FAA's Beef with ADHD

[bbchien]

So, to "that won't fly": since 95% of aviation accidents really boils down to "P_ss P__r pilot performance", so the FAA is rightly very concerned.

To those who think there isn't a gray area recognized by FAA, know that if on the neurocognitive eval, you score better than above the bottom 15th percentile of known aviators, the agency figures "whatever he 's asctually go can't be all that terrible and will let you fly.

And I have experienced the little red pills, too (after 30 hrs PIC). But the difference is, the Medical officer meets you on the ramp to determine your status. That doesn't happen in civilian world. The DOD can do some things we can't do in civil world.

It's actually quite rationally constructed. Someone with hard core ADD, you do not want to allow anywhere near the controls of an aircraft.

 

[ThatWontFly]

My apologies, I didn't mean to derail your thread.

It's not your fault, I was the one who got distracted. Please don't tell the FAA... just kidding

Congratulations on making the LTC list! And also thanks for the perspective on go pills, between you and @TCABM because it makes it sound like they're not nearly as helpful as what the DoD studies have tried to illustrate and, a while back I checked Dr. Northrup's bio (current Federal Air Surgeon) to understand who she is and recalled reading this

A private pilot, Dr. Northrup is a retired U.S. Air Force colonel. She is board certified in aerospace medicine and in occupational medicine. She is an acknowledged expert in aviation. She has authored several scientific papers on accident investigation, the use of sleep aids by pilots, cabin air quality, and bioterrorism. While serving in the Air Force, she was the U.S. Head of Delegation to NATO's aeromedical working group.

Without both you guys saying similar things about the go pills, the studies plus her background make 0 sense because the studies contradict the current opinion of the FAA. If stimulants were helpful to pilots and presented 0 safety risk you would expect any person medicated for ADHD who is able to pass the standards set by the FAA would be allowed to fly, you'd expect that opinion to have come out with the recent approval of SSRIs. Rather they took a different approach in allowing an expedited path (for extra $$$$ of course...) which is a major help to anyone with the diagnosis, wants to fly, and has the cash to cover it.

While I can't find any of the papers she's authored, from the two very similar opinions given here, and her specialties being sleep aids and accident investigation, it's not a far stretch to expect her to have an understanding of stimulants and whether or not they are a contributing factor to aero accidents. While stimulants are not sleep aids they are the opposite side of the same coin, and I doubt there are many people more informed on the subject than her - in a way if the problem of sleep deprivation contributing to aero accidents is a nail, she is the damn carpenter. So while we will may never be privy to the reasoning behind the decision, it is at least somewhat reassuring that the person making the decision isn't making that decision out of ignorance, and is probably one of the most informed people to make a safe decision...even if the FAA is naturally risk averse... So for any other person born in or after the 1980's and currently taking medication sees the studies and wonders the same thing, hopefully this thread pops up and is able to shed some light on the subject

 

[ThatWontFly]

So, to "that won't fly": since 95% of aviation accidents really boils down to "P_ss P__r pilot performance", so the FAA is rightly very concerned.

To those who think there isn't a gray area recognized by FAA, know that if on the neurocognitive eval, you score better than above the bottom 15th percentile of known aviators, the agency figures "whatever he 's asctually go can't be all that terrible and will let you fly.

And I have experienced the little red pills, too (after 30 hrs PIC). But the difference is, the Medical officer meets you on the ramp to determine your status. That doesn't happen in civilian world. The DOD can do some things we can't do in civil world.

It's actually quite rationally constructed. Someone with hard core ADD, you do not want to allow anywhere near the controls of an aircraft.

Thanks Dr. B, I was wondering if I'd see you in here... @jbarrass did a really good job of nailing the argument I was trying to make;

Someone who tests at the 25% level (no ADD per the FAA and good to go) can seek a treatment that brings them to 75% (not OK with the FAA). Many legitime doctors would support this position. I don't see how the 75% pilot is substantially more of a risk to the non-participating public then the 25% pilot. Wouldn't it make sense to let the 16% pilot get treatment and get to say, 50+%.

If the pilot is above baseline while unmedicated, and medication improves him even further, what is the issue? The DoD papers seemed to take that stance as well that medication can improve their cognition despite the stress of a sleep deprivation - but based on the opinions of two former .mil guys it really seems that any assistance the go pills provided was less substantial than the papers claim.

I'll also agree with your point that the FAA's opinion is very rationally constructed and makes it very easy for someone who may be misdiagnosed or grow out of their ADD to prove their ability and a psych eval after 90 days off medication will almost guarantee that those with hard care ADD will not make it to the controls, and is a very reasonable position for the FAA to take (with the exception of the additional cost...). But what of the person who can pass the neurocognitive eval but does believe that the medication they've taken helps? I doubt that was a blind spot the FAA missed but rather a risk they were unwilling to take when factoring in the role a stimulant will play in sleeplessness, since that is one of Dr. Northrup's areas of expertise

 

[bbchien]

Okay, you didn't "get it". The FAA has zero control over whether or not the airman remember to take his pills on the day of the crash.

