[thorn bird]

Saw him at Reno, saw him in Tasmania, many years ago. On both occasions I was left in absolute awe of his skills.

The man is a freak and an absolute gentleman to boot.

I often wonder how many of the kids he so freely chatted with in Tasmania caught the "Bug" and went on to become airmen.

[Peetwo]

AOPA in two hemispheres on Pilot medical reform -

In case you missed it yesterday AOPA Oz CEO Ben Morgan made public the following:

23rd August 2016


The Hon Darren Chester MP
Minister for Infrastructure and Transport
House of Representatives
Parliament House
Canberra ACT 2600
Australia.

Mr Mark Skidmore
Director of Aviation Safety (CASA)
Civil Aviation Safety Authority
GPO Box 2005
Canberra ACT 2601
Australia

- Members of the Aircraft Owners and Pilots Association
- Users of the Aviation Advertiser – Australia network
- Government Ministers and Senators
- Industry media


AOPA Proposed Policy on Class 2 
Private Pilot Medical Certification.

The Hon Darren Chester MP,

Over the past year aviation regulators in the United Kingdom (UK), United States of America (US) and New Zealand (NZ) have all moved to reform their medical requirements for Private Pilots License holders, following extensive evidence based assessment and review.

These reforms (which have been previously communicated to your office) have been heralded by the global aviation community and are expected to breathe essential life back into the general aviation economies of each respective country.

AOPA Australia over the past five years has received thousands of telephone calls and emails from private pilots, all calling for broad reform of Australia’s Class 2 Private Pilot Medical Certification system.  Our membership have demonstrated that a high number of Australian private pilots are being subjected to unfair and unreasonable medical assessments by CASA AVMED which has removed fit and healthy pilots from Australia’s general aviation community and subjected thousands of pilots to unnecessary delays and expense regarding medical assessment.

In consideration of our membership feedback and moves by international regulators, AOPA Australia has produced a clear Proposed Policy position on Class 2 Private Pilot Medical Certification - to which we have attached to this email and included below.

The AOPA proposed policy on Class 2 Private Pilot Medical Certification is important to the future of Australia's general aviation industry and if implemented will serve to reconnect thousands of perfectly healthy pilots who have been unfairly discriminated by the existing CASA AVMED system.

This vital reform will dramatically reduce licensing costs to industry and will remove unnecessary layers of bureaucracy and red-tape that have contributed to the serious decline in general aviation pilots in Australia, which based on CASA’s own data amounts to some 8,000+ pilots exiting our industry (see chart below).




AOPA’s policy will help kick-start and re-invigorate private flying activity within the general aviation industry, which will result in increasing demand for the varying support services whilst creating valuable jobs and opportunities for small business across Australia.

In the recently published CASA Stakeholder Relationship Health Report (click here to download), the surveyed industry stakeholders made clear their sincere dissatisfaction with regard to both CASA’s decision making and performance.  Industry has sent a loud and clear message that we cannot continue with the current system.

Australia’s general aviation industry is calling on you as Minister for Infrastructure and Transport to direct CASA to adopt the AOPA proposed policy without delay, sending a clear message of support to our industry and the small businesses who rely on it.

AOPA is ready to meet with you and looks forward to the opportunity to discuss this vital policy in more detail.

Yours sincerely,

BENJAMIN MORGAN
Executive Director - Aircraft Owners and Pilots Association

Mobile: 0415 577 724
Telephone: (02) 9791 9099
Email: ben.morgan@aopa.com.au

&..the policy:

In a parallel hemisphere...

Via one of PAIN's email chains I was sent a link for the following article from GA News, that warns industry not to become complacent as the fight for the 'Pilot Bill of Rights' & Pilot medical reform is ongoing and not yet a done deal as the FAA have until July 2017 to interpret the law into new regulations:

Medical reform: ‘It’s not over’
August 17, 2016 by Tom Snow 19 Comments

As pilots at AirVenture 2016 and throughout the nation celebrated the July 15th signing of the Pilot’s Bill of Rights 2 and the Third Class Medical reforms it included, the bill’s sponsor, Senator James Inhofe (R-Oklahom) warned “it’s not over.”

During an interview at his North 40 camp site at Oshkosh, Inhofe expressed concern regarding the FAA’s rule making latitude going forward.

“Our job is not over yet because the FAA has up to a year from the date of signing to interpret the law and write new regulations,” he said. “The clock is ticking.”

GAN writer Tom Snow interviews Senator James Inhofe at AirVenture 2016.

Inhofe added that the bill’s co-sponsors and the pilot community must remain vigilant and involved to ensure that the spirit and intent of the new law is reflected in the FAA’s revised rules for private pilots.

“Letter writing campaigns by (members of) the EAA and the AOPA were very effective in getting the bill passed,” added Inhofe. “Those letters were a great source of leverage for us and we could not have done it without strong support from the pilot community.”

Inhofe said he had many one-on-one meetings with his Senate colleagues to solicit their support.

“We had more support from lawmakers on Pilot’s Bill of Rights 2 than on the first bill,” he said, referring to Pilot’s Bill of Rights 1, which took two years to get passed.
Inhofe cited critical “across the aisle” support for the first bill from Senator Harry Reid (D-Nevada).

In addition to third class medical reform, the newly-passed bill also includes a wide range of new protections for pilots, including improved due process if an FAA enforcement action is initiated.

Inhofe, 81, is an avid pilot and aircraft owner with over 12,000 hours logged. He’s been attending the Oshkosh fly-in for 36 years and has flown in and camped for 32 consecutive years. Inhofe has owned the same Grumman Tiger for 36 years and he once bought 54 brand new Tigers from the Grumman factory in Savannah when it was closing out production of that line. However, an RV-6 is his favorite airplane.

Inhofe’s RV-8

Inhofe introduced the first Pilot’s Bill of Rights Bill in July 2011 after he experienced first-hand the deficiencies of the FAA’s relationship with the general aviation community due to the treatment he received from the FAA when he was cited for landing a Cessna 340 twin on a runway in Texas that turned out to be closed, but not by an official NOTAM.

“It took me four months to get a recording of the clearance to land I received from the controller,” said Inhofe. “For those four months, I thought some unelected bureaucrat could take away my ability to fly an airplane … and it could happen to any one of you.”

On a personal note, Inhofe is looking forward to third class medical reform because he had a quadruple heart bypass three years ago and once again experienced what he describes as the overly-bureaucratic FAA processes that discourage many pilots from renewing their medical certificates.

When the new regulations kick in come July 2017, Inhofe will no longer be required to see an FAA doctor each year to maintain his third class medical. Instead, along with thousands of other private pilots across the country, he will only be required to take an online aeromedical course every two years and to see his personal doctor at least once every four years.

Will there be a Pilot’s Bill of Rights 3? Inhofe said it remains to be seen, but that he will carefully monitor the FAA’s rulemaking process over the next year, adding he is willing to introduce a third bill if needed.

One has to admire the tenacity of Senator Inhofe but also the strong advocacy of AOPA and other like-minded Alphabets in the US.

Here is an JDA Journal article which again highlights the power of positive, unified industry advocacy as those Alphabets, led by AOPA, combined lobbied to convince the powerful insurance industry to support the PBOR2.. 

The Final Word on Risk is heard on 3rd Class Medical Reform
http://jdasolutions.aero/blog/medical-re...or-pilots/

Posted By: Sandy Murdock August 23, 2016

Medical Reform for Pilots

For many years, AOPA and a host of aviation associations have expended much time and effort convincing the FAA and Congress to loosen the requirements for a 3rd Class Medical Examination. The idea was originally proposed in a petition for Rulemaking filed in 2009.

The GA community, convinced that relaxation of the need for frequent review by AMEs, wrote to the Secretary complaining about the delay in enacting the proposed rule. They also convinced a number of Members of Congress, who were also pilots, to introduce legislation which would mandate the reform.

