Walking out of the doctor's office, holding the piece of paper on which the duly authorized Aviation Medical Examiner attested that, as of a few moments ago, I met the minimum standards to hold an airman medical certificate, I breathed a sigh of relief and headed out to the Pilot's Lounge at the virtual airport. As do many pilots I know, I get nervous at the prospect of taking my annual flight physical. I want to continue to pass it and thus continue to fly. I've also counseled enough pilots who have had difficulties in passing the medical exam, so I live in dread of the time when the doctor says that he can't issue and he's going to have to send my file to Oklahoma City for further action by the aeromedical people.
But today was not that day, and I walked into the Lounge in excellent spirits. Seeing Old Hack, who has to be older than God by a half-dozen years and is still passing flight physicals, buoyed my spirits even further. I figure if that curmudgeon with his boatload of vices and bad habits can still pass a medical, there's hope for the likes of me.
Hack was in good form: I had heard him insulting people before I even made it to the room. Of course, after he learned that I'd just passed my medical, he turned to Sandy, our resident Citabria expert and air-freight pilot and announced, "Ah, it appears Rick has again managed to bribe his way to medical certification." Sandy just rolled her eyes in response, so Hack turned his attention to me. "What did it take this time, a case of Scotch? A rare painting? Considering your outward appearance, you probably had to buy the guy an airplane. It's no wonder you haven't got a Bonanza or a 210 -- you've had to spend all your money bribing doctors all these years."
Before I could say anything, Hack turned back to Sandy and said, "Of course you heard about the conclusion of Rick's last physical? As Rick was getting dressed he said to the doctor, 'Well, Doc, how do I stand?'"
Before Hack could finish, Sandy jumped in and said, "And the doctor answered, 'That's what puzzles me.' You've got to come up with some newer jokes, Hack."
Before the wittiness achieved any level of quality, Sandy picked up a several-page document and handed it to me. "The NTSB Factual Report and the Probable Cause finally came out on that guy we knew who crashed in the Musketeer about two years ago," she said. "You remember, the engine lost power during the climbout and he did that oddball sort-of turn instead of landing in the big field off the end of the runway."
I remembered the accident well. A pilot with whom we were acquainted had died in the crash and one or two of the passengers were hurt. The group of us here at the Lounge had spent several afternoons trying to figure out what might have happened. He had a fair amount of altitude when things went south and the airplane started to sink and there were good places to land ahead. But he just sort of seemed to dither and made a turn that seemed to start and stop, rolling into and out of a moderate bank. Witnesses say the nose stayed high and the engine was running, but that he then stalled the airplane well above the ground. So high, in fact, that the nose had dropped through by the time he finally hit the ground.
We in the Lounge had hypothesized fuel contamination, a broken throttle cable or ignition-wire problems, but we never put our collective fingers on anything that made sense. Not having been privy to the investigation, we were all very interested in what the NTSB found.
Sandy said, "It's going to surprise you and you aren't going to like it at all. Back in the '50s, Lenny Bruce said no one is shocked anymore, but when I read this, I was shocked."
I took the report from her and sat down in one of the big, tattered recliners and began to read.
Sandy wasn't kidding ... I was stunned.
The engine turned out to have been in terrible shape. I had no idea how poorly my acquaintance, I'll call him "Brad," had maintained his airplane. The engine was about 200 hours past TBO. That, in itself, is no big deal; a well-kept engine can go past TBO in perfect health. However, here the ignition harness was pretty well shot, so several plugs were not getting any significant electrical input. On top of that, the plugs were badly fouled and none of them had a gap that was within published tolerances. The cylinders had no choke left, so as the engine got warm, especially on takeoff, it would steadily lose compression and put out less and less power.
The witnesses had described a very long takeoff roll and slow climb that eventually degraded into a descent. According to the report, as the problems with the engine were made worse by heat, the power dropped off to where the airplane could no longer climb, and then wouldn't hold altitude. The turn was described as very erratic and nose high, with the wings "rocking back and forth". Eventually the airplane stalled. Both of Brad's hands were broken, as were both of the handles of the control yoke. The rod connecting the yoke, through the instrument panel, to the stabilator actuating cables was bent at the panel at a location that was consistent with full nose up stabilator at impact. It looked to me like Brad just kept pulling on the yoke as the power dropped off.
What floored me was that the report stated that Brad was in the terminal stages of a disease for which he had been receiving treatment for about three years. It was eating him up and the treatments had served to only slow its progress. He was taking a regime of drugs prescribed to try and arrest the disease as well as kill the excruciating pain it had to have caused Brad. Of the seven meds he was taking, five were on the FAA's list of drugs that may not be taken by person who is going to fly an airplane. Any one of the five, if reported to the FAA, would have resulted in Brad's medical certificate being lifted, or his AME would have refused to issue.
The NTSB investigation found that Brad had been taking all five drugs for nearly two years. He had taken his airman's medical exam in the last six months and had reported nothing about any of his visits to the doctors who were treating him for his disease, the disease itself, or any of the medications he had been prescribed.