If there were (as there is for "norplant") a five year preparation implanted for which the pilot had zero contol over to forget, the agency might issue a "year by year each of five year" Special, allowing use of the med. But none such exists. That is why you Cannot qualify if you NEED the pills to perform.

 

[ThatWontFly]

@bbchien
Sorry, my posts are still moderated and sometimes it takes a little while for them to be approved. We're both saying the same thing - that use of the medication is a risk per FAA opinion so hopefully I don't give off the impression that I'm attempting to disagree with you and disregard the risks, but rather to look at the opposite side of the coin and see where being medicated presents additional risk over the same person being unmedicated.

The post in queue notes that if while unmedicated you can meet the standards, you shouldn't need the medication to perform, so how is being medicated detrimental (which is the FAA's current opinion) when you can perform while unmedicated - naturally the implication here being that one would need to perform better while unmedicated so for the sake of argument let's just assume that's true. One direction of this argument is that if you can fly while unmedicated you should remain unmedicated and that could pose a risk to the person who doesn't fly for commercial purposes however in my free time I consult in the design of automated trading systems and the books you have to read are BLAND so I expect giving up my medication is going to add unnecessary difficulty here, thus I have an incentive to remain medicated. Given the FAA accepts medication as a risk, and rather than believe there's a blind spot in the FAA's decision making I find it more logical to assume the FAA believes there is a risk associated with the use of the pills. It seemed like a logical conclusion (especially based on Dr. Northrups expertise) that FAA may see the potential for sleepless to be too big of a risk assuming that sleeplessness is a significant contributor to aero accidents.

While my argument has mainly been for PPL the justification is even easier when extended to CPL - if a medicated commercial pilot gets up at 8am, then is PIC of a 16 hour flight that leaves at 8 pm and re-medicates to maintain alertness, by the end of the flight the adverse risk from a combination of stimulants and sleep deprivation would be significant. The PPL pilot in a similar position where they're flying while sleep deprived can obviously add cause risks to additional aircraft from the mistakes they may make as well. I think this argument can really explain the FAA's position

 

[MIFlyer]

A particular family member has this concern but I'm not certain of their diagnosis. Seems it was Bipolar with Schizophrenia but there appears to be disagreement about whether this is possible and even more about the overlap (if there is one) with ADHD & Bipolar. Perhaps I'm naming an incorrect illness here but I do know that there are times when this person doesn't take the meds, thinks they are OK, and it's very evident to anyone else around that they are not ...

That makes sense, and I'm sorry for being nosey, but I've heard that with individuals with bipolar disorder, but never encountered an ADHD person in the wild that thought this way.

 

[DJTorrente]

The FAA has zero control over whether or not the airman remember to take his pills on the day of the crash.

This is also true of each and every aspect of medical fitness. A pilot can wake up on any given morning and not be fit for duty for one reason or another. This is the essence of self-certification.

 

[Lindberg]

This is also true of each and every aspect of medical fitness. A pilot can wake up on any given morning and not be fit for duty for one reason or another. This is the essence of self-certification.

Not to put too fine a point on it, but people who require psychoactive medications to function normally may not be reliable self-assessors, especially when unmedicated.

 

[DJTorrente]

Not to put too fine a point on it, but people who require psychoactive medications to function normally may not be reliable self-assessors, especially when unmedicated.

We're not talking about schizophrenic psychopaths -- we're talking about people whose function is improved by regular pharmacologic adjustment (see the 25%-75% argument above). Are you equally concerned that a pilot with high LDL cholesterol might have skipped his Lipotor?

And, as evidenced by the prevalence of the condition (for better or for worse), they are not entirely outside the mainstream.

 

[ThatWontFly]

Yeah... for anyone with ADHD it's really easy to tell if you forgot... it's not big things, but it's just small things throughout your day... Say you're leaving the house in the morning and you need to grab your keys, wallet, computer, coffee, and lunch, and a non-ADHD people are able to get into the car and say "okay, do I have everything I need today? I have my.... " where as with ADHD you're likely to jump in the car and once you finally turn out of your development look around and notice you're missing your lunch. Then scrambling into work you head into the Monday meeting with your pencil but no notebook. Or God forbid it's Valentines day... We all know the frustration of forgetting things but with people who are really ADHD it's a constant. Good routine, a well structured environment, etc... is paramount and the worst part of it is if someone reminds you of something you haven't yet gotten to, it can trigger your brain to think you've already done it. That last part will not make sense to anyone without the diagnosis and may not make sense to some minority who have been diagnosed. So the frustrations or embarrassment that people with ADHD go through on a daily basis is what drives their preference for medication - after all why not do something that makes your life easier?

