AINsight: ‘Expedite My Case, Please’

 - October 9, 2020, 11:14 AM

Whether before, or during the Covid pandemic, any pilot grounded while awaiting an FAA review of their medical documents is understandably anxious. Everyone wants their case reviewed ASAP, and everyone hopes to receive either a favorable letter of eligibility or formal special issuance authorization immediately thereafter.

FAA reviews of complicated cases typically take several months. The case documents need to be received, sent to scanning, arrive in a reviewer’s inbox (reviewers are non-physicians who do an initial evaluation of the documents before forwarding the case to an FAA physician for a formal disposition), and then ultimately wind up in the hands of an FAA physician. Once that case is reviewed, it goes from the FAA physician back into the logistical chain for the preparation of the letter to the pilot and, hopefully, the medical certificate itself. 

If the case is going to require a review by one of the consultation panels or by an independent outside physician consultant, this often adds considerable time. Such cases include, for example, the first review of a cardiac case that involved bypass surgery, stent placement, cardiac valve replacement, and/or cardiac pacemaker implantation.

The nitty-gritty of the document submission and pitfalls were discussed in my February blog. At a later date I will discuss additional recommendations in regard to making that documentation work well on an initial submission, but today I want to talk about pilots wanting their cases to be expedited.

All pilots waiting for an FAA ruling want their cases expedited. Again, given human nature, this is both natural and expected. However, this is also a time for exercising patience—and understanding.

I begin with asking each pilot to understand that for every pilot we expedite, someone else waits that much longer. To expedite a case, a reviewer and physician both might have to distract their attention from cases they are already working on. Thus, pilots who have been patiently waiting and finally have found their places to the head of the line, so to speak, wait longer still while the medical case of a pilot who has not been waiting as long gets expedited.

Certainly, there are cases that seemingly have waited forever, and we worry that they got lost in the cyber-abyss. The FAA has an unwritten rule that, in general, they do not want to be bothered about a case that has not been “in the queue” for at least 90 days. We make exceptions to that periodically, but the FAA, in general, does not think 90 days is altogether unreasonable for a complicated case review.

Most cases are reviewed at the Aeromedical Certification Division (AMCD) in Oklahoma City. Some cases, however, are reviewed at the Regional Flight Surgeon level, and for uncomplicated cases, this is an option that can sometimes, without any fanfare, receive a review in less time than it might take at the AMCD.

The initial drug and alcohol case reviews for the Human Intervention Motivation Study (HIMS) program and for the antidepressant program (Selective Serotonin Reuptake Inhibitors, or SSRI program) are designated at the Federal Air Surgeon level in Washington, D.C. These cases are complicated and involve some of the most critical decision making (and liability) in aviation medicine, and consequently, they go through a number of logistical channels, including often being reviewed by several physicians before a disposition is rendered. These reviews, as you can imagine, take some time.

Before I as an AME ask the FAA to expedite a case, requesting that my pilot be pushed to the front of the line, I ask myself—and the pilot—what makes their case compelling enough to justify having it expedited? What makes it ethical to permit other pilots to wait longer while my pilot gets expedited?

The excuse that the pilot was simply late in providing required data does not typically get much sympathy. However, a pilot who presented their data in an efficient and timely manner, has waited a considerable period of time, and is either about to run out of sick leave (or disability payments), and/or might possibly lose their job outright, gets our fullest attention. In other words, if the pilot would clearly wind up with a significant hardship if the case is not expedited, the FAA is quite sympathetic to that.

Contrary to what is the common belief in the industry, while the aeromedical system has plenty of annoying hurdles and logistical challenges, the FAA protocols are designed to return as many pilots to the cockpit as is safely possible. And the FAA staff and physicians are, in fact, quite motivated to do just that.

