aeromedical certification · • 1 out of 200 pilots have two or more duis. a1a aviation medicine,...

Aeromedical Certification Current Issues

Ian Blair Fries, M.D.Lawyer-Pilot Bar Association

Vero Beach, FL March 7 , 2019

Who I Am

• A1A Aviation Medicine, Inc. • Vero Beach, Florida• HIMS designated Senior AME• Focus on Special Issuances• TBM 900.

A1A Aviation Medicine, Inc.

Ambien

• 24 hour wait before flying

• 1 to 2 times a week


Pilots Only

• Do you drink alcohol?

• If you are a teetotaler. • If you are alcoholic and/or

addict in recovery you are excused from the next section.


Traffic Stop

• Police request Breathalyzer test–On what basis ?–Must you comply ? –Should you blow ? –What must you report to FAA ?


Why Monitor ?

• Speedometer • Radar detector • Oximeter • Breathalyzer


Breathalyzer

• BAC = Blood Alcohol Concentration• Legal Limit States and Canada is

0.08%• As of December 30, 2018 Utah’s

BAC is 0.05 percent.• Commercial Drivers 0.04%. • Under 21 years zero tolerance.


Breathalyzer

• Wait 15-20 minutes after last drink.• Breathalyzer warms up. • Take a breath and blow smoothly

until hear a click. • Sample collected from alveolar air

that has equilibrated with blood gases.


Questions

• Police see dark headlights• Police stop pilot after paper

cup is thrown out a window• Asks pilot driver to blow• Pilot agrees because he has

carefully calculated his intake. A1A Aviation Medicine, Inc.

Alcohol Facts

• Beers 2% to 8% alcohol• Wine 5% to 20% alcohol • Vermouth 20%• Sake 17% to 20%• Gin, Vodka, Whiskey

– 80 proof = 40%– 100 proof = 50%

• What is a standard drink ? A1A Aviation Medicine, Inc.

Questions

• Pilot Calculated < 0.08 BAC• Blew 0.11 and 0.13 BAC• Arrested for driving while

intoxicated.


Alcohol Facts

• We are poor judges of our level of intoxication.

• The more we drink the worse our judgement. • Tables and calculations based on alcohol

quantity, time since ingestion, body weight and sex are inaccurate.

• A designated driver does not drink at all. • Consider a Breathalyzer.


Drinkology

• FAA now fully investigates the FIRST driving while intoxicated event. – Motor Vehicle

• Car, boat, snowmobile, golf cart, ATV• Past alcohol or drug use history• Abnormal liver function tests • Pancreatitis, hepatitis, GI bleeding• Cardiac arrhythmia “Holiday Heart”


DUI Facts

• DUI driver has likely driven 80 times drunk before arrest – Sentinel event

• One third of all DUI arrests are repeats.• 50% to 75% of convicted drunk drivers

continue to drive without a license. • One out of three of us has been in an

accident with alcohol involvement !• 1 out of 20 pilots have had a DUI. • 1 out of 200 pilots have two or more DUIs.


Required Reports

• Any motor vehicle violation/action involving alcohol or drugs requires a notification letter to FAA Security and Hazardous Materials Safety Office (AXE-700) within 60 days.

• Report each action, even if due to same event. Counts as only one.

• Arrest is not specifically addressed. A1A Aviation Medicine, Inc.

Required Reports

• Report DUI on all subsequent MedXpress applications. This includes arrests.

• Both Security and MedXpressreports are required.– Reporting to an AME within 60 days

does not substitute for an FAA Security report.


Stratification

• 0.08 to 0.149 BAC requires a preliminary substance abuse evaluation (Likely by a SAP). – By a physician addiction specialist

or psychiatrist for Class I • Depending on findings, further

investigations and/or testing may be required by FAA. (0.08 case)


Professional Pilot

• On duty 0.04% is a positive DOT test.• 12 hours bottle to throttle and BAC no

more than 0.02% for most airlines. • Airline Pilot after 8 hours on duty blew

0.022%. • 20 hours before the test he reports 2

vodkas and 2 whiskeys over one hour.


Drinkology

• 0.15 – 0.19 BAC • Evaluation by board

certified addiction or psychiatric physician,preferably HIMS trained

• Modified HIMS program.A1A Aviation Medicine, Inc.

Drinkology

• 0.20 BAC or pilot REFUSESalcohol testing on a traffic stop -FAA assumes pilot is an alcoholic.

• Full HIMS program required to obtain Special Issuance.

• Lose certification for 6 months, perhaps 2 years or longer.


Drinkology

• FAA considers a second DUI -no matter how old and no matter the legal status - proof of alcohol abuse. HIMS required.


Drinkology

• FAA takes independent medical certificate action even if charges reduced to less than intoxication (e.g. reckless driving), charges dismissed, or case expunged.

• Court ordered evaluations, treatment, and education do not satisfy FAA.


What is HIMS ?