As people get older things slow down, or the longer you spend off the sauce the more you recognize where you're susceptible and you're able to mitigate those problems.

The one that I find interesting is that there is a section of the FAA policy that specifically carves out an exception for caffeine. You can drink 2 pots of coffee a day and it's no problem. Ever seen a person who drinks a pot a day when suddenly the coffee isn't around? It can be debilitating

And I hope it doesn't sound like I'm trying to hassle you into submission, but rather trying to provide some perspective on why those with ADHD feel their medication is important

 

[tspear]

I've seen it, I've seen ADD people struggle through their day and blame it on forgetting their meds - they take it the next day and they're relieved. Most people with anything more than a mild case of ADHD they can tell when they forgot their meds. Can't say that all kids are the opposite and that they prefer to stay off medication but definitely some are...I was, I seriously disliked the meds until about high school and some others seemed to echo the same thing prefer to be off medication for ADHD but as they get older their attitude towards it seemed to switch.

Here's a good example - my dad graduated with an ME degree from Georgia Tech and ran 3 companies at the same time and worked 80~90 hour weeks from mid 30's until his mid 50's. Some time around his late 50's a psychiatrist friend of his suggested he may have ADD, got him on Vyvanse and ever since my dad says he prefers to be medicated because it helps keep him things straight, and he's still taking it now into his late 60's. People don't develop ADD as they get older but rather the opposite - people tend to calm down and improve coping skills, but another example of where medication has improved someone's life. Personnally I feel the same way - I can function without it, I HAVE functioned without it, but I know I feel and focus differently. Just annoying that there is no process for reconstitution once/if you prove to the FAA you don't need medication to meet the standard

The risk aversion was something I thought of too but nearly every facet of government is allowed some discretion over when they say yes or waive that condition - except the FAA doesn't have anything except a brief note in their approved medication document saying that under rare circumstances ritalin could be approved but it's not the case anymore. If there's a story behind this I'm interested

Talking passed each other. Everyone I know with ADD or ADHD knows when they are on the meds; assuming it is only ADD/ADHD. I did know a few others with complicating conditions like bi-polar in which case yeah, they stop taking the pills because they are "better".
My point and you confirmed it above, is for ADD/ADHD alone, I have never seen cases where the user stops taking the pill because they are "cured" and is unaware of their own behavior changes.

Tim

 

[tspear]

So, to "that won't fly": since 95% of aviation accidents really boils down to "P_ss P__r pilot performance", so the FAA is rightly very concerned.

To those who think there isn't a gray area recognized by FAA, know that if on the neurocognitive eval, you score better than above the bottom 15th percentile of known aviators, the agency figures "whatever he 's asctually go can't be all that terrible and will let you fly.

And I have experienced the little red pills, too (after 30 hrs PIC). But the difference is, the Medical officer meets you on the ramp to determine your status. That doesn't happen in civilian world. The DOD can do some things we can't do in civil world.

It's actually quite rationally constructed. Someone with hard core ADD, you do not want to allow anywhere near the controls of an aircraft.

Doc,

My objection to the FAA stance on ADD/ADHD is what my son ran into. He was diagnosed with a very minor case of ADD as a kid, and reconfirmed as a teen, through actual phycologists not the teacher . He has not taken pills for it since he was roughly ten, he learned behavior modification as coping skills which worked well enough for the Marines. The FAA wanted him to see a HIMS specialist weekly for something like a year.
If the issue is the bottom 15%, I can understand the FAA requiring anyone in lets say the bottom 25% needing to see a HIMS specialist, but above that number a report from a regular physiatrist should be sufficient.
Due to running into this issue, he is no longer interested in pursuing aviation....

I believe there likely is a number of conditions where the FAA could take a more nuanced view; or create a more affordable and common variation of HIMS.

Tim

 

[ThatWontFly]

For anyone interested this looks like the only internet-available record of the FAA's reasoning behind their decision in 2008 to keep properly medicated ADHD pilots off the runways - it is the Journal of Air Law and Commerce's (SMU) publishing of the details of the Dr. Tyghe Nielsen case in which he attempted to use the exact path which we're wondering about. He was a med student and passed his flight tests prior to starting Adderall which he began to take to help him in school as well as professionally (the case dragged on through his graduation), however the FAA found out during an exam and revoked his medical. In his case the idea that he is incapable of piloting the plane without medication holds no water as he was capable of meeting their minimum standards as he had already proven, so why would they decide to hold back his medical if he was a clearly capable person? After reading the paper I would love to say that the FAA presented a very compelling argument with their justification, backed up by facts that were diligently researched and studied... but in reality they won the case despite an incredibly poor stance they took. Upon denial of his medical, Nielsen underwent several psychological evaluations which found he performed at or above average on tasks and, the FAA psychiatric evaluation resulted in an ADHD diagnosis for Nielsen - along with a recommendation to continue taking Adderall indefinitely - but "saw no reason why Nielsen should be denied a pilots license" as he had no adverse symptoms. Despite recommendations he was denied by the Federal Air Surgeon stating that Adderall is a disqualifying medication.

