FAA adds another hoop for medicals

bbchien said:
Well, the way the FAS is going to do it will allow the sleep specialist to order an overnight home recording and if that screen is negative, he'll then write "this man does not have Sleep Apnea".
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Is this new info? It seems like we've been having this entire thread with the expectation that a full sleep study will be required of anyone with a high BMI.

This method is a large improvement (sorry for the pun :rofl:).

What do you think the cost will be? Are we talking $100, $500, $1000? What kind of stuff is hooked up to you for the home study?
 
flyingcheesehead said:
Is this new info? It seems like we've been having this entire thread with the expectation that a full sleep study will be required of anyone with a high BMI.

This method is a large improvement (sorry for the pun :rofl:).

What do you think the cost will be? Are we talking $100, $500, $1000? What kind of stuff is hooked up to you for the home study?
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It records everything through one 3" dia 15" long anal probe.... The good thing is you'll be paid for it, the bad thing is it'll be on PornTube.
 
AggieMike88 said:
What is this penalty you speak of?
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The ones discussed in this thread.

Did you read the account linked in post #513?

The Special Issuance?

If yes to that, it's an easy SI to obtain and comply with if you are already diagnosed, being treated, and work with a top AME like Bruce.
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That's only part of it. As initially adopted, you also have to find the right doctor, who is not cheap, apparently, and if you want to avoid being grounded for four months, you have to engage in a research project to find the right AME (and you have to know that you NEED to engage in such a research project). Once you get your SI, You have to get it renewed every year.

None of that encourages pilots to find out if they have OSA, and most pilots probably have no clue about the considerable health benefits of getting treated.

If the FAA wants to impose a program of this magnitude (whose stated goal is to make sure that EVERY pilot with OSA is treated!), they should first make sure that ALL of their AMEs receive the necessary training or instructions to issue in office, so that pilots don't have to engage in a research project to find one of a few who can. They should also allow people to be tested in a less expensive way, and they should eliminate the annual renewal for holders of thrid class medicals.

There's a reason why Bruce said this, a suggestion that I wholeheartedly support:

"The idea on the current project, is AOPA/EAA should get together to make it CHEAP to screen and treat. You DON'T have to force it through only Board Certified Sleep guys....any pulmonary/neurol or internist can read the reports.....order the overnight screening....etc etc etc...."​

http://www.pilotsofamerica.com/forum/showpost.php?p=1318205&postcount=281

IIRC, there is a push amongst the top AME's to get OSA under the CACI realm if issuance like DM2(pill) and others were done this year.
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What does "CACI" mean? (I'm reminded of the thread that's complaining about acronyms!)
 
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bbchien said:
Well, the way the FAS is going to do it will allow the sleep specialist to order an overnight home recording and if that screen is negative, he'll then write "this man does not have Sleep Apnea".

B.
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That sounds like a big improvement over what we've been led to believe would be required.
 
Henning said:
Who led anyone to believe? It appeared everyone jumped to conclusions.
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The Federal Air Surgeon's letter uploaded in post #4 says that everyone with BMI of 40 or more has to be evaluated by a board certified sleep specialist. What percentage of those specialists do the initial screening as Bruce described in post #599?
 
Palmpilot said:
The Federal Air Surgeon's letter uploaded in post #4 says that everyone with BMI of 40 or more has to be evaluated by a board certified sleep specialist. What percentage of those specialists do the initial screening as Bruce described in post #599?
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Well according to his schema, it would be 100%. My suggestion was, let the fam doc get the overnight recorded oximetry. Then refer to the SA guy at the hospital lab if positive.

But the actually protocol has not yet been written....
 
Palmpilot said:
The ones discussed in this thread.

Did you read the account linked in post #513?
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Missed that post. I'll check that. Thanks for the pointer

What does "CACI" mean? (I'm reminded of the thread that's complaining about acronyms!)
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Conditions an AME Can Issue. From an AOPA online article:

The FAA on April 9 posted changes to the “Guide for Aviation Medical Examiners” that will streamline the medical certification process for pilots with certain medical conditions that previously required special issuance authorizations.

A new program, known as Conditions the AME Can Issue (CACI), resulted in medical certification changes for pilots with arthritis, asthma, glaucoma, hepatitis C, hypertension, hypothyroidism, migraine and chronic headaches, pre-diabetes (metabolic syndrome, impaired fasting glucose, insulin resistance, glucose elevation/intolerance), and renal cancer.​


http://www.aopa.org/News-and-Video/...s-to-special-issuance-medical-conditions.aspx


In past threads, Bruce mentioned discussions about putting OSA into this category. His advice on what to obtain and bring to the exam was a huge help on my initial medical. If other airmen followed that, and with the AME's already having the guidelines of what's acceptable and what needs OKC review, should be able to issue the acceptable ones and lighten OKC's load by a smidge.
 
