Admission To Hospital Question

Well, you don’t enter HIMS for monitoring to see if you have a problem. You enter AFTER they decide you do.

The deciding is done with weird standards. Ones that mean and do nothing. They have ZERO even anecdotal proof they have solved anything or made anyone any safer.
 
bflynn said:
That's what occupational medicine does.
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Even though I believe this is an overstatement of the actual boundaries of occupational medicine, if you insist on using that term it proves the point. Class 3 medicals are not (supposed to be) occupational.
 
Tools said:
Well, you don’t enter HIMS for monitoring to see if you have a problem. You enter AFTER they decide you do.

The deciding is done with weird standards. Ones that mean and do nothing. They have ZERO even anecdotal proof they have solved anything or made anyone any safer.
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As they do with everyone. I didn't have to do testing because they knew I had a problem. For my heart, I presented information that suggested I might and therefore was deemed to be a problem and had to prove otherwise.
 
BladeSlap said:
I also trust modern medicines opinion of health over some doctor in OKC.
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This is the point you have to get past before you can understand it. The doctors in OKC aren't giving an opinion on your health or acting as your physician. They are detecting possible conditions and applying a set of rules to how an airman can fly given those conditions.

Frequently the rules just require reporting it. Sometimes they need some verification testing; frequently short term, but sometimes very long term for behavioral issues. When testing is needed, it's the responsibility of the airman to perform the testing and send in reports. Rarely, the decision is completely grounding pilots from flying at all.

That's the system. If you're still stuck on the idea that OCK is talking about your health, then you're not going to understand it.
 
bflynn said:
They are detecting possible conditions and applying a set of rules to how an airman can fly given those conditions.
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The issue is, the methods they are using to detect these possible conditions do not conform to current professional standards. This is a regulatory decision FAA Aeromedical docs made without any such directive from Congress.

To be clear, the original criteria for CAA medicals was "normal, natural health", everything they've done since then is mission-creep.
 
bflynn said:
This is the point you have to get past before you can understand it. The doctors in OKC aren't giving an opinion on your health or acting as your physician. They are detecting possible conditions and applying a set of rules to how an airman can fly given those conditions.

Frequently the rules just require reporting it. Sometimes they need some verification testing; frequently short term, but sometimes very long term for behavioral issues. When testing is needed, it's the responsibility of the airman to perform the testing and send in reports. Rarely, the decision is completely grounding pilots from flying at all.

That's the system. If you're still stuck on the idea that OCK is talking about your health, then you're not going to understand it.
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So perhaps they should change the name of it from “medical” to something else.

If we are not following modern medicine, it doesn’t have anything to do with health, it’s now something else.
 
Jeff Oslick said:
The issue is, the methods they are using to detect these possible conditions do not conform to current professional standards.
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Professional standard of what? Of medical care? They are not providing medical care, so DSM standards of diagnosis and treatment are not appropriate. This is what I keep saying, as long as you think this is about you being healthy, you're not going to understand it.

They are detecting airmen who might not be qualified to fly and for that they must use a wider net. Even as is, they aren't catching everyone, there could be an argument to INCREASE monitoring.
 
pilot445 said:
What’s interesting is that’s exactly what the FAA is forced to do with Sport Pilot as far as medical standards go with just a Drivers License required. ADD/ADHD and Bipolar are good to go.
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...assuming the person is able to qualify for and retain driving privileges, and successfully complete pilot training and testing. As I understand it, that's by no means a given depending on the severity of the condition.

By the way, I don't think the sport pilot option was forced on the FAA.
 
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bflynn said:
They are detecting airmen who might not be qualified to fly and for that they must use a wider net. Even as is, they aren't catching everyone, there could be an argument to INCREASE monitoring.
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Despite doing EKGs on airline pilots every 6 months, they aren't catching every every heart attack before it happens either, so I don't know what point you're trying to make here.

They don't send everyone with elevated risk factors for CAD to get an echocardiogram and stress test. So why are we sending someone with 9 years of good behavior with one stupid alcohol event when they were in their teens or early 20s through the full HIMS program?
 
bbchien said:
I know the guy wasn't driving but the definiton of abuse is use of alcohol in any situation which might create a danger" Betcha didn't know that. And its the second recorded behavior that makes it abuse.

