious difference is that if you suddenly get a splitting headache in the car you don't need to do much more than hit the brakes (pulling over to the side of the road is desirable but not essential). In an aircraft, you need to continue to perform complex tasks for at least a few minutes, possibly even 30 minutes or more.

I have been through the process with Avmed myself and have some sympathy. I agree that their standards don't always match the risk. But in this case I think perhaps you are underestimating the seriousness of your condition and of the surgery. The plumbing in your head is pretty serious stuff. The reality is that medicine is not like mechanical repairs, and they can't usually make things as good as new - more often it's patch things together and hope it holds. Any scan now will show what is happening at that instant, but can't guarantee it will be the same in 6 months.

Avmed are the bad guys because they ground people, but sometimes medical conditions are real.

[Cloudee]

But in this case I think perhaps you are underestimating the seriousness of your condition and of the surgery. .

Did you miss the point that the specialist has stated he is fit to fly?

[andrewr]

Did you miss the point that the specialist has stated he is fit to fly?

That's the other half of the problem. Avmed want to know what is the risk of incapacitation, they reserve the right to make the "fit to fly" judgement themselves based on that information.

Avmed asked what is the risk of incapacitation. The specialist said he doesn't meet the class 1 medical standard - which implies there is some risk of incapacitation but doesn't quantify it. The specialist said he considers him fit to fly day VFR. Unfortunately that is not a medical standard, and the further implication is that the specialist believes he also doesn't meet the class 2 medical standard.

So the advice from the specialist is in fact:

He does not meet the class 1 medical standard
He does not meet the class 2 medical standard (which allows night, IFR etc)
He is fit to fly day VFR. That might be closest to the basic class 2 standard which Clinton has said he does not want.

Avmed want some definite statement from the specialist saying e.g. the risk of incapacitation is less than x%, so that if an accident occurs in the future they can point to it and say we were acting on this advice. Stating or implying that he does not meet various standards but is fit for day VFR isn't much help. However specialists, in general, don't want to be pinned down to that sort of statement.

Without a less equivocal statement from the specialist, the best Avmed can do is a time based test - if nothing bad happens in 12 months, the probability of something happening in the future is acceptably low.

[Clinton McKenzie]

Might be worth you reading through the thread, Andrewr.Avmed asked what is the risk of incapacitation. The specialist said he doesn't meet the class 1 medical standard - which implies there is some risk of incapacitation but doesn't quantify it.If you refer to earlier posts in this thread, you will see that specialist’s letter said, among other things:My professional opinion is that I do not consider you a risk of incapacitation now that the lesion has been treated.Is that not a statement of the risk of incapacitation? That was before the dynamic CTA and then DSA confirming ongoing success of the procedure.

But let’s ignore that for the time being.

The AATs decision on the question whether to ‘stay’ the decision to suspend my certificate said, among things (with my bolding):... CASA has pointed out that Dr Mews has said that Mr McKenzie would not meet the standard for a class 1 licence. That is so, but it is not relevant to whether he meets a class 2 standard. It is to be expected that there will be a subset of class 2 licence holders who would not meet the class 1 standard. The above is, of course, a selective quotation and emphasis. Kinda like what CASA does.
I would be careful going down that track. The Austroads medical standards say for vascular malformations of the brain treated surgically a person should not drive for 6 months - private or 12 months - commercial. Advisory only, but if I understand your description of your condition, Austroads do in fact say you should not drive.Gosh, Andrew. Are my specialists incompetent? None of them has advised that I should neither drive nor fly.

The fact that you, too, may have received the Avmed ‘treatment’ is not evidence that it’s necessary.

And I have to say that the concept of Avmed expressing opinions about objective risks of sudden incapacity is laughable. I’m sure Avmed does it, but the chances of those opinions being ballpark accurate are vanishingly small.

[Cloudee]

I wonder what qualifications the AVMED doctors are required to have. Do they have qualifications in aviation medicine? Are they also pilots? Or are they GPs who no longer want to see patients face to face and just act as an interface between DAMEs, specialists and their own lawyers?

[andrewr]

Might be worth you reading through the thread, Andrewr.If you refer to earlier posts in this thread, you will see that specialist’s letter said, among other things: My professional opinion is that I do not consider you a risk of incapacitation now that the lesion has been treated. Is that not a statement of the risk of incapacitation?

That is definitely a statement of the risk of incapacitation. However, it is undone a bit by the additional opinions that you don't meet the standards for class 1 (Why not, if you are not at risk of incapacitation?) and the suggestion that you are fit for day VFR (again, why not a normal class 2 if you are not at risk of incapacitation?).

This is why people recommend giving Avmed what they ask for, but don't volunteer extra information. Extra information confuses things and in this case throws doubt on the statement on incapacitation that Avmed were looking for.
Gosh, Andrew. Are my specialists incompetent? None of them has advised that I should neither drive nor fly.

Probably every doctor in Australia has patients that technically, legally, shouldn't be driving, but they judge that the risk is too low to be worth the inconvenience to the patient in our car-dependent society so it is never discussed. Basically a case of don't ask, don't tell. If you did ask, they might be obliged to refer to the Austroads standards, and advise that you should not be driving. (I suspect you are also qualified to make a distinction between should not and must not.)

And I have to say that the concept of Avmed expressing opinions about objective risks of sudden incapacity is laughable. I’m sure Avmed does it, but the chances of those opinions being ballpark accurate are vanishingly small.

I'm sure that is true in many cases, but that is their job and that is the system we need to work in. Surgery involving the blood supply to the brain probably does have a real, relatively high risk of sudden incapacitation compared to many of the areas where people have trouble with Avmed.

You dismissed Nowluke's post because it was a first post, but to me it looks like an expert evaluation of your situation. I think a careful re-reading would help you to understand your situation WRT Avmed, and help you understand your potential path forward.

(Although I think Nowluke's suggestion of a basic class 2 might be a non-starter, because it appears to me (as a layperson) that you also would not meet the unconditional commercial driving standards.)

Legal challenges to Avmed are likely to be counterproductive, because it locks them into a position and forces them to put together a case to show why they should NOT grant a medical. It means any additional information needs to be much stronger before they will change their position.

[Clinton McKenzie]

Surgery involving the blood supply to the brain probably does have a real, relatively high risk of sudden incapacitation compared to many of the areas where people have trouble with Avmed.I’m guessing that’s true, but I’m not an expert.

Fortunately, I didn’t undergo surgery involving the blood supply to the brain.

This is part of the problem with non-experts, like Avmed, wading in with their 2 cents’ worth.

I didn’t “dismiss” nowlukes post. I responded to it. Others can judge whether it answered any of the points made.

[Clinton McKenzie]

Legal challenges to Avmed are likely to be counterproductive, because it locks them into a position and forces them to put together a case to show why they should NOT grant a medical. It means any additional information needs to be much stronger before they will change their position.And that’s another fundamental flaw in the system.

If CASA were, in fact, an objective evidence-based and objective risk-based regulator, it would inexorably follow that a challenge in the AAT to a decision to suspend a person’s medical certificate should make zero difference to CASA’s subsequent assessment of the person. That’s because, as a matter of objective fact, there is no causal connection between a person’s compliance or otherwise with a medical standard and the existence or otherwise of an AAT challenge to Avmed’s decision that the person does not comply with the standard.

“It means any additional information needs to be much stronger before they will change their position.” That’s not being objective.

Avmed is emotionally engaged in the ‘defence’ of these decisions. That’s why they emphasise some things and downplay others, and selectively quote and interpret, in their statements and requests for “independent” opinions. That’s why the AAT in the Bolton matter disregarded the opinion of Avmed’s Principal Medical Officer.

My view is CASA should not be the contradictor - the other ‘side’ - in these AAT matters in the first place.

[Nowluke]

To clarify, a specialist is a post graduate fellowship in a relevant discipline. Aerospace medicine specialists are denoted by the post nominals FACASM in Australia, the lesser post graduate qualification being a diploma in aerospace medicine, generally from the UK and generally held by (ex) military doctors; NZ also has a program and some Aus universities have started up equivalents to a lower post grad level. It also generally a secondary speciality after general practice, general surgery etc. There would be 10 or fewer surgeons in Aus with the qualification. It, like all specialties, takes several years and has an examination process. The other end of the scale has a number of 6-12 week courses to become a DAME, this is the minimum amount of training to provide some occupational context for clinical advice to be placed in alongside regular professional development. I don't know what mix of these differing skillsets CASA has.

It's obvious you feel strongly about your issues but you do yourself a disservice and practice the same alleged selective use of facts in how you're going about engaging on this. Repeatedly you choose very limited aspects that support your narrative to the cost of your credability here.

As previous, the absolute gold standard for your condition would a meta-analysis of a number of long term follow up studies in aircrew to determine your risks. The opinion of a "specialist" is the lowest evidentiary weight in clinical decision making. Brandishing your supporting narrative and and then claiming that it 'proves' you're cured and thus now at baseline risk is meaningless in the context of the decision being made. All it does is demonstrate, at a single time point that you remain at the baseline risk of your clinical cohort- not back to the standard. You may indeed be theoretically 'fit to fly' on that day and the next but nowhere has it been addressed, in what you put forward, in a comprehensive way, with clear clinical research based evidence.

It is churlish to suggest you have not undergone surgery in the broader sense, an endovascular procedure is of the same nature as keyhole surgery or imaging guided interventions. Generally, they have more positive results (quicker recovery, less infections etc), hence the trend towards them. However, just because no one has opened your skull and put a scalpel in does not mean you no longer fall under the post operative precautions and physiological changes that are universal to all physical interventions to anatomical structures. A change was made and hopefully you are now at lower risk of an event but it is not a stochastic on/off; yes/no change with an absolute outcome.

You again attempt to shape your narrative around “it wasn’t my/in my brain” therefore the rules don’t apply. It’s the circulation to the sac your brain sits in, both are dependant on blood from your neck and spine and the same endovascular access techniques are used. A poor outcome to your treatment will absolutely affect the function of your brain.

The high value you continue to place on your limited ‘specialist’ opinions on fitness to fly has not been situated anywhere up the clinical evidentiary scale. It remains the very lowest evidentiary (in the clinical, not legal) basis to assess your risk. There is large body of work on neurovascular, neuro-malignancy and head trauma that underlies the position for having a post incident/intervention 12 month assessment period. I devalue them even further when the absolute statements along the lines of “no risk of incapacity” and “100% success” are made by your treating doctors. They have misspoken grossly and not provided an accurate assessment of your risks; at best a statement of short term resolution can be drawn from them and some further extension into the medium term from your imaging. Again, it forms a foundation for long term success and risk reduction but it does not allow you to then infer this off into 1-2 years into the future.

Unfortunately, my position is somewhere approaching the objective one. If there is no higher research on your risks then it does become a case of trumps. Until you (or your supportive specialists) start dropping things like :

Link, M. J., Coffey, R. J., Nichols, D. A., & Gorman, D. A. (1996). The role of radiosurgery and particulate embolization in the treatment of dural arteriovenous fistulas. Journal of neurosurgery, 84(5), 804-809.

and quoting out the long term risks and rates, you’re not even on the playing field (note this is not applicable to you, just a very proximal cohort using a different process). That they have not done this is a big issue in any serious consideration of your concerns.

The position you’re in of apparently insurmountable standards is just that, insurmountable, you logically cannot provide proof of a negative prospectively. You no longer met the standard, the current gold standard relevant clinical research defines the guidelines and no amount of single point in time imaging will change the fundamental hazard that underlies the ‘waiting period’ - esp. when your question of fitness to fly is in it’s full context - i.e. the 1/2 year licence period.

To its extreme, it will end up the case that at day 364 you remain not fit and then the next day, through administrative magic, you then are. Unless you can create the body of knowledge to change the gold standard position i.e. a number of longitudinal clinical studies on endovascular repair of AVM of your type in aircrew using your technique and compound then you’re going nowhere fast, no amount of letters from a procedural specialist will change that. There is a vast difference in your apparent clinical ‘fix’ and returning, with evidence, to the standard.

As andrewr said it may even be the case you no longer meet basic class 2 as well. Vis Austroads the non-driving for intracranial procedures is advisory only; non-driving periods may be varied by the neurosurgeon - this may be applicable to the basic class 2 but I would say CASA may/may not align with this.

You've taken repeated umbrage and described it as dishonest when terms like significant and high etc are used. It is a shorthand for the rate of unacceptability at which the hazard is realised when an appreciation of the condition in the environment is made with respect to the standards acceptable within the safety management system. This rate is whatever is set by the regulator and it is the best that can be made with the scientific, not single expert, knowledge available and it will change over time. And people will disagree with it.

I don’t want to engage in some giant internet forum battle over this. I only responded initially as you were very vocal along a narrative that was fundamentally incorrect from a (my) clinical aeromedicine view. I don’t care about your CASA dealings or the administrative parts as the root cause has been the failures of communication with you by your treatment team and the lack of understanding of aeromedicine. My position may even be incorrect as in the future the evidence I spoke about will come into being, it could even exist now. Although you would not be in this position were that the case.

