Consequences for FAA Medical Exam with an underserved implied consent charge.

W. Stewart said:
Are you sure there are no toxicology reports at the hospital? Drawing levels would be pretty standard in such a situation.

Wells
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Actually, you might be surprised that its NO LONGER the standard for many physicians. Your alcohol level really doesn't drive most aspects of your medical care inside the hospital.

If the cop has a basis to have your alcohol level drawn, he has to make his case and get a warrant with probable cause, then have a compulsory draw performed. In certain LIMITED circumstances it can be done without a warrant (such as if the suspect was involved in an accident that killed someone or caused a serious injury that may result in a fatality in short order)...

But.. if the ER doc draws an alcohol level, and that draw is not medically indicated, then you have a data point floating around in your chart that can be very easily subpoenaed after the fact, using evidence for probable cause that may not have been apparent in the immediate aftermath of the incident.

So then the doc and hospital can incur civil liability for drawing the sample in the first place, and it gets really uncomfortable in a deposition when the patient's attorney wants you to explain how having that data point made any difference at all in your treatment and outcome... when that data point has perhaps resulted in the patient's loss of income, licensure, etc.. Docs dont like getting sued (even though it happens) and they REALLY dont like getting sued when its hard to win.

So.. the point I'm trying to make is that some ER docs and some hospital systems have run this past their legal counsel, and they no longer routinely draw serum ethanol levels on MVA patients unless there is a clear, overriding need to do so. Over the years I've worked with docs who do, and docs who dont.

My philosophy is, let the cop do his job and let me do mine. If the cop has an overwhelming cause to pull a specimen, he will provide the paperwork AND the tube for the specimen, and he will send it to the law enforcement's reference lab. Cuts the hospital, doc and phlebotomist out of the equation altogether.
 
Question (and unfortunately, with what I know of the FAA so far, I sadly probably already know the answer to this): Lets say this guy fights it, goes to appellate court, and wins. The FAA still considers it an alcohol related arrest, right? Would not he be better saying "screw the courts" and play the FAA game instead? Best case, he gets something taken off his record after thousands of dollars with the court system, and he STILL has to pay thousands of dollars trying to get the FAA to be reasonable.

Seems better to just deal with the FAA on this one and admit that, like so many others, FAA Medical Dept is just as crooked as that cop and the lawyer.
 
Oh - and if this ever happens again, could you not say "**** you, cop, I'm going to have the doctor pull tox on me" and the doctor would be obligated to do so, right?
 
Unregistered said:
Oh, one more thing. If I had a time machine i'd take you right there to watch the whole thing transpire. So you could feel like the @$%^&(# you come off as.
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Well that's just silly.

If you had a time machine, go back in time and stop the accident.
Or stop 9/11.
 
SkyHog said:
Oh - and if this ever happens again, could you not say "**** you, cop, I'm going to have the doctor pull tox on me" and the doctor would be obligated to do so, right?
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You can always request it... and they may accomodate you.. You could even go to a free standing lab... (or they may say, no, this is an ER, you can go to the free standing lab on your own when you discharge...) but with regards to the average MVA patient who ends up in an ER, if the patient doesn't want it, and there's no valid medical reason, its an unrealistic expectation to believe that every doc will "routinely" obtain one.
 
Doggtyred said:
Actually, you might be surprised that its NO LONGER the standard for many physicians. Your alcohol level really doesn't drive most aspects of your medical care inside the hospital.

If the cop has a basis to have your alcohol level drawn, he has to make his case and get a warrant with probable cause, then have a compulsory draw performed. In certain LIMITED circumstances it can be done without a warrant (such as if the suspect was involved in an accident that killed someone or caused a serious injury that may result in a fatality in short order)...

But.. if the ER doc draws an alcohol level, and that draw is not medically indicated, then you have a data point floating around in your chart that can be very easily subpoenaed after the fact, using evidence for probable cause that may not have been apparent in the immediate aftermath of the incident.

So then the doc and hospital can incur civil liability for drawing the sample in the first place, and it gets really uncomfortable in a deposition when the patient's attorney wants you to explain how having that data point made any difference at all in your treatment and outcome... when that data point has perhaps resulted in the patient's loss of income, licensure, etc.. Docs dont like getting sued (even though it happens) and they REALLY dont like getting sued when its hard to win.

So.. the point I'm trying to make is that some ER docs and some hospital systems have run this past their legal counsel, and they no longer routinely draw serum ethanol levels on MVA patients unless there is a clear, overriding need to do so. Over the years I've worked with docs who do, and docs who dont.