Opposed to this measure were the Aviation Medical Examiner (AME) Association and the American Medical Association. More objectively and thus more impressively the NTSB and its Chairman expressed concerns about this change, which they saw as a diminution of the safety standard.



U.S. Senator Joe Manchin (D-WV), one of the recipients of the industry lobbying, applauded the enactment of the Federal Aviation Administration (FAA) Reauthorization Bill, which extends the FAA authority through September 2017, especially a section containing reforms to the medical certification process for general aviation pilots that increase training and educational opportunities and encourage more dialogue with their personal physician. As AOPA explained: “pilots who have held a valid medical certificate any time in the decade prior to July 15, 2016, may never have to take another FAA medical exam. While the FAA has up to one year to develop and issue regulations before pilots can fly under the reforms…”



While the technical opinions of the NTSB are, and should be, held in high regard, their general concerns are “trumped” (is that no longer a PC word?) by the following statement based on the insurance carriers expertise:

“We learned that, nearly across the board, medical reform should have no negative impacts on insurance coverage. What most of our carriers told us is that if a pilot is in compliance with the FAA regulations (including medical reform when finalized), then that pilot is in compliance with their company insurance requirements as well.

In fact, in most cases, the language in policies doesn’t even need to be changed. Many policies already state that a valid FAA medical, if required, must be in place for the airplane owner and if the owner follows the new regulations, nothing will change. Of course, we only spoke to the carriers with whom we partner on behalf of our members. To be prudent, when the FAA finalizes the regulations, you should check with your own airplane insurance carrier to determine its position on medical reform.

There’s more good news for AOPA members. Again, nearly 100 percent across the board, our carriers told us that they do not foresee any rate increases in insurance premiums due to medical reform. Do you know why? Because in more than a decade, insurance companies cannot cite any losses due solely to the medical condition of the pilot that would have been discovered from a third class medical exam.

Our insurance carriers are on board with medical reform. They will abide by the new FAA regulations and, frankly, see no changes required. That’s good news all around for the GA community!”

The actuarial wizards, who calculate the relevant risks of pilots without as rigorous medical regime to about five decimals =/- 0.000001. The insurance carriers are best equipped to measure the marginal differences due to the new standard.
They have the data, the statisticians and the risk best qualified to make these judgments. If they are wrong, they will be paying out a lot of claims; that places a very heavy weight on the number crunchers’ precision.
The NTSB knows aviation safety, but the insurance industry knows risk quantification. What’s truly amazing, the private market is even better than the omniscient ones at OMB. 

Top job EAA, AOPA & like-minded Alphabets USA...



MTF...P2

[Cap'n Wannabe]

I just received this email from CASA, as I'm sure others did.  

Please be advised that Av Med staff won’t be taking calls on Thursday, 15 September 2016.

This is to allow all staff to spend the day assessing medicals to reduce the number of applications waiting to be processed.

Staff will be answering Av Med phones as usual from Friday, 16 September 2016.

I got a laugh out of it, anyhow..

[P7_TOM]

They are not a bad crew at the coal face; I’ve always had the very best of service from ’em. The crew are trying to deal with a situation they did not create; they are patient and mostly courteous but; ‘they’ cannot, no matter how much ‘they’ may wish to, change the ‘system’ they are obliged to work with. Those as designed and support the current excess have no interest in exposing the department to risk – so both ‘we’ and ‘they’ are, for the moment, stuck with it. The ‘heavy’ end of town is not happy with much to do with ‘Avmed’ so slowly, but surely, things may improve. If booze and bad living let you live long enough.

Be polite and patient with the Avmed troops, they too need to earn their crusts; and, are probably no happier with the mess than we are. No one but a few would be.

[Cap'n Wannabe]

They are not a bad crew at the coal face; I’ve always had the very best of service from ’em.  The crew are trying to deal with a situation they did not create; they are patient and mostly courteous but; ‘they’ cannot, no matter how much ‘they’ may wish to, change the ‘system’ they are obliged to work with. Those as designed and support the current excess have no interest in exposing the department to risk – so both ‘we’ and ‘they’ are, for the moment, stuck with it.  The ‘heavy’ end of town is not happy with much to do with ‘Avmed’ so slowly, but surely, things may improve.  If booze and bad living let you live long enough.

Be polite and patient with the Avmed troops, they too need to earn their crusts; and, are probably no happier with the mess than we are. No one but a few would be.

Oh I most certainly agree...the lady I've been dealing with over my issue has been incredibly helpful.

[Peetwo]

Sorry to butt in here Capt Wannabe but I think you might find this of interest...

First note this quote from off the SKIDMORE GONE thread:

...And one of those areas of unwillingness has long been the AVMED branch. They have stubbornly defied three directors now when it comes to Class 2 medicals, and it seems AOPA in particular has had enough. They've started a petition to send to Minister Darren Chester asking him to direct CASA to adopt their policy, which is basically for the same medical criteria as RAAus, which some modifications. It is good to see AOPA staying on the case, but I'm not convinced that a petition to Canberra will keep the heat on the minister. Darren Chester has had enough briefings on general aviation to be well aware of the push for a "driver's licence" medical, and I personally will be very disappointed if it takes a petition to make him act. And just how well will the petition be received in Canberra? There are rumblings that the department is not happy with the bull-at-a-gate approach the association has adopted recently, and the petitions and letter could be seen as just another example of pressuring as distinct from lobbying. But I doubt AOPA is going to apologise to anyone for that.

May your gauges always be in the green,

Hitch

Read more at http://www.australianflying.com.au/the-l...wb3c7KT.99

And in rebuttal to Hitch's last on Avmed & the AOPA petition, courtesy Sandy:

Steve,

You say, quote, 

(Re the AOPA medical petition) "...and I personally will be very disappointed if it takes a petition to make him act. And just how well will the petition be received in Canberra? There are rumblings that the department is not happy with the bull-at-a-gate approach the association has adopted recently, and the petitions and letter could be seen as just another example of pressuring as distinct from lobbying. But I doubt AOPA is going to apologise to anyone for that."

Mate are you serious? You'd be disappointed if we had a policy change that would boost GA? 
Bull at a gate? Where's that? Would you think that tame pussy cat is the way to go? Look where that's got us.

AOPA has built a serious and substantial reform package and that's virtually folded into TAAAF and AMROBA with their joint reform policies to present a united front. 

Oh gee, poor Department and CASA not happy! ..well maybe it's just that I've been around for a lot longer than some and have watched a good industry go down the drain and numerous extremely unhappy  individuals be whacked with often no proper reason and certainly no recourse to any of the usual norms of justice. 

So what are you really saying, or are you tongue in cheek trying to provoke? Where's your plan?  What's the difference between pressuring and lobbying? Have you tried lobbying? Some find it quite lucrative, and some would point to the obvious downsides of the practice of paid lobbying. I've taken a deputation to Minister Truss trying to get his interest in reform at the behest of nobody and unpaid. Was that wrong or less than optimal? You can be Mr. Independent, the Voice of Reasonable, perhaps a go between, sure, stand back and take a long look. However I urge you to walk back to around 1980 and look widely, then turn retrace back through the destruction and look forward. 

Without government policy change I challenge you to see anything but more misery for GA and expensive mismanagement all around. Steve please if you can contribute insights to achieve reform we are all ears. 

Otherwise keep on and keep well,

Sandy Rumbling 
(My italics and bold in quote) 

MTF...P2

[Gobbledock]

Good point P2.

I hate to butt in but I also agree with Sandy - he has been around for a long time in this industry. That gives him every right to rumble as much as he wants to because he has a wealth of actual first hand experience and understanding of the subject matter being discussed. On the other hand you have the selfie taking manscaping Chester, a young boy whose skills are mostly limited to a degree in politics, probably paid for by a rich daddy, and the closest he comes to getting his hands dirty is when some of his black hair dye sneaks inside the latex gloves.