[megan]

I wonder what qualifications the AVMED doctors are required to have. Do they have qualifications in aviation medicineCan't answer your question directly, but going back a couple of decades my understanding of the process was Avmed had a meeting once a month with a panel of medicos, drawn from where I know not. It was from this panel that a yes/no would be forthcoming. In one particular case the Avmed director went into bat for the applicant and pressured a recalcitrant medico specialist to make a decision that he could take to the monthly board. So even specialists at times are reluctant to give a yes/no, a sign of our litigious society I guess. In the case mentioned the applicant was given a thumbs up.

[Seagull201]

Feel free, first post as I haven’t had much to contribute. As you can check though, I have been a member for a while. I’m offering a perspective from a different part of the aviation community; take whatever value you wish, discard it if you want. As I said, it’s a shame you’re not flying, it’s doubly so that communication issues have compounded your distress.

Mr. Nowluke,

Are you a pilot, or hold any type of pilot's license, whether it's a ppl/cpl/atpl?

You know what's strange, you have been a member for a while, as you have mentioned, but you have zero posts or opinions on other matters on aviation,
except, half page essays on aviation medicine.

So please tell me, have you got a pilot's license and have you passed a Class 1 medical?

[On eyre]

Seagull I believe your question as to Nowluke holding either a pilot licence and/or aviation medical is completely irrelevant to the medical issue being discussed.

[Seagull201]

How about Nowluke, writes a half page essay, on other aviation topics, as discussed by others.

He has a speciality towards aviation medicine, but no opinion on other topics?

I don't buy that!

[On eyre]

Seagull why on earth would/should Nowluke write on other aviation topics where clearly aviation medicine is his forte. I believe he shows commendable wisdom and perhaps you could learn from this also.

[Sunfish]

it’s called in debating the “appeal to authority” argument. luke is merely saying “show us the detailed long term follow up research on perhaps thousands of pilots who had your condition that proves you are not a risk to humankind” - and when this is not available as it never will be, that Clinton is an unacceptable risk. It (the argument) is dressed up because luke purports to be an aeromedical surgeon.

i say “never will be” since who is going to bother researching the outcomes in pilots? As for the general community, you would expect such studies in comparison with other available treatments.

His argument is specious because what matters is the risk associated with poor Clinton’s conditions compared to all the other risks of sudden incapacitation. A bad meal being top of the list.

But all that is irrelevant because there is no guarantee that Avmed will change its view in twelve months. if avmed were to state that a full certificate would be granted at the end of a year of good health , that would be different and perhaps justifiable.

[Clinton McKenzie]

You refute things I haven’t said, and spin things, nowluke. A bit like Avmed.Brandishing your supporting narrative and and then claiming that it 'proves' you're cured and thus now at baseline risk ”Brandishing”? That seems a rather emotive word to describe mere quoting.

I’m merely quoting the words of my specialists and the results of scans. I realise you simply dismiss those opinions and results (unless they are against my interests) because they’re from mere specialists, but all I have to rely on is their opinions and expertise.

And I haven’t said, anywhere, that this “proves” I’m “cured” and now at baseline risk. What I’ve pointed out is, among other things, the incongruity of my being allowed to continue to drive and pilots who self-certify being allowed to share the sky with RPT jets, and the patently biased approach to dealing with doubt. And who makes money out of that approach? It is churlish to suggest you have not undergone surgery in the broader sense, an endovascular procedure is of the same nature as keyhole surgery or imaging guided interventions.”Churlish” is another strange word to describe merely responding to andrewr’s implied statement that I had undone surgery involving the blood supply to the brain, when that is simply not true.

And you know that. Your response implicitly acknowledges it: “Surgery in the broader sense”. “Of the same nature”. Once again, selective specificity.

I realise it’s in Avmed’s interests to allow or encourage people to believe I’ve undergone “brain surgery”, but that’s not being objective.

[andrewr]

andrewr’s implied statement that I had undone surgery involving the blood supply to the brain, when that is simply not true.


I get the feeling that is the statement of a lawyer trying to find a loophole, rather than what doctors would view as involving the blood supply to the brain. You said it was the cranial blood supply, which in my understanding is the blood supply to (parts of) the brain. Are the vessels on the inside or outside of your skull? I don't think there are many major vessels inside the skull that are not somehow involved in blood supply to the brain. And just because it wasn't IN the brain doesn't mean it wasn't blood supply TO the brain.

You said the potential outcome if it was untreated could have been severe. How is that the case if it did not involve the blood supply to the brain? The severity of possible future complications probably correlates with the severity of outcomes if it was untreated, or complications during the surgery. The main question would seem to be the probability.

[Clinton McKenzie]

If a loaded gun is held to your head, and someone intervenes so that your brains aren’t blown out, does that intervention “involve the blood supply to the brain”? I suppose it does “in the broader sense” ...

The way it was explained to me by the specialists was that the purpose of the intervention, and the way in which the intervention was carried out, was to avoid interference with the blood supply to the brain. That makes pretty good sense to me.

The advice to me was that if there had been no intervention or the intervention had gone wrong, lots of bad things could have happened. Fortunately, the advice to me was the intervention on 23 August was a success, confirmed by a subsequent dynamic CTA on 9 November and intravenous DSA on 30 November.

But I get it that even amateurs like you know better.

[andrewr]

the purpose of the intervention, and the way in which the intervention was carried out, was to avoid interference with the blood supply to the brain

Which strongly suggests to me that this vascular malformation involved the blood supply to the brain.

If someone with medical training wants to contradict that, I am happy to be corrected.

[Dexta]

I think the crux of the matter is the belief Nowluke and AVMED have of The opinion of a "specialist" is the lowest evidentiary weight in clinical decision making. . Having worked in the medical industry and having friends and family who are in the medical profession this statement I think would be insulting. I know of two people who are considered to be in the top 10 in the world in their field, the data input to any "gold standard clinical trials" would consist partly of their work. They would be the best people to understand any nuances born out of any clinical trials that may have been conducted, rather than some statistical analyst or bureaucratic medical officer. Yet the arrogance of AVMED and Nowluke suggest that these people know nothing of the outcomes of the procedures they perform!

[Sunfish]

We are talking here about an ADMINISTRATIVE decision. The point of Clinton’s complaint is that the ADMINISTRATIVE decision is flawed on many levels. This is not a forum for pissing competitions by doctors.

The logical outcomes of Avmeds deliberations Should have been;

1. yes

2. no

3. yes, in twelve months, provided.....

instead he got “let’s put off any decision at all for twelve months or perhaps longer and we still may decide not to issue for unspecified reasons”.

[michigan j]

Thanks Nowluke. Interesting (and I assume informed) posts.

[Clinton McKenzie]

My 2 cents’ worth is that nowluke seems to me to have provided an accurate and expert description of the current reasoning for the current approach. As posted and noted earlier:The opinion of a "specialist" is the lowest evidentiary weight in clinical decision making.That is a manifestation of an important concept that was new to me: I’ve learnt that there’s a willie-wagging hierarchy in medicine. Apparently, there’s a causal link between a person’s compliance or otherwise with a medical standard and the recognised comparative length, in the medical hierarchy, of the willie of a medical professional expressing an opinion about the person’s compliance. Go figure.

I have an appointment with someone whom, I’m advised, has the largest willie in the hierarchy. I’m looking forward to getting the person’s opinion and the reasons for it.

[Clinton McKenzie]

Fees incurred in battling CASA so far: $6,522.00.

On current advice, if I have to go to a ‘full blown’ AAT hearing I wouldn’t expect too much change out of ten times that.

No one on an average income or less could afford to do this.

[Fight_Engineer]

There's one small problem for those excusing CASA's appeal to "prudent caution": one of CASA's own published Aviation Medicine case studies.
It's the one describing "Jim's" stroke at age 76, which finally grounds him (just in case this, my first PPRUne post, does not permit URLs, and any of you need to search).

In this case study, CASA describes grounding a pilot who has a stroke, at the age of 76. This means, by CASA's own documentation, CASA continued to renew Jim's Class 1 medical certificate (with conditions) when Jim was aged 75, and diagnosed with Type 2 diabetes, and known to have high cholesterol and high blood pressure.
Here are some "medical" stats:
1. The absolute annual risk of one quite severe medical condition (mild death, with recurring symptoms) for the average 75 year old Australian male is about 4%. Just go to the ABS and take a look at the life tables to confirm. 5% annual chance of death is reached at about age 77 for the average Australian male.
2. Life expectancy for people with Type 2 diabetes is substantially reduced, possibly up to 10 years. If I need to find credible data, I will, but I am sure the forum medical experts will have such data on-hand and should be happy to quote.
3. Thus, the absolute annual risk of death for 75 year old "Jim" with diabetes, plus CASA-documented high cholesterol, plus CASA-documented high blood pressure is "significant" / "non-trivial". You don't need advanced maths/stats to know that it's "significantly higher" than the 4% annual risk for the average 75 year old male. As a guide, IFF the life expectancy for a Type 2 diabetic Australian male is, say 75, then Jim had a 50% total chance of already being dead at the age CASA renewed his Class 1 medical certificate. Despite my limited medical expertise, I am confident that death is regarded as an incapacitating condition with substantial negative consequences, even among lay-people. And that's before we consider what other non-death incapacitations diabetic old "Jim" might also be at a higher risk of suffering (it's debatable whether we should lump in the full risk of Jim's actual factual stroke with the general elevated risk factors already identified for Jim - it's a veritable smorgasbord of possibilities for his age and documented conditions).

I have read the Ambekar and Adamczyk studies, and it is not credible to contend that CASA's approach between Clinton's case and Jim's case is objectively consistent from a statistical safety-driven standpoint. The only way to get close (from a statistical risk viewpoint) is to assume that the consequences of (just a) recurrence of a DAVF after having been "nominally cured" (ie. Clinton's current state) is worse than the consequences of actual death. I don't need to be a specialist in anything, or beat my chest about experience/qualifications to state authoritatively that the incapacitation consequences of DAVF recurrence cannot be worse than the incapacitation consequences of death.

So, for those of you who think CASA's approach in these two cases is "consistent", please explain what stats, studies and numbers you are using to justify your "trumps". For me, it's just about the numbers - and using population-level stats, plus CASA's own published information and cited studies, their approach to pilot incapacitation risk/safety cannot be described as consistent in these two cases.
It's also obvious that if the default approach is: " we're not sure, so we'll ground if in doubt and defend initial decisions no matter what", then pilots have a strong vested interest in never revealing anything voluntarily to their regular GP or "DAME". That's objectively a sub-standard outcome.
And a CASA medical officer who effectively instructs an "independent expert" doesn't seem confident that his own conclusions will be confirmed. This behaviour is indefensible [in a decision review scenario].

[Clinton McKenzie]

Interesting comparison, FE.

I’d be surprised if CASA’s “Jim” is a real case study. If he is, good on him for managing to maintain a Class 1 medical certificate to the age of 75 with type 2 diabetes and high cholesterol and high blood pressure.

But, like you, I don’t know how CASA could reasonably come to the view that, if you take a sample of 100 Jims, there’s a less than 1% risk that one of them will suffer sudden incapacitation in their 75th year. Maybe I’ve misunderstood how CASA’s magic percentages work. Nowluke might be able to clarify.

I agree with your view that the terms of the letter from the CASA decision maker to the “independent” expert were “unforgivable”. As I’ve said, it was in my view biased and intellectually dishonest. Which brings up another interesting comparison: The ‘uber’ specialist I’m seeing has instructed me as follows: “Please note, Professor [X] does not review documentation until after he has seen each patient, to allow the taking of an unbiased history and physical examination.” I’m relieved that at least he gets the concept.

[Clinton McKenzie]

A PPRuNer sent me a PM saying that he wanted to post the following, but thought better of it. However, he is happy for me to post it without attribution:

Is there anyone else besides your truly, who feels that this whole thread is quite disturbing?

The reason I have reached this opinion is that over, say the last four or five years, I have had a number of Medicos, including several DAME's say to me the following words;

"The less they (CASA Avmed) are told, the better!"That experience is typical.

There are very sound reasons for that advice.

But at least in those cases the pilots are talking to doctors and getting assistance. My primary concern - and the reason for my view that Avmed is now a force inimical to aviation safety - is that there are now pilots who are too scared to raise issues with any doctor, for fear of it getting back to Avmed.

[michigan j]

“the most important consideration is safety”
Having a full and open discussion with your DAME can result in you offering information which gets you grounded for potentially long periods.
An indefinitely grounded pilot is the safest pilot...