My philosophy is, let the cop do his job and let me do mine. If the cop has an overwhelming cause to pull a specimen, he will provide the paperwork AND the tube for the specimen, and he will send it to the law enforcement's reference lab. Cuts the hospital, doc and phlebotomist out of the equation altogether.
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What he said. As one who does this for a living, if it's not medically indicated, I don't order it. I've seen this point mentioned on several of these threads..."If you were seen in the emergency department after your car crash, they must have done an alcohol level." Not so. If it's not going to affect the treatment or disposition, most of us don't routinely order it anymore. If law enforcement desires a blood alcohol, they have the authority and means to obtain it themselves. But their purpose is not the same as ours.
 
Question for the docs: You have an MVA patient with LOC which you dx as concussion. You have a lot of other injuries here apparently as well. You will need to provide certain drugs and pain meds and similar - don't you want to know the ETOH level at that point? It seems medically indicated to someone who stayed at a Holiday Inn Express last night.
 
comanchepilot said:
Question for the docs: You have an MVA patient with LOC which you dx as concussion. You have a lot of other injuries here apparently as well. You will need to provide certain drugs and pain meds and similar - don't you want to know the ETOH level at that point? It seems medically indicated to someone who stayed at a Holiday Inn Express last night.
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Joe, Brian R has it right.

The answer to your question is, not necessarily, because toxic metabolic impairment examines diffusely (nonfocally) will resolve leaving only the structural issues. See Plum and Posner's, "Diagnosis of Stupor and Coma".

It basically boils down to, if you aren't going to do something differently because of the test, "what is the utility of getting it?"
 
To the OP, where where you before the accident and were there any witnesses that testified for you that you were not drinking? You work in a bar, and around here you cannot drink a drop and work in a bar.

There are many pilots flying with DUI's. You'll need to dance with the FAA for a while. Many be your better off putting your efforts into that rather than fighting a corrupt legal system.

Don't think to bad about the posts here. We have heard it all, and many times have been " taken" by people claiming they are innocent. Hell. The whole prison system is full of innocents, just ask them! :lol:

Good luck, and don't be a stranger.
 
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Firstly let me apologize to Comanche Pilot. I know in your strange way you are trying to help but your way of doing so got under my skin and for letting that happen I do apologize. Looks like the mods decided my last post wasn't acceptable which im thankful for. Was completely out of emotion due to my frustrations with you.

Geico266 said:
To the OP, where where you before the accident and were there any witnesses that testified for you that you were not drinking? You work in a bar, and around here you cannot drink a drop and work in a bar.
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Yes this is true for where I worked as well. I didn't drink to begin with and frankly bartending illuminates the downsides to drinking. My regulars as much as I liked them had problems and on more occasions then I could count we had to send them home in cabs even before we served them a drop, simply because they came in drunk.

My manager from the evening was there on my behalf and the time the accident happened was about 20 minutes after I left which is about exactly as long as it took me to get home. Like most accidents it happened a minute from my driveway.

Geico266 said:
There are many pilots flying with DUI's. You'll need to dance with the FAA for a while. Many be your better off putting your efforts into that rather than fighting a corrupt legal system.
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I agree. I wasn't coming here to fight the system any more. I gave that up when I ran out of money. It was for information on as you said doing the dance. It just got turned into something else.

Geico266 said:
Don't think to bad about the posts here. We have heard it all, and many times have been " taken" by people claiming they are innocent. Hell. The whole prison system is full of innocents, just ask them!
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I'd rather never have to find out personally but this i do understand but I won't change my stand on it. I don't drink and wasn't drunk. Now if you want to talk about weed then i'll say I was into that in my younger years, but even that is going on 7 years ago now. ;)

Geico266 said:
Good luck, and don't be a stranger.
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Thanks and will do.
 
If I get under your skin then I'm doing my job as an advocate. I'm nothing compared to real cross examination. Just a harmless fuzz ball. I'll make nice next time.
 
comanchepilot said:
Question for the docs: You have an MVA patient with LOC which you dx as concussion. You have a lot of other injuries here apparently as well. You will need to provide certain drugs and pain meds and similar - don't you want to know the ETOH level at that point? It seems medically indicated to someone who stayed at a Holiday Inn Express last night.
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Joe,

Bruce answered more succinctly than I could. :D

I will admit my perception is probably skewed by working in community hospitals the past 15 years...where the vast majority of the MVAs are "pre-litigation" exams with little pathology. Prior to that, when I was at a trauma center, lots more stuff got ordered...much of it medically unnecessary, by today's standards.

But, when we have to sedate someone, we just assume they ingested a 12-pack and a large pizza immediately prior to coming in, and proceed accordingly. If we waited for a BAL they'd probably be dead. Yeah, that whole concept gives anesthesiologists the shakes ("OMG, you mean you gave Propofol without a 12 hour fast?") but that's life in the ER.

