Medical Trouble Incoming

I

In a Pickle

Guest
To put it lightly I am going to have trouble when I go to get a new medical certificate. I have gone through pretty much every post on here dealing with alcohol and haven't seen a situation like mine. I'm a 21 year old CFI at a college flight program. Early in September, I had COVID. It wasn't bad except for a fever, aches, chills, fatigue, diarrhea and loss of appetite. Flash forward a couple weeks and I'm in the hospital with Pancreatitis. Doctor asks me if I drank anything and I said yes I drank over the weekend with my friends. Boom, slapped with alcohol induced pancreatitis and social worker in my hospital room trying to see if I had a problem. She left after 3 minutes. Self grounded myself per the FAAs guidance and started to research the process for getting my medical back. Realized I hadn't reported an ER visit for alcohol (in September 2018) where my BAC was 0.202 according to my records. I truly didn't think it counted as a hospital visit or a visit to a health professional (I put down visits to doctors for tonsilitis, etc. I was 19 at the time and wasn't thinking). Now that I've had time to browse the internet and discover more about my situation I'm wincing. I have no DUIs, no FAA violations, no criminal record, no drug use and definitely wasn't trying to intentionally falsify any records. I want to make this right with the FAA and I'll do whatever it takes. I've already started looking for an attorney. I really need to choose the right one as this is quite the pickle. What am I going to do?
 
Eldorado said:
Last thing you need is an attorney.
Click to expand...

Ugh, he has a factual misrepresentation on a medical application that involves a high BAC alcohol medical issue. The FIRST thing he needs is an aviation attorney. It's not about the medical, it's about him not losing all his certs, getting a huge fine, or ending up in prison. He's a CFI and responsible for being one of the gatekeepers to aviation and teaching others to fly. Additionally he's most likely training to be a professional pilot.

If there ever was a case to draw legal attention from the FAA this one is it.

OP,

Before I start, this isn't about judging you or trying to throw a label on you. It's about trying to help you with the best information I have. I'm not an AME or an attorney, but I have some amateur experience with AMCD and alcohol.

21 years old with 2 hospital encounters related to alcohol already. Sounds like the drinking thing isn't working out too well for you. It may be time for some introspection about your relationship with alcohol and how it's impacted(ing) your life. If you're in a collegiate flight program I assume you have professional aviation aspirations. Your current lifestyle and the life of a professional pilot are most definitely not in alignment.

You might not fit the diagnosis criteria for alcohol use disorder in a clinical sense, but the FAA uses the FARs to define abuse and dependence. The FAR criteria are much more strict than the DSM. You're almost definitely going to end up in HIMS. The only chance (and it's a very remote one) you have of avoiding that would be if the pancreatitis is attributable to something other than heavy alcohol consumption. Even with that, I'd bet my retirement on HIMS. If you want to keep flying, your drinking days are over.

My opinion is that you meet the criteria for substance dependence as defined by 67.307(a)(4)(ii). You meet the criteria for 67.307(a)(4)(ii)(A) with a previous BAC of .202 demonstrating increased tolerance. You meet the criteria for 67.307(a)(4)(ii)(D) with 2 alcohol related hospital visits (damage to physical health), impairment of occupational functioning (you can't work as a CFI, future aviation options jeopardized), and impairment of social/personal functioning (you can't be in a collegiate flight program if you can't hold a medical). You only needed to meet one of these to be considered substance dependent.

If it's not dependence it will be abuse. You meet the criteria of 67.307(b)(1) (BAC test > .04) and 67.307(b)(2) (2 uses of a substance that was physically hazardous). You only need 1 of those to be diagnosed with substance abuse.

Here's what I would do if I were in your shoes.

1. Keep in mind the Sport Pilot and BasicMed consequences of failing an FAA medical or having your medical revoked/withdrawn. I would not take another FAA medical exam until I had more information from professionals (HIMS AME & attorney). You're already going to have enough educational/professional hurdles, but you don't want to close all aviation doors.

2. Figure out what impact alcohol has on your life and if you have a problem. If booze isn't doing good stuff for your life then get it under control. Get this piece right before you worry about your medical. Consider whether you're really ready to be done with alcohol. If you aren't, you'll most likely make your situation worse by starting HIMS.

