Attention Deficit Disorder Meds

[Henning]

Bruce, he isn't looking to get a medical, he's looking to get back on his meds and thinks this will make him ineligible for Sport Pilot, is that correct or incorrect?

 

[bbchien]

Oh. Man, I read that wrong.

There is no medical standard for Light Sport Pilot Ops other than what this family doc, local best medical advice sez (and the non-commercial DL). FAA is against it, but doesn't dare say anything as they will find their Federal butts in the defendant dock.

 

[RJM62]

And that, gentlemen, is that.

-Rich

 

[Tarheel Pilot]

Bruce, he isn't looking to get a medical, he's looking to get back on his meds and thinks this will make him ineligible for Sport Pilot, is that correct or incorrect?

Yea, that's pretty much the gist of it.

 

[Gary F]

How is the typical physician supposed to know what is required to fly safely? I believe the sport pilot standard simply requires that the patient's physician determines that the patient is capable of driving a car safely. OK to drive equals OK to fly. Am I wrong on this one?

 

[bbchien]

That was the thinking in 2005 when the discussions were going on. Also evident in the <10,000 foot provision.

That plus the 1320 lb rule 2 seats limited the collateral damage from this general lack of knowledge in the nonaviation community.

That is why "super light sport" on a CDL signoff is regulatorily attractive. 3200 lbs = more collateral damage, but a doc has to sign you off (family doc), and would still be limited to 10K MSL.

 

[DJTorrente]

That's Henning's personal opinion. The FAA says otherwise. Choose wisely on whether to follow Henning's personal opinion or the FAA's written guidance linked above.

Ron, the FAQ you liked reads, in full:

Provided I otherwise qualify and have never sought FAA medical certification, am I authorized to exercise sport pilot privileges on the basis of a current and valid driver�s license if I have a chronic medical condition such as diabetes?

Response by the Federal Air Surgeon
You should consult your private physician to determine whether you have a medical deficiency that would interfere with the safe performance of sport piloting duties. You may exercise sport pilot privileges provided you are in good health, your medical condition is under control, you adhere to your physician�s recommended treatment, and you feel satisfied that you are able to conduct safe flight operations.

I don't see anything in there about the pilot having responsibility to know whether or not and to what extent any medical condition they may have is disqualifying under Class III medical standards (like, for instance, ADHD). If that's what the FAA intended, then shame on them -- they're like the mortgage brokers giving no-doc loans: they're begging to be lied to so they can wash their hands of responsibility if anything goes "pear shaped".

Pilot holds driver's license; in stable medical condition (which may or may not be satisfactory to the FAS for Class III); go fly Sport Pilot. (No that's not a legal opinion. YMMV)

What if the FAA were to give up the failed medical fiction and acknowledge that th DL Medical is a different standard than Class III. Then say, if a state issues a DL in light of and with disclosure of the otherwise DQ condition that precluded issuing a Class III, then go fly sport pilot. For something like ADHD, there ARE other checkpoints on the road, like DPE giving a practical exam, or a CFI giving a FR, where problems can be caught and fixed.

 

[DFH65]

I will never understand why some people desire to have more regulation in their lives.

 

[poadeleted20]

How is the typical physician supposed to know what is required to fly safely?

That is neither the pilot's nor the FAA's problem -- just the physician's.

I believe the sport pilot standard simply requires that the patient's physician determines that the patient is capable of driving a car safely. OK to drive equals OK to fly. Am I wrong on this one?

You are wrong. See 61.53 and the FAS's guidance linked.

... a person shall not act as pilot in command, or in any other capacity as a required pilot flight crewmember, while that person knows or has reason to know of any medical condition that would make the person unable to operate the aircraft in a safe manner.

 

[poadeleted20]

Ron, the FAQ you liked reads, in full:
I don't see anything in there about the pilot having responsibility to know whether or not and to what extent any medical condition they may have is disqualifying under Class III medical standards (like, for instance, ADHD).

Then read 61.53, too. It's clearly stated there that "a person shall not act as pilot in command, or in any other capacity as a required pilot flight crewmember, while that person knows or has reason to know of any medical condition that would make the person unable to operate the aircraft in a safe manner."

