3rd Class SI stuck in HIMS

Discussion in 'Medical Topics' started by BigShark, Sep 17, 2020.

  1. SneakyGrouse

    SneakyGrouse Pre-Flight

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    How about the mental gymnastics where you have to retire 121 at 65 even if you can pass your 1st class, or the whole Hoover story.

    The FAA, where a traffic ticket is a diagnosis, a 10yr old kid with a joke ADHD diagnosis has to practically solve cold fusion to fly, yet 737 Max practically is self certified.

    It’s clown world.

    I wish OP the best and hope he can just let his 3rd expire and basic Med it, Im surprised anyone who isn’t forced to subject themself to the FAA medical world, doesn’t just go basic med today.

    I do stand by my opinion that a FAA versed lawyer will put you on a MUCH better path than most AMEs.
     
    Last edited: Sep 20, 2020
  2. ThatOtherGuy

    ThatOtherGuy Pre-Flight

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    More on topic....

    If you've been diagnosed with substance dependence here's what I would do:

    1. Take ownership of your recovery, and do whatever it is you need to do to get the dependence monkey off your back. Don't even think about starting unless you KNOW you're ready to be DONE with that lifestyle.
    2. Decide whether the limitations of BasicMed will work in your situation. Then pick one:
    a. Decide on the BasicMed route.
    b. Accept that you'll have to hold a medical certificate and be under drug/alcohol monitoring for life.
    c. Consider Sport Pilot/gliders/balloons/ultralights. Do not do anything that would compromise your ability to utilize Sport Pilot.
    c. Pick a different hobby, enjoy your recovery, and hope regulations improve in the future. ​
    2. Get a special issuance for the condition.
    3. Pass a medical and get issued a 3rd class medical certificate.
    4. Continue to comply with EVERY detail of the SI letter while you hold the medical certificate. In fact, it wouldn't be a bad idea to go above and beyond.
    5. Allow the 3rd class medical certificate to expire. Do not renew the medical.
    6. Continue to fly under BasicMed.

    Optionally, hold medicals under the SI for at least 2 years to document your commitment to recovery from substance dependence.

    I would NOT make an issue of things by surrendering your medical before it expires, or communicating in any fashion with the FAA about the terms/length of the SI letter. Better to fade away than shine a light on yourself.

    Rationale:

    As long as someone holds a medical with a substance dependence diagnosis that airman will be on some form of intrusive drug/alcohol testing. The days of release from monitoring for dependence are over. Putting someone under substance monitoring for a LIFETIME is just ridiculous. It's an overreach, counter-productive, overly financially burdensome, lifestyle intrusive, and not necessary to insure aviation safety. We now have a system that places more scrutiny on 3rd class substance dependence SI medicals than some dependence diagnosed airmen actively flying airliners.

    The reg calls out substance dependence within 2 years as disqualifying for BasicMed. 14 CFR 68.9 (a)(1)(4). Note that abuse is not specifically called out as disqualifying, however then you get into the self certifying issue. 14 CFR 68.3 (b) (5). If you get the SI letter for dependence, get 1 issuance of a medical, don't renew the medical, then you're in compliance with BasicMed for that single disqualifying condition (dependence). To stay in compliance with BasicMed the medical certificate cannot be revoked or suspended. 14 CFR 61.23(c)(3)(ii). Note that only the medical certificate is called out in this reg, NOT the special issuance letter.

    If substance dependence SI pilot on BasicMed subsequently develop any of the other BasicMed disqualifying conditions, they're going to have to get an SI for that new condition. This means proving they're still abstinent and dependence is under control as well as proving the new condition is under control. Think about what proving you're still good on substance dependence after years would mean.

    There are 2 dates of importance.

    The first is the expiration date of the SI letter. That is the last date when an airman can be issued a medical certificate under the SI letter. Once the SI letter expires, the airman has to obtain a new SI letter in order to continue being issued medical certificates. The terms of the special issuance letter are only enforceable as long as the airman holds a medical certificate. This date is only relevant to airman that want to hold medical certificates, and has little relevance to BasicMed.

    The more important date is the expiration of the currently held medical certificate. Once the medical certificate is expired the FAA cannot use the SI letter as a mechanism to require anything from the airman. This is explained in the FAA's own legal interpretations. Not holding a medical certificate also exempts the airman from the FAA's ability to use 67.413 to require airman to hand over medical records. In short some, but not ALL, aspects of 14 CFR 67 become non-applicable to airmen that do not hold medical certificates. The FAA can still require additional information from BasicMed airmen under 14 CFR 68.11.