• Human Intervention and Motivation Study (HIMS)

• ALPA-FAA cooperative program– Originally for Major Air Carrier Pilots– Rehab less expensive than training a new pilot– Since 1975 >6,000 pilots returned to duty – Currently >1,300 flying with HIMS SIs– 85% of pilots in HIMS recover and receive a SI– 12% relapse once, 2% twice, 1 pilot three times


HIMS Program

• 30 day or longer residential program• Detoxification (withdrawal) if necessary• Formal group aftercare• Alcoholics Anonymous or Narcotics

Anonymous 90 times in 90 days, and then typically three times a week.

• AA or NA and Pilot SponsorsA1A Aviation Medicine, Inc.

HIMS

• HIMS AME typically monthly meetings• Documented Complete Abstinence • Random testing for alcohol and other

substances – regardless of specifically abused substance. 14+ times/year

• Soberlink – facial recognition


Special Issuance

• Typically 6 months grounded• Good recovery demonstrated• Psychiatric & Neuropsychological

Evaluation and Testing prior to SI. • Cost $10,000 for first year.• Little if any coverage by medical

insurance, unless a major airline pilot.


Special Issuance Granted

• After SI can fly, but HIMS continues– HIMS AME visits– Random testing– AA, NA, BOAF, after care, sponsors– Total program 3 to 5 years, but may continue

for entire career. (Previously was 2 years)– Abstinence for as long as medical certificate

is maintained – even if SI has ended. A1A Aviation Medicine, Inc.

HIMS Expectations

• It will be longer then you think• It will be more difficult then you think• It will cost more than you think


FAR Definitions

• Substance Dependence (Addiction)– Increased tolerance (Pilot with 0.33 BAC)– Withdrawal symptoms– Impaired control of use– Continued use despite damage to

• Health• Social, Personal, or Occupational

FunctionsA1A Aviation Medicine, Inc.

FAR Definitions

• Substance Abuse– Physically hazardous (DUI)– Makes a person unable to safely

perform as a pilot (toll booth error)– DOT drug test failure or refusal– BAC 0.04 or greater on DOT test

• Both definitions are specific to FAA medical certification – not DSM-5


Pilots’ Substances

Drug of Choice RelapseAlcohol 91% 12%Cocaine 2% 24%Opiates 2% 42%Rx Opioids* 1% 33%

HIMS relapse rate 15%AA relapse rate 60%


HIMS for Drugs

• Similar to alcohol protocol• Typically longer before and after

SI, because relapse rate is two to three times higher than alcohol.


MARIHUANA

• State laws allow recreational (9 states) or physician prescribed use (23 states & DC).

• FAA considers Marihuana in any form and for any reason an illicit substance – Schedule I with Heroin, LSD, Ecstasy


MARIHUANA

• CBD (cannabidiol) products• FDA approved seizure drug, Epidiolex• Unregulated CBD products often

contain THC (tetrahydrocannabinol) and will show up as a positive on DOT and other testing.

• FAA considers no form of marihuana or byproducts compatible with aviation. A1A Aviation Medicine, Inc.

MARIHUANA

• If you ever used Marihuana…• If you have a positive test for

Marihuana…– Passive or inadvertent exposure

is not an acceptable excuse• You will need to be in a HIMS

Program. A1A Aviation Medicine, Inc.

Risky

• Substance possession or sales– Georgia beach possession – Marihuana candy in car– Cocaine sales Hong Kong

• Positive alcohol or drug test by public or private employer, even unrelated to piloting or driving.

• Marihuana mentioned to chief pilot. • New MedXpress examples.


VA Disabled Pilots

• Department of Justice, U.S. Attorney’s OfficeNorthern District of California August 28, 2018

• Four bay area aviators arraigned for false statements (on MedXpress) - PTSD (2), major depressive disorder, tension headaches

• Pilots allegedly lied about medical disability benefits from Department of Veterans Affairs.

• Aware of at least 18 cases – so far. • Excused if corrected and not mental diagnosis.


BasicMed

• Transitioning from Special Issuance to BasicMed.

• FAA will not accept a surrendered SI medical.

• Must complete all requirements, and then transition.


FAA Communications

• Oklahoma City medical certification phone services.

• FAA cannot accept electronic medical documents (pdf) except ECGs.

• OKC and DC separate computer systems.• FAA advises 10 business days to scan

documents before seen by analysists. • New computer system promised by 2020.


FAA Communications

• Lost documentation. • Delayed decisions – 90 days.• Administrative vs medical delays• Government shutdown• Outside consultants• Diagnostic panels.• Internal Certification Panel (ICP)• Neuropsychological testing.


FAA Communications

“Please note that your medical certificate has not been denied; however, if no reply is received within 60 days from the date of this letter, we will either refer your case for legal enforcement or deny your application…”

(underlining as in FAA letter)A1A Aviation Medicine, Inc.

RECOMMENDATIONS

• Do not drive after drinking.– If you do, use a Breathalyzer

• Don’t be a NO BLOW PILOT• Do not possess or use Marihuana

even if prescribed and even in states where legal.

• All communications with FAA via certified or tracked mail.


RECOMMENDATIONS

• Consider an aeromedical consultation as soon as possible– After a DUI– After a significant medical issue – Before you complete MedXpress– To correct a MedXpress error/omission– Before you respond to an FAA request


QUESTIONS


aeromedical certification · • 1 out of 200 pilots have two or more duis. a1a aviation medicine,...

Documents