Another point: for years, here in NY, insurers could and did deny payment for MVA-related injuries if they could establish that alcohol was involved*. I don't honestly know if that's still the case, since I'm on the clinical end, not the billing/collections part, but why would I order a test that could result in my employer not getting paid, if the results didn't affect treatment?

*"The patient is responsible," they'd maintain. Yeah...good luck collecting on those.
 
Thanks Brian and Bruce - I see the liability angle and thought of it as well - and see that etoh is not that relevant unless its an od situation and you want to know a level but its still not going to matter I guess to ER care.

when I did my header off the bike last September and broke the ribs the ER Doc asked me if I'd been drinking - gosh it was 10am - ugh. The mere thought of alcohol that early . . . but he's gotta ask.



BrianR said:
Joe,

Bruce answered more succinctly than I could. :D

I will admit my perception is probably skewed by working in community hospitals the past 15 years...where the vast majority of the MVAs are "pre-litigation" exams with little pathology. Prior to that, when I was at a trauma center, lots more stuff got ordered...much of it medically unnecessary, by today's standards.

But, when we have to sedate someone, we just assume they ingested a 12-pack and a large pizza immediately prior to coming in, and proceed accordingly. If we waited for a BAL they'd probably be dead. Yeah, that whole concept gives anesthesiologists the shakes ("OMG, you mean you gave Propofol without a 12 hour fast?") but that's life in the ER.

Another point: for years, here in NY, insurers could and did deny payment for MVA-related injuries if they could establish that alcohol was involved*. I don't honestly know if that's still the case, since I'm on the clinical end, not the billing/collections part, but why would I order a test that could result in my employer not getting paid, if the results didn't affect treatment?

*"The patient is responsible," they'd maintain. Yeah...good luck collecting on those.
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One final attempt at this.

Assume the worst if you like it is completely irrelevant.

What can I do at this point? Who can help me, who should I ask, what can I do?

I've canceled my next two weeks of flight training as there is no point in continuing until I can get my Medical. I'm close to solo, two flights or less away.
 
comanchepilot said:
yeah, that too. It funny how these posts always have pertinent facts missing, misstated, omitted or characterized.

EVERYBODY Lies.

How is a cell phone evidence of intoxication? It might be evidence of texting and driving - but intox?
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Unregistered said:
One final attempt at this.

Assume the worst if you like it is completely irrelevant.

What can I do at this point? Who can help me, who should I ask, what can I do?

I've canceled my next two weeks of flight training as there is no point in continuing until I can get my Medical. I'm close to solo, two flights or less away.
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Reread the thread, with careful attention to Dr. Chien's post, and I think you will find your answer there. He is usually right on target when it comes to medical issues, and is certainly on target when it comes to aviation medical issues.
 
From a LEGAL perspective:

Go spend the money for a really good civil rights lawyer. I would think that you have about a zero percent chance at this stage - but someone may have a different opinion.

From the FAA Medical perspective:

You have been told several times to contact Bruce Chien. Pay him his $100 for his consult fee - then decide if you want to use him to get a medical - but you need to fully disclose EVERYTHING to him. He can't help you without helping him.
 
comanchepilot said:
From a LEGAL perspective:

Go spend the money for a really good civil rights lawyer. I would think that you have about a zero percent chance at this stage - but someone may have a different opinion.
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It's been almost two years. Can I still do this?



comanchepilot said:
From the FAA Medical perspective:

You have been told several times to contact Bruce Chien. Pay him his $100 for his consult fee - then decide if you want to use him to get a medical - but you need to fully disclose EVERYTHING to him. He can't help you without helping him.
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Will do. What's the best way to contact him? Through a PM on the forums?
 
Unregistered said:
Will do. What's the best way to contact him? Through a PM on the forums?
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Call his office directly. You can find the phone number on the contacts page of his website, www.aeromedicaldoc.com.

As said before, if you are 100% honest with him, he will be 100% in your corner.

He has helped many an airman, both private and professional deal with cases similar to yours that he really knows what it is you need to go do and what records to get, so that if you make him your AME of record, he can go to the right person at OKC to make sure you are represented correctly. Very few AME's do that.
 
Unregistered said:
It's been almost two years. Can I still do this?

Will do. What's the best way to contact him? Through a PM on the forums?
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Civil rights is not a challenge to the original charge - I don't know if after 2 years there is still a COA or not.

Yep - look on his posts - website then phone or pm.
 
He asked about evidence, not definitive evidence. Send it fifteen minutes before you are pulled over, it goes on the scale with all the other evidence.
 
alaskaflyer said:
He asked about evidence, not definitive evidence. Send it fifteen minutes before you are pulled over, it goes on the scale with all the other evidence.
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I will make an app that send it to a random person in my contact list ever y30 minutes. Put that on your scale.
 
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