3. Gather all of the medical records for the hospital admission and the pancreatitis incident from the hospital medical records office.

4. Review with your attorney to head off any legal consequences of the failure to report on previous medicals. The medical records will be helpful here. Hopefully they can "work something out" to keep you out of revocation or criminal territory.

5. Once you have the legalities sorted, deal with the medical. Locate a HIMS AME and engage them on a consultative basis to discuss your case and their willingness to work with you. Again, the records will be helpful. Dr. Chien and Dr. Fowler are around on this board and they're great options. The HIMS AME will provide you with the best course of action to begin establishing proof of sobriety and recovery. These are 2 related but very different things and you need to demonstrate both.

6. Once you and your HIMS AME are satisfied that you'll meet the criteria for a special issuance medical you can complete the exam and get a special issuance. Whatever you do, do not complete a medical exam unless you and your AME are confident that you'll meet the criteria for a special issuance and prepared to submit all the required documentation in one pass.

Your special issuance will include requirements for years of ongoing drug/alcohol monitoring. As it stands right now, if you are diagnosed substance dependent you'll continue this monitoring in some capacity for as long as you hold an FAA medical certificate.

It's going to be expensive (>$10k), take a lot of time (years), and a lot of work on your part, but it can be done. The question is how bad do you want it.
 
Have you only omitted once?
Omission severity is "repetition based" and if it's only once you DO have a pathway but it involves surrendering your certificate, going to rehab and proving your abstinence+ doing the recovery activities.

Sure you can hire the attorney. It'll cost you 18 months until the docs are allowed to address you situation again.

But if you omitted more than once, that's another ball of wax....(1) is an Omission, (2) is a lie on an affadavit.
 
bbchien said:
Have you only omitted once?
Omission severity is "repetition based" and if it's only once you DO have a pathway but it involves surrendering your certificate, going to rehab and proving your abstinence+ doing the recovery activities.

Sure you can hire the attorney. It'll cost you 18 months until the docs are allowed to address you situation again.

But if you omitted more than once, that's another ball of wax....(1) is an Omission, (2) is a lie on an affadavit.
Click to expand...

Only once.... it was an honest mistake. I hope the FAA realizes that when I come forward and tell them before they find out. I plan on finding treatment. The question for me is where. I know the FAA needs to see that. What’s the 18 months for if I hire an attorney? Haven’t made any moves yet, just trying to figure out a plan.
 
ThatOtherGuy said:
Ugh, he has a factual misrepresentation on a medical application that involves a high BAC alcohol medical issue. The FIRST thing he needs is an aviation attorney. It's not about the medical, it's about him not losing all his certs, getting a huge fine, or ending up in prison. He's a CFI and responsible for being one of the gatekeepers to aviation and teaching others to fly. Additionally he's most likely training to be a professional pilot.

If there ever was a case to draw legal attention from the FAA this one is it.

OP,

Before I start, this isn't about judging you or trying to throw a label on you. It's about trying to help you with the best information I have. I'm not an AME or an attorney, but I have some amateur experience with AMCD and alcohol.

21 years old with 2 hospital encounters related to alcohol already. Sounds like the drinking thing isn't working out too well for you. It may be time for some introspection about your relationship with alcohol and how it's impacted(ing) your life. If you're in a collegiate flight program I assume you have professional aviation aspirations. Your current lifestyle and the life of a professional pilot are most definitely not in alignment.

You might not fit the diagnosis criteria for alcohol use disorder in a clinical sense, but the FAA uses the FARs to define abuse and dependence. The FAR criteria are much more strict than the DSM. You're almost definitely going to end up in HIMS. The only chance (and it's a very remote one) you have of avoiding that would be if the pancreatitis is attributable to something other than heavy alcohol consumption. Even with that, I'd bet my retirement on HIMS. If you want to keep flying, your drinking days are over.

My opinion is that you meet the criteria for substance dependence as defined by 67.307(a)(4)(ii). You meet the criteria for 67.307(a)(4)(ii)(A) with a previous BAC of .202 demonstrating increased tolerance. You meet the criteria for 67.307(a)(4)(ii)(D) with 2 alcohol related hospital visits (damage to physical health), impairment of occupational functioning (you can't work as a CFI, future aviation options jeopardized), and impairment of social/personal functioning (you can't be in a collegiate flight program if you can't hold a medical). You only needed to meet one of these to be considered substance dependent.