 

[Capt. Geoffrey Thorpe]

Then read 61.53, too. It's clearly stated there that "a person shall not act as pilot in command, or in any other capacity as a required pilot flight crewmember, while that person knows or has reason to know of any medical condition that would make the person unable to operate the aircraft in a safe manner."

So, you would agree that if said ADD is under control (with medication if necessary) and an individual is able to operate an aircraft in a safe manner, (and the aforementioned individual is taking the appropriate medication as necessary,) then said individual is good do go. Right?

 

[DFH65]

(b) Operations that do not require a medical certificate. For operations provided for in §61.23(b) of this part, a person shall not act as pilot in command, or in any other capacity as a required pilot flight crewmember, while that person knows or has reason to know of any medical condition that would make the person unable to operate the aircraft in a safe manner.

Still failing to see the word physician anywhere in there. You can quote the guidance if you like but that is not law and even in the guidance it says "should" not must or shall. Why the desire to complicate this?

I will agree with you that OK to drive does not equal OK to fly on the off chance you are healthy enough to drive but not healthy enough to operate an aircraft. While that would be a pretty odd circumstance I could think of a few conditions that could fit into that category but it would be a fairly small subset.

 

[DJTorrente]

Then read 61.53, too. It's clearly stated there that "a person shall not act as pilot in command, or in any other capacity as a required pilot flight crewmember, while that person knows or has reason to know of any medical condition that would make the person unable to operate the aircraft in a safe manner."

Just reading the text, it means to me, take the example of an ATP, the person has the ability to pass a Class I medical. For a commercial pilot, a Class II, etc. For a Sport Pilot, why doesn't that simply mean the ability to obtain a DL in the pilot's state?

Listen I don't doubt that that there are factions in the FAA that don't care for SP, want to see it go away, and will enforce some medical equivalent of the boundless FAR 91.13 to advance their agenda. Nor do I doubt that some such people in the regional counsels' offices will get away with it -- most people looking to exercise SP are hobbyists. All but the most motivated will just say F*** it! and go take up golf*; maybe fly motor gliders instead. It just doesn't mean that the proper interpretation of SP is that: yeah, you are medically competent if you posses a DL, but you're unfit to fly if you can't pass a Class III.

* This can't possibly be why the pilot population is relentlessly decreasing, can it?

 

[DFH65]

Lets for argument say a Sport Pilot crashes his plane into my chicken coup. He lives to tell the story and when I pull his body from the wreckage I notice that he is acting funny and since I am in the local fire department I happen to find out he was having (very rare for him) low blood sugar issue. He felt fine when he took off but my chickens are dead and I am in mourning.

I am going to sue the guy to fix my chicken coup, replace my chickens, loss of egg production and pain and suffering for having to watch my girls go up in flames.

What is the FAA going to do to the guy? Revoke his ticket because he didn't consult his physician? My guess is if they are going to pull it they are going to pull it regardless of whether his Dr. gave the OK for him to fly or not.

What other recourse does the FAA have with the guy? Fine him? For what? You have to establish he broke the law and the way it is written I don't think they can prove that if he says he felt fine and had no reason to believe he was incapable of flying the aircraft safely that day.

I can still sue him though and that is going to happen whether it was stupid pilot tricks or a health issue that caused the wreck. So again I think it boils down to what will the insurance company cover and what is in the policy.

 

[Henning]

The FAA will do nothing.

 

[poadeleted20]

So, you would agree that if said ADD is under control (with medication if necessary) and an individual is able to operate an aircraft in a safe manner, (and the aforementioned individual is taking the appropriate medication as necessary,) then said individual is good do go. Right?

As long as that person's personal physician agrees, and their most recent medical certificate (if they had one) was not denied/suspended/revoked, and they have a valid US drivers license, I'd say yes, they are within the FAA's published guidance medically legal for Sport Pilot privileges.

 

[poadeleted20]

Still failing to see the word physician anywhere in there. You can quote the guidance if you like but that is not law and even in the guidance it says "should" not must or shall.

The guidance tells you how to comply with the regulation, same as the AIM does with flight rules. If you deviate from the guidance, the FAA will say you haven't complied with the regulation, and the NTSB will back them up. Yes, it's possible that the FAA may agree that you were safe to fly, but if they don't, you haven't a legal leg on which to stand. OTOH, if your personal physician agrees with you, you're home free.