This is where things get kind of...um, silly.

Nielsen brought a lot of character witnesses from his profession to the judge overseeing the case who all had positive things to say about him, as well as affirming his ability to function and be an effective physician while taking Adderall and claimed 40 mg/day was not excessive. Witnesses also noting that for people being treated for ADHD, once stabilized you are monitored but further problems are not expected. If you read Nielsen's portion it honestly is a hell of a defense...

FAA brought the case that "you have ADHD, these are the problems people generally have with ADHD and they're totally incompatible to flight." To make the assertion that was the case they brought up the warnings of potential side effects (the warnings that remove companies from liability) which noted that Adderall may contribute to serious cardiovascular events, adverse psychiatric events, including emergence of new psychotic or manic symptoms and visual distrubances, along with weakness, headache, agitation and a few other things" which was reported by approx 5% of adults taking Adderall. FAA's defense included their expert witness admitting there was no indication that Nielsen suffered from any of Adderall's possible side effects other than occasional trouble falling asleep.

Ultimately the judge sided with the FAA. It found that Nielsen's ADHD was a disqualifying condition because of his symptoms (ironic), and that Adderall was a disqualifying medication because of the potential side effects. While the it was recognized that he was perfectly able to perform his duties as an airman while medicated, the potential severe, life-threatening side effects could arise in the future without warning. Secondly the "judge also chided Nielsen for not taking his medication on occasional weekends and stated that the FAA cannot monitor airmen to ensure that they are taking their medications, that their medications continue to be effective, and that airmen do not develop any advese side effects."

Ironic outcome given that the FAA puts a lot of trust in the pilot to determine if or when they are safe to fly.

https://scholar.smu.edu/cgi/viewcontent.cgi?article=1317&context=jalc

To sum it up the FAA's position, based on the argument they presented is; "Did you read the label? Sounds bad."

 

[bbchien]

Doc,

My objection to the FAA stance on ADD/ADHD is what my son ran into. He was diagnosed with a very minor case of ADD as a kid, and reconfirmed as a teen, through actual phycologists not the teacher . He has not taken pills for it since he was roughly ten, he learned behavior modification as coping skills which worked well enough for the Marines. The FAA wanted him to see a HIMS specialist weekly for something like a year.
If the issue is the bottom 15%, I can understand the FAA requiring anyone in lets say the bottom 25% needing to see a HIMS specialist, but above that number a report from a regular physiatrist should be sufficient.
Due to running into this issue, he is no longer interested in pursuing aviation....

I believe there likely is a number of conditions where the FAA could take a more nuanced view; or create a more affordable and common variation of HIMS.

Tim

I sure won't argue with a more nuanced view, but given the FAA backlog, every new nuance is bout to cost the pool of special issuance aviators an unusustainable wait to 15 months from 12 month review time period. We are just.....outaa gas. The new speaker sez, "no more gas". And so it goes.

 

[Clip4]

We're not talking about schizophrenic psychopaths -- we're talking about people whose function is improved by regular pharmacologic adjustment (see the 25%-75% argument above). Are you equally concerned that a pilot with high LDL cholesterol might have skipped his Lipotor?

And, as evidenced by the prevalence of the condition (for better or for worse), they are not entirely outside the mainstream.

Is a pilot with high LDL required by the FAA to take Lipitor? Does he have to give up $100 hamburgers that day?

 

[Pinecone]

You need meds to properly function. What happens when you stop taking them?

How is that different from say insulin dependent diabetes??

 

[Lindberg]

How is that different from say insulin dependent diabetes??

Have you seen the requirements to get a medical as an insulin-dependent diabetic?

 

[Half Fast]

Have you seen the requirements to get a medical as an insulin-dependent diabetic?

Yep. But if you already have a medical when you develop diabetes, you can go to any state-licensed physician and walk out with Basic Med if the doc thinks you're safe. It's not on the list of conditions requiring a one-time SI. So why isn't diabetes on the CACI list for 3rd class?

 

[TCABM]

How is that different from say insulin dependent diabetes??

From an FAA perspective, diabetes starts on the ‘medical’ illness/disease side of the ledger; ADHD starts on the ‘mental’ illness/disease side.