And a fact not to be overlooked is this - a pilots medical and licence is more often than not it is his income, his livelihood, his kids college fees, his future self funded superannuation, his funeral costs. So it's no wonder our aviators are so passionate about this topic. But of course the politicians and bureaucrats couldn't give a flying fu#k because their existence doesn't depend on any licence or any accountabilities.

It's a pity that politicians aren't meant to have a licence of endorsement to operate in their field. Perhaps an annual competency exam and a lie detector test? Then have a Sherriff hanging all over them every second of the day, regulating them! Wankers

[Peetwo]

CASA AVMED: Case for the case against?

Last Friday week I did the op check, and "passed" with flying colours. It took the docs at AVMED just over a week to give me a choice.....either come up with some clinical evidence proving I won't have a repeat episode, or accept restrictions on both my class 1 and 2 medicals. Basically I won't be able to fly without a safety pilot.
On August 27 2015, I had a mild stroke. I was in hospital for 3 days, and discharged with no medication requred, and no rehab necessary. I was a bit tired for the next two weeks, but I was back at work as soon as I got home from the hospital....working from home made it easier. I didn't really even surrender my drivers licence, although I didn't drive for a month.
Two neurologists and my gp reckon I had a once-off event. My blood pressure is excellent, and I've never been hypertensive. I've made some changes since I got out of hospital....quitting smoking, watching what I eat, and exercising.
So....back onto the clinical evidence....does anyone know of any other pilots who've had a stroke and gotten back into flying with no restrictions, or am I pissing into the wind?

Cap'n Wannabe thought I'd bring your QON up to the sexual life of the camel, because in light of some recent discussion (especially from Sandy.. ) and the AOPA petition/proposal (along with SAAA) to CASA on changes to the Class 2 pilot medical requirements, then it is probably about time we opened up the debate...

To kick it off and very relevant to your QON CW, I am not sure if you have seen this latest AAT 'setting aside' of a CASA decision to reject a class 2 medical - Courtney and  Civil Aviation Safety Authority  [2016] AATA 755 (28 September 2016) - IMO it is definitely worth a full read. But for those time constrained amongst us (or simply too lazy), here is a brief summary (paragraphs 46-54) of the case for & against, plus the final decision (para: 55-72)...    

  

SUBMISSIONS

Mr Courtney

46.Mr Courtney in his submissions relied on Doctors Habersberger and Keighley, who had found his chances of having a cerebrovascular accident or an episode of myocardial ischaemia while flying was extremely low. Although neither of them was able to place a percentage on the risk, they intimated it was less than one per cent.

47.Mr Courtney submitted that as CASA focuses on times and percentages in relation to risk, on his estimations he was in the air flying his aircraft for 1.1 per cent of total time in a year and 23 per cent of that 1.1 per cent was flying in or around a settled area being Moorabbin airport. The majority of his flying was in the outback, where the chances of hitting a member of the public on the ground were very remote.

48.Based on the overall evidence from 2012 onwards, Mr Courtney contended that despite having no symptoms he had undergone various forms of treatment which reduce any risk he might be to himself, his passengers, other aircraft and the public in general. He contended that no abnormality had been demonstrated on radio nuclear myocardial scanning in January 2014. The scan in February 2015, (performed using a different technique and reported on by a different cardiologist) had revealed an area of left ventricular apical ischaemia despite normal left ventricular function. This apical defect was the subject of disagreement in terms of its relevance and when the scan was repeated 10 months later there was no further change. Mr Courtney submitted that if there had been any change it occurred between January 2014 and February 2015 and had not advanced thereafter.

49.Mr Courtney sought to have the condition of only flying with a safety pilot removed. He also sought that the requirement for a CT coronary angiogram, if regarded as necessary, should be delayed until his next application for licence renewal.

Mr Carter for CASA

50.Mr Carter reiterated the opinion of CASA authorities that Mr Courtney did not meet the requirements for a class 2 licence. Based on the authority of Re Window and  Civil Aviation Safety Authority  [1999] AATA 525; (1999) 56 ALD 316, the test to be adopted was whether the risk was real and not remote.

51.Mr Carter addressed Mr Courtney’s long history of cardiac problems - with the necessity for coronary grafting and various medication, insertion of a pacemaker and a persistence of an elevated cholesterol as he was not able to take statins. Mr Carter pointed to the CHADS VASc score calculated at 3.2 per cent and also Mr Courtney’s age of 77 which alone carried according to the ABS 3.6 per cent risk of death. While Mr Courtney had stated in his evidence that he was not afraid to die, the Act required CASA to consider the pilot’s safety as well as that of passengers, other aircraft and the public in general.

52.Mr Carter contended that we were essentially dealing with unknowns. While the evidence was that each particular condition from which Mr Courtney suffered carried with it a very low risk of a sudden debilitating event, in totality concern was raised. Further considerations were that Mr Courtney always flew with his partner Megan and while she had had flying lessons she was not a licenced pilot despite her belief that she could land a plane. Mr Courtney had also said he would like to take his grandchildren on flights.

53.In his submissions Mr Carter raised the question of whether Mr Courtney had revealed his medical conditions to RAA who did require a declaration of any health matters. Mr Carter supported the idea of CT coronary angiography to assess whether there had been any progress of Mr Courtney’s coronary artery disease.

54.In response to Mr Carter’s question regarding RAA, Mr Courtney advised that he had completed the necessary declarations for RAA.

TRIBUNAL’S DELIBERATIONS

55.Mr Courtney has well documented but at all times asymptomatic coronary artery disease treated by off-pump coronary artery bypass grafting with the internal mammary artery. He has paroxysmal atrial flutter/fibrillation of 20 years duration requiring medication with Sotalol, and as a result of the development of bradycardia and sick sinus syndrome required the insertion of a pacemaker. Since ceasing the statin Crestor, his cholesterol level has become mildly elevated. On the basis of these medical conditions, his CHADs VASc score relating to the risk of a cerebrovascular accident was calculated at a 3.2 per cent annual stroke rate.

56.As already stated, Mr Courtney has always been free of symptoms relating to these medical conditions and they have in fact been diagnosed as a result of CASA’s requirements of annual cardiology assessments consequent upon his age and also because of his documented history of paroxysmal atrial arrhythmia since 1994/95. It was the Holter monitoring procedure requested by his DAME that revealed the presence of myocardial ischaemia presenting as ST depression on ECG. This of course led to a chain of events, including coronary angiography followed by bypass surgery.

57.It could be said that if Mr Courtney was not a pilot and as his cardiac coronary artery disease was asymptomatic, none of the investigations and treatment outlined above would have been indicated in normal clinical practice.

58.With each medical intervention or recommendation, Mr Courtney has followed the advice of his treating cardiologists. As a result of his coronary artery bypass surgery in June 2013, his left ventricular function as measured by left ventricular ejection fraction has been normal since the operation, the latest levels being 67-69 per cent (normal ejection fraction being 55 per cent or greater). The left ventricular ejection fraction increased marginally in the study of December 2015 despite the finding in both February and December 2015 of a small area of apical diminished profusion that had not changed in the intervening 10 months.

59.Dr Keighley has sent copies of all but two letters relating to Mr Courtney to CASA and these letters have been generated at three to six monthly intervals since 2012. Most of the letters have been addressed to Dr Drane who appears to have been a senior aviation medical officer, or to a Dr Clem, with only one being direction to Dr Seah. Every letter has been copied to Mr Courtney and the relevant DAME. Dr Clem was sent a summary of Mr Courtney’s progress in January 2016.

60.In mid-2013 CASA required further medical investigations and provision of results before reissuing Mr Courtney’s class 2 medical certificate. This was eventually issued on 6 March 2014. The expiry date of this certificate was 7 January 2015 but again delays relating to further requested testing and information resulted in Mr Courtney’s licence not being issued until 28 August 2015. It appears to the Tribunal that while these processes were extremely slow given that Dr Keighley rapidly responded and provided all investigation results, it was not until Mr Courtney saw his DAME to initiate the required investigations for reissue of his licence in January 2016 that a further reconsideration of his class 2 medical certificate and licence was initiated apparently by Dr Seah. The Tribunal presumes that Dr Keighly’s explanation that the abnormality in the radio-nuclear myocardial scan reported in February 2015 was an artefact and thus of no clinical significance, had been accepted.