Thus the comment about the only way to really drink is to do it at home. You really need to read better.
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How is going to a bar with an uber home creating a more dangerous situation than drinking at home? (Hint: it isn't, but I'll be curious to read your snide response anyway)
 
Jeff Oslick said:
Class 3 medicals are not (supposed to be) occupational.
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bflynn said:
Citation? Or opinion? I'm not sure the FAA agrees since they only have one system.
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I think his point is that having only one system is not justified for people whose occupation is not "pilot." I guess they would have to figure out what to do about CFIs, however, since they are currently allowed to instruct with only a third-class medical.
 
Palmpilot said:
I think his point is that having only one system is not justified for people whose occupation is not "pilot." I guess they would have to figure out what to do about CFIs, however, since they are currently allowed to instruct with only a third-class medical.
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I don't disagree. But this is an difference of an idea of "should" vs "is". I'm talking about the reality of what we work with rather than my opinion of it.
 
172andyou said:
How is going to a bar with an uber home creating a more dangerous situation than drinking at home? (Hint: it isn't, but I'll be curious to read your snide response anyway)
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More dangerous? No, they're both dangerous when you've already show signs of tolerance. I don't think we need to pick nits on the degree of danger.
 
Jeff Oslick said:
They don't send everyone with elevated risk factors for CAD to get an echocardiogram and stress test. So why are we sending someone with 9 years of good behavior with one stupid alcohol event when they were in their teens or early 20s through the full HIMS program?
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Because the country is substantially run by hypocritical puritans. And, worse, once something like this is on the books, it's pretty much impossible to remove it because there is only downside to being the one that signs off and then something bad happens.
 
bflynn said:
More dangerous? No, they're both dangerous when you've already show signs of tolerance. I don't think we need to pick nits on the degree of danger.
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How is having tolerance dangerous?
 
Jeff Oslick said:
Despite doing EKGs on airline pilots every 6 months, they aren't catching every every heart attack before it happens either, so I don't know what point you're trying to make here.
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I'm pointing out that in asking for a change, it isn't assured you'll get what you want. If there is a change to be made, then in keeping with the mission Congress charged the FAA with, their change should be more stringent testing, not less. Their goals are not the same as our goals. Good catch on those EKGs, maybe they should go to once a month.
 
172andyou said:
How is having tolerance dangerous?
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Serious question? Alcohol tolerance is a sign of dependence and alcoholism. It does not diagnose that in every person, but its a symptom and needs to be checked.

It's a free country, you can disagree with me. But if you drink excessively and have an event that causes a high BAC to be reported to the FAA, you cannot disagree with them. You either play their game or stay on the ground.
 
bflynn said:
in keeping with the mission Congress charged the FAA with, their change should be more stringent testing, not less.
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I must have missed the part in the the FAA's authorizing legislation where they told them to not use current, professional standards in medical decision making. Feel free to point that out to me.
 
bflynn said:
Serious question? Alcohol tolerance is a sign of dependence and alcoholism. It does not diagnose that in every person, but its a symptom and needs to be checked.
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And how is that dangerous to being a pilot? So long as the pilot is unimpaired at the stick, why does it matter (medically, I understand it's a rule, I'm taking the position that it's a stupid and puritanical rule) if they are a practicing alcoholic?
 
Jeff Oslick said:
I must have missed the part in the the FAA's authorizing legislation where they told them to not use current, professional standards in medical decision making. Feel free to point that out to me.
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The original legislation that established the FAA says this in Section 602:

(b) Any person may file with the Administrator an application for an airman certificate. If the Administrator finds, after investigation, that such person possesses proper qualifications for, and is physically able to perform the duties pertaining to, the position for which the air- man certificate is sought, he shall issue such certificate, containing such terms, conditions, and limitations as to duration thereof, periodic or special examinations, tests of physical fitness, and other matters as the Administrator may determine to be necessary to assure safety...”

Note that it is the responsibility and authority of the FAA to establish “tests of physical fitness...as the Administrator may determine to be necessary to assure safety.”

No mention of prevailing medical opinion or standards. It’s up to the FAA to decide what is necessary to be fit to fly.