 

[tspear]

I sure won't argue with a more nuanced view, but given the FAA backlog, every new nuance is bout to cast to pool fof special issuance vaiaitors an unussustainable uout to 15 months from 12 month review time period. We are just.....outaa gas. The new speaker sez, "no more gas". And so it goes.

In my "dream world" The FAA Medical branch would flip the script. Now, with such a hard stance, each case is required to come to the FAA. By taking a more nuanced view point, they could let existing medical professionals adjudicate and now have to submit to the FAA.

Tim

 

[Dana]

How is that different from say insulin dependent diabetes??

The FAA assumes a diabetic, though he may have a health issue, can be trusted to take his meds. The FAA assumes anybody with any kind of mental issue is crazy and can't be trusted.

 

[bbchien]

IDDM is so closely chemically monitored and objectively monitored that we SHOULD know just before the train leaves the rails....

 

[Lindberg]

Yep. But if you already have a medical when you develop diabetes, you can go to any state-licensed physician and walk out with Basic Med if the doc thinks you're safe. It's not on the list of conditions requiring a one-time SI. So why isn't diabetes on the CACI list for 3rd class?

Since the thread is about ADHD and not diabetes, in order to keep from going farther afield, I'll point out that someone who has a medical when he "develops" ADHD is also eligible for Basic Med if the doc thinks he's safe.

 

[Palmpilot]

The FAA crackdown on mental health issues has been attributed to the GermanWings disaster. My guess is that a diabetic pilot is less likely to murder a planeload of passengers than a pilot who is nuts.

 

[robin ardoin]

The FAA crackdown on mental health issues has been attributed to the GermanWings disaster. My guess is that a diabetic pilot is less likely to murder a planeload of passengers than a pilot who is nuts.

So, what are you trying to say?

 

[ThatWontFly]

Maybe the FAA figures its easier to find snacks in the sky than adderall when you really need something to get you back to normal. Never heard of an ADHD coma though

Realistically though I'm not sure how much GermanWings has to do with it but I'm not on much of a position to argue otherwise. However all the ADHD talk was in 2010, about 5 years before GermanWings. Certainly can't blame any pilots for not speaking up about mental health issues after that though.

I give it about 10~12 years before the FAA reverses course on ADHD...something about labor pools, pilot shortages, minimal adverse effects when properly medicated, ability to maintain successful careers, and enough pilots are already clearly ADHD and undiagnosed or on the cash program with an understanding shrink

 

[Jon Wilder]

The FAA crackdown on mental health issues has been attributed to the GermanWings disaster. My guess is that a diabetic pilot is less likely to murder a planeload of passengers than a pilot who is nuts.

I watched the NTSB Safety Summit back in December. There was a flight attendant there who told the story of her husband, who was an airline transport pilot. Prior to Germanwings, he went as long as he could before he finally grounded himself to address his mental health issues. On his next medical application, he reported it, which triggered the deferral. The FAA would ask for this test, and that test, all through back and forth snail mail. They'd as for this, then they'd ask for that, and every hoop he was required to jump through he was doing it.

Then Germanwings happened. Shortly after, he received the thing he feared the most...a denial letter.

On the next flight that his flight attendant wife was assigned to, he went to a hotel room, brought his handgun with him, and shot himself.

The FAA I'm certain would use this to their advantage, citing "Yep, he was suicidal. Therefore, we were justified in denying him."

It's been said by many that the enforcement action which grounds a pilot, especially permanently, is enough to cause great depression in otherwise healthy pilots. For most all pilots, being a pilot is as much their identity as their birth name. You take that away from them, you take away their whole purpose in life. AAM-300 knows this. But they act as if this is not acceptable and is a mental disorder in itself, thus another reason to ground a pilot. Their draconian practices, not wanting people to understand the system, archaic regulations and standards, not trusting their own AMEs, establishing punitive consequences for incidents that happened well over 10 years ago (HIMS), they're creating this backlog. They are directly responsible for the pilot shortage. Don't think they're not. They will defend their stance with "If you can show that you're being treated and the treatment has shown to be effective, 100% chance you will get back in the cockpit." But then you hit them with "When? 3-4 years?" and they go "Well...we're backlogged and short staffed...".

They seem to have greater interest in keeping pilots grounded than flying. FAA = Friends Against Aviation

The Administrator once stated that the barriers that pilots face for being honest about their mental health are "perceived barriers". It was stated at the NTSB Safety Summit that "I hardly believe we would be gathered here today if these barriers were merely a perception." When you have more than 56% of pilots foregoing reporting their mental health information, you cannot argue that the barriers are "perceived".

