AINsight: Beware the Past Medical History

One of the more common ways that pilots find themselves in a bit of hot water with the FAA is when previously undisclosed past medical history diagnoses are discovered.

Rest assured that I will not leave you hanging. In most cases, the pilot will ultimately maintain their FAA medical certification even after the previously unreported medical situation came to light. The pilot may have their tail between their legs for a while and some homework to do, but usually things work out favorably.

Before visiting with an AME to obtain a new medical certificate, pilots must fill out FAA Form 8500-8 through the online MedXPress platform. This virtual process has been mandatory for more than a decade.

In the application, several medical questions are asked, including medications taken (item 17), past medical history (item 18, these reports continue with each subsequent medical exam indefinitely), and separately in a section for medical evaluations throughout the past three years (item 19).

Suffice it to say that if the FAA requests information via the small sampling of questions on the application, there are good reasons for doing so. While these reasons are not always obvious at first glance, they do relate to aviation safety.

Suppose a pilot had open-heart surgery, for example. This will be reported in item 18g (“heart or vascular trouble”) and would thereafter always be reported at all subsequent medical examinations. Any post-procedure medications would be reported in item 17. Relevant medical consultations, the surgery itself, and post-operative evaluations are reported in item 19.

Given that heart disease requiring surgical intervention is considered a “specifically disqualifying condition” per the FARs, a special issuance authorization (SIA) is required for the pilot to regain their FAA medical certification.

To no surprise, a boatload of medical data must be provided to the FAA for review.

Once recovered fully from the heart surgery, and while carefully adhering to FAA medical expectations and protocols, the pilot cheerfully presents the requisite data to the FAA, optimistic about receiving an SIA sometime in the course of the upcoming fiscal decade (kidding aside, FAA review times have somewhat improved of late).

Herein lies the problem. Let’s continue with the above example. In the review of the cardiology data, contained in virtually all evaluations presented, in addition to the heart surgery itself, there will be past medical history (PMH) notations.

The PMH may include, as it does far too often, known aeromedically significant diagnoses that have not been reported to the FAA. Some of the more common examples are kidney stones, sleep apnea, diabetes, and glaucoma, to name just a few.

Bear in mind, with just a tad of patience and planning, all of these conditions are, if medically stable, typically approvable by the FAA.

During an initial pre-SIA consultation with a pilot, it is my job as an AME to proactively find all of the issues that will potentially raise eyebrows at the FAA. It is commonplace and unfortunate that a medical condition other than the one that brought the pilot to my office in the first place conceivably raises the most concern. However, with a bit of due diligence, we can usually work through the unexpected complications. Doing the research in advance of the documentation submission to the FAA is the best course of action.

Why do medical conditions occasionally go unreported?

• The pilot fears temporary or permanent grounding. Fair enough. Generally, such fears are unfounded, but I fully understand the concerns.
• Pilots often instruct other pilots not to tell the FAA anything. That only works until the unreported condition is incidentally discovered and/or there is an accident or incident (see below).
• Finally, and entirely mind-boggling to me, pilots will confide that “My old AME told me not to report anything.”

It must be remembered that the pilot is legally responsible for reporting medical conditions accurately, and that whatever other pilots or their prior AME told them is not an excuse for non-reporting.

Once the FAA comes upon an unreported medical condition, what happens next? Do not fret—a team of forensic medical investigators will not storm the pilot’s front door. But indeed, be prepared to perform the medical equivalent of a “rug dance” for an irate chief pilot.

The FAA will not grant an SIA when there remains any medical condition that has not yet been adequately and satisfactorily explained. Therefore, while they may be OK with the cardiology data, instead of obtaining an SIA, the pilot will next receive—by both regular and certified mail—an unfriendly nastygram from the FAA requiring evaluation data regarding the previously undisclosed medical condition.

For common medical conditions, while this situation may add weeks to months to the authorization process, generally, the FAA will grant the coveted SIA after the additional data is reviewed. Follow-up SIAs for our aforementioned example may include reference to both the heart surgery and whatever additional medical condition came to light.

Caution: The FAA may be less lenient if the unreported conditions include mental health treatments, drug and/or alcohol use disorders, or driving under the influence (DUI) arrests and/or convictions. FAA protocols include reasonable and aeromedically proven pathways to certification for many, not all, mental health conditions, substance disorders, and DUIs. Non-reporting of any of the situations mentioned in this paragraph will most certainly raise the ire of the FAA.

Applying for a medical certificate automatically authorizes the FAA to access the U.S. National Driver Register (NDR). Word to the wise: Report any DUIs to the FAA before it finds out through an NDR search.

The ethics of reporting are clear, and the pilot is legally responsible for doing so.

The MedXPress application also includes, in a section usually ignored by the pilot (reminiscent of the incomprehensible legalese a patient must agree to when signing medical consent forms for even the most minor procedures), a statement that fraudulent reporting could bring upon the pilot a $250,000 fine and/or five years in jail.

While this is a situation that rarely occurs, if there were an aviation accident that may have been partially caused by a medical condition that the FAA was unaware of, the pilot should be prepared to pay a bevy of attorneys to defend them. The consequences could be quite troublesome, to say the least.

My goal in highlighting reporting ethics is not to cause unnecessary stress to unsuspecting pilots who simply want to go to work and do their jobs. Quite the contrary, my goal is to proactively prevent FAA medical and/or legal problems for the pilot.

When an AME hands the pilot a medical certificate, which is based on the reporting statements provided by the pilot, that medical certificate clearly appears legal and valid. Nobody at the FAA or the pilot’s employers would have any reason to be concerned.

When might the medical certificate be called into question? If there is an aviation accident or incident, it is more likely than not that the pilot’s medical qualifications will be reviewed by the FAA—and the attorneys representing both sides of the case—and possibly, depending on the extent of any action taken against that pilot, in a court of law.

The medical experts and attorneys working against the pilot will, without question, emphasize to the FAA and/or in court that there were serious deficiencies in the pilot’s reporting ethics. Even if the unreported medical condition was unlikely to be causative in the accident itself, it never looks good to the powers who make the final judgments that the pilot was unethical in their reporting. A pilot does not want the presiding administrative law judge to hear condemnatory information about their ethics.

The core idea today is to remind pilots that reporting medical conditions promptly may prevent significant problems later. While it is frustrating to be temporarily grounded while a medical condition is being evaluated by the FAA, that is a very minor inconvenience compared to the potential pitfalls of non-reporting of noteworthy medical diagnoses.

My goal is to have the medical certificate upheld as legal and valid if it comes under scrutiny.

Most AMEs and private aviation medicine consulting firms are qualified to provide sage advice regarding the best ways to efficaciously evaluate and report medical conditions that may be of aeromedical significance. Doing so proactively, versus having the medical condition discovered later, is the best tack.