    Airmen can voluntarily surrender their medical certificates, but it's not always that easy. The FAA can refuse to accept the return of a medical certificate if it's an attempt to avoid certificate action or investigation. Keep in mind the term investigation is broad. For example, an FAA request for more information after a medical exam constitutes an "investigation". The pertinent scenario here would be surrendering a medical to go BasicMed, and the FAA refusing the surrender then revoking the medical, thus making the airman disqualified from BasicMed.

    For those thinking, "great I'll just wait 2 years after my dependence diagnosis, not renew my medical and then go BasicMed", it's probably not a good idea. If you held a medical, got a dependence diagnosis, didn't renew, waited 2 years, then started on BasicMed you'd be on pretty shaky legal ground. There's the issue of when exactly does someone with dependence stop being dependent. The current FAA/FAS stance is pretty clear that once dependent you're always dependent and require total abstinence. My layman's opinion is that going to treatment/meetings/remaining abstinent for 2 years then back to "1 beer with dinner" in the 3rd year means you're still dependent in the eyes of those that matter. Also, if you develop a condition that requires an SI to continue under BasicMed the dependence will have to be disclosed at that time. Additionally, there isn't a lot of case law around BasicMed and you're very likely going to be entering "test case" territory.
     
  3. BigShark

    BigShark Filing Flight Plan

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    Dr. Chien, should a single dui within 2 yrs of application be classified as abuse? .147 BAC. Is that considered close enough for abuse? Should I even be in the HIMS program?

    You mention 2 yr. Monitoring since SI was issued before Jan. My 6 months is up in Feb. Should I just stick it out another 6 months and hit the 2 yr mark of monitoring and be done? Is there a guarantee ill be released? Or should I just jump to Basic in Feb?
     
  4. bbchien

    bbchien Touchdown! Greaser!

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    It is so close to 0.15 that it gets looked at very closely. Actually if the Constabulary ran the exhalation concentration curve all the way out it would be 0.15.

    The only guy who can authoritatively make that decision is the HIMS psychiatrist. And I have NEVER had one in the 0.14 -0.149 range in which they took my word for it. Even with a CADC evaluation. In your zone it's about 40% favorable and 60% abuse at a minimum. I had one guy who was so "WHAT'S FAA's problem. I don't drink any more than the next guy!"....he's in rehab.

    A lot depends on how you understand the difference between dependency and abstinence and how you are able to verbalize it. The way to get an education is to go regularly to a CADC for counseling and education or attend AA and learn from the old guys who come regularly, sit in the back and maybe make three comments the entire meeting. They "get it". It is a whole language that if you don't get, you "don't get it".

    Try to remember: If you're creditably trying to drive at what really is 0.15, you are only that tolerant because you drank long an hard to get that tolerant. I'd be face down at the curb. The FAA and the HIMS AME did not give you that DUI. You did.

    PS. I use urine ethyl glucuronides for my maintenance guys who I am confident "get it". Those are $65 a pop (CHEAP, the whole year is $1,200!). That is really, just surveillance. I do have one guy who was reissued by the FAS himself after a few really really low ETS positives, on condition of "tighten his test program so that if he EVER takes a drink we will know". So, now I use (for him) PETHS 21 days apart for that + random urine + a soberlink. I think he isn't drinking, and that he just isn't taking "scrubbing his environment of incidental alcohol exposures" seriously enough. But now, if he ever gets near hand sanitizer, Vanilla extract, Alcohol containing bathroom cleaners, Meenen aftershave, or Vicks Vapo rub, I'm-a-gonna know. So it really depends how much confidence the HIMS AME has in you and how much trust you've earned.
     
    Last edited: Dec 5, 2020
  5. allPrimes

    allPrimes Pre-Flight

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    ****. Now I'm terrified! I love to bake and use extracts (e.g., vanilla and almond) often. Hopefully, the heat in baking drives off the alcohol in the extracts. I haven't had a positive ETG yet (since I've been doing twice/month, beginning in September, now down to 14 in 12). Guess that's a good sign?
     
  6. bbchien

    bbchien Touchdown! Greaser!

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    Be careful out there! You ARE RESPONSIBLE to get negative tests.
     