I think their standards are sometimes idiotic, but it’s up to them and they are not legally beholden to the larger medical community. Sorry, but that’s a losing argument.
 
Half Fast said:
The original legislation that established the FAA says this in Section 602:

(b) Any person may file with the Administrator an application for an airman certificate. If the Administrator finds, after investigation, that such person possesses proper qualifications for, and is physically able to perform the duties pertaining to, the position for which the air- man certificate is sought, he shall issue such certificate, containing such terms, conditions, and limitations as to duration thereof, periodic or special examinations, tests of physical fitness, and other matters as the Administrator may determine to be necessary to assure safety...”

Note that it is the responsibility and authority of the FAA to establish “tests of physical fitness...as the Administrator may determine to be necessary to assure safety.”

No mention of prevailing medical opinion or standards. It’s up to the FAA to decide what is necessary to be fit to fly.

I think their standards are sometimes idiotic, but it’s up to them and they are not legally beholden to the larger medical community. Sorry, but that’s a losing argument.
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That sounds like a poorly thought out piece of legislation

Let’s trust the department of transportations opinion on health over that of the entire modern medical society.

I’d say between that and the story of the guy who might lose his job for getting stabbed, and the lady who lost her medical for being sexually assaulted, seems low hanging fruit to get a congress person to fix the system. It all should be like basic med, get a real doctor to sign his name under his medical license, that a airman can perform the duties listed and let that be the medical. If they have a condition, or the FAA thinks they have a condition, let the airman go to a real specialist and have them make the call with under their medical license.

Having DOT employees and sub par doctors not acting under their licenses make these calls seems like a bloated mess that’s not serving the airmen, passengers, public, or the practice of real medicine very well.
 
BladeSlap said:
That sounds like a poorly thought out piece of legislation

Let’s trust the department of transportations opinion on health over that of the entire modern medical society.

I’d say between that and the story of the guy who might lose his job for getting stabbed, and the lady who lost her medical for being sexually assaulted, seems low hanging fruit to get a congress person to fix the system. It all should be like basic med, get a real doctor to sign his name under his medical license, that a airman can perform the duties listed and let that be the medical. If they have a condition, or the FAA thinks they have a condition, let the airman go to a real specialist and have them make the call with under their medical license.

Having DOT employees and sub par doctors not acting under their licenses make these calls seems like a bloated mess that’s not serving the airmen, passengers, public, or the practice of real medicine very well.
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Under this line of thinking, why aren’t CDL holders held to the same medical standard as a third class medical at least? A tanker on wheels full of gasoline is pretty much a loaded bomb, that has the ability to do far more damage than a 172 for instance.
 
pilot445 said:
Under this line of thinking, why aren’t CDL holders held to the same medical standard as a third class medical at least? A tanker on wheels full of gasoline is pretty much a loaded bomb, that has the ability to do far more damage than a 172 for instance.
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One dumpster fire at a time
 
I know the FAA rules over a lot of medical conditions are pretty draconian, especially mental health issues. I used to assume that the DUI part was, too. Now, after reading all of the - I don't know how to put it but whining - in this discussion and others, I'm thinking that the real problem isn't just that we have too many drunks, it's that many of them either don't believe they are, or think it's somehow OK. There's always an excuse, it's always someone else fault, etc.

Twenty years ago, maybe a bit longer, when they first started with stronger drunk driving laws, people complained that there were being charged as being at fault for accidents just because they were drunk. The common story was "yeah, I was .12, but I was just driving along and so and so just cut in front of me". People sometimes felt sorry for those people, then. Now, I think most people know better. You drink, your fault, get over it.

So now I'm thinking that the FAA drinking rules are fine, but maybe the loopholes make it unnecessarily complicated. Caught twice over .15? Done. It's just simpler. And I'm wondering why the same thing shouldn't apply to driving. I'm all for a second chance, but a second chance means one bad event goes through, not multiple. I do think it makes sense to take the DOT rules down the same road. Based on all of these recent posts, I'm thinking it couldn't hurt.

Petitioning the FAA or congress to have more modern standards for mental health issues, especially for returning service people with PTSD? Absolutely. More options for people with a drinking problem, and no underlying diagnosed mental health issue? Why? Maybe that's puritanical. I just see alcoholics trying to fly planes, complaining about rules and looking for loopholes. Lots of fine occupations for alcoholics. Some of them in government!
 
