Medical Reform: Just When You Think It Can’t Get Any Worse …


Watching the last-minute machinations over legislative efforts to eliminate or at least curtail the Third Class medical requirement reminds me of arguments I used to have with my Dad when I was kid and wanted something forbidden. When all the logic a 10-year-old could summon seemed to be backing the old man into a canyon from whence there was no apparent escape, he would simply unsheathe the ultimate parental response to a wise-ass kid: Because I said so. Case closed.

We’ve come to that point on efforts to unburden ourselves of this truly reprehensible requirement for medical examinations. Over the weekend, the Air Line Pilots Association added its own because-I-said-so to derail the long-awaited reform of the medical requirement. Surely an organization as serious as ALPA must have the resources to develop data to back up their concerns. They may have, but you can read the letter (PDF)yourself and perhaps illuminate for me anything that supports the argument, other than an appeal to emotionalism.

ALPA’s letter shouldn’t come as much of a surprise, given the association’s position was cited in a letter to FAA opposing medical reform from the Aerospace Medical Association. And it does cite data in support of the association’s opposition. Read it here (PDF).Perhaps it’s just me, but AMA’s letter is full of the logical flaws that seem to characterize this argument about medical certification. For instance, the letter notes that a review of autopsy data on 471 pilots involved in fatal accidents between 2011 and 2014 was conducted. Of those, 403 were medically certified, 68 were not, flying under the sport pilot rule.

The autopsy data revealed that 25 percent of the medically certified pilots had “moderate to severe medical hazards” while 60 percent of the uncertified pilots did. Wow. Sounds scary. But what the report doesn’t say is how many of those accidents were caused by medical issues. If it did, it would sound a lot less scary. So I swept the data myself and found that of those 403 fatals, 18 or 4.4 percent were caused by medical incapacitation. Research AOPA conducted found that between 2004 and 2013, medical incapacitation accounted for even fewer accidents; just 1.6 percent of all fatals. On a flight-hour basis, AOPA says it amounts to one accident every 625 years. You can make your own judgment, but those are small numbers. And now we get into the rabbit hole.

All of those dead pilots had medicals and the system failed to detect them and stop them from plying the skies with their medical infirmities. In arguing that medical cert isn’t a burden, AMA’s paper said 98 percent of applicants are approved; 2 percent are rejected or require special issuance. If that’s so, isn’t the entire system a rubber-stamping fiasco that screens exactly nothing? Does it actually catch a statistically significant number of pilots who represent a clear and present danger? Those aren’t rhetorical questions. The answer is of course medical certification is a waste of time and money for everyone.

In further support of its argument and a position I suspect is supported by ALPA, AMA notes that medically certified pilots have a lower accident rate than do sport pilots with no medical certification. Well, no kidding. Sport pilots are flying light little kites without anything like the structural protection of certified aircraft, two dots AMA fails to connect because it would erode what little logic the underlying argument has. Then the AMA docs really go for the maximum reach. Citing a study in 1999 that found that 6.4 percent of auto crashes were due primarily to driver incapacitation, it extrapolotes that if the Third Class is eliminated, up to 2503 new accidents would occur. Yet a closer reading of the data, reveals this study (PDF)by NHSTA which found that 1.2 percent of driving crashes are due to incapacitation which is, curiously, about the same percent we find with pilots who are actually medically certified. One reason this is so, of course, is that evenholders of First Class medicals have to self-certify between AME visits, so the validity of medicals at any level is sketchy. In my view, AMA’s citing of statistics is the most dishonest use of data I’ve seen in, well, maybe ever.

What no one can seem to figure out is what ALPA’s real motives are in opposing reform. It’s clearly not really safety because the numbers supporting that argument are laughably non-existent. If it’s a political chit of some kind, what is that exactly? I’ll bet there are more than a few pissed-off ALPA members who may have been planning to tuck away a Bonanza or a Skyhawk for their retirement years and, thanks to their union, will have to sweat medicals with the rest of us.

And sweat is the right word, for fear of medical loss hangs over this declining industry like a pall. Removing the medical requirement once and for all would be a breath of relief we desperately need. In the end, Mr. Spock got it wrong. The needs of the few—AMA members—outweigh the needs of the many. But then that’s the way U.S. politics has always worked.