 

[poadeleted20]

Just reading the text, it means to me, take the example of an ATP, the person has the ability to pass a Class I medical. For a commercial pilot, a Class II, etc. For a Sport Pilot, why doesn't that simply mean the ability to obtain a DL in the pilot's state?

Because the FAA said it doesn't. Argue with them, not me.

 

[poadeleted20]

Lets for argument say a Sport Pilot crashes his plane into my chicken coup. He lives to tell the story and when I pull his body from the wreckage I notice that he is acting funny and since I am in the local fire department I happen to find out he was having (very rare for him) low blood sugar issue. He felt fine when he took off but my chickens are dead and I am in mourning.

I am going to sue the guy to fix my chicken coup, replace my chickens, loss of egg production and pain and suffering for having to watch my girls go up in flames.

What is the FAA going to do to the guy? Revoke his ticket because he didn't consult his physician? My guess is if they are going to pull it they are going to pull it regardless of whether his Dr. gave the OK for him to fly or not.

What other recourse does the FAA have with the guy? Fine him? For what? You have to establish he broke the law and the way it is written I don't think they can prove that if he says he felt fine and had no reason to believe he was incapable of flying the aircraft safely that day.

I can still sue him though and that is going to happen whether it was stupid pilot tricks or a health issue that caused the wreck. So again I think it boils down to what will the insurance company cover and what is in the policy.

I have neither the time nor the patience to list all the legal holes in your post, but they are many. I would suggest doing some research on FAA enforcement, civil liability, and insurance law. J. Scott Hamilton's "Practical Aviation Law" would be a good start.

 

[JeffDG]

I have neither the time nor the patience to list all the legal holes in your post, but they are many. I would suggest doing some research on FAA enforcement, civil liability, and insurance law. J. Scott Hamilton's "Practical Aviation Law" would be a good start.

What does the estimable Mr. Hamilton say about the difference between "should", "shall" and "must" is his tome?

 

[DJTorrente]

Because the FAA said it doesn't. Argue with them, not me.

Here's the full text of 61.53

(a) Operations that require a medical certificate. Except as provided for in paragraph (b) of this section, no person who holds a medical certificate issued under part 67 of this chapter may act as pilot in command, or in any other capacity as a required pilot flight crewmember, while that person:
(1) Knows or has reason to know of any medical condition that would make the person unable to meet the requirements for the medical certificate necessary for the pilot operation; or
(2) Is taking medication or receiving other treatment for a medical condition that results in the person being unable to meet the requirements for the medical certificate necessary for the pilot operation.

(b) Operations that do not require a medical certificate. For operations provided for in § 61.23(b) of this part, a person shall not act as pilot in command, or in any other capacity as a required pilot flight crewmember, while that person knows or has reason to know of any medical condition that would make the person unable to operate the aircraft in a safe manner.

(c) Operations requiring a medical certificate or a U.S. driver's license. For operations provided for in § 61.23(c), a person must meet the provisions of—
(1) Paragraph (a) of this section if that person holds a medical certificate issued under part 67 of this chapter and does not hold a U.S. driver's license.
(2) Paragraph (b) of this section if that person holds a U.S. driver's license.

In subpart (a), if the operation requires a medical certificate, then the pilot's medical condition at the time of operation must be "[]able to meet the requirements for the medical certificate necessary." In subpart (b) -- through subpart (c)(2) -- the relevant standard is "[]able to operate the aircraft in a safe manner." If they had meant that to mean "[]able to meet the requirements for the medical certificate", then they would have said that, like they did in subpart (a).

I contend that the two different phrases cannot logically or legally under the circumstances mean the same thing. All the FAA says, e.g. in the FAQ, is "a medical deficiency that would interfere with the safe performance of sport piloting duties" is disqualifying. The standard for "safe performance of sport piloting duties" is ability to hold a DL, not a class III medical.

I'm genuinely curious what any controlling authority has to say on the question.

 

[poadeleted20]

I'm genuinely curious what any controlling authority has to say on the question.

Then read what the Federal Air Surgeon said -- the link is above.

 

[DJTorrente]

Then read what the Federal Air Surgeon said -- the link is above.

I linked to it myself. How do you get to 'Class III medical certificate' as the baseline when the FAQ says

a medical deficiency that would interfere with the safe performance of sport piloting duties.