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If OSA wasn't an SI that required either a trip to Peoria or a 100+ day hold on your medical, then I expect more pilots would fess up to it.
 
I got an email this afternoon for a Webinar tomorrow to discuss this. Looking forward to what the FAS has to say.
 
flyingcheesehead said:
Interesting:

AME Group Objects to FAA Sleep Apnea Policy

And I say "interesting" because it seems the docs here are universally in support of it. I also didn't even know there was an AME group.
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Well I'm a member of CAMA, and this is the group that failed to endorse ANY alternate action on the Super light sport- 3200 lbs Day VFR, Fixed Gear, prop and <10,000 foot on a CDL.

Problem is, this is futile.
sigh.
 
bbchien said:
Dr. Tilton is retiring.
Everyone understand that Fred is NOT a politician.
!!!
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According to this article from Flying Magazing, it sounds like he's going to ram this through before he goes.

During a December 12 webinar, Tilton insisted he would instruct Aviation Medical Examiners to implement the controversial plan starting next month. "If Congress passes a law [forcing industry consultation], we’ll be compliant with it," Tilton said during the webinar. "Until they do so, we will move forward with this."​
http://www.flyingmag.com/news/feder...ep-apnea-issue-fast-track#0XZEP0to8QUqxS4d.99
 
Richard you can scream all you want. This is not the stuff of rulemaking. Look at 67.313, 67.213 and 67.113. That is the rule that gives him the authority. He already has the authority.

The medical standard set forth in 1953 in the original legislation is that the standard is "normal natural health" or the equivalent as determined by the FAS on best available advice.

The FOOL in this is AOPA. If there is legislative intervention, we will be screening down to 36 rather than 40.
The sad part is that the science is very very good. The focus of aopa needs be on how to make this cheap. They are three steps behind. Legal knee-jerk JERK.

Now let's say in the future we find a different, better, cheaper way to treat Sleep Apnea. It would then take an act of congress to change how the certification is done.

Don't be a JERK JERK JERK.

*****

Will start in January.
 
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bbchien said:
The medical standard set forth in 1953 in the original legislation is that the standard is "normal natural health" or the equivalent as determined by the FAS on best available advice.
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No kidding? Hmmm... Why don't they just say that instead of listing specific diseases that, over 60 years ago, weren't exactly known as well as now. Diseases like diabetes and cardiovascular disease. "Normal natural health" changes character the more we know about it. In 1953, doctors were promoting cigarettes in TV ads. Times change. IVUS exams reveal how ubiquitous coronary artery disease is in people with clean angiograms--the plaque is there, but has modeled outward so as to not leave a clue. In other words--cardiovascular disease is NORMAL! At least amongst meat eaters that don't eat whales or drink raw blood from live cows' necks. You've sort of put a different perspective on things for me. I think the reg should be revised to reflect only "normal natural health", so it can expand with the medical knowledge base. Maybe add an amendment to the new bill for driver's license medicals? Hmmm... :idea:

dtuuri
 
Palmpilot said:
Sorry, I didn't realize I was screaming.
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You keep reiterating the same thing. May not quite the same as screaming. But the peanut gallery in the balcony does that, and you it appears, are joining them.....

So, did you read 67.313? That, is a REG. It has been through the Rulemaking process, as it is a published REG which ahs been there for all 35 years I have been flying in civil space.

dturri said:
Maybe add an amendment to the new bill for driver's license medicals? Hmmm...
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Yes that is at the heart of it. Now, how are you going to write that in a politically acceptable form?

"We don't require natural health"...that'll go over big.
"We will allow a certain level of impairment"....that'll go over big.
Remember, it was just a while ago that Pena was declaring "we will tolerate no more accidents!". Jay_us.

This is about our ill -educated population, our even less educated media which professes to educate the public, and how congressmen manipulate the media to stay in office.
 
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So, what is the PoA record for "thread with the most posts" anyway?

(Serious question)
 
weilke said:
Never thought it would be one revolving around belly fat.
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Actually...it likely is...sort of...

[snark]I'm guessing the record is held by One of Kimberly's initial threads when every swinging d*ck here with a fat belly was trying to impress her!

:goofy:

Oh, those were the days. 50 and 60 year-olds acting like they were going thru puberty.[/snark]

Okay, truth be told, maybe I don't miss it. :no:

It was quite humorous and entertaining though. Everyone stumbling over each other trying to be the first one to respond to her every utterance.

Oh, the simple pleasures in life! :thumbsup:
 
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gprellwitz said:
I think that it is "let's make Friday joke day." Over 2000 posts.
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I think you have it. One can search threads by number of replies, which makes it easy to locate such threads - provided you provide a keyword that isn't a simple word. I used the word "post" since it seems likely someone is bound to refer to another post using that word. Attachment is a snapshot with the threads with over 1000 replies found this way.
 

