Witnesses before a recent hearing of the aviation subcommittee of the House Transportation and Infrastructure Committee said that the Federal Aviation Administration is making progress in improving its oversight of the Airman Medical Certification (AMC) process.
But the U.S. aviation agency must tighten oversight of pilots’ medical fitness to ensure that they are healthy enough to fly and don’t pose a hazard to others, the U.S. Department of Transportation’s inspector general stated.
The FAA determines whether airmen are medically fit to fly. In most cases, a medical condition would not preclude a pilot from obtaining a medical certificate, although the FAA requires these conditions to be disclosed and evaluated by an Aviation Medical Examiner (AME). There are a handful of disqualifying medical conditions, including diabetes, heart problems, neurological disorders and mental illness that would keep a pilot on the ground.
While the FAA-required medical exams have some ability to detect disqualifying conditions, the exams rely heavily on self-reporting. And many conditions, including severe mental problems, may not be readily apparent to an AME seeing an applicant one time.
With over 600,000 pilots holding FAA medical certificates, the aviation agency faces a “potential systemic problem,” said DOT Inspector General Calvin Scovel, whose office reviewed the files of 40,000 pilots in 2005, as part of Operation Safe Pilot, finding that eight percent (3,200) were getting Social Security disability benefits, including those for medically disabling conditions. The IG investigation uncovered “egregious cases” of airmen lying about debilitating medical conditions on their applications for AMCs.
As a result of the probe, the DOT recommended that the FAA coordinate with the Social Security Administration and other providers of medical disability to identify individuals whose documented medical conditions are inconsistent with sworn statements made to the FAA. The IG also recommended that the application form for an AME be amended to ask applicants whether they are currently receiving medical disability payments.
(Social Security disability benefits are based on 100 percent disability, disqualifying the applicant from holding an AMC in virtually all cases. However, Department of Veterans Affairs (VA) disability benefits, for example, cover a wide range of gradation for disability, from minor to total, and many conditions that would qualify for VA benefits would not necessarily disqualify the applicant from legally flying an aircraft.)
In 1987, an enforcement policy was implemented following an IG investigation of failure to disclose alcohol- or drug-related motor vehicle convictions on the AMC application. And the FAA’s own research has documented hundreds of fatal accidents where pilots failed to disclose potentially disqualifying medical conditions on their AMC applications.
In a study of every fatal accident (386) between 1995-2005, the FAA researchers found toxicology evidence of serious medical conditions in nearly 10 percent of pilots. Fewer than 10 percent of the medical conditions were disclosed to the aviation agency. Furthermore, of the 386 pilot included in the study, nearly 40 percent were rated for air transport or cargo operations, showing that the falsification issue is not limited to recreational general aviation pilots.
Mitchell Garber, a medical officer for the National Transportation Safety Board (NTSB), testified that lying on the AMC can have fatal results. Five years ago, a commercial- rated pilot performing wolf survey flights for the Michigan Department of Natural Resources was killed when his plane crashed. The aircraft checked out. The pilot had serious medical conditions, including congestive heart disease and diabetes. His personal physician was his AME and his medical conditions were concealed from the FAA for many years. When word got out about the pilot’s poor health, the physician was decertified as an AME. A new AME pulled the pilot’s AMC, but the airman kept flying. The Safety Board ruled that the accident was caused by pilot incapacitation. A contributing factor was the pilot and his physician providing false information on the pilot’s medical applications.
Garber said an NTSB review of over 20,000 aviation accidents since 1995 found 327 in which impairment, incapacitation, or a medical condition were identified as causes or factors. Eighty-four involved prescription medications while 52 involved illicit substances and 73 involved alcohol.
“It is important to note that these numbers are certainly an underestimate of the extent to which this issue is involved in accidents,” said Garber. “In a number of cases, potentially addictive prescription medications were found at levels well in excess of normal therapeutic concentrations, strongly suggesting the possibility of substance dependence,” he added. Alcohol levels also exceeded FAA limits.
Garber noted a number of instances in which the FAA did not request details regarding driving under the influence (DUI) convictions in order to determine the circumstances. Additionally, the Safety Board found that information available to the FAA on substance dependent pilots was not provided to AMEs. Garber is also concerned by the fact that the FAA does not monitor pilots with substance dependence during the period they hold a medical certificate. The Safety Board in June issued recommendations to the FAA covering these matters (A-07-41 to -43).
Nicholas Sabatini, the FAA’s associate administrator for safety, told lawmakers that the aviation agency takes this matter seriously and is committed to expanding its efforts to review medical certificates and pursue appropriate enforcement actions when falsifications are discovered.
Sabatini said the IG recommendations on falsified airmen medical applications are being implemented as well as other solutions to the problem. The aviation agency is developing a program to cross-check randomly selected applicants for FAA AMCs with the Social Security disability database. At the same time, the AMC application is being amended to include a question regarding disability benefits.
Meanwhile, the FAA’s Civil Aerospace Medical Institute (CAMI) has developed an integrated Scientific Information System (SIS) that provides a continuous monitoring of all airman medical certification records compared to aviation accidents or incidents and post-mortem toxicology reports.
Last year, the FAA’s Office of Aerospace Medicine initiated a procedure to evaluate and improve the efficiency of airman medical certification within the FAA. The Aviation Medical Examiner (AME) Airman Certification Quality Assurance study evaluated the accuracy of AMEs in determining the suitability of AMCs, Sabatini noted.
Phil Boyer, president of the Aircraft Owners and Pilots Association, told the subcommittee that pilots should be trusted in grounding themselves, adding that no additional federal oversight is needed.
Rep. James Oberstar (D-MN), chairman of the full committee, is worried that some pilots have lied about their health. “The number of fatal accidents caused by medical incapacitation is low, but we shouldn’t have to rely on the grace of god to get there,” he stated.