If it's not dependence it will be abuse. You meet the criteria of 67.307(b)(1) (BAC test > .04) and 67.307(b)(2) (2 uses of a substance that was physically hazardous). You only need 1 of those to be diagnosed with substance abuse.

Here's what I would do if I were in your shoes.

1. Keep in mind the Sport Pilot and BasicMed consequences of failing an FAA medical or having your medical revoked/withdrawn. I would not take another FAA medical exam until I had more information from professionals (HIMS AME & attorney). You're already going to have enough educational/professional hurdles, but you don't want to close all aviation doors.

2. Figure out what impact alcohol has on your life and if you have a problem. If booze isn't doing good stuff for your life then get it under control. Get this piece right before you worry about your medical. Consider whether you're really ready to be done with alcohol. If you aren't, you'll most likely make your situation worse by starting HIMS.

3. Gather all of the medical records for the hospital admission and the pancreatitis incident from the hospital medical records office.

4. Review with your attorney to head off any legal consequences of the failure to report on previous medicals. The medical records will be helpful here. Hopefully they can "work something out" to keep you out of revocation or criminal territory.

5. Once you have the legalities sorted, deal with the medical. Locate a HIMS AME and engage them on a consultative basis to discuss your case and their willingness to work with you. Again, the records will be helpful. Dr. Chien and Dr. Fowler are around on this board and they're great options. The HIMS AME will provide you with the best course of action to begin establishing proof of sobriety and recovery. These are 2 related but very different things and you need to demonstrate both.

6. Once you and your HIMS AME are satisfied that you'll meet the criteria for a special issuance medical you can complete the exam and get a special issuance. Whatever you do, do not complete a medical exam unless you and your AME are confident that you'll meet the criteria for a special issuance and prepared to submit all the required documentation in one pass.

Your special issuance will include requirements for years of ongoing drug/alcohol monitoring. As it stands right now, if you are diagnosed substance dependent you'll continue this monitoring in some capacity for as long as you hold an FAA medical certificate.

It's going to be expensive (>$10k), take a lot of time (years), and a lot of work on your part, but it can be done. The question is how bad do you want it.
Click to expand...

Thanks for taking the time to respond and offering such a substantial response, very helpful. My days with alcohol are over. They have to be if I want to be successful with this. I’m already one month sober. Doesn’t seem like much but I didn’t have any withdrawal symptoms or any urge to drink so it’s been easy. You’ve confirmed much of what I’ve been reading.... I’m willing to do anything it takes. Thanks again!
 
One of our attorney members says, "You never want to turn a medical problem into a legal one."
 
I would note that, at age 21, an “official blood alcohol” of .202 on one occasion and a diagnosis of alcoholic pancreatitis on another are both big warning flags and tend to indicate a serious drinking problem. You may have a hard time convincing the FAA that it was an inadvertent omission. For that, you need the advice of a HIMS physician like Dr. Chien, not an attorney.
 
In a Pickle said:
Only once.... it was an honest mistake. I hope the FAA realizes that when I come forward and tell them before they find out. I plan on finding treatment. The question for me is where. I know the FAA needs to see that. What’s the 18 months for if I hire an attorney? Haven’t made any moves yet, just trying to figure out a plan.
Click to expand...
I'm having an issue with the "honest mistake" characterization, so I'm thinking that the FAA may also.
 
In a Pickle said:
Thanks for taking the time to respond and offering such a substantial response, very helpful. My days with alcohol are over. They have to be if I want to be successful with this. I’m already one month sober. Doesn’t seem like much but I didn’t have any withdrawal symptoms or any urge to drink so it’s been easy. You’ve confirmed much of what I’ve been reading.... I’m willing to do anything it takes. Thanks again!
Click to expand...

You're welcome for the advice. Sometimes we need a kick in the a$$ to wake us up. Sounds like you have the right attitude, and if you maintain that you should make it through this. I genuinely hope that you do and get your medical back. More importantly, I hope that this will set you up for a healthy happy life.