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bbchien said:
Yes that is at the heart of it. Now, how are you going to write that in a politically acceptable form?

"We don't require natural health"
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No, man. I'm saying it is "natural" to have certain diseases in some state of progression. Type II diabetes might be an example, but the rule is 60 years old and still doesn't allow it even though the FAS routinely does under special issuance authority.

When ATO changes procedures in a way that runs contrary to current regulations, like the 'Lost comm amendment 91-189', they simply update the rule by "executive order" after a short notice of proposed rule making. No big deal. Why can't/won't the FAS do the same? :confused: Are citizens meant to forever be stuck with a medical world-view dated 1953? Does the "F" in FAS stand for "Fiefdom"? Starting to sound like it to me. :dunno:

dtuuri
 
bbchien said:
You keep reiterating the same thing.
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I brought up the magazine article because I got the impression that Tilton's departure was imminent, and because I was surprised that his statements as quoted seem to contradict what ALPA says they were told by the FAA.

May not quite the same as screaming. But the peanut gallery in the balcony does that, and you it appears, are joining them.....
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I have no interest in defending opinions other than my own.

So, did you read 67.313? That, is a REG. It has been through the Rulemaking process, as it is a published REG which ahs been there for all 35 years I have been flying in civil space.
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Not only did I read that reg, I believe that I was the first person to cite it in this thread.
 
I was thinking about this issue some more as I was driving home from a family gathering, and it occurred to me that the problem with the FAA's approach to this is that it has too much stick and not enough carrot.

Besides informing pilots of the benefits of treatment, the carrot could be that any pilot who voluntarily gets tested for OSA, and treated if necessary, would not need an SI or annual renewals, but could simply report the OSA diagnosis and the method of treatment on his regular medical certificate application. People who do that should not be required to provide "proof" of compliance, because we're not dealing with drug addicts here. There are all kinds of medical conditions for which the AME takes the applicant's word for it about his or her medical status and history.

I get the impression that this is not some bleeding-edge untested area of diagnosis and treatment. Is there really any sound medical reason for this to be a condition that requires an SI if it's being successfully treated?
 
Do you know the requirement for telling the FAA that you are well treated?
It's pretty simple and not a horror, Richard. I'll bet you don't know how simple it is.

Rather than quiz you and wait for a response, here it is:


The current way we confirm that it's well treated is a letter from the doc + a CPAP machine download. Not much of a burden, Richard. REALLY.

All the special does is insure a mechanism to enforce receipt of the reports, annually.

We (about 80 of the AMEs) though it should be CACI'd, e.g, if your certificate lasted 2 years, 2-yearly reports would be okay. But that was what we asked for in May 2012. Now we see why, of the 19 CACI conditions, we were not allowed to have Sleep Apnea on the CACI list.
 
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bbchien said:
All the special does is insure a mechanism to enforce receipt of the reports, annually.
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If that's the motivation for having it be an SI, that raises the question of why does the FAA feel they need to have annual reports for this, but not for so many other conditions that pilots report being diagnosed and treated? It sounds like this is not some new, experimental treatment.
 
Palmpilot said:
If that's the motivation for having it be an SI, that raises the question of why does the FAA feel they need to have annual reports for this, but not for so many other conditions that pilots report being diagnosed and treated? It sounds like this is not some new, experimental treatment.
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See other string, Richard. You would not believe the list of other conditions that are now covered by SI. This was the last demand of then House Aviation subcmte Chairman Oberstar, written into the LAST budget of the United States, 2009.

My Opinion: This condition needs CACI'd. We requested that in 2012.

The certification should be for full term of the certificate but no shorter than one year, like the rest of CACI.
 
bbchien said:
See other string, Richard. You would not believe the list of other conditions that are now covered by SI. This was the last demand of then House Aviation subcmte Chairman Oberstar, written into the LAST budget of the United States, 2009.

My Opinion: This condition needs CACI'd. We requested that in 2012.

The certification should be for full term of the certificate but no shorter than one year, like the rest of CACI.
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I fully agree that this needs to be under CACI....
 
Jim, the devil is in the details. I just wrote Dr. Tilton a page long missive, but I'm not going to publish it here.

So have a few of the examiners from OKC.

We have a very DEFINITE "you might sink the ship with this" take on it, and "how to not sink the ship"

B
 
Maybe BMI over 40 period will now become the next target?
 
The science is too good to resist guys. It will occur. No congresscritter is going to say, "microsleep like on the Hudson line is okay". In fact single pilot operators are likely to bear the brunt as there is no backup.

We need to focus instead, and get out front, on keeping it cheap.

The current proposal (In house) requires a board certified sleep doc to sign off even on the overnight screening, can you say $$s.

This could be spec'd out and CACI'd, for heaven sake.
 
Could they require a wakefulness test instead, or would that be even more expensive?
 
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