[Nowluke]

For Flight_Engineer - your assumptions and conclusions are incorrect. Whilst death is an outcome for everyone and its all cause rate after a certain age approaches 100% (somewhere near 117). This does not then mean that the risk acceptance threshold changes or if your other condition risks are less than this then the system is flawed. As before, the risk decision is composed of the full view of the "rate of unacceptability at which the hazard is realised when an appreciation of the condition in the environment is made with respect to the standards acceptable within the safety management system. This rate is whatever is set by the regulator and it is the best that can be made with the scientific, not single expert, knowledge available". Yes death is a single event, yes it is pretty bad (for the individual and whoever is nearby in the aircraft) but whilst the individual effect is large, the statistical event risk is lower than a plethora of other safety significant events (or risks of events).

The hazard is not death (although that is an outcome), it is the condition or treatment causing impairment &/or incapacity &/or death &/or the aviation environment effects and/or mitigations on the condition over the term of the licence.

I would be surprised to hear of anyone flying on a Class 1 CPL/ATPL internationally over 65 and domestically without investigations every 6 months and would also be surprised if companies employ them (in a passenger flying role) over 70 (and only domestic multi-crew) at all for broader insurability reasons (partly due to that all cause death rate you raise). Noted though there are some QFI/FIs flying students well into late 60's/early 70's, again with some pretty strict conditions.

The proposal of "never tell anyone" about medical issues and describes an attitude of wilful violation of the broader safety system and a lack of integrity. The, "I know best" and "if you mention anything you'll be grounded" combination will undermine safety even when there isn't mistrust in the system- and there are no quick fixes when those under regulation actively undermine that system. It is also under-appreciated that the decisions that are made are in the broader public interest rather than the individual.

It's nowhere near perfect and people will be upset, your response to actively mismanage one's own occupational healthcare puts others lives, property and reputation at risk in a repugnant and self-indulgent way that no one would reasonably support.

If you transcribed some of these conditions under discussion to the engineering space and started talking about 15%, 40% yearly failure rates or degradations of critical engine/flight surface parts then I'd say there would be some spirited discussion of continuing to use those parts...

Vis your magical Jim, no idea what the detail is. You could very easily sign off on anyone on a class 2 for VFR, daytime flying in remote contexts and then restrict the operating area - i.e. cattle surveying/remote property access work in a defined area and then add on multi crew restrictions or time limits, whatever mitigates the risk, in context, to an acceptable level. If the risk is indeterminate or there are multiple risks/risk factors then a conservative approach is always going to be the case. The other considerations though are much lowered if the only victim is yourself and your private property. Similar processes occur in the road transport context. The regulator is not going to do the legwork to demonstrate or research these mitigations without government direction.

[ersa]

The problem with CASA is they place to much emphasis on statistics, and not actual data on persons

[Sunfish]

Nowluke, you are either a troll or wilfully ignorant about the subject of risk. There are rigorous processes for managing risk available right now ((even from ICAO) that you do not seem to have any understanding of, or, like the regulator, CASA, you do know but prefer your own brand of self serving necromancy to established fact,

This rate is whatever is set by the regulator and it is the best that can be made with the scientific, not single expert, knowledge available".

There are current ICAO standards for the probability of death via aviation, there are also numerous actuarial metrics. From memory we are talking of the order of forty million to one. These are internationally accepted standards for risk. Neither CASA nor the AAT seems to make use of these datums which is a crime.

The proposal of "never tell anyone" about medical issues and describes an attitude of wilful violation of the broader safety system and a lack of integrity. The, "I know best" and "if you mention anything you'll be grounded" combination will undermine safety even when there isn't mistrust in the system- and there are no quick fixes when those under regulation actively undermine that system. It is also under-appreciated that the decisions that are made are in the broader public interest rather than the individual.

It's nowhere near perfect and people will be upset, your response to actively mismanage one's own occupational healthcare puts others lives, property and reputation at risk in a repugnant and self-indulgent way that no one would reasonably support.

Sanctimonious codswallop. The alleged "broader safety system" lacks even a shred of integrity as evidenced by the regularly reported bizarre behaviour of CASA staff including Avmed and despite the numerous pleadings, reviews and negotiations attempted by industry. Given that the system is broken there is no safety case to undermine.

As for your appeal to "the public interest" you must be joking. To educate you, any test of what "the public interest' is actually involves two components; the cost to the community of an event (a medical incapacitation causing an accident) versus the cost to the community of mitigating the risk of said accident. IT IS THIS SECOND HALF OF THE EQUATION THAT IS NEVER CONSIDERED BY YOU AND CASA - AND THOSE COSTS ARE HORRENDOUS!!!!!

The result is a system of regulation that has destroyed thousands of jobs and billions in investment (let alone opportunity costs) without saving the community from any meaningful expense at all. So much for your notion of public interest. You have to take into account the cost to the community of regulation and this seems to have escaped both CASA and you. Again there are ICAO metrics and procedures available right now to do these calculations.

Other jurisdictions have considerably better and more relaxed regulatory environments. Their publics profit from it and their skies aren't raining aluminium either.

[Clinton McKenzie]

Vis your magical Jim, no idea what the detail is.As FE explained, it’s a scenario on CASA’s website in the Avmed section: https://www.casa.gov.au/licences-and-certification/aviation-medicine/stroke-case-based-scenario

I’d be interested in your expert opinion on the “magical Jim”, once you’re across his details.

[Nowluke]

ICAO provides a medical framework which Australia/CASA aligns to in our environment, large portions will be wholly adopted or partially will be with localising changes and there will be exceptions. I am familiar with the medical standards and know there is a large amount of flexibility in their application and guess what, a nation can put any further restrictions or exemptions in place that it feels are necessary. These deviations are on the air services website. The loose wording of the standards, I would say, purposefully allows a large amount of latitude for medical issues. Further, for this case, ICAO is silent on these clinical particulars.

I don't agree with your goading tirade or the position that some enormous harm is being manifested. Your absolute position- that it's all f#%$ed, no planes are crashing and there's river of cash and jobs we're missing out on sounds like a politician's fever dream. Unfortunately there is a culture of grievance and refusal to accept a situation when it doesn't match an entitled opinion. If there is such a swathe of systemic issues then stand up a (new) senate committee or write to your MP and put them to light. Blowing hard on the internet's not likely to do much.

I agree the system has (not insurmountable) issues and in the medical space it can be extremely difficult to run a situation down to a statistical value. As I've repeatedly said, you're never going to have a regulatory organisation accept a critical/catastrophic risk scenario in the absence of quality data without a period of non-event to support it. End of.

[Clinton McKenzie]

And your expert opinion on the “magical Jim” is?

Surely CASA wouldn’t fabricate the scenario.

[Capt Fathom]

you're never going to have a regulatory organisation accept a critical/catastrophic risk scenario in the absence of quality data without a period of non-event to support it.

Yet they allow aircraft to take off every day. :confused:

[Nowluke]

...because there is quality data that those risks are improbable or negligible (post mitigations)...

[Nowluke]

vis Jim, it all appears pretty reasonable, he probably would have met the threshold in some guidelines for some more invasive cardiac screening (CCT/Angio) years before his stroke if you take him as a Class 1 who does single pilot air show work and some instructing. Retrospectively his condition may have been present for a number of years prior and wasn't/couldn't be detected. If all of the required/indicated investigations were negative and then guidelines stratified him into lower risk cohorts of diabetic, hypertensive elderly men he may not be (in the narrative he obviously isn't') above the level where his Class 1 is revoked. What's the exact issue? There is a conflict though at around that age, where as it was raised, it doesn't really matter how many negative tests you have, it's getting close to closing time percentage wise- this conflict I understand is based on age discrimination issues, you can't blanketly revoke licences on that basis and there aren't sensitive enough tests to demonstrate prospectively what pathology Jim has.

Post his event they made him fly privately with QFI only as a mitigation as out of 100 Jims much more than 1% will suffer an incident, not going to be a fun day for the QFI though as Jim's 10 through 38 keel over and not appropriate to have it occur in a commercial context i.e. multicrew as a mitigation (although it could be feasible in a younger, less comorbid individual as their culminative hazard would be less but that's a different story).

[Clinton McKenzie]

Post his event they made him fly privately with QFI only as a mitigation as out of 100 Jims much more than 1% will suffer an incident, not going to be a fun day for the QFI though as Jim's 10 through 38 keel over and not appropriate to have it occur in a commercial context i.e. multicrew as a mitigation (although it could be feasible in a younger, less comorbid individual as their culminative hazard would be less but that's a different story).Sophistry.

Out of 100 Jims much more than 1% would have suffered an incident in their 75th year. Yet CASA issued him with a Class 1 medical certificate. That, as I understand it, is FE’s point.

And post event nobody “made” Jim do anything. He was free to fly as a passenger in any aircraft he liked and CASA couldn’t do anything about it.

Of course, there’s always the possibility that Jim’s scenario is a complete fabrication.

[Fight_Engineer]

Nowluke... I think your post at 13:11 is quite revealing. Firstly, I made no assumptions, except ones which are inarguably obvious. Obvious, like, I don't need to see a double blind peer-reviewed study with controls to know, say, that parachutes save lives.
Secondly - and not that it matters in the context of this discussion - I am not (and never have been) a pilot, and have very little to do with aviation other than as a regular passenger on typical commercial airlines. "My" response is an objective analysis of comparative data and CASA's decisions based on that data. Whatever assertion you make about "me" in regard to the effects CASA actions will have on whether actual pilots reveal medical information is (like some of your qualitative maths) way off the mark. If the regulator appears to punish honesty and (more importantly) obstinately defends/protects its own decisions from new information and independent review, then the end result will be increased dishonesty = reduced safety. Whether you or I like it is irrelevant - unless you are a person with responsibility in the field. If you are, I counsel against denial.
"My" magical "Jim" is described in CASA's own published case study. I cannot post links (yet), otherwise I would have saved you 5 secs of search.
I suggest you read its details very, very carefully and understand fully the facts it reveals, and then try again to credibly defend your carefully crafted claptrap - after recovering from your surprise. It's clear you did not read the Case Study, when you theorise about all those mitigating restrictions which were not placed on Jim's flying. Similarly, disingenuously quoting failure rates of 15% to 40% in engineered parts as if these are the numbers that equate to Clinton's incapacitation risk was the icing on the cake.
I will repeat for you, but I know your opinion is set (perhaps you should apply for a job at CASA - or better still, don't): despite the comparative stats and data/studies available, CASA's application of stats for safety risk assessment between Clinton's case and "Jim's" case is inconsistent.

[Nowluke]

See above? or as copied Retrospectively his condition may have been present for a number of years prior and wasn't/couldn't be detected. If all of the required/indicated investigations were negative and then guidelines stratified him into lower risk cohorts of diabetic, hypertensive elderly men he may not be (in the narrative he obviously isn't') above the level where his Class 1 is revoked.

That said, it's a narrative story with none of the references to the decision makers reasoning or guidelines/evidence applied to underpin the decision. His changing licence restrictions aren't annotated as he aged into the 60+ zone nor are the frequency and types of tests he most definitely would have needed prior to then to support the decision i.e. ATPL loss, CPL loss or restrictions etc. In the absence of these, and a point where you are correct, is that his baseline risk, without investigation would have likely precluded his renewal.

It's a repetition of previous, "here's a "safe" apple!!!!!" "now apply it to my orange". "Here's a single related story, and I say CASA got it wrong!!!!" therefore "everything must be wrong!!!"

The percentages were not linked to anything, just that they were in a range where it is not negligible and it's not above odds- I don't think Clinton in this case (and I'm not spending a couple of hours trawling through neuro/radiology journals) has a clearly evidenced prospective risk percentage (for or against a renewal), hence the waiting period/non consideration (as I understand it) for 12 months. I don't think the CASA decision reasoning has ever been fully placed on here, only Clinton's interpretation/recall of it and my perspective on what the reasoning possibly was.

[Fight_Engineer]

vis Jim, it all appears pretty reasonable, he probably would have met the threshold in some guidelines for some more invasive cardiac screening (CCT/Angio) years before his stroke if you take him as a Class 1 who does single pilot air show work and some instructing. Retrospectively his condition may have been present for a number of years prior and wasn't/couldn't be detected. If all of the required/indicated investigations were negative and then guidelines stratified him into lower risk cohorts of diabetic, hypertensive elderly men he may not be (in the narrative he obviously isn't') above the level where his Class 1 is revoked. What's the exact issue? There is a conflict though at around that age, where as it was raised, it doesn't really matter how many negative tests you have, it's getting close to closing time percentage wise- this conflict I understand is based on age discrimination issues, you can't blanketly revoke licences on that basis and there aren't sensitive enough tests to demonstrate prospectively what pathology Jim has.

And yet, despite all that extensive, invasive screening, investigations, long history and stratification into lower risk cohorts (presumably by individual experts) among the large statistical population of Type 2 diabetics, Jim then went on to have a "surprise" stroke before the year was out. Perhaps if CASA had used this case study to then document and publish some revised, substantially more cautious approach to dealing with the patently obvious high risk Jim posed, then that might justify CASA's inconsistent statistical approach in these two cases. That's the exact issue. You, and CASA, have used the fewer (but still sufficient for statistical analysis) data points associated with "nominally cured" DAVFs as a blanket excuse to bend the incapacitation risk to a level the data/maths does not support.