In light of Dr. Chien's advice, it sounds like talking with the attorney and the HIMS AME in parallel might be the best course of action. If you could get them all to discuss your situation as a team, even better. Many members here advocate not getting an attorney involved at all. I agree with the premise that introducing an attorney in a formal capacity with the FAA can make things adversarial and grind things to a halt. The tipping point would be the minute the attorney has direct contact with the FAA on your behalf. I disagree with treading into legally dangerous waters without at least discussing your situation with an attorney. Like many things in life, it's a question of balance and making the best choices that suit your situation/risk tolerance in less than ideal circumstances.

One month sober is an accomplishment if you have a life that's highly centered around alcohol, congratulations. Most pilots I know are action oriented and problem solvers. We don't like sitting around and waiting. I'll offer some suggestions about things to think about and actions you can take:

Priority number 1 is getting this thing under control and leading a healthy life. This is not a road where you tick items off a list and you're done. The people along this road have heard it all before and they have amazingly sensitive BS detectors. As I stated before, abstinence and recovery are not the same thing if you have an alcohol issue. Start reading about the difference.

Give real thought to just how much you're willing to change to be healthy. If you have a lifestyle centered around alcohol, it hits your social life, romantic life, family relationships, leisure activities, consumes large amounts of time, and becomes a component in all kinds of life decisions. If that sound like you, that's all going to have to change. Give thought to the changes and what you're willing to give up. Write it down.

Consider how you'll maintain that sobriety once the sting of this situation begins to wear off. Pain can be a good short term motivator, but it eventually fades. In my experience, those with successful recovery from substance abuse issues find long-term motivation from a very personal place within themselves. Give some real thought to why you want to change and what the future looks like if you do change vs don't change. Write it down.

You're going to be encouraged (forced) to do a lot of things that might not have been at the top of your list in life. Things will go immeasurably better for you if you do them with full commitment and see them as opportunities to lay a foundation for a happy and healthy life. You have to spend the time so you might as well get something out of it. Start getting ahead of those things so you at least feel like you're an active participant rather than a victim.

You're going to feel resentment at some points. A lot of this can come from wanting life to be as it "should be" instead of dealing with it as it IS. Let it go. Resentment won't do any good and it will ultimately only hurt you.

Give some thought to attending group support meetings. If you go through HIMS you won't have a choice about this. Might as well start looking for a group in your area that resonates with you. I wont get into the 12 step (AA) vs non 12 step program debate. Be advised that support groups are for support, not treatment. They're full of amateurs and they're not intended to replace the work of a mental health professional. You can start this today with nothing to lose as group attendance isn't reportable to the FAA.

Consider individual counseling/therapy. You want to get to the root of your drinking, not just band aid over the top of it. A mental health professional can be effective in that endeavour. Even if you don't get to the root of your drinking it's very likely that you'll gain some deeper insight into yourself and your behaviors. This one could have FAA implications so discuss with your HIMS AME. You're most likely going to be mandated in some capacity here anyway (substance abuse evaluation and possibly HIMS psychiatric evaluation).
 
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#1 is to start on a private, FAA style (needs criteria) Proof of abstinence documentation plan, so that the clock runs in your favor.
Although each and every alcoholic needs be congratulated each day he is sober, the FAA requires substantiation to that assertion.

#2 is to surrender your certificate. You can do so by certified mail and you don't have to explain why- just "returned for cancellation" which takes the enforcement "Heat" off of you. Then you have time for consultation(s). If you get on the "enforcement" list, it will be a very very long time B4 the FAA docs even consider your situation.
 
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An attorney can neither hide nor change the facts. You did it, you know you did it, you know the only path forward is to admit it. In this situation, it isn’t necessary and you are on the right path.

Stick to it, you’ll be back in the air.
 
bbchien said:
#2 is to surrender your certificate. You can do so by certified mail and you don't have to explain why- just "returned for cancellation" which takes the enforcement "Heat" off of you. Then you have time for consultation(s). If you get on the "enforecement" list, it will be a very very long time B4 the FAA docs even consider your situation.
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I assume you mean surrendering his medical certificate.
 
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