61.In addition to the question of whether there was persisting myocardial ischaemia or, in the alternative, progression of the underlying disease, presumably in the right coronary artery as it is the dominant vessel, CASA’s medical section expressed concern regarding Mr Courtney's CHADS VASc score of 3.2 per cent per annum. In his reports Dr Keighley had made it clear that this figure of 3.2 per cent only applied in individuals who had frequent paroxysmal atrial arrhythmia or were in chronic atrial fibrillation and where not anticoagulated. He had advised that Mr Courtney did not fall into this group as his episodes of atrial arrhythmia were very infrequent and short-lived. As Mr Courtney has a pacemaker in situ, he is in the unusual position of being continuously monitored in terms of arrhythmias. There was thus irrefutable scientific evidence on which Dr Keighley based his opinion.

62.In June 2016 when Mr Courtney’s pacemaker check revealed that he had experienced a more prolonged episode of atrial flutter Dr Keighley commenced anticoagulation with an oral anticoagulant and this continues. While this was outside the period following the making of the decision it is relevant to this decision.

63.Dr Keighley has given evidence before the Tribunal which essentially affirmed and expanded on his voluminous reports to CASA over the years. He reiterated his written opinion that the risk of a cerebrovascular accident occurring in Mr Courtney is very low and his risk of a cardiac event is less than one per cent. Dr Keighley negated the diagnosis of hypertension in Mr Courtney as episodic systolic hypertension had been ascribed to the so called white coat effect and Mr Courtney’s home monitoring of his blood pressure revealed normal readings.

64.Dr Habersberger is essentially of the same opinion as Dr Keighley. He estimated the risk of a cardiac event and cerebrovascular event as being extremely low and opined that it was impossible to give a meaningful percentage figure. Dr Habersberger said he would have treated Mr Courtney in exactly the same manner as Dr Keighley had done. However, he could not rule out the possibility of some progression of the underlying coronary artery atheroma process without further investigation. He did however respond to the Tribunal’s query as to why CT coronary angiography had not been employed, agreeing that this was very appropriate method of monitoring. He recommended that Mr Courtney undergo CT angiography annually.

65.Dr Seah was of the opinion that as Mr Courtney, based on his age alone, faced a 3.6 per cent annualised risk of death according to the ABS, this must be added to any heart or cerebrovascular accident risk and resulted in an unacceptable level of risk for a standard class 2 medical certificate. He did however agree that the risk of a cerebrovascular accident had been reduced by the prescribing of anticoagulants.

66.Clearly CASA is, by virtue of s 9(a) of the Civil Aviation Act 1988, required to consider the safety of air navigation in Australia above all else. This includes the ability of persons licenced as pilots to exercise the privileges conferred by the licence. The Regulations (CASR) provide in Table 65.155 the standard for a class 2 medical certificate as it applies to private pilots. CASA contends that Mr Courtney fails to meet a class 2 medical standard because of his coronary artery disease requiring bypass grafting, his radio nuclear scan evidence of reversible ischaemia, his sick sinus syndrome, paroxysmal atrial flutter, requirement for a pacemaker and hypercholesterolemia which it is argued elevate the risk of Mr Courtney having an acute coronary event or acute cerebrovascular event. For the same reasons he does not meet Item 2.9 as he clearly has a heart abnormality.

67.The Tribunal has heard the evidence of both Dr Keighley and Dr Habersberger, both of whom assessed the risk of a coronary artery event and an acute cerebrovascular event as being low; in Dr Keighley’s opinion less than the one per cent standard set by CASA.

68.The Tribunal was provided with the CASA evaluation graph (Exhibit R4) and, based on the evidence of Dr Keighley, Mr Courtney’s risk would be between insignificant and minor with the likeliness of an event occurring being low at either level. On Dr Habersberger’s evidence the risk would be minor and also unlikely and therefore low. According to the key at the bottom of this risk evaluation, persons classified as having a low level of risk are to be treated with routine procedures.

69.Based on the medical evidence before the Tribunal coupled with CASA’s own risk evaluation document, and particularly in view of the delays to which Mr Courtney has been submitted in the making of a decision regarding his medical certification the Tribunal determines that the decision under review be set aside and that Mr Courtney be issued with a class 2 medical certificate without the safety pilot condition. The certificate should be issued for a period of 12 months and in the interim, at Mr Courtney’s convenience, a CT coronary angiogram should be undertaken as both Dr Habersberger and the legal representative of CASA, Mr Carter, have agreed that this is an appropriate method of assessing the possibility of any progression of the underlying coronary artery disease.

70.Given Mr Courtney’s right coronary artery was said to be the dominant artery with only a 30 per cent stenosis it would seem unlikely that a critical degree of progression would have occurred in a period of three years.

71.The Tribunal has not addressed the question of Mr Courtney flying in an alternative manner through RAA approval, as he has stated he has no desire to be limited to the flying imposed by such licencing. Mr Courtney has been an impressive witness with an extraordinary grasp and understanding of his medical condition, and an acceptance of what has been good advice, which has led to an excellent clinical result. The Tribunal is not surprised to find that his Montreal Cognitive Assessment performed on 6 March 2015 resulted in a score of 30 out of 30.

72.The Tribunal sets aside the decision under review and substitutes its decision that Mr Courtney be issued with a class 2 licence without the condition that he can only fly with a safety pilot but that he undergo CT coronary angiography when convenient.




I certify that the preceding 72 (seventytwo) paragraphs are a true copy of the reasons for the decision herein of:
Miss E A Shanahan, Member

MTF...P2  

[Cap'n Wannabe]

CASA AVMED: Case for the case against?

Last Friday week I did the op check, and "passed" with flying colours. It took the docs at AVMED just over a week to give me a choice.....either come up with some clinical evidence proving I won't have a repeat episode, or accept restrictions on both my class 1 and 2 medicals. Basically I won't be able to fly without a safety pilot.
On August 27 2015, I had a mild stroke. I was in hospital for 3 days, and discharged with no medication requred, and no rehab necessary. I was a bit tired for the next two weeks, but I was back at work as soon as I got home from the hospital....working from home made it easier. I didn't really even surrender my drivers licence, although I didn't drive for a month.
Two neurologists and my gp reckon I had a once-off event. My blood pressure is excellent, and I've never been hypertensive. I've made some changes since I got out of hospital....quitting smoking, watching what I eat, and exercising.
So....back onto the clinical evidence....does anyone know of any other pilots who've had a stroke and gotten back into flying with no restrictions, or am I pissing into the wind?

Cap'n Wannabe thought I'd bring your QON up to the sexual life of the camel, because in light of some recent discussion (especially from Sandy.. ) and the AOPA petition/proposal (along with SAAA) to CASA on changes to the Class 2 pilot medical requirements, then it is probably about time we opened up the debate...

To kick it off and very relevant to your QON CW, I am not sure if you have seen this latest AAT 'setting aside' of a CASA decision to reject a class 2 medical - Courtney and  Civil Aviation Safety Authority  [2016] AATA 755 (28 September 2016) - IMO it is definitely worth a full read. But for those time constrained amongst us (or simply too lazy), here is a brief summary (paragraphs 46-54) of the case for & against, plus the final decision (para: 55-72)...    

  

SUBMISSIONS

Mr Courtney

46.Mr Courtney in his submissions relied on Doctors Habersberger and Keighley, who had found his chances of having a cerebrovascular accident or an episode of myocardial ischaemia while flying was extremely low. Although neither of them was able to place a percentage on the risk, they intimated it was less than one per cent.