[Sunfish]

you are way out of your depth Nowluke, and you know it. You don’t get to “localise” data (Your post 96) meaning cherry pick the ICAO standards, methodology and procedures, especially as they refer to humans, unless you wish to make the racist claim that australian pilots are subhumans. The Australian regulations are a cancerous concoction that is worse than the sum of its parts

[Nowluke]

and standby

[Nowluke]

Sorry Sunfish, http://www.airservicesaustralia.com/aip/current/sup/s18-h44.pdf I'd already referenced it but if you need a hand hold over to the active document here it is. Maybe you define localise differently to me, maybe you're also "way out of your depth", maybe you can't be bothered to read the tabulated lists of how Australia either exceeds, does not meet or is of no effect against the ICAO standards i.e. the localisation...

A country, any country will have arrangements via legislation to adopt international agreements. ICAO standards (adopted in the Air Navigation Act https://www.legislation.gov.au/Details/C2016C00936 & the Civil Aviation Act https://www.legislation.gov.au/Details/C2016C01097 ) are no different to the Geneva convention (https://www.legislation.gov.au/Details/C2016C01093) or other international treaties we adopt into our sovereign processes. Someone (unless you are the ICC or at war) just doesn't generally get to apply a set of rules/norms/law without a domestic implementation of the international agreement.

[Sunfish]

Meaningless waffle Luke. My point is that CASA and you, refuse to apply international standards, the most important being a refusal to apply risk management approach to regulation.


CASA even has a report on the subject but refuses to apply it.

https://www.casa.gov.au/file/149106/download?token=WVqD2Yb0


To put it simply, do the calculations for the benefit in dollar terms of the current medical regime versus the horrendous cost to the community of its application.

[Nowluke]

...and that's where our disagreements will remain extant. Your subjective position doesn't relate to the objective things out there that will continue to exist no matter how much you declaim the opposite.

[mullokintyre]

The fact that any/many countrries have a localised version of international rules does not make them any better/worse than the original.
It would seem that the majority of non CASA aviation personnell would suggest that" OZification" of the FAA rules are very much a case of making things worse.
Mick

[LeadSled]

Meaningless waffle Luke. My point is that CASA and you, refuse to apply international standards, the most important being a refusal to apply risk management approach to regulation.
CASA even has a report on the subject but refuses to apply it.
https://www.casa.gov.au/file/149106/download?token=WVqD2Yb0
To put it simply, do the calculations for the benefit in dollar terms of the current medical regime versus the horrendous cost to the community of its application.


Sunfish,
Well Said.
But it should be read and understood as a consequence of Bruce Byron's Directive 1 of 2007. ie: Part of the implementation of Directive 1 of 2007.

Once the system got rid of Byron and Vaughan, all this CBA nonsense (ie; complying with Government directives and the diktats of the Office of Best Practice Regulation (OBPR) was dropped like a hot brick.

Interestingly, one of the exercises done "back in the day", was to apply the then AS/NZ for Risk Management to a big swodge of "maintenance" rules ----- the result was most interesting, about 80% of the those rules would have been reduced to advisory material or dropped altogether , on the basis they were normal or standard trade practice.

Tootle pip!!

[Clinton McKenzie]

On advice from my lawyer, I made an appointment with a DAME. The appointment was for last Friday morning (21 December). (The point of a DAME examination is not obvious to me - CASA will ignore the DAME’s opinion unless, of course, the opinion is against my interests. I guess it’s because my now-suspended medical certificate nominally expires on 30 January 2019. And, during the stay hearing in the AAT, CASA’s lawyer made much of the fact that I hadn’t seen a DAME after the embolisation procedure.)

I took half day of leave to make sure I was at the appointment early and with plenty of time to deal with whatever new bright ideas Avmed has come up with to deal with us presumptively lying and untrustworthy pilots. You know, stuff like the two-sets-of glasses requirement, because those of us who are in the habit of flying without an adequate spare set of glasses will of course stop doing so as a consequence of being forced to do a eye test with two separate pairs of glasses in a doctor’s surgery once every two years. And stuff like having to trace the lines in the Ishihara plates to trap the lying and dangerous CVD subhumans who memorise the numbers in the numbered plates. (Let’s face it: Those CVDs can’t be trusted.)

Managed to drive to the medical centre without having a stroke. Lobbed up to the counter in the medical centre.

Me: I’m here a little early for an appointment with Dr X, as I usually have to do some tests with a nurse before seeing the Dr.

Counter staff: Dr X is in India.

Me: Do you have an appointment in your system for me with Dr X this morning?

Counter staff: Yes.

Me: Sooooooo....

Counter staff: Sorry, Dr X is in India.

These kinds of interactions and the inexorably-expanding intrusion of Avmed’s intelligence-insulting and integrity-insulting ideas into doctors’ surgeries is why, as I said in my submission to the review of Avmed, the 2 yearly interaction with the Avmed system is now the single most stressful event in my life. (And I deal with a lot of stressful stuff, on a daily basis.) It’s like entering a different world in which logic, legal principle, courtesy and trust are mere bagatelles and barriers to “the safety of air navigation”.

Whilst the DAME’s stuff-up on this occasion is not Avmed’s fault, I still ‘look forward’ to another round of watching the DAME battle with the MRS while expressing the view that the questions asked are “stupid” (my DAME’s word from last time). I still ‘look forward’ to the nurse and I laughing at the nonsense of having to do eye tests with two separate pairs of glasses. Medical staff ‘get it’ that trying to police an operational requirement by treating it as a medical issue is patently stupid.

And note that on this occasion I’ve been forced to pay a fee to CASA for a service that CASA will not provide. CASA will not consider my application and issue a medical certificate, even if my DAME says I meet the standard. And I have to pay my DAME for his time (assuming he’ll be back in the country for the rescheduled appointment with me).

A wonderful Alice In Wonderland double bind: If you do not submit and pay for a medical certificate application and get and pay for an examination by a DAME, CASA will weigh that against you, but if you get an examination by a DAME and the DAME says you meet the standard, CASA will ignore the DAME’s opinion.

[bolthead]

I wonder which lucky IT consultants got the contract for the MRS. I applied for class 1 renewal earlier this year. About the same time the rules were altered to allow me to use a class 2. You beauty I thought. I'll get another 12 months automatically. If a lot of other people are in this same situation, think of the administrative savings. Recently, I wanted to put in another application for a class 1 renewal. Even though the MRS explicitly states that an application is only valid for 90 days, 9 months later the computer says 'no', you already have an application current. OK I say. This is starting to smell fishy, but I'll go along with it. Jump through the hoops and after a few days there's a problem, which seems to be related to how old the application is. So now well over 2 weeks have passed, no more correspondence and no certificate. Feel free to waste your time sending them an email. With christmas and new year now you wouldn't have to be Nostradamus to predict that I'm cooked for another 2 or 3 weeks minimum.
So my advise would be, get your renewal application rolling at the earliest opportunity, and the IT consultant can safely order a new car (Porsche?) or house because that contract has a long way to go.

[Falling Leaf]

Has anyone who has been denied a Class 1 had a Class 2 issues instead by their DAME or CASA under the new Class 1 exemption (2018)? I jump through a number of hoops every year being under CASA audit for my Class 1, but now only need a Class 2 for my work. I have a horrible feeling though, that CASA and most DAME's treat Class 2 the same way; with the same level of 'aeromedical risk'.

If this is the case, it goes against CASA's own guidance material stating the new 'Class 1 exemption' is to allow pilots to continue their flying careers under the less restrictive Class 2 if they couldn't meet the requirements of a Class 1, or were finding maintaining a Class 1 'too onerous'.

Will be interesting to see if this is actually going to be the case, or is a Class 2 in CASA eyes only less onerous as you get to renew it every 2 years? I note that in the DAME's handbook, the two classes of medical seem to have identical requirements in the tables...

[Clinton McKenzie]

Saw the Uber-specialist yesterday. $3,410.00 for 45 minutes. And you thought lawyers charge through the nose...

I look forward to his report in a week or two.

[Clinton McKenzie]

The uber-specialist’s opinion from his report dated 11 January 2019:

HISTORY
[deleted in the interests of brevity]

PERSONAL HISTORY
[deleted in the interests of brevity]

PHYSICAL EXAMINATION
[deleted in the interests of brevity]

DOCUMENTATION
[deleted in the interests of brevity]

OPINION

Mr McKenzie was a well-groomed, intelligent man, who presented his case in a very simple and unembellished fashion. It was Mr McKenzie whobrought his health status to the attention of CASA and it does appear that CASA has overreacted, although it has gone to the length of contacting Professor Mark Stoodley for an independent opinion and has reviewed the literature.

The report from Professor Stoodley is a typical response in an area that is essentially an evidence vacuum. The opinions provided, and also those relied upon by CASA, are based on very small sample studies and do nothing to look for bias or scientific rigour.

The risks that are posed by Mr McKenzie were serious and significant, prior to intervention and, subsequent to intervention all the available material, would indicate complete resolution of the problem. This does not negate the potential for recurrence but it must be accepted that what Mr McKenzie presents was asymptomatic, in the first place, and it is unclear how many other pilots have similar issues that are asymptomatic and diagnosed coincidentally. It is also questionable how many other pilots would show as much integrity and honesty as was the case with Mr McKenzie who brought his health status to the attention of CASA.

A totally arbitrary figure of one year has been imposed as the time for follow-up and follow-up investigation. Mr McKenzie had follow-up investigation much earlier at 3 months after the procedure, and I have no doubt would be happy to undergo further MRA investigations, on a more regular basis, if that were sufficient to convince CASA of his bona fide commitment to ensure both his own health and air traffic safety.

To impose arbitrary, essentially non-scientific qualifications on fitness to fly, appears contradictory to CASA’s commitment to impose rigorous scientific techniques to its assessment of pilots.

The rigour to which CASA has explored the validity of claims must be seen as a great credit to CASA, including the involvement of a Professor of Neurosurgery. Nevertheless the data upon which CASA and Professor Stoodley rely is, of itself, based on arbitrary dates and speculative risk factors which do not appear to apply to Mr McKenzie, who not only was shown to have complete resolution of the fistula at the time of performing the ONYX embolisation but the subsequent imaging 3 months later showed ongoing resolution without any recanalisation, which appears to be the major concern of all those wishing to stop him flying.

The point that needs to be considered is the fact that Mr McKenzie was asymptomatic at the time of his presentation, with regard to the fistula, and the hearing deficit was of a different aetiology. He did see an Ear, Nose and Throat surgeon, who organised the MRI, which produced the coincidental finding. Further, Mr McKenzie did follow through with neurosurgical opinion and spent a great deal of time considering his options and chose that which he felt was the safest and most reliable option.

Mr McKenzie has proven himself to be an absolutely reliable and straightforward witness and I have no doubt would be prepared to have further imaging, as may be required from time to time, and thus far he has had 3 month follow-up imaging that was normal, as was the imaging of the time of the procedure, and I am sure would be prepared to have further imaging if that could be agreed to be sufficient to allow him to reinstate his Class 2 license.

Having respect for all the risks, already identified both by CASA and Professor Stoodley, I tested Mr McKenzie’s higher centre function and he scored well above average. It is thus not a cognitive issues that is causing any concern.

Likewise there were no focal or lateralising neurological signs with no suggestion of raised intracranial pressure on fundoscopy and his hearing, that was the basis of the initial complaint, at least within the confines of an office examination, was completely normal. Corrected vision was likewise perfectly normal at N4 and 5/6, thus demonstrating that there was absolutely no current neurological basis upon which he should be denied access to flying, at this time, other than speculative risks based on poor quality data taken from small number surveys that have no relevance when applied to a single case.

This single case represents a completely normal individual with normal testing, who would be prepared to have further testing, if that was all that was required, to confirm his status, and that should be sufficient to respond to the arbitrary rules, based on pseudoscience from small case series. I would hope that commonsense would prevail to accommodate all who are involved.

[Falling Leaf]

From Clinton's original post:

I note also that CASA seized upon the specialist’s opinion about my not meeting the class 1 standard as being relevant to my not meeting the class 2 standard. Setting aside the obvious point that I don’t need to or want to meet the class 1 medical standard, this is yet another example of CASA relying on my specialists’ opinion as an objective truth only when it is unfavourable to me.

Does this suggest that if you are denied a Class 1 medical for any reason, say aeromedical risk, that you are also ineligible to be granted a Class 2?

I thought the whole purpose of the two different classes is that they represented differing levels of aeromedical risk. That is why CASA moved to allow DAMEs to issue Class 2 medicals on the spot, unless one had an excluded medical condition?

[Clinton McKenzie]

Having reviewed the Uber-specialist’s report in detail, even I am surprised by the extent of the express and implicit criticism of Avmed’s approach (although I obviously agree that the criticism is justified).