The many side effects of the various medications Brad was taking included drowsiness, confusion, slowness to react to stimuli and difficulty in judging time and distance.
What began to trouble me as I neared the end of the report was that Brad may be more common than we know. As the average age of pilots moves upwards this may become a less-rare situation. I wondered, in Brad's situation, would I make the same decision, to lie on my medical application and hope I don't get caught, and to continue flying? I asked Sandy and Hack about it, and we had a long talk. I'll try and recount the gist of our conversation.
On one level, we think of the times we've flown with a serious head cold, perhaps knowing that we could not have passed the medical exam for our class of certificate on that day, but we pressed on anyway. Maybe we did so because we consider ourselves pretty tough, and we aren't going to let something as seemingly minor as a head cold or sinus infection or "what's going 'round" keep us from flying. And every once in a while we read the accident report of the guy who was flying along on a gorgeous day and entered into one of those descending spirals that accelerate and tighten up until the airplane either breaks up or hits the ground. And we read that the guy had a major-league head cold that the line boy described as hacking and slobbering and sniffling. And then we read the reports of the medical folks who describe the effects of an altitude change of only a few thousand feet on infected sinuses and plugged Eustachian tubes and how it can cause total physiological upset and inability to walk, much less control an airplane.
But that kind of accident is truly rare, so we press on and sometimes fly when we are under the weather.
And we get older.
And our friends have heart attacks and tell us, on one hand, that the FAA has become much more enlightened in terms of issuing a medical after a heart attack. However, it's expensive as all get out to get the medical tests needed, plus your Aviation Medical Examiner can't issue the medical certificate. He or she has to send all the stuff to Oklahoma City where it disappears into the unseen maw of the aeromedical crowd and usually, eventually, it spits out a medical certificate.
And, over those late night beers and martinis, you have heard fellow pilots say that when they can no longer pass a medical that they've found a rural airstrip where they can keep their airplane and go right on flying and to hell with the FAA and regulations. And maybe you know one or two who are doing precisely that.
For most of us it is a fact of life that at some point our bodies or minds will deteriorate to the point that we are not medically qualified to hold a certificate. If history is a guide, most of us will gracefully accept the inevitable. There are, however, a certain percentage of us who will rationalize that process and essential say, "Screw the government, it can't tell me I can't fly" and keep doing so, either by lying on the medical application or not even bothering to take any more medicals. It's interesting that many of those are pretty rabid "law and order" types who pontificate about civilization going to hell in a hand basket because people have no respect for laws. But, irony aside, their inability to face reality means they will go on flying and potentially kill themselves and others because they will not be able to handle an event they probably could have dealt with back when they were healthy.
For some, the Sport Pilot regulations will provide a way to continue to fly. They will simply let their current medical lapse and not apply for another. So long as they can get a drivers license, they will comply with the letter of the law and, in more modest airplanes, can continue to enjoy the sky with a reasonable degree of safety. Others will chose to fly gliders or balloons, where medicals are not required, and they will fly safely for several more years.
Perhaps it's appropriate to interject here that if a pilot starts the medical application process -- that is, fills out and signs the application and gives it back to the receptionist -- there is no backing out. If the doctor says he or she cannot issue a medical certificate then the pilot is faced with what may be a tough situation. The paperwork goes to Oklahoma City and the FAA aeromedical folks will probably send a letter to the pilot asking for more information, usually medical test results, before they will issue a medical certificate. If the pilot is willing to spend the money to have the tests and sends in the results, the result is usually that the FAA will issue. If the tests show that the pilot's health is not adequate, the FAA will issue a denial. If the pilot decides that the tests are too expensive and doesn't take them, and therefore does not comply with the FAA's request for more information, the failure to comply functions as a denial. And, with a denial of a medical certificate, the FAA has said that the pilot cannot fly under the Sport Pilot regulations.
So what does a pilot do when the hand of age, disease or an injury makes it questionable whether he or she can pass that third class medical examination? We've learned in the last year that a certain number of pilots whose health was such that they qualified for social security disability also held FAA airman medical certificates. It appears that some of them did not mention the disability condition they had and/or the medications they were taking when they filled out the application for those medical certificates. In the back of our minds we know that it is illegal to lie on a medical certificate application. In fact, it's a felony. Yet, it's not one that is regularly prosecuted, so the recent spate of criminal actions caught a lot of people by surprise.
The reality is that our system functions almost exclusively on trust -- on the honor system. When Congress set up the FAA through the Federal Aviation Act, it thankfully did not set it up with a plethora of cops who would monitor a pilot's every action. It set up a system where pilots and mechanics are on their honor with regard to virtually everything they do and say. Each of us is on our honor not to fly on one of those days that we are sick even though we hold a medical certificate. We are on our honor to actually have three takeoffs and landings in the preceding 90 days before we carry passengers. We are on our honor to be honest when we list the medications we are taking when we fill out the airman medical application. (While the FAA has the authority to go to all of our treating physicians and get our medical records, it does not do so as a regular practice -- it waits for something to give it reason to do so.) Because of this honor system, we have one of the most open and free aviation setups in the world.