Albany Tom said:
I know the FAA rules over a lot of medical conditions are pretty draconian, especially mental health issues. I used to assume that the DUI part was, too. Now, after reading all of the - I don't know how to put it but whining - in this discussion and others, I'm thinking that the real problem isn't just that we have too many drunks, it's that many of them either don't believe they are, or think it's somehow OK. There's always an excuse, it's always someone else fault, etc.

Twenty years ago, maybe a bit longer, when they first started with stronger drunk driving laws, people complained that there were being charged as being at fault for accidents just because they were drunk. The common story was "yeah, I was .12, but I was just driving along and so and so just cut in front of me". People sometimes felt sorry for those people, then. Now, I think most people know better. You drink, your fault, get over it.

So now I'm thinking that the FAA drinking rules are fine, but maybe the loopholes make it unnecessarily complicated. Caught twice over .15? Done. It's just simpler. And I'm wondering why the same thing shouldn't apply to driving. I'm all for a second chance, but a second chance means one bad event goes through, not multiple. I do think it makes sense to take the DOT rules down the same road. Based on all of these recent posts, I'm thinking it couldn't hurt.

Petitioning the FAA or congress to have more modern standards for mental health issues, especially for returning service people with PTSD? Absolutely. More options for people with a drinking problem, and no underlying diagnosed mental health issue? Why? Maybe that's puritanical. I just see alcoholics trying to fly planes, complaining about rules and looking for loopholes. Lots of fine occupations for alcoholics. Some of them in government!
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Are you proposing we only follow modern medicine on some conditions, and ignore it on others?

Or are you saying we should weaponize medicine to punish crimes?

A doctor doesn’t take away your driving license if you do something bad multiple times behind the wheel, the state DMV does.

My understanding is if you to something really bad in a plane the FAA can emergency revoke your certificate as well. So we already have what you are talking about.
 
172andyou said:
And how is that dangerous to being a pilot? So long as the pilot is unimpaired at the stick, why does it matter (medically, I understand it's a rule, I'm taking the position that it's a stupid and puritanical rule) if they are a practicing alcoholic?
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I think you meant “functional” alcoholic? Every alcoholic that drinks is practicing. Put the glass down…;)

Again, serious question? What are the problems with being an alcoholic?

From the FAA’s point of view: Out of control drinking, leading to flying impaired, crashing, and potentially killing innocent people.

if you’re being selfish and looking out for your own health,
- your health - diabetes, liver, kidney issues. When your liver and your kidneys go, you’re done.
- changes in brain chemistry, including but not limited to: short term memory loss, cognitive impairment, loss of brain cells (toxins), paralysis, and emotional,disorders
- vision problems such as cataracts and loss of night vision
- impaired immune system
- muscular breakdown
- nerve damage, including balance problems, pins and needles in extremities, erectile dysfunction, diarrhea
- bone loss
- heart disease
- Pancreatitis
- multiple types of cancer
- inability to stop drinking and inability to function without drinking.
 
BladeSlap said:
Are you proposing we only follow modern medicine on some conditions, and ignore it on others?
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I think this is about the third time I’ve said this…this isn’t medicine, it isn’t about your health. It is a safety program
 
I'm saying that we already have effectively two threads in the FAA, a non-current science one for mental issues, and a non-current science one for drinking. Of those two, I think the mental one deserves some sympathy and some adjustment. The drinking one, I just don't have any sympathy for, and I'm not sure I trust whatever the modern medical views on it are, given that recidivism around all of the substance abuse issues are incredibly high and unpredictable. If someone's in that bucket I think there are better things for them to do than fly.
 
BladeSlap said:
Are you proposing we only follow modern medicine on some conditions, and ignore it on others?

Or are you saying we should weaponize medicine to punish crimes?

A doctor doesn’t take away your driving license if you do something bad multiple times behind the wheel, the state DMV does.