“To impose arbitrary, essentially non-scientific qualifications on fitness to fly, appears contradictory to CASA’s commitment to impose rigorous scientific techniques to its assessment of pilots.”

“Arbitrary rules, based on pseudoscience from small case series”.

“Speculative risks based on poor quality data taken from small number surveys that have no relevance when applied to a single case.”

Seems to me to identify some of the flaws in Avmed’s current approach quite accurately.

Avmed’s current approach is in my view a variation on what’s called “noble cause corruption”. It is in my view not corruption in the strict sense but rather bias and intellectual dishonesty.

According to Caldero and Crank (2004, p.17) noble cause is a “moral commitment to make the world a safer place.” This commitment is why most people join law enforcement agencies, and while this is an admirable goal, when the commitment to make the world a safer place becomes more important than the means to accomplish these goals, corruption may result. Sound familiar?

We all know what the “noble cause” is: The safety of air navigation.

Avmed seems to me to believe that it’s OK to spin the facts in whichever way puts a pilot in the worst light, that it’s OK to spin whatever data they can find to portray risks to be as high as they could possibly be portrayed when it’s convenient, that it’s OK to spoon feed a supposedly independent expert some selected studies and selectively emphasised passages from studies, and that the law is for others and not them. It’s OK in their minds because it’s done for the noble cause of the safety of air navigation. It’s OK in their minds because it’s a “conservative approach” and “what the public would expect”.

There is no special expertise required to do that. It’s easy. And, sadly, it’s easy to make a comfortable living out of it.

Meanwhile I went to my appointment with the DAME and underwent the usual intelligence-insulting and integrity-insulting Avmed process. The two pairs of glasses bull**** is still being imposed - a signal example of Avmed over-reach. As usual most of the time was taken up by the DAME battling with the MRS, with me telling him again that I underwent routine lung function tests when I was in the RAAF 20 years ago and underwent occasional ECGs as part of whatever the RAAF thought they were for when I was in the RAAF over 20 years ago, and that I had my tonsils out when I was four years old, all of which stuff has been told to them over and over and over and over and over and over again before. Naturally the DAME had to charge extra because of the extra time taken. As with so much that CASA does these days, there was never any data to show that the MRS was a causally beneficial response to any safety risk. When I suggested to the DAME that the MRS was effectively an entrapment system, he agreed.

My overarching concern is not so much about the careers and life’s passions that are destroyed by Avmed unnecessarily - that’s just money and careers and aspirations and other mere bagatelles. And it’s not so much the stultifying and destructive effect is has on what should be a vibrant and expanding general aviation sector. It’s more that it’s got to the point where it’s creating risks to the safety of air navigation in fact, rather than Avmed’s delusional view of what that concept means. Avmed’s current approach creates an enormous incentive for pilots not to raise potential medical issues at all with anyone.

[Squawk7700]

Avmed seems to me to believe that it’s OK to spin the facts in whichever way puts a pilot in the worst light,

Welcome to the world of “Policing.”

They willl never put anything positive “for you” in there... it’s how Police statements and briefs work. They are trying to charge you get get you convicted, so why would they put anything in their brief that may actually help you?

Once it’s there in writing and it is being read by you and others, you can’t simply have it removed and it looks bad. It will even have you thinking you are at fault if you read it enough.

[Sunfish]

Squawk, that is why “sex offender registries”, mandatory sentencing, strict liability and electronic health records are all such bad ideas; once an entry has been made “on paper”, the exact circumstances of the event and any mitigating circumstances are ignored. I am starting to see the associated corruption and work-arounds already appearing.

[Falling Leaf]

So does no-one have any insights into the different levels of aeromedical risk between Class 1 & Class 2?

[aroa]

squawk..aint only avmed that 'spin the "facts" Its a CAsA policy used to denigrate the victim. Any old BS will do.
The CAsA "corporate spokesperson" Mr Gobsome, is a master of the lie MO.

As for the difference between Cl1 and Cl 2...CAsA posits ...none. See their whacky excuses re CSF (gotta have a new acronym) volunteer pvt flights
'There will be more stress on the (cl2) PPL volunteer than Charter (cl1) CPL.' Really...?
Charter folk have stress of employment/boss pressure, passenger pressure, weather and time contraints.
The PPL volunteer has none of that except for the wx decisions

[Clinton McKenzie]

My lawyer sent the Uber-specialist’s report (quoted above at #116) to Avmed a couple of weeks ago. My lawyer then sent me an email that said he’d sent the report to Avmed. His email also said:I bet they [Avmed] sit on it [the report] until the conference [in April] – why? Because they can!I interpret my lawyer as suggesting that Avmed will delay consideration of the report because they are - to use the Australian vernacular - arseholes.

If Avmed in fact does delay just because they can, I will add unethical and unprofessional to my view of Avmed’s behaviour, on top of biased, intellectually dishonest and unlawful.

[aroa]

All that and more LB !!
Currently getting the run around for a simple PPL.
Could it be because you're NOT in MHR they want all this extra. Have to hunt up 2 years of doctoring ( 2 x DL medicals , eyes done/re cataracts 3 yrs ago) And a stress test which has never applied to a PPL in my past
And a MoCA test !! WTF is that.? Nobody locally knows but Dr Google tells all. Its an assessment to see if you're losing yr marbles.
(Montreal Cognitive Assessment)
So someone has just decided , in spite of having Drivers Licence tests ...which allow me to fly , not the VH one the same, but only the numbered one...They posit I'm going senile. Nor do they say the why, or give any reason...its just an edict.
I take that as an insult at my current state of robust good health.!!

Or perhaps this extra/ delay is because AvMed recently had to remove (not delete from their records, I bet) an old ASIC ID photo.
Revenge theatre comes easy to CAsA. Because they can.

[mrmoodyk]

My issue is similiar to Clinton's

[Sunfish]

Aroa. Payback?

[LeadSled]

And a MoCA test !! WTF is that.? Nobody locally knows but Dr Google tells all. Its an assessment to see if you're losing yr marbles.
(Montreal Cognitive Assessment)
So someone has just decided , in spite of having Drivers Licence tests ...which allow me to fly , not the VH one the same, but only the numbered one...They posit I'm going senile. Nor do they say the why, or give any reason...its just an edict.
.

aroa,
Cast your mind back ---- some years ago, within CASA there was this wonderful theory that public criticism of CASA was proof of two disqualifying conditions:
(1) Mental instability/insufficiency/degradation, and
(2) Not having an adequate, acceptable and approved safety ethos.
If my memory serves me correctly, this was around the time you were on the AOPA Board, so not much has change (except for the worse) in almost 20 years.
Tootle pip!!

[Capt Fathom]

If my memory serves me correctly



Don't let CASA / AVMED hear you say that!:uhoh:

[mrmoodyk]

I want to join the NSW Police and get into polair, I have a legal medicine report from a Prof Roy Beran and John Maitland (Ray Mancini put me onto him) who says I should fight for a class 1 as I've had two medicals denied. Currently doing an avmed again through Dr Arnaudon in Camden. I have a HR licence..

[aroa]

Someone earlier mentioned that the cost of a cl 1 had become too onerous., go lower for Cl 2
Now for the private pilot its the same. Having a go at the Austroads COMMERCIAL D.L. was big WOFTAM. Made no trucking sense for flying.!
The current Cl 2 runaround and all the extras thrown in, have/ will cost a bundle..might as well chuck it and save the money for fuel and maintenance of the numbered one.
CAsA has made discrimatory regs re the Pvt Drivers Licence....RAAus numbered a/c only.. Pigeon-holing bs.
CAsA has made COMMERCIAL* regs forcing those with a numbered machine to throw money at the RAAus monopoly.
All that 'annual fees' for everything money could be better spent on fuel and maintenance... and being able to afford to fly and keep current

* 'CAsA is a Safety regulator NOT a commercial regulator'.... ceo McComic big verbal upchuck, Senate hearing 2011/ 13

See what I mean about 'any old BS will do'.?

[Clinton McKenzie]

I'm advised that the arrival of the Uber-specialist's report in AVMED did not result in involuntary squeezing of their eyes shut, hands slapped to cover their ears and ululation such that AVMED was physically incapable of reading the content. What's more, I'm advised that AVMED have read the content and assessed it against the pseudo-scientific percentage waffle they've confused the AAT into believing in a past matter.

Accordingly, AVMED must have been making it up when it said this in the letter suspending my medical certificate:Please be advised, CASA is unable to make a risk assessment for your fitness to return to flying until 12 months has elapsed following your embolisation procedure.Surprising as it may seem to AVMED these days, even AVMED is subject to both the laws of physics and man-made laws. Not only could they, they were obliged to.

I'm advised that the only remaining issue in dispute is what kind of recurrent scanning should be done, and when. AVMED is pressing for the most dangerous form of scan - they demonstrated their ignorance of the various risks of the various kinds of scans during the stay hearing - and are pressing for it to be done, not on the anniversary of the most recent scan in November, but rather on the anniversary of the procedure in August. As is sadly usual these days, AVMED seems to me to choose the approach that will be most risky, expensive and inconvenient for the certificate holder. AVMED seems to me to be prepared to destroy the village to save the village - it's about 'safety' after all.

I've instructed my lawyer that I am completely uninterested in AVMED's views on these issues and will rely on the specialist's views on the most appropriate balance of risk and reward on follow-up scanning.

I will eventually post a 'lessons learned' out of all of this, but for those who have yet to take the hint: Be very, very careful about submitting to testing without knowing what it could coincidentally disclose. Some of you have what I had. And around 1 in 50 of you have a brain aneurysm. Now. Fortunately, the probabilities of that aneurysm rupturing are very low. As joseph w said earlier: "MRIs/CAT scans/Angiograms/whatever will show up all sorts of wonderous things that we more than likely would have been blissfully unaware of until we dropped dead at age 98 - from something completely unrelated...". I think we can confidently guess what AVMED will do if they find out that you have a "brain aneurysm". Imagine how much they could scare people with a term like "brain aneurysm" and selective quotes from the scariest 'studies' (just as they do with "vision deficiency" as in "colour vision deficiency").

[SCPL_1988]

Just recently filled in the CASA online application and what is disturbing is the
expectation that you have kept a record of every visit to a doctor in your life time.

Then there is the CASA Risk Factor Sheet, that shows a range of numbers and
provides no feedback on what affects those scores or what you can do to
change those scores.

Whats next, a DNA test to determine when your genetics will trigger the expiration of your
medical?

[Clinton McKenzie]

The MRS is, in my view, a system designed to entrap you and justify AVMED's existence.

An interesting irony of AVMED overreaching itself is that medical professionals and specialists are now actively assisting pilots to avoid being trapped. Medical professionals and specialists do not like AVMED effectively dictating the clinical management of people who aren't AVMED's patients, AVMED having arrogated itself into areas of expertise it does not have.

I suggest you track down a real DAME - one that's been around for at least a couple of decades, despite AVMED's bull****, and who has been commended to you by someone you trust - and ask him/her to walk you through the implications of the answers and permutations of the MRS.

[Cloudee]

Just recently filled in the CASA online application and what is disturbing is the
expectation that you have kept a record of every visit to a doctor in your life time.

Then there is the CASA Risk Factor Sheet, that shows a range of numbers and
provides no feedback on what affects those scores or what you can do to
change those scores.

Whats next, a DNA test to determine when your genetics will trigger the expiration of your
medical?

This link https://www.casa.gov.au/licences-and-certification/aviation-medicine/44-special-reports-and-tests-required-medical shows the risk factor chart and what affects the risk factor score. Basically they use sex, age, total cholesterol, LDL cholesterol, systolic blood pressure to get a number. You can lower the scores by having blood pressure under 113 and having low total cholesterol and high LDL cholesterol. You need to make sure the risk factor score stays under 14. This becomes very hard as you get older! Particularly if you are male. Not sure this would be accepted if females were scored higher than males purely on age.

[SCPL_1988]

"a biased, intellectually dishonest regulator"
An excellent description of an out of control government
authority that abuses its absolute power.

Now to vent.

After being away from Australia for decades, I'm shocked at the universal hatred pilots have towards
CASA.

Its reflected in the number of senior pilots who cannot afford the financial or emotional stress of a complying with all the CASA requirements that often include requirements that are not required by other ICAO countries.

Its tragic that a government department has grown into a monster that is out of control and beyond pale.

Its' own rambling writing shows the "intellectual dishonesty".

I noted that LOSA used the enforcement word "audit" whereas the FAA use the word "assessment".

The FAA use of the word "assessment" implies a collaborative approach.

The medical questions differ from that of the New Zealand application that is more realistic , more practical and actually covers more without being "intellectually dishonest".

CASA's medical questions appear to be designed for "entrapment", to be able to find a literal fly spot one the wall in order to gain a conviction for a false statement.

I agree that the "closing" of the application after you submit it, is offensive.
It is easy to forget to include answers to questions that could involve trying to recall
a visit to a doctor decades earlier about a matter that was so trivial you don't even bother to note it.