Lastly, the FAA frowns upon autism of any kind. This is counterproductive because you have to be somewhere on the spectrum in order to fly a plane and do it safely like we do, with all of the simultaneous information processing required to do it (especially in instrument flying...all while having to ignore your own internal senses).

 

[FlyingBiscuit]

I haven't been following this conversation at all, but I wanted to add my $0.002.

I think cognitive stuff like this should really be determined by whether your CFI is comfortable with you soloing and whether can pass a checkride. Maybe there's some more guidance given to CFIs on whether a student is ready to solo. Obviously the standards should be more strict for commercial pilots. I'm just talking about people who want to fly around in their Cessnas.

I cannot fathom how AAM-300 believes the full battery is objectively reasonable in 99% of cases given the time and costs associated with it.

 

[Tools]

It’s the natural progression of things with no consequence, and autocracy.

There’s no need to change the system really, just enforce consequences for those who don’t do their job, or do it wrong… you know the drill, LIKE THEY DO TO US.

 

[Lindberg]

The FAA I'm certain would use this to their advantage, citing "Yep, he was suicidal. Therefore, we were justified in denying him."

Are you arguing that the guy who killed himself when his medical was denied was mentally fit to fly airliners? Really? Millions of people lose their jobs and don't kill themselves. In fact, the vast majority of people in this situation don't kill themselves. It's not a normal, healthy reaction. What if the FAA had given him a medical and he'd gotten some bad news that challenged his identity right before entering the cockpit of a plane full of passengers?

 

[Half Fast]

Are you arguing that the guy who killed himself when his medical was denied was mentally for to fly airliners? Really? Millions of people lose their jobs and don't kill themselves. In fact, the cat majority of people in this situation don't kill themselves. It's not a normal, healthy reaction. What if the FAA had given him a medical and he'd gotten done bad news that challenged his identity right before entering the cockpit of a place full of passengers?

And in that case, the choice is whether the pilot might commit suicide or might commit mass murder. Pretty obvious choice, if those are the only two options.

I certainly don't know how to fix the situation, but it might be nice if mental health denial letters came packaged with some sort of help. I have no earthly idea how to do that, though. Does the evaluating psychiatrist, who is supposed to be intimately familiar with the pilot's mental by this point and should anticipate the impact of a denial, have any ethical responsibility to get the person some help? Legally, FAA docs are not treating patients; they're evaluating pilots. But does it end there, or does the doctor have a compelling obligation as a physician?

 

[Jon Wilder]

Millions of people lose their jobs and don't kill themselves

Millions of people aren't forced to fight like hell and spend thousands and tens upon thousands getting tests and repeat tests, jumping through hoops with no end in sight, followed by more snail mailed requests for more information (and some because the original submitted information expired before the FAA got around to looking at their file), only to receive a denial and lose their jobs in the end, yet here we are.

 

[Tools]

Legally, FAA docs are not treating patients; they're evaluating pilots.

This is part of where their system is failing… they DO treat. Without consequence OR expertise.

They shouldn’t be, but they do, both constructively, occasionally by omission, and once in a while directly. And there is no appeal.

They are using LICENSED doctors in this administrative process, so yes, there certainly is SOME level of more than administrative responsibility (which they also abrogate).

They wanna just administrate? Give up the license.

 

[SebIp]

I watched the NTSB Safety Summit back in December. There was a flight attendant there who told the story of her husband, who was an airline transport pilot. Prior to Germanwings, he went as long as he could before he finally grounded himself to address his mental health issues. On his next medical application, he reported it, which triggered the deferral. The FAA would ask for this test, and that test, all through back and forth snail mail. They'd as for this, then they'd ask for that, and every hoop he was required to jump through he was doing it.

Then Germanwings happened. Shortly after, he received the thing he feared the most...a denial letter.

On the next flight that his flight attendant wife was assigned to, he went to a hotel room, brought his handgun with him, and shot himself.

The FAA I'm certain would use this to their advantage, citing "Yep, he was suicidal. Therefore, we were justified in denying him."

It's been said by many that the enforcement action which grounds a pilot, especially permanently, is enough to cause great depression in otherwise healthy pilots. For most all pilots, being a pilot is as much their identity as their birth name. You take that away from them, you take away their whole purpose in life. AAM-300 knows this. But they act as if this is not acceptable and is a mental disorder in itself, thus another reason to ground a pilot. Their draconian practices, not wanting people to understand the system, archaic regulations and standards, not trusting their own AMEs, establishing punitive consequences for incidents that happened well over 10 years ago (HIMS), they're creating this backlog. They are directly responsible for the pilot shortage. Don't think they're not. They will defend their stance with "If you can show that you're being treated and the treatment has shown to be effective, 100% chance you will get back in the cockpit." But then you hit them with "When? 3-4 years?" and they go "Well...we're backlogged and short staffed...".