47.Mr Courtney submitted that as CASA focuses on times and percentages in relation to risk, on his estimations he was in the air flying his aircraft for 1.1 per cent of total time in a year and 23 per cent of that 1.1 per cent was flying in or around a settled area being Moorabbin airport. The majority of his flying was in the outback, where the chances of hitting a member of the public on the ground were very remote.

48.Based on the overall evidence from 2012 onwards, Mr Courtney contended that despite having no symptoms he had undergone various forms of treatment which reduce any risk he might be to himself, his passengers, other aircraft and the public in general. He contended that no abnormality had been demonstrated on radio nuclear myocardial scanning in January 2014. The scan in February 2015, (performed using a different technique and reported on by a different cardiologist) had revealed an area of left ventricular apical ischaemia despite normal left ventricular function. This apical defect was the subject of disagreement in terms of its relevance and when the scan was repeated 10 months later there was no further change. Mr Courtney submitted that if there had been any change it occurred between January 2014 and February 2015 and had not advanced thereafter.

49.Mr Courtney sought to have the condition of only flying with a safety pilot removed. He also sought that the requirement for a CT coronary angiogram, if regarded as necessary, should be delayed until his next application for licence renewal.

Mr Carter for CASA

50.Mr Carter reiterated the opinion of CASA authorities that Mr Courtney did not meet the requirements for a class 2 licence. Based on the authority of Re Window and  Civil Aviation Safety Authority  [1999] AATA 525; (1999) 56 ALD 316, the test to be adopted was whether the risk was real and not remote.

51.Mr Carter addressed Mr Courtney’s long history of cardiac problems - with the necessity for coronary grafting and various medication, insertion of a pacemaker and a persistence of an elevated cholesterol as he was not able to take statins. Mr Carter pointed to the CHADS VASc score calculated at 3.2 per cent and also Mr Courtney’s age of 77 which alone carried according to the ABS 3.6 per cent risk of death. While Mr Courtney had stated in his evidence that he was not afraid to die, the Act required CASA to consider the pilot’s safety as well as that of passengers, other aircraft and the public in general.

52.Mr Carter contended that we were essentially dealing with unknowns. While the evidence was that each particular condition from which Mr Courtney suffered carried with it a very low risk of a sudden debilitating event, in totality concern was raised. Further considerations were that Mr Courtney always flew with his partner Megan and while she had had flying lessons she was not a licenced pilot despite her belief that she could land a plane. Mr Courtney had also said he would like to take his grandchildren on flights.

53.In his submissions Mr Carter raised the question of whether Mr Courtney had revealed his medical conditions to RAA who did require a declaration of any health matters. Mr Carter supported the idea of CT coronary angiography to assess whether there had been any progress of Mr Courtney’s coronary artery disease.

54.In response to Mr Carter’s question regarding RAA, Mr Courtney advised that he had completed the necessary declarations for RAA.

TRIBUNAL’S DELIBERATIONS

55.Mr Courtney has well documented but at all times asymptomatic coronary artery disease treated by off-pump coronary artery bypass grafting with the internal mammary artery. He has paroxysmal atrial flutter/fibrillation of 20 years duration requiring medication with Sotalol, and as a result of the development of bradycardia and sick sinus syndrome required the insertion of a pacemaker. Since ceasing the statin Crestor, his cholesterol level has become mildly elevated. On the basis of these medical conditions, his CHADs VASc score relating to the risk of a cerebrovascular accident was calculated at a 3.2 per cent annual stroke rate.

56.As already stated, Mr Courtney has always been free of symptoms relating to these medical conditions and they have in fact been diagnosed as a result of CASA’s requirements of annual cardiology assessments consequent upon his age and also because of his documented history of paroxysmal atrial arrhythmia since 1994/95. It was the Holter monitoring procedure requested by his DAME that revealed the presence of myocardial ischaemia presenting as ST depression on ECG. This of course led to a chain of events, including coronary angiography followed by bypass surgery.

57.It could be said that if Mr Courtney was not a pilot and as his cardiac coronary artery disease was asymptomatic, none of the investigations and treatment outlined above would have been indicated in normal clinical practice.

58.With each medical intervention or recommendation, Mr Courtney has followed the advice of his treating cardiologists. As a result of his coronary artery bypass surgery in June 2013, his left ventricular function as measured by left ventricular ejection fraction has been normal since the operation, the latest levels being 67-69 per cent (normal ejection fraction being 55 per cent or greater). The left ventricular ejection fraction increased marginally in the study of December 2015 despite the finding in both February and December 2015 of a small area of apical diminished profusion that had not changed in the intervening 10 months.

59.Dr Keighley has sent copies of all but two letters relating to Mr Courtney to CASA and these letters have been generated at three to six monthly intervals since 2012. Most of the letters have been addressed to Dr Drane who appears to have been a senior aviation medical officer, or to a Dr Clem, with only one being direction to Dr Seah. Every letter has been copied to Mr Courtney and the relevant DAME. Dr Clem was sent a summary of Mr Courtney’s progress in January 2016.

60.In mid-2013 CASA required further medical investigations and provision of results before reissuing Mr Courtney’s class 2 medical certificate. This was eventually issued on 6 March 2014. The expiry date of this certificate was 7 January 2015 but again delays relating to further requested testing and information resulted in Mr Courtney’s licence not being issued until 28 August 2015. It appears to the Tribunal that while these processes were extremely slow given that Dr Keighley rapidly responded and provided all investigation results, it was not until Mr Courtney saw his DAME to initiate the required investigations for reissue of his licence in January 2016 that a further reconsideration of his class 2 medical certificate and licence was initiated apparently by Dr Seah. The Tribunal presumes that Dr Keighly’s explanation that the abnormality in the radio-nuclear myocardial scan reported in February 2015 was an artefact and thus of no clinical significance, had been accepted.

61.In addition to the question of whether there was persisting myocardial ischaemia or, in the alternative, progression of the underlying disease, presumably in the right coronary artery as it is the dominant vessel, CASA’s medical section expressed concern regarding Mr Courtney's CHADS VASc score of 3.2 per cent per annum. In his reports Dr Keighley had made it clear that this figure of 3.2 per cent only applied in individuals who had frequent paroxysmal atrial arrhythmia or were in chronic atrial fibrillation and where not anticoagulated. He had advised that Mr Courtney did not fall into this group as his episodes of atrial arrhythmia were very infrequent and short-lived. As Mr Courtney has a pacemaker in situ, he is in the unusual position of being continuously monitored in terms of arrhythmias. There was thus irrefutable scientific evidence on which Dr Keighley based his opinion.

62.In June 2016 when Mr Courtney’s pacemaker check revealed that he had experienced a more prolonged episode of atrial flutter Dr Keighley commenced anticoagulation with an oral anticoagulant and this continues. While this was outside the period following the making of the decision it is relevant to this decision.

63.Dr Keighley has given evidence before the Tribunal which essentially affirmed and expanded on his voluminous reports to CASA over the years. He reiterated his written opinion that the risk of a cerebrovascular accident occurring in Mr Courtney is very low and his risk of a cardiac event is less than one per cent. Dr Keighley negated the diagnosis of hypertension in Mr Courtney as episodic systolic hypertension had been ascribed to the so called white coat effect and Mr Courtney’s home monitoring of his blood pressure revealed normal readings.

64.Dr Habersberger is essentially of the same opinion as Dr Keighley. He estimated the risk of a cardiac event and cerebrovascular event as being extremely low and opined that it was impossible to give a meaningful percentage figure. Dr Habersberger said he would have treated Mr Courtney in exactly the same manner as Dr Keighley had done. However, he could not rule out the possibility of some progression of the underlying coronary artery atheroma process without further investigation. He did however respond to the Tribunal’s query as to why CT coronary angiography had not been employed, agreeing that this was very appropriate method of monitoring. He recommended that Mr Courtney undergo CT angiography annually.