CASA fail to qualify their questions. Its overboard, its a tragic pretense of safety when its more about ever escalating the bureaucracy and justifying the expenses that they force pilots to incur such as the fee for submitting a report.

To project this forward, as to where CASA may be going,
take a look at New Zealand's $120 charge for filing a medical or their ability to charge $284 an hour for doing work on a medical certificate.

Its effectively penalizing those who have additional health concerns
that need addressing.

Its a form of intimidation, a disincentive towards full disclosure and fails to honour
the principle that safety interests are best served with a collaborative approach.

The CASA approach is turning a medical from an opportunity to meet with a expert on aviation medicine to a meeting with a representative of the CASA gestapo.

What is really offensive is CASA's name, its that word "Safety" that
is a political statement, a delusional idea that they are entitled to do anything they like to increase their own bureaucracy in the name of "safety" that is often the complete opposite.

Every other country refers to themselves as an "Aviation authority" or Department of Transport"
which is what Australia used to call its aviation authority.

Every time I call CASA I want to puke. You are forced to endure their endless passive aggressive dictatorial announcements that contain a message of fear and intimidation.

Its that "tone of voice" that you sometimes hear when you are talking with one of their "officers".
Its that same tone of voice you get from those who are accustomed to abusing absolute power.

Take the way they tell you that "no one is available" when what is really happening is you are going to join the queue to speak to someone. Its designed to mislead a listener into giving up on their call, to get rid of callers. That is, they don't want you to call them. Its part of the sick nature of their corporate attitude that is systemic, habitual and unfortunately, multi-generational.

The arrogance is mind boggling. They threaten to terminate a call upon being asked
any simple question or infer on the phone that you are stupid for asking a question to which the answer is obvious to them.

These are not public servants, or "representatives" but "officers".
When did that change occur?

My view is that the entire legislation needs to be rewritten to something that is modeled on the simple language and easy to follow language with the universal terminology of the FAA.

Why is it that CASA sees a need to remove every noun, adjective and acronym used by the FAA and replace it with some devious figment of a CASA narcissist?

The CASA name is offensive.
Civil and Safety are two words that need to be removed.

[thorn bird]

"Basically they use sex,"

Bugger that Cloudee, I'm not going to have sex with them.
What next, a camera in your bedroom to record your sex life!!
Its bad enough that everyone in CAsA down to the tea lady can
access your medical file without some miscreant getting of on
me and domestic tyranny "at it".

Oh sorry sex as in gender yes err right.

I thought gender was optional these days

SCPL_1988..........Hear bloody Hear.

[zanthrus]

Simple approach to AVMED. Tell the bastards nothing ....EVER,

[Clinton McKenzie]

CASA has issued me a medical certificate.

As noted above, AVMED must have been making it up when it said:Please be advised, CASA is unable to make a risk assessment for your fitness to return to flying until 12 months has elapsed following your embolisation procedure.As I also noted above, surprising as it may seem to AVMED these days, even AVMED is subject to both the laws of physics and man-made laws. Not only could they assess, they were obliged by law to assess.

AVMED seems to me to believe that they have to act lawfully only after someone insists they do. They only complied with the law in this case because I took them on. This is not the first occasion on which I have had to press AVMED to act lawfully.

An organisation that only acts lawfully when pressed to do so seems to me to be one with little-to-no corporate integrity. The tediously repetitive claims to be acting in the interests of the safety of air navigation is, in my view, merely a form of ‘noble cause corruption’. AVMED is, in my view, just a bunch of non-specialists who’ve been able to arrogate to themselves judgments they are not qualified to make, simply because they have the power of certification. And we have the Mafia-like threat implicitly made in an earlier post by nowluke: If you don’t comply with AVMED it could be bad for your health.

I repeat what the Uber-specialist said in his report, about AVMED’s judgments:“To impose arbitrary, essentially non-scientific qualifications on fitness to fly, appears contradictory to CASA’s commitment to impose rigorous scientific techniques to its assessment of pilots.”

“Arbitrary rules, based on pseudoscience from small case series”.

“Speculative risks based on poor quality data taken from small number surveys that have no relevance when applied to a single case.”

I despair at the fact that had this happened around the time I was working in CASA, the response of AVMED would have been: Well done in following up a potential medical issue ‘when in doubt’ and for getting the DAVF treated. Because your treating specialists say the procedure was a success, confirmed by subsequent scans, and because Australia’s foremost specialist in the area agrees, your medical certificate is no longer suspended. Go forth and fly safely. Because you’re obviously a responsible adult and you take these matters seriously, we know you’ll act on your specialists’ advice as to follow-up tests, if and as necessary.

CASA now wants the AAT proceedings to go away - move on everyone, nothing to see here. Not so fast, CASA... I reckon I’m owed a refund of the application fee to the AAT (as I got the last time I took CASA on by applying to the AAT) because the only reason you issued me with a medical certificate is that I took you on in the AAT. The application fee is not a small sum: $920. However, I could be wrong as there was a stay hearing. I’ll leave this issue to my lawyer.

I’ll get to a comprehensive post about lessons learned in a few weeks, but at this point I’ll note another one: We should all take them on every time they make a decision we don’t like.

All of us.

Every time.

The only thing necessary for the triumph of evil is for good men [and folks of other genders] to do nothing. Edmund Burke

[Cloudee]

Thanks for keeping the rest of us in the loop Clinton, it’s been very interesting, well done!

[Sunfish]

From a public service perspective, Clinton, I believe you might be askew in your conclusion that you somehow “won”. I think the AVMED Doctors won. Remember Roosevelt’s famous instructions to his supporters asking him to do something he was already in favor off? “Make me”.

What you have done is given an AVMED Doctor an ironclad, gold plated piece of paper- an incontrovertible specialists report, that provides him absolute career protection to his act of giving you your certificate. It now doesn’t matter to HIM if you have an accident, he did everything in his power to deny you, but you finally trumped him.

This is not to criticize you; well done, but until we work out how to prevent AVMED operating in this arse covering mode all the time, the embuggerance will continue.

[thunderbird five]

Wait.... what??? There's doctor's in AVMED????

[thorn bird]

Thunderbird,

QUACK....QUACK

[Far Canel]

Anyone been made to do a sleep study😳? I hear it’s a long dragged out process and $$$$, to come to the conclusion that you like millions of other people snore.

[Paul O'Rourke]

Anyone been made to do a sleep study😳? I hear it’s a long dragged out process and $$$$, to come to the conclusion that you like millions of other people snore.

I know a chap whom was made do a sleep test as he showed a hint of sleep apnoea. After he passed that test he was made do a wakefulness test, among some other tests. His experienced featured in an edition of AOPA last year. His all up costs were in the early thousands not including lost income and lost about 3 months of his 12 month validity. He passed his medical.

[Sunfish]

Sleep apnoea is the latest cash cow for the medical profession. Before that it was ADHD. Before that it was cholesterols.

[Clinton McKenzie]

It’s called ‘the medicalisation of normal’.

Very lucrative for the medical industry.

Very fertile ground for Avmed.

[Clinton McKenzie]

I’ll try to distil what I consider to be key lessons that may be of assistance to others.

As background I note that I have had more interactions with the medical system in just the last 18 months than in the entirety of the previous 56 years. In the previous 56 years my one or two yearly visits to a DAME were about it so far as interacting with doctors was concerned, aside from tonsils out at the age of 4, some guinea pig testing in the RAAF and some hearing issues as a consequence of noise exposure. Accordingly, it may be that all of the below is ‘durr-obvious’ and I’ve just been living in a different world than many others.

For example, when asked who “my GP” was, I’d say I didn’t have one - because I didn’t. But apparently everyone’s supposed to have their own GP. When I went to the specialist I was asked for my referral and I said “what’s that?” One of the more bizarre interactions I had was with a receptionist, to whom I finally said: “I wish to buy the expertise of the specialist you work for, in return for the payment of money. Is that possible?” The receptionist looked at me as if I were from another planet.

The other eye-opener has been the discovery of the extent to which pilot medical issues are now managed without Avmed’s knowledge. A related issue - probably causally connected with the first - is the extent of the open contempt that treating specialists and other experts have for Avmed.

Beware the “diagnosis”

This is the process through which a mere opinion magically transforms into an objective truth. Once diagnosed, you have a “condition” that has to be “managed”.

Despite the fact that the history of medical science and medical judgment is littered with research conclusions and diagnoses that turned out to be wrong, the current generation of medicos usually consider themselves to be the apotheosis of medical wisdom. And the medical ‘industry’ has a financial incentive to medicalise normal.

So be very careful about putting yourself in a situation in which you can be diagnosed with a “condition” which will provide Avmed with an excuse to intervene, intrude and destroy on the basis of its inexpert opinion. As joseph w said earlier: "MRIs/CAT scans/Angiograms/whatever will show up all sorts of wonderous things that we more than likely would have been blissfully unaware of until we dropped dead at age 98 - from something completely unrelated..."

A colleague was diagnosed with a condition about 6 years ago and Avmed intervened to destroy. The subsequent 6 years have demonstrated that the original diagnosis was wrong. But that is of no concern to Avmed.

As it turns out, I accepted the opinion of the specialist as to the existence of my DAVF. However, I have doubts about the correctness of the specialist’s opinion as to the classification of the severity of the DAVF. We’ll never know about the latter, because the former has been dealt with.

What we do know is that Avmed considered the specialist’s opinions on both those issues to be objective truths, but then ignored opinions expressed about the success of procedure to deal with the DAVF. Avmed preferred, instead, to intervene on the basis of “speculative risks based on poor quality data taken from small number surveys that have no relevance when applied to a single case” and apply “arbitrary rules, based on pseudoscience from small case series”. Not my words, but those of someone with more medical expertise in his big toe than a bunch of glorified GPs in Avmed.

Avmed is now, in my view, a force inimical to aviation safety

I’ve explained why, throughout this thread. As I said earlier, Avmed seems to me to believe that it’s OK to spin the facts in whichever way puts a pilot in the worst light, that it’s OK to spin whatever data they can find to portray risks to be as high as they could possibly be portrayed when it’s convenient, that it’s OK to spoon feed a supposedly independent expert some selected studies and selectively emphasised passages from studies, and that the law is for others and not them. It’s OK in their minds because it’s done for the noble cause of the safety of air navigation. It’s OK in their minds because it’s a “conservative approach” and “what the public would expect”.
There is no special expertise required to do that. It’s easy.


What seems to have happened is that Avmed has arrogated itself to a position of quasi-specialisation, simply because it has the power to issue and not issue medical certificates. Avmed seems to be suffering the delusion that having the power to certify somehow confers on Avmed some expertise it doesn’t have.

An analogous situation is the practical dictation by CASA of the content of an AOC holder’s Operations Manual on the one hand and the denial of liability for the consequences of compliance with that Manual on the other. Some folklore-propagating FOI says you’re not going to get your AOC unless your Operations Manual contains X but, by the way, you the AOC holder are entirely liable for the consequences of compliance with X.

Avmed practically dictates the “management” of a pilot’s “conditions” because the pilot isn’t going to get his or her certificate unless Avmed gets its way (or you have the time and money to take them on in the AAT). But this is often in the face of the opinion of the treating doctors and specialists who bear liability for their patient’s health and treatment. This is one of the reasons for Avmed being held in contempt.

It’s got to the point where some pilots are simply too scared to seek medical assistance ‘when in doubt’, or to disclose potentially safety-relevant medical issues to Avmed, for fear of consequential overreaction by Avmed.

Avmed’s response is ever-increasing procedural requirements during periodic DAME examinations that manifest a complete lack of trust of pilots, which results in a reciprocal lack of trust in Avmed. You don’t trust me any more? OK then, I don’t trust you any more.

Subject to the next lesson learnt, you should take Avmed on, every time

Every interaction I have had with Avmed since 2015 has involved unlawful behaviour on Avmed’s behalf. Every interaction. This is not my opinion: it has been conceded by CASA.

It started with the printing of “for CASA audit” as a purported “restriction” on my medical certificate. I had to pull them up twice - once in 2015 and then in 2017 when Avmed issued my medical certificate with that bull**** printed on it - to have it removed. As I said in my submission to the review of medical certification, medical certificates are not a blank canvass for use by Avmed to express its creative theories about how to save the world.

And as it turned out, this assertion by Avmed in its most recent decision was wrong not only as a matter of the laws of physics but also as a matter of man-made law: “Please be advised, CASA is unable to make a risk assessment for your fitness to return to flying until 12 months has elapsed following your embolisation procedure.”

It appears to me that CASA does not have the corporate integrity to ensure that Avmed understands that even Avmed is obliged to comply with the law, and ensure that Avmed understands that the medical certification system is defined and constrained by the law, not Avmed’s bright ideas. It therefore seems to me that it is left to us to make Avmed comply with the law. If not us, who?