The balance on the scale of this honor system is that if we violate it, if we take advantage of it and are caught, the FAA gets more than a little hot under the collar. It has the power to not only suspend a pilot or medical certificate for a transgression, it can also criminally prosecute; and it will do so. The actions against the pilots in California receiving disability checks brought that to our attention. The FAA has a fair amount of horsepower it can bring to bear on someone who violates the honor system. Some years ago another guy and I owned an Aztec. We sent the engines out for overhaul and got back junk. The logs with the engines were carefully filled out and signed off, and even said they'd been run two hours on a test stand. Yet the ignition system wasn't even all there. We found that the cylinders and pistons were only worth their value for scrap aluminum. The FAA got involved and went after the engine overhauler. To make a long story short, he was convicted of a felony and spent time in a federal penitentiary.
Such events are extremely rare. Real life for most of us means we have to decide for ourselves when it is time to not fly because of our health.
Over the years, I've flown with pilots who were on various medications because of health conditions. Of those pilots, some could pass a medical exam. Some could not, and knew it, so they hired me to sit in the right seat to make the flight legal. I had reached an understanding with each of them that simply said that they were going to do all of the flying, but that I was the pilot in command and would step in and take over if, in my judgment, the situation warranted. I've also found myself in airplanes with pilots who had no business flying because of health or medications, yet continued to do so because they were able to pass the medical exam.
I've read some studies where pilots were given measured amounts of alcohol and then flew instrument approaches in a simulator. What I saw when I flew with pilots who had some significant degree of medical impairment and what I read in those alcohol studies was quite similar. With a number of the pilots who could not hold a medical, I saw that their reactions were visibly slow. I watched them sit there and do nothing for a long time as a situation developed, usually incipient loss of directional control on landing rollout. When they did take action, it was appropriate in terms of control input, but not always for magnitude or duration of the input. In reacting to a swerve they applied control input to stop the swerve, but did not take out the input when the swerve was corrected. Often they induced a swerve in the opposite direction. Most of the time they would eventually damp things out, leading to a landing rollout that looked a bit like a drunken sailor; but on occasion, I had to take the airplane.
What struck me was that they were guys (and these were all men) who were simply aging and had decided to not apply for a medical or had lost their medical. They all recognized that they had had trouble handling the airplane. They each talked about it with me and would say something along the lines that they were glad they made the decision to stop flying solo. The ones who were on medications, often for pain, did not recognize that they had performed poorly. Not only were their reactions bad, they could not evaluate themselves. They were generally satisfied with their performance unless I had to take the airplane. In those circumstances they were often puzzled as to why I did so or, occasionally they were upset that I stepped in when they "had things under control." It matched the alcohol studies. The pilots not only did poorly, performing far below their normal levels, but they had no idea they were doing poorly and frequently thought they were actually doing better than they did when sober.
In a perfect world, each of us would recognize at precisely the right time when we should stop flying as pilot in command. Each of us would not wait to fail a medical. None of us would even consider omitting something from the application. None of us would fly when taking medications that are contraindicated by the FAA and none of us would put ourselves or others at risk by continuing to fly when our bodies or minds are no longer up to handling what we can expect to see on a flight.
The FAA has regulations regarding the appropriate physical and mental condition of pilots. Most are good, some are out of date, and I am aware that there is constant pressure to modernize the regs. Nevertheless, I am also aware that a certain percentage of pilots don't give a fig about what the regs are and are going to continue to fly so long as they can make it to the airplane. And a certain percentage of those are going to kill people.
A few pilots are going to recognize that such a thing is happening in a fellow pilot and are going to work up the courage to go to the FAA and start the process to have the pilot grounded. I suspect those folks will save a few lives while some friendships will be lost.
I don't have the answer to this situation. It is very personal among pilots and it is one we do not often discuss. I certainly don't want the FAA becoming any more of a traffic cop; my privacy is invaded enough as it is.
That means that we, as pilots, have to talk about the subject, to bring it into the open. If it shows up on aviation forums on the Internet, and is talked about in pilot lounges, restaurants and bars where pilots gather, it may mean that pilots will think about it. Pilots who give consideration to "what if" -- to what they would do in the event of something happening in the future -- tend to make pretty good decisions when the event does come about. So, let's talk about the subject. As a result, some pilots may go to their doctors and make sure that the medications they are taking are ones that allow them to fly (there may be acceptable meds that can be used to treat the same condition). Or, if they must take medications that prohibit flying, that they will not fly without another pilot in the airplane until such time as they don't have to take those meds any more. Or, they will take that deep breath and admit to themselves that it was a very good run, they had some wonderful times in the sky and it's time to quit while they and their loved ones are alive and can look back at the years of flying with happiness.
See you next month.
Want to read more from Rick Durden? Check out the rest of his columns.