They seem to have greater interest in keeping pilots grounded than flying. FAA = Friends Against Aviation

The Administrator once stated that the barriers that pilots face for being honest about their mental health are "perceived barriers". It was stated at the NTSB Safety Summit that "I hardly believe we would be gathered here today if these barriers were merely a perception." When you have more than 56% of pilots foregoing reporting their mental health information, you cannot argue that the barriers are "perceived".

Lastly, the FAA frowns upon autism of any kind. This is counterproductive because you have to be somewhere on the spectrum in order to fly a plane and do it safely like we do, with all of the simultaneous information processing required to do it (especially in instrument flying...all while having to ignore your own internal senses).

I don't know how we can take a case of someone being grounded and then killing himself as a reason for more lenient approach to mental health?

I would think if you can't see your way past an event like that, there exists a valid question what else could have caused you to snap?

Frankly, that individual only considered himself. What about his wife? Friends and family? Did he thinks about them? Expand it to passengers and people on the ground should something happens while they are at the controls?

 

[FlyingBiscuit]

And in that case, the choice is whether the pilot might commit suicide or might commit mass murder. Pretty obvious choice, if those are the only two options.

I certainly don't know how to fix the situation, but it might be nice if mental health denial letters came packaged with some sort of help. I have no earthly idea how to do that, though. Does the evaluating psychiatrist, who is supposed to be intimately familiar with the pilot's mental by this point and should anticipate the impact of a denial, have any ethical responsibility to get the person some help? Legally, FAA docs are not treating patients; they're evaluating pilots. But does it end there, or does the doctor have a compelling obligation as a physician?

I know you're specifically talking about mental health, but the problem is far more broad. The current system incentivizes pilots to (a) lie on their medicals or (b) not seek treatment for problems. Both of these represent serious threats to aviation safety. Even the NTSB acknowledges this.

In order to fix the problem, you must change the incentives. Pilots need to be incentivized, or at least not disincentivized from being upfront about their medical situation. Earlier I said that cognitive testing (note this is separate from mental health) should be replaced by a CFI/DPE determining you are capable of operating an aircraft. I standby this. My ideas are, what I think, would help in areas of both mental and physical health.

Here's my ideas:
- Before any standards are actually changed, AAM-300 needs to be completely reworked from the ground up. It should be easier to communicate with them. Replace snail mail with an online portal with all documents. Review times <1 month from submission. Extensions are easier to obtain. This means hiring more people.
- The standards for each class of medical needs to be reworked. People who are applying for second class medicals to fly crop dusters for hire shouldn't need to meet the same standards as an applicant for a first class medical with ATP privileges to fly hundreds of passengers. In the same vein, a third class applicant who wants to fly their Katana for personal enjoyment shouldn't have to meet the same standard as a crop duster. Yet, here we are. All pilots must meet the First Class standard (more or less). With this, I imagine the medicals become more granular in terms of what aircraft you are allowed to fly with them.
- If the FAA wants extra testing, they should pay for it. Perhaps with an administrative fee on the part of the applicant (no more than $100).
- If a career pilots loses their medical, their employer should be compelled to pay them until the situation is resolved one way or the other. Perhaps create carve outs for cases where the pilot's own negligence caused the problem.

One other thing, and I'm not really sure where to put this, is I think it's important for us pilots to have a certain amount of humility. If I had a heart condition that made it so I might drop dead at any moment, I think I'd have a humility to accept that I'm not fit to fly and it's fair for the FAA to deny my medical. At the end of the day, there are always going to be some people who just aren't able to safely operate an airplane. The problem is not that not everyone can fly, the problem is that some people aren't allowed to fly for somewhat arbitrary reasons.

 

[Lindberg]

Millions of people aren't forced to fight like hell and spend thousands and tens upon thousands getting tests and repeat tests, jumping through hoops with no end in sight, followed by more snail mailed requests for more information (and some because the original submitted information expired before the FAA got around to looking at their file), only to receive a denial and lose their jobs in the end, yet here we are.

Actually, a lot of people go through a lot of stuff. And medical issues can interfere with people's jobs in all professions, even if not to the same extent as pilots. Short and long-term disability insurance exists and is provided by many employers for exactly this reason. But your example seems to be one where subsequent history shows the FAA got it right. Losing his medical wasn't the sole cause of that pilot taking his own life, but he lost his medical in the setting of preexisting mental illness. It's sad for sure, but I really don't see any good argument that he should have been in the cockpit.

 

[bbchien]

It is generally, the guys who hold out, hide the ball until it’s IMPOSSIBLE, who do the worst in the certification system.

 

[Jon Wilder]

- If the FAA wants extra testing, they should pay for it. Perhaps with an administrative fee on the part of the applicant (no more than $100).