(link)(emphasis mine)

 

[Gary F]

How is the typical physician supposed to know what is required to fly safely?

That is neither the pilot's nor the FAA's problem -- just the physician's.

There is a huge problem with this. Can you reference any specific training in aviation medicine other than the 2 military and 3 civilian residencies or the FAA's AME program? Only a small handful of physicians have completed this training. If you expect the average primary care provider to make decisions on fitness for aviation activities then they will need to make it up as they go which is considered bad practice. In the absence of formal training physicians are not qualified to do what you believe the FAA requires.

I believe the sport pilot standard simply requires that the patient's physician determines that the patient is capable of driving a car safely. OK to drive equals OK to fly. Am I wrong on this one?

You are wrong. See 61.53 and the FAS's guidance linked

... a person shall not act as pilot in command, or in any other capacity as a required pilot flight crewmember, while that person knows or has reason to know of any medical condition that would make the person unable to operate the aircraft in a safe manner.

How would a non-aviation physician be able to make this determination? Are physician assistants, nurse practitioners, or other miscellaneous health care providers qualified to advise pilots? Does the FAA provide any specific qualifications?

 

[Gary F]

Only an unwise non AME physician would ever tell a sport pilot candidate that he or she is capable of safely operating an aircraft. Imagine the following scenario:

A wealthy retired 72 year old gentleman comes to me to inquire if he has any medical problems that would prevent him from safely operating an aircraft under sport pilot rules. I review his records and perform a thorough physical exam. Just for grins (and to cover my ass) I get a stress test that he passes with flying colors.

Two months later he is flying under sport pilot rules with a passenger when he misjudges his altitude on landing or loses consciousness or whatever. The outcome in medical parlance is "suboptimal". The pilot dies and the passenger barely survives. The passenger does not understand how a physician could not have predicted the pilot's limitations. A year later I am being questioned by the plaintiff's attorney and ask to explain my qualifications. I rattle off a list of my formal medical training and four board certifications.

The lawyer looks at me with a puzzled look and says "Excuse me doctor, but I must have missed the part where you told us of your training in aviation medicine, or at least the training that qualified you to determine the decedent's ability to fly safely"

My response "I have been reading the posts in the POA medical forum for a couple of years, does that count?"

 

[vintage cessna]

There is no requirement for a Sport Pilot to consult a Doctor to determine ones fitness to fly. The FAA recommends consulting a family Doctor if one is unsure of their fitness for flying .

But if a Sport Pilot determines he is fit enough to drive to the Doctor's appointment why is he going in the first place.

Read the regulations, read the FAQ about Sport Pilot on the FAA web site. It's not difficult to figure out.

 

[bbchien]

There is a huge problem with this. Can you reference any specific training in aviation medicine other than the 2 military and 3 civilian residencies or the FAA's AME program? Only a small handful of physicians have completed this training. If you expect the average primary care provider to make decisions on fitness for aviation activities then they will need to make it up as they go which is considered bad practice. In the absence of formal training physicians are not qualified to do what you believe the FAA requires.



How would a non-aviation physician be able to make this determination? Are physician assistants, nurse practitioners, or other miscellaneous health care providers qualified to advise pilots? Does the FAA provide any specific qualifications?

One of the original considerations in the discussions leading up to 2005 was <10,000 feet really precludes a lot of the physiology changes that separate aviation from driving a car. See neshtus, et al, CAMI 97/9 for details.

So the community physician signs him off as able to drive a car; they're used to that.

 

[Henning]

One of the original considerations in the discussions leading up to 2005 was <10,000 feet really precludes a lot of the physiology changes that separate aviation from driving a car. See neshtus, et al, CAMI 97/9 for details.

So the community physician signs him off as able to drive a car; they're used to that.

So, if the doctor didn't tell them "You need to quit driving" isn't that defacto authorization to fly SP?

 

[bbchien]

I've actually experted a case. The attorneys decided that the physician's silence on the matter was NOT assent.

Attorneys. Why is it always attorneys??
(apologies to Indiana Jones)

 

[Henning]

I've actually experted a case. The attorneys decided that the physician's silence on the matter was NOT assent.

Attorneys. Why is it always attorneys??
(apologies to Indiana Jones)

So you have to go in and ask, "Doc, am I still good to drive a car?"?