Avmed doesn’t care if its intervention kills you

Taking Avmed on is costly and stressful. And Avmed doesn’t care if taking them on kills you financially, mentally or, ultimately, physically. (I am here reminded of Mr Carter’s Orwellian assertion, during the stay hearing, that: “CASA has a duty to protect Mr McKenzie’s safety, too”. That duty apparently extends to the dictation of scans that involve a risk of death. As I observed earlier, Avmed will destroy the village to save the village.)

This is a manifestation of the ‘Bull**** Asymmetry’: The amount of energy needed to refute bull**** is an order of magnitude bigger than to produce it.

It’s easy for Avmed to intervene on the basis of “speculative risks based on poor quality data taken from small number surveys that have no relevance when applied to a single case” and apply “arbitrary rules, based on pseudoscience from small case series”. The cost and stress of refuting that bull**** is orders of magnitude higher than the energy it took Avmed to produce it.

I feel the least healthy I have in my life, primarily as a consequence of the stress of dealing with Avmed’s bull****. And I haven’t much change left out of $10,000 spent on specialist reports and legal fees, even though we didn’t get to a substantive hearing in the AAT.

There’s an irony here: My ‘day job’ is administrative law and, accordingly, AAT and other other administrative law proceedings are mundane for me. I also have some insight into the detail of the aviation law. But it is because of my expertise and experience that I find dealing with Avmed’s bull**** so stressful. It’s like entering a parallel universe in which objective evidence, objective risk, disinterested decision-making and legal principle go out the window, simply through invocation of “the safety of air navigation”.

However, I don’t see what other choice we have, other than to fight them.

A special mention: Mr Anthony Carter

I’ve thought long and hard about how best to express my views about Mr Carter’s behaviour during this matter. Given that I understand he is a lawyer, I decided that the best way to express my views was through a hypothetical situation in which Mr Carter was working in my legal team and I was giving him some professional guidance. Here’s what I’d say, in those hypothetical circumstances:

AAT proceedings are inquisitorial, not adversarial. It’s not commercial litigation in which you are trying to use leverage and technicalities to ‘win’. AAT proceedings are not about ‘winning’ and ‘losing’.

You have a duty to protect the AAT from opinions based on “speculative risks based on poor quality data taken from small number surveys that have no relevance when applied to a single case”, not ‘defend’ those opinions.

You have a duty to protect the AAT from opinions based on “arbitrary rules, based on pseudoscience from small case series”, not ‘defend’ those opinions.

If you do not know why Deputy President Hack SC said this in the Bolton matter (Bolton and Civil Aviation Safety Authority [2013] AATA 941 (23 December 2013) (http://www8.austlii.edu.au/cgi-bin/viewdoc/au/cases/cth/AATA/2013/941.html?stem=0&synonyms=0&query=Civil%20Aviation%20Safety%20Authority)), we’ll need to arrange for you to do some remedial professional development:Dr Navathe’s witness statement concluded . Despite the fact that the statement does contain the declaration of duty required by the Guidelines it could not be plainer that Dr Navathe is an advocate for his own decision. I do not propose to have any regard to his opinions. For the future I would trust that CASA’s Legal Branch would exercise independent judgement in deciding what witnesses ought be relied upon and the content of their statements. They ought, obviously enough, be confined to matters that are relevant and witnesses ought be those who can truly provide an independent opinion.

It might be worth you refreshing yourself on the reasons of the AAT and Federal Court in [i]Re Medtest and Minister for Health and Ageing [2002] AATA 566; (2002) 70 ALD 580, Civil Aviation Safety Authority v Hotop [2005] FCA 1023; (2005) 145 FCR 232; 87 ALD 551, Re Tompkins and Civil Aviation Safety Authority [2006] AATA 591; (2006) 91 ALD 492, Re Transglobal Airways Corporation and Civil Aviation Safety Authority [2010] AATA 68; (2010) 113 ALD 218.

Although the above cases are about stay decisions, the overarching reasons are about ensuring the AAT’s ultimate order in a matter is effective. If the AAT has power to grant stays that have the positive effect of keeping an air operator’s certificate in force after it expired - as happened in a couple of the matters I’ve cited above - the AAT has power to grant stays that have the positive effect of keeping a medical certificate in force after it expired.

The effect of the position pressed by you in Mr McKenzie’s matter is that the holder of a suspended medical certificate is apparently deprived entirely of the right to any beneficial order from the AAT, simply because the procedure giving rise to the suspension decision randomly happened 5 months before the expiry date of the certificate, leaving insufficient time for the AAT to review the decision. It is in my view an absurdity and a perversion of the underlying policy of the AAT’s existence to conclude that an Applicant’s substantive rights and the AAT’s powers in aviation medical certification matters depend on the random coincidence that a reviewable decision happens to be made sufficiently in advance of a certificate’s expiry. There is no causal connection between the occurrence of potentially medically significant events and the date of expiry of a certificate.

I’d like you to consider the underlying reasons for the decisions in the AAT and Federal Court matters I’ve cited, extrapolate those reasons to medical certification matters, in the light of the underlying policy of the AAT’s existence, then come and discuss your views on the issue with me.

Finally, I understand from Mr McKenzie’s lawyer that he perceived that you and Dr Sharma “gloated”, during the conference, about Mr McKenzie’s concession that he undergo an annual scan of a kind that (you assume) is intrusive. If Mr McKenzie’s lawyer’s perception of your behaviour is accurate, I note that you (and Dr Sharma) are supposed to be disinterested and objective. “Gloating” about something disadvantageous to a certificate holder strikes me as manifesting an emotional and therefore inappropriate engagement with the substance of the matter. I don’t think it’s appropriate for a supposedly disinterested legal advisor and a supposedly disinterested administrative decision-maker to gloat about someone having to undergo a scan that entails a risk of death. The necessity and timing of scans should be decided on the basis of the opinion of independent, disinterested experts, taking into account the potential risks and benefits of those scans, not on the basis of the opinion of non-experts with an emotional engagement in the matter. However, I stress that Mr McKenzie’s lawyer may have misperceived your and Dr Sharma’s actions in the circumstances. Finally, and though not a legal matter, it might be worth you and Dr Sharma doing some googling about the scan in question. You might find that your assumption about the nature of the scan in question is inaccurate - hardly surprising, given that neither of you is an expert.

Epilogue

I note this from another thread on PPRuNe:Meanwhile CASA's CAAP 155-1, Aerobatics, still has a dangerously incorrect and unhelpful description of Va and furthermore is generally irrelevant after Part 61.

I also note that a friend recently reported to me that an FOI who ‘sat in’ on an IFR rating renewal chipped the pilot for not setting 25/25 for climb after take off in the piston twin he was flying.

It is bad enough that millions continue to be wasted on the never-ending aviation regulatory ‘reform’ dog’s breakfast that produces ever more complexity with little-to-no positively causal improvement in aviation safety in return for the cost. But millions are also now wasted on the peddling of dangerous operational folklore as well as what I consider to be the safety-inimical activities of Avmed.

It’s broken. I hope against hope that it won’t take a disaster for it to be fixed.

[SCPL_1988]

I'd describe CASA AVMED as a "Bull**** Factory".

I'd like to warn any older pilot about their current practice of looking for anything to add extra expense
to the cost of medicals. It would be interesting to know just how many plus 60 or plus 65 age pilots escape
a medical without any additional requirements.

Example, every one over say 65 has some hearing loss, its only a matter of time before a hearing aid is needed
or very expensive in flight testing.

Then there is eyesight, dam near every Australian has cataracts starting and CASA then require eye specialist reports at every medical
even when your eye sight passes the vision tests etc. What's the point? Either you pass or you don't.

There is no collaboration, they don't give a dam about your real health issues. You could have high blood pressure, high cholesterol and or a high PSA or other blood results come back that really do send warning bells but, CASA do not act on these very serious issues but
focus on finding "something" and seem to grasp at straws.

CASA has a reputation of piling bull**** on bull**** and it makes you wonder where they are going next.
An MRI on every renewal? Additional hearing tests every six months in case the hearing suddenly crosses a line?

They could call for a video recording for a tour of your rectum, bladder, stomach or anything else,
it could end up being as bizarre as asking for semen sample and a DNA test hunting for yet to be discovered
that lack the relevance applied in other ICAO countries.

That's where I think CASA let Australia down, they see themselves as being obliged to have more restrictions and demands than
any other jurisdiction.

Then of course there is the reality that a CASA medical can take all of 60 or 120 seconds with the actual CASA doctor.
I've seen some fast FAA medicals in my time but I've never seen anything faster than a CASA DAME. At that rate, they could
make $100,000 a week.

[thunderbird five]

LIKE button pressed

[aroa]

LIKE pressed again.
With ref to Clintons post #147 and comments therein...
1 . SPIN and BS. Those in CAsA eg P Gobsome , and many others that I am aware of, will say and do anything to make their " case". Lies BS whatever it takes.
Sure makes the CAsA Code of Conduct stating Honesty, Integrity, Truth and Fair dealing a motherhood crock of very smelly POO. NOBODY in CAsA tales the slightest bit of notice of it.

2. CORPORATE INTEGRITY. Sorry to say THERE IS NONE.! When the current ceo is happy to join in to pervert the course of justice, when the Head of Legal is upfront in the action, as well as others...and altho trained in the law, lectured in the law, Dr Discrepancy aka Smart Aleck does obviously NOT believe in the Rule of Law...and is quite happy to see criminals let off the hook..as per another ceo's requirement.
NOT poor wording in the FALSE SWORN statements, as claimed by , Aleck, but outrageous and BLATANT LIES- about something that NEVER occurred
The "agency" that is CAsA is beyond rotten to the core, its a stinking cess pit that is costing this nation mega millions and destroying an industry in the process.

3. AVMED. Is but one of the corrupted principalities that make up the failed State of CAsA.
FOIs with their own opinions and sometimes unlawful at that, AWIs that just love nitpicking and laying down their 'law'. And the 3 AWIs that I was involved with, Larard, RETSKI and Clark..you wouldnt want them inspecting yr grandkids' Tonka toys !

4. BUREAUCRATS V CITIZENS. The Bs have the time, the money and a major CYA systems behind them. Any costs involved, the victim just has to suck it up.
If they feel stressed...need a little holiday aka " stress leave" at the taxpayers expense.
No such thing available to the victims/citizens

5. THE ERECTION ELECTION. MIght be for some, the 'winners' , but dont think too many in the Aviation Industry will be getting excited about any radical, much needed reforms and changes the put GA back an a vibrant growing track. So much for 'democracy' and our individual freedoms.
CAsA is a free range 'agency' with NO oversight and has become a Law unto Itself.
So sit back and enjoy the 'same old same old'

[SCPL_1988]

aroa, I understand what you are trying to articulate, however we stand the risk of just being
seen to "vent" and tire biting with out accurately stating the issue and avoiding "steam".

Your entire last post could be summarized with just part of your last post.
"CAsA (has) NO oversight and has become a Law unto Itself."

My limited understanding is that the legislation of CASA is decided by Parliament and it will take
a majority of politicians to support the disbanding of CASA and making the changes to bring into
comparison with the efficiency and simplicity of the FAA.

The first thing that has got to go is that word "Safety", its a subterfuge for an unlimited expense account
billed to the pockets of everyone in Aviation with destructive financial consequences to the Australia economy.

Its a psychological and economical cancer or millstone that destroys the aviation industry and the damage done is
often permanent.

Take the slow but sure destruction of rural airports and the habit of changing "landing fees".
If the politicians had to pay a fixed charge of paying $25 for stopping at their local gas station
then they might just get the message.

Its the old story, absolute power corrupts absolutely, and its that total lack of accountability
that further encourages endless escalation of their abuse of power.

I hear AOPA is now working on bringing change to CASA.
Would anyone like to pick up this ball?

[aroa]

Not much point in just 'venting' if you cant give examples. And I'll keep letting off steam until justice is served.
CAsA hates criticism and having the truth put out there. All the more reason to keep up the publicity.

While AOPA is 'working to change CAsA Very commendable. Such endeavor has been going on for how long ??
BUT only UNTIL enough Politicians, with sincere interest and fortitude finally get the message and 'will pick up the ball', ..GA is stuffed.

[Sunfish]

Given what has been revealed about water shenanigans in the Murray Darling basin, visas for mates and a whole lot of other scams by politicians, public servants at both state and Federal levels, on all sides of politics, why should anyone be surprised at the antics of CASA?

The sad sad part is that the industry is going to inevitably respond in kind. Probably starting with flight training establishments for foreign students if the Four Corners report tonight into university shenanigans involving overseas students is any guide.

On the Avmed front, anecdotes suggest that its systems are already broken to the point where lying (or being economical with the truth) by doctors and pilots is the only viable option because the system otherwise produces unjust and counterproductive outcomes.

Government, like the proverbial fish, is rotting from the head. I’ve heard labor and liberals lambast Clive Palmer recently; are they any better themselves?