Without a doubt, the system is an unwieldy beast and there are not enough people available to permit all cases to be reviewed on as timely a basis as we might want. Until if and when somebody magically provides the FAA with unlimited funding and resources to hire sufficient staff and physicians to review all cases on an immediate basis, we all need to take a deep breath and remain patient. If a long delay makes a case become compelling, the FAA will help out.

How then, do we actually get the case expedited? It is easiest to do if the AME was the one who reviewed and submitted the documentation in the first place. Then, the AME knows the case intimately, so when the time comes, he/she can have an educated discussion with the FAA physician who may have agreed to review the case.

One of the things that AMEs don’t like hearing is when a pilot tells them that their separate aeromedical consultant organization (who actually got paid to review and process the documents) has told the pilot that, “The AME can just call to get approval to issue the medical certificate.” This makes it sound like a simple process that takes just a few minutes and does not inconvenience either the FAA or the AME to do so. It's not that simple.

The FAA typically has one “doc of the day” to handle virtually all calls from all AMEs around the county. Typically, the doc of the day is usually available only four days weekly. You can imagine how “simple” it is for the AME to call that one physician, assume that he/she is available, and obtain a ruling on the spot.

Typically, the process involves an extended period of time on the phone, waiting on hold, as there is one phone number, with one extension, for all AMEs to call. Often this results in a seemingly endless series of phone-tag messages.

If the AME finally gets in touch with the doc of the day, it is pretty embarrassing if a separate aeromedical consultant had submitted the data and the AME is not completely familiar with the case specifics. The AME is then basically asking the FAA physician to make a ruling on a case that the AME might know very little about. That does not sit well with the FAA physician.

I fully understand that, for example, an airline pilot’s union dues might have paid for the separate aeromedical consultant. Understood.

But, after embarrassing myself a few times earlier in my career, my personal policy these days is that I do not call the FAA for an authorization to issue a medical certificate unless either I submitted the data myself, or unless the pilot provides me all of the data that the aeromedical consultant had reviewed and submitted to the FAA. That way I have knowledge of the case before discussing it with the FAA.

And, yes, this process will entail some consultation billing time for the pilot. However, that investment is repaid many times over if that pilot returns to work weeks or months sooner than might have happened otherwise.

The bottom line is that, when a case is compelling enough to expedite, both the AME and FAA are motivated to make it happen. We all still need to have some patience, but if we determine that a case truly warrants that little bit of extra attention, it receives that attention.

During Covid, with some additional logistical hurdles causing the increasing prevalence of remote working, FAA review delays that are longer than desirable have been inevitable. The FAA is doing its best—it really is—under the circumstances, but no different than the daily-new-norm (which will be somewhat different tomorrow), we are continually learning new ways to “make it happen” and to flex and flow with a situation that none of us wanted, and none of us previously had any experience with. It is a daily learning process.

As employers struggle, and as pilots might wind up getting furloughed, the prospect of being without a medical certificate is daunting and frustrating for that pilot. The FAA has been sympathetic to the fact that obtaining required documentation has not been simple, as many physicians' offices were closed for quite some time for anything but emergent services.

The FAA has gone to great lengths to try to lessen those impacts. Yes, the FAA does care. The FAA has provided some slack in the logistics of certain programs, such as HIMS, which can be very costly for pilots out of work.

As for other special issuance considerations, the FAA has allowed a “one-time, case-by-case” extension for certain documentation requirements. However, to obtain that consideration, it adds to the phone call burden that also impacts the same system as the requests for expediting cases. The logistical burdens are immense at present, and this is a trying time for everyone in aviation.

As applies at all times, and can not be waived while obtaining an extension in the documentation submission requirements, FAR 61.53 mandates that safety of flight and self-assessment of fitness for duty remain in effect.

I continue to maintain hope that the industry comes through the pandemic in a position to heal and grow again, getting pilots and ancillary staff and vendors back to work. Let’s be patient, and understand and appreciate that we are all struggling together, albeit perhaps on different levels, due to Covid. Our best chances at success require that we work together cooperatively and remain patient with each other along the way.