 

[Gary F]

How is the typical physician supposed to know what is required to fly safely? I believe the sport pilot standard simply requires that the patient's physician determines that the patient is capable of driving a car safely. OK to drive equals OK to fly. Am I wrong on this one?

You are wrong. See 61.53 and the FAS's guidance linked.

It appears that as far as the FAA is concerned the requirement for driving a car and sport pilot are equivalent if you believe Dr. Bruce. See below.

One of the original considerations in the discussions leading up to 2005 was <10,000 feet really precludes a lot of the physiology changes that separate aviation from driving a car. See neshtus, et al, CAMI 97/9 for details.

So the community physician signs him off as able to drive a car; they're used to that.

Even if altitude is not an issue flying an airplane may have physical requirements that exceed those of driving a car. If someone has significant heart or lung disease they may have develop hypoxia below 10,000 feet. I can advise a patient if I believe that he or she has limitations that would preclude safe driving and will leave it at that.

 

[bbchien]

The problem is for the family physician.

The plaintiff's attorney says: "Review for us, doctor, how much time you had in residency doing aviation medicine?"
Answer: none. "But my breadth of training does qualify me to make a judgement as to what is required to driving".
Attorney: "would you feel that your opinion is equally valid as that of an occupational medicine physician, who has three years of training in this area"
Doc: "Um....no. Of course not".
Attorney: "And doctor, can you show that you had specific training in, atmosphere, and CV physiology of G forces, physiology of the altitudes?"
Doc: "Um....no".
Attorney: Your honor, I submit that this witness NOT be admitted as an expert.

They can make you look like a horses patoot pretty quickly......so Gary is completely right about limiting his discussion to driving a car.

Even if altitude is not an issue flying an airplane may have physical requirements that exceed those of driving a car. If someone has significant heart or lung disease they may have develop hypoxia below 10,000 feet.

Yah. I know that and you know that. But the FAA can't say much or they will be the deep pocket.

 

[Jeff Oslick]

We should use "in condition to operate a snow blower" as the criteria. (Yes, I'm aware a good number of people drop dead using a snow blower each year.)

 

[Gary F]

We should use "in condition to operate a snow blower" as the criteria. (Yes, I'm aware a good number of people drop dead using a snow blower each year.)

That might work. I actually told several patients not to do that (or shovel snow) when I saw them in the clinic today. Snow is just around the corner for the U.P. of Michigan. The temp was 32 degrees yesterday morning. It's no fun being on call when the first big snowfall hits.

 

[Doggtyred]

That might work. I actually told several patients not to do that (or shovel snow) when I saw them in the clinic today. Snow is just around the corner for the U.P. of Michigan. The temp was 32 degrees yesterday morning. It's no fun being on call when the first big snowfall hits.

Bruce, I was on call with the cath lab (rooming in at the hospital) when Hurricane Ike hit. We had two stemi's in short order that were associated with boarding up houses.. And one after associated with taking em down.

 

[bbchien]

I kinda like Jeff Oslick's idea.
Back in the day we used to check orientation x 3 with the third question being, "who's the Mayor?". no matter if it was Bilandic, Burne or Washington, we accepted "Daley"

 

[mnewb1]

I kinda like Jeff Oslick's idea.
Back in the day we used to check orientation x 3 with the third question being, "who's the Mayor?". no matter if it was Bilandic, Burne or Washington, we accepted "Daley"

 

[Tarheel Pilot]

Would I even be able to consult an AME on this issue without inadvertently causing myself to be kicked out of the left seat of a LSA?

 

[comanchepilot]

Would I even be able to consult an AME on this issue without inadvertently causing myself to be kicked out of the left seat of a LSA?

Is the AME being seen in his/her capacity as a 'health care provider' within the meaning of the 8500-8? AME visits are NOT reportable since they are not being consulted - if you are seeing an AME on a consulting basis for the purposes of certification then it is not a health care provider visit needing to be reported -

that should answer your question

 

[Henning]

Have you ever heard the phrase, "It's easier to as forgiveness than permission."? If you go to the doc who's going to prescribe these meds and ask, "Will I be able to continue driving on these meds?" and they answer, "Yes", you have fulfilled the letter of the statute.