^^^THIS!!! Especially when you've shelled out thousands for the test, send it in, the FAA sits on your case for months on end (dare I say years), only to then send you a letter stating that they need you to redo the tests because the previous tests are now more than 6 months old, thus you're in this feedback loop that will end up costing you thousands upon thousands in repeated tests, all because "oh...yeah...backlogged and short staffed".

The problem is not that not everyone can fly, the problem is that some people aren't allowed to fly for somewhat arbitrary reasons.

Again...^^^THIS!!! Clearly if you have heart issues or any sort of issue that could cause you to become incapacitated or medically unsafe to operate an aircraft (diabetic episode, heart attack, stroke, random seizures, etc), well...it is what it is unless you can somehow get that under control to the satisfaction of AAM-300. This I can more than understand.

In the case I described above, the guy was in deferral. He was doing everything the FAA asked for. If there had been anything wrong with the tests he'd already sent in, they would have already denied him. Their decision to deny him was just a knee jerk reaction to Germanwings. Completely unfair, and after he'd shelled out thousands upon thousands to jump through the hoops, they deny him because of an incident that had nothing to do with him.

Shout all you want about "Well his reaction..."...the FAA is NOT without fault here. They treat pilots unfairly, act arbitrarily and capriciously, of which the courts have noted they are a repeat offender of this, forcing airmen to then have to shell out another thousands upon thousands to fight them in court. Even Congress is now involved with this. The "right reaction" isn't to "just bend over and take it". Although this is precisely the only thing they will accept as proof of "established clinical evidence of recovery satisfactory to the Federal Air Surgeon".

 

[Lindberg]

In the case I described above, the guy was in deferral. He was doing everything the FAA asked for. If there had been anything wrong with the tests he'd already sent in, they would have already denied him. They only denied him because of Germanwings. Completely unfair, and after he'd shelled out thousands upon thousands to jump through the hoops, they deny him because of an incident that had nothing to do with him.

Doing everything the FAA asks for does not mean you're healthy or eligible. He was deferred because he wasn't apparently eligible. And the further testing apparently supported that conclusion. Other than his compliance, do you have evidence that the FAA made the wrong decision?

 

[SebIp]

^^^THIS!!! Especially when you've shelled out thousands for the test, send it in, the FAA sits on your case for months on end (dare I say years), only to then send you a letter stating that they need you to redo the tests because the previous tests are now more than 6 months old, thus you're in this feedback loop that will end up costing you thousands upon thousands in repeated tests, all because "oh...yeah...backlogged and short staffed".


Again...^^^THIS!!! Clearly if you have heart issues or any sort of issue that could cause you to become incapacitated or medically unsafe to operate an aircraft (diabetic episode, heart attack, stroke, random seizures, etc), well...it is what it is unless you can somehow get that under control to the satisfaction of AAM-300. This I can more than understand.

In the case I described above, the guy was in deferral. He was doing everything the FAA asked for. If there had been anything wrong with the tests he'd already sent in, they would have already denied him. Their decision to deny him was just a knee jerk reaction to Germanwings. Completely unfair, and after he'd shelled out thousands upon thousands to jump through the hoops, they deny him because of an incident that had nothing to do with him.

Shout all you want about "Well his reaction..."...the FAA is NOT without fault here. They treat pilots unfairly, act arbitrarily and capriciously, of which the courts have noted they are a repeat offender of this, forcing airmen to then have to shell out another thousands upon thousands to fight them in court. Even Congress is now involved with this. The "right reaction" isn't to "just bend over and take it". Although this is precisely the only thing they will accept as proof of "established clinical evidence of recovery satisfactory to the Federal Air Surgeon".

I think lots of people are confusing the conditions vs the bureaucracy.

Bureaucracies often have problems, don't feel right, don't feel fair to the individual. That isn't new and often is actually a necessary evil. Not saying anyone should take it or leave it, it is a case by case situation. There is no easy answer and saying the courts and congress says anything in immaterial. Lots of folks got real railed up on the Boeing stuff and want FAA to be more active and harder on them. And frankly the courts and congress in your country from a external point of view leaves a lot to be desired.

It is hard to expect civil servants to do anything other than what's outline to them by their department rules. In your highly litigious country that isn't a risk I think normal people wants to take.

To a question of whether mental illness are cause for being barred from flying? I think the example you tried to use is actually shouting a loud yes. If you wanted to make a point that was not the right story at all. What it demonstrated was someone who was on the edge and one more thing caused him to snap. That makes the deferral before the incident seemingly in mistake.

Life isn't fair man. And flying is not a right. If it was we'd have wings instead of arms and no one would complain about the cost of aircraft, gas or anything.