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  7. allPrimes

    allPrimes Pre-Flight

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    My takeaway: no more baking with extracts. Thanks for the heads up. The woman that processes my UAs has said to me that it would take ingestion of quite a bit of alcohol to show up in the test and I know of someone who, at the beginning of COVID lockdowns, was religious about sanitizing with hand sanitizer who had a positive ETG. Scary stuff!

    I recently had some dental work done and, coincidentally, was called in for a random that same day. I took a doctor's note from the dentist just in case anything showed up on the screen. Notably, all was negative.
     
  8. jstone

    jstone Ejection Handle Pulled

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    Then I’m guessing you don’t use choice labs? Because they are wayyy more expensive than that.
     
  9. MalibuJim

    MalibuJim Pre-Flight

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    Labcorp, $65/pop, I have 70 on order with about 60 more to go! Not to mention the 12 trips to Chicago over 5 years to see Dr. Bruce! Figure about another $10k more on top of the $120k in testing to satisfy the FAA.
     
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  10. jstone

    jstone Ejection Handle Pulled

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    I’m paying 100-130 per test, but I don’t have any control over where I go.
     
  11. bbchien

    bbchien Touchdown! Greaser!

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    Your HIMS AME can do better than that.
     
  12. jstone

    jstone Ejection Handle Pulled

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    HIMS AME uses choice lab. Should I ask if that can be changed?
     
    Last edited: Dec 7, 2020
  13. Tools

    Tools Pre-Flight

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    This includes creatinine control (as normalization usually not applied) and proper Dried Bloodspot collection procedure adherence. Necessities not required by HIMS nor provided by the people you over pay.

    If you don’t know what I’m talking about, that is yet another failure of “the program”.

    Did you know original Kilz stain blocking primer is shellac based? Therefore alcohol based.

    The technology of abstinence monitoring using biomarkers is experimental at best, and you are a human guinea pig.
     
  14. jstone

    jstone Ejection Handle Pulled

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    Yup. Peth is complete garbage. I don’t understand how the FAA allows the use of Peth on pilots when it’s not FDA approved. They probably don’t care how many lives it destroys as long as their friends are making tons of money.
     
  15. Tools

    Tools Pre-Flight

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    Actually, we are responsible for maintaining abstinence, as delineated in our SI, and sometimes adjunct contracts. I don’t remember agreeing to making sure a tests NO ONE understands is reporting accurate results.

    One would at least think an entity like the FAA would require expert interpretation of experimental tests. Especially since the FAA requires that for pilots NOT IDENTIFIED as a risk. Kinda counterintuitive. If there’s this many false positives, God knows how many FALSE NEGATIVES are out there...
     
  16. bbchien

    bbchien Touchdown! Greaser!

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    That reflects a fundamental non-undestanding of test cutoffs. There's plenty of data to support either an ETG cutoff of 500 ng/ml; we're using 300 ng/ml.

    FAA View: "An addict will get the substance any way he can."
     
  17. Tools

    Tools Pre-Flight

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    Some airlines use 100!! Greg Skipper now recommends 1500!

    The MAIN problem is simply lack of some form of what’s known as a MRO, medical review officer. And that is in the context of DOT screening, much more well known and researched tests. We need specialists in experimental biomarker interpretation, and frankly that doesn’t exist.

    still, simple protocols of a battery of tests isn’t invasive or really complicated. If they quit acting so forensic in a clinical environment, we would be on the right track.
     
  18. Tools

    Tools Pre-Flight

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    PETH tests are producing wildly variable false positives and NO ONE knows why. I have ideas, very sure it’s related to collection procedure problems, but honestly, no one knows.

    there’s LOTS of empirical proof, so now enter the real reason they keep their head in the sand, fear of liability.
     
  19. KeepWatch

    KeepWatch Pre-takeoff checklist

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    Cutoffs on my lab report indicate an ETG cutoff of 100 ng/ml. Is that just the detection limit?
     
  20. Tools

    Tools Pre-Flight

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    Nope, if that verbiage is there your “program” has requested a 100 cutoff. As far as I’ve seen only airlines and some AME’s use 100. Of course this is also the only use of these biomarkers without some sort of MRO.

    while MRO’s are never required, most entities do use them anyway, such as health boards of doctors, nurses, pharmacists, dentists, etc.

    of course legal “MRO”s aren’t specifically trained in the interpretation of biomarkers, which are different in that they need to be looking at preanalytical errors, not just “reasons”. The reason this condition exists is that any time a MRO is “required”, a FDA approved test exists, from a certified lab that requires blind sampling and outside oversight and inspection, none of which exists in HIMS. So a MRO function really needs to be covering what the FDA and a REAL certifying agency would be doing.