65.Dr Seah was of the opinion that as Mr Courtney, based on his age alone, faced a 3.6 per cent annualised risk of death according to the ABS, this must be added to any heart or cerebrovascular accident risk and resulted in an unacceptable level of risk for a standard class 2 medical certificate. He did however agree that the risk of a cerebrovascular accident had been reduced by the prescribing of anticoagulants.

66.Clearly CASA is, by virtue of s 9(a) of the Civil Aviation Act 1988, required to consider the safety of air navigation in Australia above all else. This includes the ability of persons licenced as pilots to exercise the privileges conferred by the licence. The Regulations (CASR) provide in Table 65.155 the standard for a class 2 medical certificate as it applies to private pilots. CASA contends that Mr Courtney fails to meet a class 2 medical standard because of his coronary artery disease requiring bypass grafting, his radio nuclear scan evidence of reversible ischaemia, his sick sinus syndrome, paroxysmal atrial flutter, requirement for a pacemaker and hypercholesterolemia which it is argued elevate the risk of Mr Courtney having an acute coronary event or acute cerebrovascular event. For the same reasons he does not meet Item 2.9 as he clearly has a heart abnormality.

67.The Tribunal has heard the evidence of both Dr Keighley and Dr Habersberger, both of whom assessed the risk of a coronary artery event and an acute cerebrovascular event as being low; in Dr Keighley’s opinion less than the one per cent standard set by CASA.

68.The Tribunal was provided with the CASA evaluation graph (Exhibit R4) and, based on the evidence of Dr Keighley, Mr Courtney’s risk would be between insignificant and minor with the likeliness of an event occurring being low at either level. On Dr Habersberger’s evidence the risk would be minor and also unlikely and therefore low. According to the key at the bottom of this risk evaluation, persons classified as having a low level of risk are to be treated with routine procedures.

69.Based on the medical evidence before the Tribunal coupled with CASA’s own risk evaluation document, and particularly in view of the delays to which Mr Courtney has been submitted in the making of a decision regarding his medical certification the Tribunal determines that the decision under review be set aside and that Mr Courtney be issued with a class 2 medical certificate without the safety pilot condition. The certificate should be issued for a period of 12 months and in the interim, at Mr Courtney’s convenience, a CT coronary angiogram should be undertaken as both Dr Habersberger and the legal representative of CASA, Mr Carter, have agreed that this is an appropriate method of assessing the possibility of any progression of the underlying coronary artery disease.

70.Given Mr Courtney’s right coronary artery was said to be the dominant artery with only a 30 per cent stenosis it would seem unlikely that a critical degree of progression would have occurred in a period of three years.

71.The Tribunal has not addressed the question of Mr Courtney flying in an alternative manner through RAA approval, as he has stated he has no desire to be limited to the flying imposed by such licencing. Mr Courtney has been an impressive witness with an extraordinary grasp and understanding of his medical condition, and an acceptance of what has been good advice, which has led to an excellent clinical result. The Tribunal is not surprised to find that his Montreal Cognitive Assessment performed on 6 March 2015 resulted in a score of 30 out of 30.

72.The Tribunal sets aside the decision under review and substitutes its decision that Mr Courtney be issued with a class 2 licence without the condition that he can only fly with a safety pilot but that he undergo CT coronary angiography when convenient.




I certify that the preceding 72 (seventytwo) paragraphs are a true copy of the reasons for the decision herein of:
Miss E A Shanahan, Member

MTF...P2  

Thank you for posting that, P2.  I hadn't seen the case at all, and it gives me some hope that I can beat the need for a safety pilot.  Whether the same will be applied to a Class 1 remains to be seen..
In a nutshell, I feel 100% (actually, better than my pre-stroke days on account of the lifestyle changes I've made..)  My neurologists and my GP doubt that it'll happen again.  Whether or not they're prepared to put a number on it - 1%, 2%, I don't know, but they seem to feel that I'm no more at risk than the next person, with the exception that I've already a stroke.  I was just running some flying numbers through my head based on what I want to do flying-wise, and even the worst case scenario tells me the risk is very remote of having a repeat episode while in the air.

Edit:
Please correct my maths if they're wrong!
8760 hours in one year - 365 x 24.
1000 hours is the *maximum* I can fly in one year.
Realistically, that's about 800 hours actual air time when you factor in time spent on the ground prior to take off and after landing, so I'll be airborne for 9% of the year.
Assuming a 2% chance of another stroke (I believe the average person is at 1%), that means the chances of me having another stroke while in the air are:
9% of 2% = 0.18%
But just in case I work at an airport with no taxi time, I'll be airborne for 11% of the year.
11% of 2% = 0.22%

Just thinking out loud...

[Kharon]

CW – P2 spotted that case and thought you’d like it. ‘Expect the worst and hope for the best’ is an old adage. May I suggest that you carefully study the nuances and strategies employed by both CASA and the appellant.  We have yet to see your result and Avmed may yet see things it your favour; and, rest assured, it would be folly to pre-empt that decision. However, ‘just in case’, do the research and mount a counter argument; it cannot hurt and it may help – if trumps turn to worms.  Either way, any careful examination of the CASA game is of value, they are good at it, very good indeed, so why not become familiar with both the method and madness.  The aged Boy Scouts motto – 'Be prepared' - is another adage which has passed the test of time.

Bon chance.

[Cap'n Wannabe]

Well, an eventful day....no, not really...just a couple of phone calls. The first to a neurologist/DAME who advised me not to fight the restriction for now - they can always be reviewed. He also suggested I document any and all flying I do in the next 12 months, and get my other pilot to do the same.
The other phone call was to my contact at AVMED, who told me that all restrictions are reviewed at each renewal. So an email was sent, and that's that for now.
I guess in the short term, it changes what I do next with my flying from a GA instructor rating to an MECIR. Hopefully there'll be somebody willing to take me on once I get that!

[Cap'n Wannabe]

Well, it's over....but it's not...  As I said in my previous post, I have accepted restrictions on both my Class 1 and Class 2 medicals, which means I won't be soloing for a while.  In the meantime, ATPLs call, as does a MECIR, and possibly a multi-crew course - once I figure out what I need it for!  For pleasure, there'll be tailwheel and aeros.  Luckily, I've got a mate who used to compete in aeros comps who can be my safety pilot..
In 12 months, a review will be done, with the requisite uber-expensive testing, and all being well, once again I'll be able to fly single-pilot.
RA-Aus is a funny organisation.  In the course of 12 months, I've been told I can instruct again, can't instruct again, can fly with pax, can't fly with pax, but can fly solo.  All by the same person, too.. Of course, they don't have a medical expert on hand to make a decision, but hopefully soon..
Thanks for the support and advice I've received over the last 12 months - it's been good to read the comments left after my posts.  They've helped me keep my sanity as my feet have been firmly planted on the ground.  

[Kharon]

Was a pleasure CW; you are not the first and certainly will not be last who have run into a ‘medical’ problem, we have, in our quiet way seen a few through the trauma of it all. But you have three big positives:-

1) CASA have landed on the safe side of very safe, which is pretty much par for the course world wide. But now you know where the challenge lays and can stop ‘worrying’ about the ‘what ifs’; you have a twelve month to get sorted out and, CASA have agreed to take a further look with the chance of a review. I’d say that was a good outcome, all things being equal..

2) ATPL subjects take a lot of time and effort – if you intend to really learn your trade. Anyone can learn to ‘pass’ an exam then immediately forget ‘all that crap’, professionals try to retain as much of the theory as possible, simply because one day it may come in very handy. So no distraction study time is a bonus.

3) As you are looking to multi crew and need an ‘off-sider’ why not use the flight time to ‘practice’ multi crew discipline. There is a mile of information available on ‘how to do it’ most of it good stuff; use the second pilot as a check list ‘challenge’ and response cross check; learn ‘scan-flow’, learn about ‘briefing the approach’ and executing same – as briefed; on speed on profile - with all possible bets covered. It is an interesting, disciplined method of operating and much may be learned. IF under the hood (buy JepShades) is also invaluable.