[Ollie Onion]

I normally have to do a sleep study every renewal as although I show NO signs of Sleep Apnea my BMI is 31 (limit 30 when over 40 years old) , neck circumference is 43cm (limit 42 when over 42 years old) and I am over 40 years old. For 3 years in a row now the sleep studies have all shown that I don't snore, and do not have sleep apnea. Yet every year I know its coming, I have to admit I have never found CASA to be too bad with the processing times etc, I can normally get the study done within the two month medical extension resulting in no down time. I did peak at a BMI of 35 which through a lot of lifestyle change is slowly coming down, I am realistic in that I know that as long as I am above the acceptable limits this is just what has to be done. The studies that I have done are just at home, self administered and you then send the machine back to the clinic who processes it and sends all of the results through to the DAME, it takes around a week.

[Clinton McKenzie]

Hi Ollie

Has any specialist advised you that the ongoing annual sleep studies are clinically necessary?

You are of course free to choose to comply, without protest, with whatever recurrent testing Avmed chooses to impose on you, based on Avmed’s inexpert opinions. I’d merely note that Avmed bears no liability for the risks or costs or medical efficacy of the recurrent testing it dictates.

And you can always get your BMI under control without government supervision, if you want to.

[Super G]

Far Canal, if you can possibly avoid it, DO NOT DO A SLEEP STUDY! invariably the clinic that does the study WILL find a reason to sell you an extremely expensive piece of equipment which you will not be able to tolerate and make your night's sleep even worse. In addition if you were referred for the sleep study by your DAME they are obliged to report the results to CASA AVMED and you will be in their clutches for LIFE!

If you are concerned about your sleep then by all means have the sleep study but have it referred by a non DAME, ideally a doctor that doesn't know you're involved in aviation.

As mentioned elsewhere in these pages 'sleep apnea' is the new medical cash cow and these clinics and the wider sleep industry are making a motza. Worse still CASA AVMED aids and abets them by treating 'sleep apnea' as a life threatening medical condition. The weird dichotomy is that CASA does not require every pilot/ATC/engineer/flight attendant to compulsorily take a sleep test to discover their apnea status. You only fall into their clutches if you stupidly (like me) tell your DAME that you wish you could get a better night's sleep and then go for the sleep test.

So the important lesson here - if your DAME asks 'how are you sleeping?' or 'do you ever have day time sleepiness?'. The correct answers in order are 'I sleep like the dead' and 'I am alert and full of energy all day long, thanks for asking!'

[thunderbird five]

A fella I worked with some years ago truthfully told his DAME that he had a glass of wine each night with his dinner. This somehow flagged him as a possible alcoholic and he had to jump through all sorts of expensive hoops to clear his name. Absolute true story, not "I heard about some guy...."

[josephfeatherweight]

Glass? Glass of wine?? If you open a bottle, you've gotta polish it off, surely?

[Stickshift3000]

A fella I worked with some years ago truthfully told his DAME that he had a glass of wine each night with his dinner. This somehow flagged him as a possible alcoholic and he had to jump through all sorts of expensive hoops to clear his name. Absolute true story, not "I heard about some guy...."

Colourful stories, gossip and hearsay involving AvMed don’t surprise me at all, I saw the disjointed machine in action for myself.

Upon starting ab initio flying training, I applied for a Class 2 medical. The DAME asked whether I’d ever operated machinery under the influence of alcohol; I advised the DAME of a drink driving offence a decade earlier, I also voluntarily completed an alcohol intake questionnaire (at the suggestion of the DAME). I was at the time usually sharing a bottle of wine on the weekend with my partner, and having <5 stubbies of beer a week. CASA subsequently advised that I had “admitted” to consuming alcohol and was required to undergo blood testing for a biomarker of alcohol abuse (carbohydrate-deficient transferrin [CDT]). Not many labs conduct this analysis (due to low demand), and by the time I could get a doctor appointment and referral, it took a number of weeks to get results as the analysis is also not conducted often. Results of the test were fine (I had no reason to doubt this).

Due to advising of my drink driving offence I was also requested to provide a police check so CASA could determine that I was a fit and proper person. Funnily enough, this is not a valid reason for VicPol to issue a police check, so I had to lie and state that it was for an aviation ‘job’, by then I was getting sick of the appointments (time off work) and paperwork I had needed to gather and provide...

It took greater than 4 months to receive my medical (with included conditions and reduced medical period). In that time my flying training was severely restricted as I wasn’t allowed to solo. To say my skills and safety in the air deteriorated is not an overstatement, I basically had to start all over again.

This was my first interaction with our aviation regulator and I was appalled at their approach. I myself have a decade of regulatory experience: CASA is not adopting a ‘risk-based’ approach (particularly with regard to reducing regulatory burden), and assumed I was guilty without adequate information. I offered all the truth to my DAME, and felt that I was penalised by CASA for doing so; this is a very poor regulatory model as there is no incentive for regulated entities - you and I - to comply.

Many pilots I now know advise students to “tell them nothing”, I hear it all the time and I now understand why! After this dealing with CASA, I promptly opted out of ‘My Health Record’; I can only imagine one day in the future that CASA will overreach, abuse their powers and submit a request to court for the release of a pilot’s private information during the course of an investigation.


p.s. I am a fit young person with (fortunately) very few health issues in my life, I genuinely feel for those at the other end of the spectrum and their dealings with CASA.

[thunderbird five]

Thank you for sharing your story.

[Sunfish]

Stick: CASA is not adopting a ‘risk-based’ approach (particularly with regard to reducing regulatory burden), and assumed I was guilty without adequate information.

CASA is adopting a risk based approach - minimising the risk to their careers, not the general public. I don’t blame them for this.

Under current law and regulation, there is no upside for them in allowing you to fly. Period.

On the other hand, if you crash an aircraft and injure a passenger or bystander, and it can be alleged by the newspapers that alcohol abuse played ANY role in the accident, then the CASA staff who let you fly have lost their jobs if it can be shown that they should have detected your drinking history.

You have to be fair to CASA AVMED, they are only trying to keep their jobs. They have no choice. When you tell them something, they HAVE to act or they risk losing their jobs!

[Pinky the pilot]

You have to be fair to CASA AVMED, they are only trying to keep their jobs. They have no choice. When you tell them something, they HAVE to act or they risk losing their jobs!

So, Sunfish; Are you therefore saying/implying /inferring that we should 'tell 'em nothing!':}:E

Think that someone has already suggested similar.:E

[Sunfish]

No Pinky, I am saying that the regulations are such that CASA is forced into overkill by the existence of new tests for all sorts of conditions.

Sleep apnea is a good example.The regulations need to be changed. What happens if next year a test is divised that predicts propensity for strokes ten years out? Is CASA then going to deny medical certificates on the grounds that you have a long term risk?

Another example. https://www.dailymail.co.uk/sciencetech/article-7022667/Netflix-style-algorithm-detect-DIE-heart-attack-90-cent-accuracy.html

I have given up alcohol and can report that the freedom from worrying about Police, DUI and CASA is quite liberating. I might now be boring, but am in demand as the designated driver :)

[thunderbird five]

Readers, take a look at the Class 2 medical regulations CASR Part 67) as an example. (and probably all the Part 67 medical regulations)
CASR 67.155 Who meets medical standard 2.
There is no mention of sleep apnoea. It's 100% pure fresh steaming BS. Yes, it appears in their DAME guidelines - which are not regulations that you must abide by. It's BS. And people fall for it. Just say no to BS.
Also search the Part 67 regulations for these words: Height. Weight. BMI. all of which are lead to the sleep apnoea conclusions.
Height, or weight, are not declarable items within a Class 2 medical standard. They are using information gained improperly from you, against you. Yet, we cannot pass GO without declaring those things. It's not right.
(Clint - your thoughts on that?)

[lucille]

I have given up alcohol

Phoooahh, that’s a bit extreme isn’t it?

[Sunfish]

Lost 6kg. too.....:;)

[Pinky the pilot]

I am saying that the regulations are such that CASA is forced into overkill by the existence of new tests for all sorts of conditions.
Which only creates the scenario of a CASA bureaucrat saying in effect;
'Your career or mine goes down the tube. Better it's yours!' :mad:

[Clinton McKenzie]

Readers, take a look at the Class 2 medical regulations CASR Part 67) as an example. (and probably all the Part 67 medical regulations)
CASR 67.155 Who meets medical standard 2.
There is no mention of sleep apnoea. It's 100% pure fresh steaming BS. Yes, it appears in their DAME guidelines - which are not regulations that you must abide by. It's BS. And people fall for it. Just say no to BS.
Also search the Part 67 regulations for these words: Height. Weight. BMI. all of which are lead to the sleep apnoea conclusions.
Height, or weight, are not declarable items within a Class 2 medical standard. They are using information gained improperly from you, against you. Yet, we cannot pass GO without declaring those things. It's not right.
(Clint - your thoughts on that?)Hi T5

My view is that it's just one of the many manifestations of CASA Avmed overreach and exaggeration of risk. They've arrogated themselves to a position in which they presume to override the clinical opinions of the people with the expertise and liability for the health and treatment of their patients who happen to be pilots. My opinion is that CASA Avmed's behavior is, apart from the other comments I've made, simply unethical.

CASA Avmed is effectively dictating procedures that treating experts do not consider are, in all the circumstances, necessary, and CASA bears no responsibility!

Meanwhile, on my reading of the 'fine print' on an application for a medical certificate from CASA Avmed, you are purporting to 'consent' to them using information about you in their 'research' by submitting the application. Again, on my reading, there was no box to tick refusing consent. If my reading is correct, that's not "consent". That in my opinion is called "duress".

CASA Avmed seems to me to be on a mission to try to prove to the world that they know better than people with real expertise, but the main outcomes being achieved are the alienation of those people and their pilot patients.

I note a couple of key passages from Dr Rob Liddell's submission (here: https://www.infrastructure.gov.au/aviation/asrr/submissions/files/069_r_liddell_24_jan_2014_redacted.pdf ) to the aviation safety regulatory review. Dr Liddell was the Director of Aviation Medicine (which position subsequently became the Principal Medical Officer).
I suspect that due to my previous role in CASA, I seem to attract many pilots who are totally confused and despondent at their medical certification by CASA aviation medicine. This involves conditions such as head injury, hearing, cardio vascular disease and prostate cancer, where the opinions of the pilots own specialist doctors are ignored and stringent and expensive repetitive imaging and blood testing is required if the individual wishes to retain their medical certificate. On a weekly basis I receive requests for assistance by pilots with conditions ranging from renal stones to early type 2 diabetes where the pilots own specialist’s advice is ignored by CASA and further expensive or repetitive testing in required to obtain a medical certificate.

The dangerous result of CASA’s draconian regulatory measures is that now many pilots tell CASA as little as possible about any medical problems in order to protect themselves from expensive and repetitive investigations or possible loss of certification . Most pilots are responsible people and they have no desire to be in charge of an aircraft if their risk of incapacity is unacceptable. When their DAME and their specialist believe they meet the risk target for certification without endless further testing demanded by CASA and the advice of their own specialist is ignored by the regulator then the pilot’s lose confidence in the regulator."The dangerous result of CASA's draconian regulatory measures...". Those words would not have been used lightly by a professional like Dr Liddell. And he knows what he's talking about.

In his submission to the CASA medical certification standards discussion (available here: https://www.casa.gov.au/standard-page/responses-medical-certification-standards-discussion-paper) Dr Liddell said, among other things: My reason for [making a submission] is that as a DAME performing in excess of 400 medical exams on pilots a year, I have been on the front line of seeing the wastage of pilots that fly privately (class 2 medical) from the industry due to the cost and effort required to maintain certification. We are now watching the decimation of the private pilot sector of general aviation with activity numbers down by nearly 50% from historical norms.
...
In my opinion the most urgent requirement is to rescue the private and recreational sector of the industry by altering the management of the class 2 medical certification system. The certification of private pilots in Australia is well out of step with what I have experienced in other major aviation countries such as the USA and the UK.As I said in my submission to the medical certification standards discussion, CASA Avmed has not provided any evidence to show that its relatively-recent change in behavior was a causally positive response to a substantial increase in medical-related accidents and incidents. That's because there was no such increase and, in any event, as Dr Liddell and others have pointed out in other terms, CASA's Avmed's "draconian regulatory measures" have had a "dangerous result".

Great to see a ray of hope across the ditch: The head of the NZ CAA has seen through the CVD bull**** propagated by various Avmed zealots.

[Captain Spock]

Wow Clinton what a saga. I’m currently involved in a medical tussle with CASA. I won’t go into details now as I’m contemplating legal action. Are you able to contact me on 04xxxxxxxxxx for a chat. Understand if you can’t/ don’t want to . Cheers Captain Spock

[Clinton McKenzie]

Will call some time over the weekend.

[Captain Spock]

Thanks for the chat and the advice Clinton. I must say I feel a lot better and more confident after speaking with you. I’ll keep you posted on my progress. regards Spock