    See the rub?
     
  21. KeepWatch

    KeepWatch Pre-takeoff checklist

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  22. Tools

    Tools Pre-Flight

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    Medical Review Officer. A MD or DO with a certification to act as an intermediate between a testing authority and a subject.

    has the authority to cancel a test if a legitimate reason exists for a positive result.
     
  23. bbchien

    bbchien Touchdown! Greaser!

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    No. The detection limit is commonly 20 ng.

    Also misleading and untrue. Your head is in the sand or you are maybe trying to justify continued consumption(?). There are large population studies of just how much ETG is in the normal population. The discriminant "r" is set in the 90% zone so that there are a few misses and a few false positives. There ARE some for sure. Especially on the "dried bloodspot" PETH, which few knowledgable monitors are willing to employ. It's after all, "only a career". Dried bloodspot PETH is for someone else's airmen.

    That is why after my most current candidate's minimal positive, the FAA let him continue flying. it was after his second and third that we said, "no way, you're down".

    Just like against the Tr_mpers, I'm going to defend science here.....
     
    Last edited: Dec 13, 2020
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  24. BigShark

    BigShark Filing Flight Plan

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    I informed my Doctor today that I elect not to renew my medical which expires 2/28/21. He still thinks I cant do that cause I am being monitored and is going to call the FAA, along with requiring another 600$ blood draw today while I am knee deep in a foot of snow. (Main reason I am done with testing) My arrest was July 4th 2018 for motorboat DUI .147. I've held my SI medical for 18 months now. I've got the physical signed off on by state doctor and I have completed the online course that was extremely easy btw. Is it really going to be this easy? Is the FAA going to stop my plans before the end of the month? My HIMS AME knows I am going the basic route. Is the DUI from 2018 going to hit the NDR report again? Is the FAA going to recognize I have been issued a SI for this dis qualifying condition? Am I going to get a letter 6-12 months from now revoking my basic med? Have I made the right decisions?
     
  25. Palmpilot

    Palmpilot Touchdown! Greaser! PoA Supporter

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    I'm no expert, but as long as you meet the statutory requirements for BasicMed, if the FAA wanted to stop you from going that route, I think they would have to revoke your medical certificate before it expires (although maybe they could take some kind of adverse action on your SI, not sure about that).*

    *[ Edit: See link in ThatOtherGuy's post below.
    https://www.pilotsofamerica.com/com...s-si-stuck-in-hims.128395/page-2#post-3049215 ]
     
    Last edited: Feb 17, 2021
  26. PaulS

    PaulS Touchdown! Greaser!

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    You should've answered all these questions before you started this ball rolling. Seems to me that if you have a valid medical that requires this testing, if you stop the testing while it's valid, they will probably revoke your medical. But I'm not an expert, just seems logical to me, hopefully someone who knows will answer.
     
  27. Palmpilot

    Palmpilot Touchdown! Greaser! PoA Supporter

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    2021
     
    Last edited: Feb 17, 2021
  28. PaulS

    PaulS Touchdown! Greaser!

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    So 12 more days, why not wait until after that? Ask the questions first, know what the outcome will be, then act. Ready, shoot, aim.
     
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  29. bbchien

    bbchien Touchdown! Greaser!

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    You comply through 02/28/2012. If you comply, then you are in compliance. If you do not, you will get a revocation letter and you have to start over...and then No basic med for you. All for wont of a single test.

    It will appear (I'm not saying it is) to the FEDS, that you just can't wait to get to that beer.”
     
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  30. ThatOtherGuy

    ThatOtherGuy Pre-Flight

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    This is why I tell people just to stay quiet until the medical is expired.

    Whatever you do, make sure you absolutely comply with the terms of your SI letter until 3/1/21. There is no authority to enforce the terms of an SI letter if the airman doesn't hold a valid medical. Once the medical is expired the FAA cannot require you to provide additional medical information.

    See this legal interpretation:
    https://www.faa.gov/about/office_or...ngo-afx-1-2 - (2018) legal interpretation.pdf

    You may want to share this with your AME, although it's probably better not to poke the bear. Hopefully the FAA will educate him on their legal opinions.
     
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  31. Palmpilot

    Palmpilot Touchdown! Greaser! PoA Supporter

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    Thanks for posting that link. It's great to have that in writing from the FAA.