Lots to play for, all good fun. But – keep us posted, or I’ll set GD to fox you out.

[Cap'n Wannabe]

Was a pleasure CW; you are not the first and certainly will not be last who have run into a ‘medical’ problem, we have, in our quiet way seen a few through the trauma of it all. But you have three big positives:-

1) CASA have landed on the safe side of very safe, which is pretty much par for the course world wide.  But now you know where the challenge lays and can stop ‘worrying’ about the ‘what ifs’; you have a twelve month to get sorted out and, CASA have agreed to take a further look with the chance of a review. I’d say that was a good outcome, all things being equal..

2) ATPL subjects take a lot of time and effort – if you intend to really learn your trade. Anyone can learn to ‘pass’ an exam then immediately forget ‘all that crap’, professionals try to retain as much of the theory as possible, simply because one day it may come in very handy. So no distraction study time is a bonus.

3) As you are looking to multi crew and need an ‘off-sider’ why not use the flight time to ‘practice’ multi crew discipline. There is a mile of information available on ‘how to do it’ most of it good stuff; use the second pilot as a check list ‘challenge’ and response cross check; learn ‘scan-flow’, learn about ‘briefing the approach’ and executing same – as briefed; on speed on profile - with all possible bets covered. It is an interesting, disciplined method of operating and much may be learned.  IF under the hood (buy JepShades) is also invaluable.

Lots to play for, all good fun. But – keep us posted, or I’ll set GD to fox you out.

Agreed on points one and two. But, you know, I'd never considered point three. And it's a good 'un!

[Cap'n Wannabe]

Something I found on "UP" - CASA have asked for submissions regarding medical standards, and the potential review thereof.  This is a subject that's very close to me personally, and while I mentally work on my submission, I also wonder if it is worth it.  I guess if I put it all in writing, then it's there, and I can decide whether or not to submit..

CASA Review of medical certification standards

[thorn bird]

Cap'n, tis a quandry I agree, probably a waste of time; but,submit one must. Complacency being half the reason we are in the pickle we are in. My two Bob's worth, which I will be submitting.

There is little chance of much change in the level of medical scrutiny as its mandated by ICAO; but, it could be streamlined and made a whole lot cheaper if:

Adopt the US system where resources are utilized to train appointed doctors in aeromedical issues, then trusting them to carry out medical assessment, rather than treating them like criminals they haven't caught yet, alluding to their lack of competence and probity thus requiring oversight and completely ignoring the advice of specialists consulted for a particular ailment. As in operational matters CAsA ain't the experts.

Cease and desist allowing CAsA FOI's to use their medical division to sanction pilots who have incurred their wrath.

Allowing the DAME to issue the medical on the spot, as in the USA. That would have the advantage of reducing CAsA's costs by eliminating the plethora of clerks who do the assessment via an arduous tick in the box point system. An error in the application could quickly be cleared up by the DAME, "You've ticked the box saying you continuously pass out , piss off your family members and can't remember the next day you bared your arse at a family wake"....CAsA clerks would immediately brand you as an alcoholic with bi-polar disorder and order you committed. A DAME would more likely ask "are you sure you ticked the right box"?.

Right now there are too many pilots grounded who could be gainfully employed but for 'medical issues', while the grist is ground to the inevitable conclusion, that they were fit to fly. Not only a financial penalty to them, to their employer; and, ultimately the taxpayer who misses out on tax but probably also has to stump up for welfare.

[Sandy Reith]

In any submission it should be noted that CASA have never made a safety case for the necessity of their AVMED system. There is no doubt that we who have been around for some long time did not really question the basic reason d'etre. We were younger and untroubled by the thought that we might not pass the medical and it probably satisfied some ego and self esteem. It made us special, bad luck now if you've been scotched out. You drive to the doc's surgery and then drive home. Extraordinary;   when one must make logical choices when flying, yet put up with mindless habit taught on the ground. We accepted, and subordinated to a bureaucracy dedicated to its own survival, maybe just too busy to interpret the signs of decay.

Indulge me a few off topic points, and end of year off my chest comment following:-

National Wonders;  

General Aviation is being smashed by bureaucratic mania, the great CASAastrophe.

The beef stock National Livestock Identification System (NLIS) electronic ear tags is expanded for sheep, and... wait for it...goats too!!
Better make that all four legged animals including alpacas, wombats and rabbits. A micro version for bees should be developed.
But wait there's more! Chooks pigs and kangaroos must be on the agenda surely! After all they are on our menus.

I suggest NILSense as a name for this program.

Predictions 2017 :-

The final assault of the Bureaucratic Horde as they burst out of soulless and sterile Can'tberra in order to fully dominate and enjoy the real Australia, vibrant, yes sometimes messy but beach accessible living.

Commonwealth and State Corporate bureaucratic governance matures into undisputed mastery and the $1 postage stamp becomes $2.

Seeing the emerging Corporate Regime sally forth, armed and threatening with more thousands of criminal strict liability regulatory provisions, we subjects doffs our lids and hide best we can.

Unable to work to the latest stringencies we sell our homes and farms to the moneyed Corporate Regime elites and downsize; some moving reluctantly to the now very cheap leaseholds in the ACT.

Our bureaucratic masters have the money, even now the the PS top dogs are earning far more, some of them millions more, than the figure head Ministers.

Happy 2017

[thorn bird]

Our public servant are no longer servants of the public Sandy, they are self servers.

Their obscene salaries will pale into insignificance after they retire and receive the nudge nudge wink wink rewards for services rendered during their tenure.

What a nice little earner.


Happy NY Thorny :-

[Peetwo]

Our public servant are no longer servants of the public Sandy, they are self servers.

Their obscene salaries will pale into insignificance after they retire and receive the nudge nudge wink wink rewards for services rendered during their tenure.

What a nice little earner.


Happy NY Thorny :-

On UP duty (yawn -   ) I note that there is a thread (currently active and not yet shutdown    ) that is endeavouring to discuss the CASA Avmed discussion paper...

Last post courtesy of thorny...

TB - "Following in from my comments in the PT61 thread, there were less than 100 responses to the letter the DAS put out".

You mean to tell me there are still 100 pilots left in Australia!!!!!
CAsA is obviously not doing its job stamping out these criminals, everyone should write to the minister and complain.

Besides thornbird's latest contribution, which risks possible moderator sanction due suspicions of sarcasm and possible CASA derogatory comment, there seems to be much confusion and scepticism on the real intent and purpose of the CASA bollocks DP...

Here is a small cross section of some of the UP posts:

drpixie - Is this the latest version of the Xmas eve fax - want to avoid discussion, put out a discussion paper when no one will see it?

---

Eyrie - Yep, drpixie, this IS the current version of the Christmas Eve fax. All 45 pages of it.


AOPA have pushed for a similar medical standard to that which will be used in the USA for PRIVATE PILOTS. The UK has brought in something similar.

Porter, nobody is even questioning the Class 1 yet CASA puts this and many other considerations on the table and has pulled the wool over the Minister's eyes.

The medical isn't for YOUR benefit, it is a risk mitigation exercise to protect people on the ground and others in the air. There is a complete lack of evidence that it does any good. Both in the US and Australia glider pilots operate on a self certification basis and RAAus pilots in Australia on a State car driver's licence (around 40% of pilots in Australia) so the experiment has been run for decades. You are at greater risk of killing an innocent pedestrian or a car full of of passengers coming the other way in the event of sudden incapacitation than you are of hurting anyone else in a small aircraft for the same reason.

Regulation should be evidence based and if there is no evidence, it should be abolished.

The CASA paper looks to me like a calculated insult to AOPA Australia.
CASA will manage to keep this whole thing going for decades to avoid taking action.

---

Old Akro -

So how does CASA determine for itself that you are a fit and proper person to hold the licence?