My understanding is if you to something really bad in a plane the FAA can emergency revoke your certificate as well. So we already have what you are talking about.
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A doctor can in fact take away a drivers license for mental health reasons, if that person is in the view of the doctor unsafe to drive.
 
pilot445 said:
Under this line of thinking, why aren’t CDL holders held to the same medical standard as a third class medical at least? A tanker on wheels full of gasoline is pretty much a loaded bomb, that has the ability to do far more damage than a 172 for instance.
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actually, their alcohol program is even stricter. Any single test over .04 and they’re grounded.
 
Albany Tom said:
I'm saying that we already have effectively two threads in the FAA, a non-current science one for mental issues, and a non-current science one for drinking.
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It isn't just these two. I'm doing Basic Med now because I don't want to potentially deal with the FAA again if I get another kidney stone. I am eligible to get a 2nd or 3rd Class now, but if I get another stone, it would likely cost me thousands in additional tests/scans that are medically unnecessary, even after a urologist tells me I'm good-to-go for flying. There are many other conditions that result in similar medical mission creep at OKC. The pilot's specialist docs say no-problem, but the FAA keeps asking for more tests. Because they apparently think they know more about a patient they've never seen.
 
So for things like that I do think it makes sense for there to be an independent review/appeal process. I just don't think it makes sense to extend that to dependency issues. Lobbying for flying alcoholics just doesn't sounds like a great idea to me.
 
bflynn said:
actually, their alcohol program is even stricter. Any single test over .04 and they’re grounded.
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If they're driving. And the same .04 limit applies to flying and I don't think anyone disputes that a pilot flying over that limit should be suspended. But while I know it's gone pretty far, this thread is about someone who wasn't operating a vehicle.
 
Albany Tom said:
So for things like that I do think it makes sense for there to be an independent review/appeal process. I just don't think it makes sense to extend that to dependency issues. Lobbying for flying alcoholics just doesn't sounds like a great idea to me.
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No one is lobbying for flight alcoholics

The whole problem is that the FAA is making up its own medically unfounded terms on who is a alcoholic.
 
After reading through this thread, to me they seem reasonable to too soft.
 
Lachlan said:
DUIs are not always sent to HIMS. Crank up that BAC to a high enough level and you’ll get your wish. It’s not only alcohol, though. Drug possession convictions often require very similar evaluations and expensive follow up. ADD/ADHD, bipolar disorder, schizophrenia, etc., some have “no chance, ever!” But alcohol, that should be allowed to slide? Why? Or why not? Should we just have the FAA bag it all and hand out licenses to everyone who feels they deserve to fly? What’s the worst that could happen?
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Probably not much actually. I would be down for that experiment.
 
bflynn said:
I think you meant “functional” alcoholic? Every alcoholic that drinks is practicing. Put the glass down…;)

Again, serious question? What are the problems with being an alcoholic?

From the FAA’s point of view: Out of control drinking, leading to flying impaired, crashing, and potentially killing innocent people.

if you’re being selfish and looking out for your own health,
- your health - diabetes, liver, kidney issues. When your liver and your kidneys go, you’re done.
- changes in brain chemistry, including but not limited to: short term memory loss, cognitive impairment, loss of brain cells (toxins), paralysis, and emotional,disorders
- vision problems such as cataracts and loss of night vision
- impaired immune system
- muscular breakdown
- nerve damage, including balance problems, pins and needles in extremities, erectile dysfunction, diarrhea
- bone loss
- heart disease
- Pancreatitis
- multiple types of cancer
- inability to stop drinking and inability to function without drinking.
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And yet despite 90% of the alcoholic pilots who are NOT identified, we have never had a part 121 incident attributed to being impaired...

It doesn’t add up...

And part 121 pilots DIE behind the yoke due to heart disease, and that’s not NEARLY as draconian.

Part 121 pilots KILL PEOPLE via suicide by airplane. But if you claim alcoholism is the cause of your suicidal ideation, 35 days of rehab and you’re good to go! Woo hoo! I know one of these guys who just killed himself, fortunately he didn’t take a 767 full of people with him... And I know several others at that airline flying around...

What if another pilot spotted the guy with the heart problem across a room clutching his chest... BAM... schedule exploratory surgery just in case. Based on HIS word. Maybe base that surgery on a lab test done in strip malls by labs not certified to type blood... using methods not approved by the FDA. And make him admit to God and strangers he has a problem eating fatty foods... THATS the HIMS program.
 
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