CASA does this via a network of delegated DAME's. The trouble is that CASA neither trusts them, nor the specialists to whom they seek additional opinion, nor the drug companies who make recommendations about side effects, etc, nor indeed the FAA who publish a much more comprehensive DAME manual than CASA.

Instead CASA centralises all decision making and review, but employs people with inadequate qualifications or experience, thus they have guidelines & protocols provided. But these are inadequate, contradictory and incomplete. And none of the administrative staff will take responsibility for going outside the guidelines (more than their jobsworth). So anything that is not black & white, enters a spiral of review until the pressure for a decision finally becomes overwhelming.

All CASA needs to do is:
a) harmonise its medical standards with other Australian bodies / overseas agencies. Australian aviation does not need unique standards for blood pressure, blood sugar, etc.
b) make the DAME guidelines clear & easy (or copy the FAA one)
c) allow DAME's to have proper authority. They are well qualified, serious people, seriously, why can't they be the arbiter of who is fit to fly? They or their colleagues do it for driving, boating, scuba diving and a range of occupations. As much as we would like to think otherwise, pilots aren't a special breed.

---

Icarus2001 - I think you missed the point that Mr Approach was trying to make Akro. The DAME DOES NOT decide if you are a "fit and proper person" to hold a licence. They simply assess your HEALTH indicators against a set of standards.


Fit and proper is a whole other ball of wax.

---

Old Akro - Icarus

Got it now. But, without having read the relevant legislation, I would expect that a pretty much identical phrase appears regarding driving licences, boat licences and a whole range of other things from gun licences to explosives licences.

CASA stands alone in creating such convoluted, contradictory, ill defined medical requirements. It also stands alone in the bureaucratic structure it has created to administer this.

Other bodies find easy, cheap, efficient ways of dealing with these requirements. CASA pretty much stands alone in wanting to not delegate any authority and administer it all centrally in Canberra.

Don't believe me? Go and get a heavy truck licence (administered Nationally, but delegated to the state bodies). It involves medical requirements, skill & knowledge requirements and fit & proper person requirements. And a truck driver can do a whole lot more damage in a 40 tonne truck than I can in a 1.9 tonne light twin.

---

Sunfish - The problem is that CASA will pervert the idea of a relaxed medical standard for private pilots. They will do this by restricting existing privileges available to the new class (for example IFR, controlled airspace,etc.) or by hedging the new class with restrictions so as to make it meaningless (for example limitations in respect of cancer, diabetes and other common conditions).


What we have now is a meaningless system and I don't believe CASA is going to do anything but window dressing. The phrase "all assistance except actual help" comes to mind.

I could go on.

---

Eyrie - Sunfish, you got it in one. There won't even be any window dressing. This will drag on until everyone forgets it or there is a change of government which kills it. All according to plan.


I hope AOPA is on to this perversion of their proposal. BTW glider pilots currently can fly in controlled airspace in Australia on their self declaration medical so the experiment has been run.

All the evidence I've seen says medical incapacitation WHICH MAY HAVE BEEN DETECTABLE IN A CLASS 2 MEDICAL is a very, very small cause of aviation accidents.
holdingagain, BOHICA may be your style but it isn't mine. 

 Which leads me back to the TB post...     

While on the CASA Avmed DP, this was from the horse's mouth Herr Comardy in the introduction to the DP:

Introduction

The Civil Aviation Safety Authority (CASA) has been streamlining its approach to medical certification. The introduction of the new Medical Records System in March of 2016 was an important milestone in this effort. With a view to further advancing improvement in CASA’s medical certification process, individuals from all sectors of the aviation industry have suggested that CASA adopt some of the approaches recently introduced or being considered overseas, with a view to making the certification process in Australia quicker, less onerous and less burdensome administratively.

Aviation medicine is complex, involving medical, regulatory and legal considerations. Mindful of this complexity, we have decided that a wide-ranging discussion paper is the best way to canvass community views about medical certification in the sport and recreation, general aviation, aerial work, air transport and air traffic control sectors alike.

This discussion paper raises a number of issues, your responses to which will help us to determine whether to make changes to the current medical certification regime which encompasses class 1, class 2 and class 3 medical certificates, as well as the recreational aviation medical practitioner’s certificates. The decisions taken in respect of one sector may well have implications for the others, and any decisions taken across the board will have implications for the aviation industry as a whole.

The discussion paper is intended to stimulate debate and raise awareness about our current approach to aviation medicine, the propriety of current medical fitness standards, the factors involved in aeromedical decision-making and related considerations and developments internationally and in other jurisdictions. Ultimately, our objective is to identify modifications to our approach that will make the most sense for Australia today and in the future.

If there are other issues or sources of information not included in this discussion paper, but which are relevant to medical certification for any of the affected sectors, we will be happy to receive comments on those matters as part of this process.

Input to the discussion paper will be accepted up to 30 March 2017 to allow plenty of time for all relevant areas of the public and aviation community to contribute.

This discussion paper will form the basis for future consultation between CASA and all affected stakeholders on the issues raised and any action CASA proposes to take. Such consultation would take place through a dedicated development team, possibly leading to release of a notice of proposed rulemaking (NPRM) for industry and public consideration.

This discussion paper does not contain proposals for or draft regulations. That would be premature. What we need to do now is to identify and articulate the issues, and to begin to consider better ways to address those issues.

I appreciate the commitment in time and energy that people will make in providing comments on this important topic, and I thank you in advance for your effort and contributions.

Shane Carmody A/g Chief Executive Officer and Director of Aviation Safety

MTF...P2

[Kharon]

Hook:-

CASA intro:- “Aviation medicine is complex, involving medical, regulatory and legal considerations. Mindful of this complexity, we have decided that a wide-ranging discussion paper is the best way to canvass community views about medical certification in the sport and recreation, general aviation, aerial work, air transport and air traffic control sectors alike.”

When there is a slim chance that a submission to a ‘discussion’ paper will be weighed, measured and considered, it is worth spending the time and making the effort to provide one. This ain’t one of those times. CASA Avmed can more readily access empirical statistics from sister bodies, such as the USA and would have done so, should there be an internal desire to utilize a similar system. The data, protocols and system details have been available for donkey’s years and if there was any chance of ‘change’ then the discussion paper would be referenced to the proposed changes to system.

Line:-

CASA intro:- “This discussion paper will form the basis for future consultation between CASA and all affected stakeholders on the issues raised and any action CASA proposes to take. Such consultation would take place through a dedicated development team, possibly leading to release of a notice of proposed rulemaking (NPRM) for industry and public consideration.”

The vast majority of ‘stakeholders’ (read pitch fork wavers) have little to no acceptable expertise “involving medical, regulatory and legal considerations”. Unqualified submissions may then be disregarded with impunity. The local DAME may well be qualified to provide ‘expert’ medical opinion; but their comment on ‘legal’ and ‘regulatory’ matters will, for the reasons mentioned, be discarded as quickly as those from the ‘unshriven’.

& Sinker:-

CASA intro:- “This discussion paper does not contain proposals for or draft regulations. That would be premature. What we need to do now is to identify and articulate the issues, and to begin to consider better ways to address those issues.”

No doubt ‘irritated’ by the constant yapping of the small dogs next door – a juicy bone is lobbed over the fence; this will keep ‘em quiet and occupied for a good long while.

Any real attempt at reformation would be presented as “we have considered the FAA pilot medical system and propose to bring a similar system into law”. “This discussion paper and the attached NPRM is provided for industry and public consideration”. Anything else is simply a bollocks, cunningly designed to provide employment for a number of years and make it appear as though CASA are actually doing something.  No doubt there will be many sound, solid, well argued submissions presented, all making perfectly good sense; and it must be done. But the temptation to toss the discussion paper into the bin and never think of it again is great. In truth, ‘tis irresistible – THUD.

Toot- toot.

Last thought: perhaps a ‘discussion’ paper on how to stop CASA getting away, every time, with this sort of frivolous, time wasting, costly exercise would draw more ‘suggestions’ from ‘stakeholders’