Basic Med Ethics

[Rockymountain]

I am a physician, and I have done some basic med forms. I had a patient that I am following for complex cardiopulmonary disease ask me if his diagnos(es) would allow him to renew his class III. I told him given the severity and complexity of his diagnoses, that I did not think it was very likely that he could renew his medical, and even if he could the special issuance process would be pretty horrible. I told him to think about basic med. And then he asked if I would do his basic med.

I thought about it.

I would have no problem with this guy driving a car, during the day, on shorter trips, in good weather, as long as he self assessed every drive, and was realistic. I also would have no problem from a pure medical standpoint, him flying a basic med appropriate aircraft, VFR, VMC, during the day, on shorter trips, at lower altitudes, in good weather. But unlike a driver’s license, where you can set limits, like Day VFR, must wear oxygen etc. there are no limits on basic med. He could theoretically take a small light jet up to 18,000, at night, in stormy weather, loaded with pax, and make a long trip. Now knowing this patient, I don't see that happening, but pilots are pilots, and we sometimes fly near the edges. So the basic med is a pretty unrestricted medical if I sign it, but he should not (IMHO) be an unrestricted pilot.

Just contemplating if I might be setting the guy up for failure with unknown consequences for him and others nearby.

 

[TCABM]

…Just contemplating if I might be setting the guy up for failure with unknown consequences for him and others nearby.

Good on you for considering BasicMed. If he is medically fit, you can either sign the form or not, just like any other qualified medical professional.

Your qualm isn’t whether he’s medically fit to fly or not. BasicMed isn’t equivalent to an unrestricted medical and you face the same dilemma with any pilot with any class of medical. The pilot has to self-certify if they are fir to fly before every single operation they undertake. You could take steps to educate the aviator on your concerns, but I don’t see an ethical dilemma given what you’ve posted.

 

[Brad Z]

The mantra I give regarding BasicMed is that it is ideal for people who *could* get a medical, but don't want to jump through the hoops and costs necessary to do that.

You are correct that you cannot apply limitations on your signature. When you sign off someone for BasicMed, you're attesting that on that day, that person, as he presented to you, has no condition that would prevent him from safely operating an aircraft.

There are going to be people who just shouldn't fly based on their condition. The conditions you describe sound like a better circumstance for either LSA, or flying with a friend as PIC.

 

[Anthem]

<Content deleted by User>

 

[Matthew]

It sounds like you trust his judgement, “…knowing this patient, I don't see that happening…”

 

[Tools]

As it’s been described to me the SI process for MS is cognitive, basically determining if you exhibit that you will self ground if/when it comes to it….

This seems the same. But frankly, as mentioned, it’s the same for ANY pilot with ANY class of medical.

Generally, the higher paying your job, the higher the risk with your decisions.

 

[Rcmutz]

Are you concerned from a financial liability standpoint? As someone said, the pilot still must self assess before each flight. However, if you are, then perhaps consult your attorney?

I do like what one person said above about providing some addition education and your additional thoughts medically to him about his condition and flying. Maybe he will put some self imposed minimums on himself.

 

[Half Fast]

I would have no problem with this guy driving a car, during the day, on shorter trips, in good weather, as long as he self assessed every drive, and was realistic. I also would have no problem from a pure medical standpoint, him flying a basic med appropriate aircraft, VFR, VMC, during the day, on shorter trips, at lower altitudes, in good weather. But unlike a driver’s license, where you can set limits, like Day VFR, must wear oxygen etc. there are no limits on basic med.

When you approve any pilot for Basic Med, or even a class 1, 2, or3 medical, you are placing a certain amount of trust in the pilot. Even if no grounding conditions exist, you trust the pilot to self-ground when something occurs. For those who do have concering conditions, or even those who have an SI medical, you trust them to continue taking any required meds, to use their CPAP machines, to control blood sugar, etc., etc.

IOW, there's always some element of trust.

Now, for this particular pilot, you said:

Now knowing this patient, I don't see that happening,...

so it seems you trust him.

Therefore I don't see any ethical issue at all for you to exercise your own professional judgment, explain to him your concerns and discuss his personal limits, put some trust in his judgment, and approve Basic Med.

If it makes you feel better, agree on limits (day VFR, flights less than two hours, or whatever) and put them in writing. Get his signature acknowledging the discussion if you want.

Remember - unlike true FAA medicals, under Basic Med you are NOT asserting to the FAA that the pilot is fit to fly. Rather, the pilot decides his own fitness, using the Basic Med physical and the training course to inform his decision. With that in mind, discussing and recommending limitations is simply providing him additional information for his decision.

 

[UTLonghorn_1979]

The reality is there are folks flying under class 3 that should not be either…it’s clear they have buddies that are AMEs. I’ve met several pilots with class 3 that absolutely are not fit to fly by any measure.

 

[pfarber]

Q48 from the FAA BasicMed FAQ is pretty clear:

" The physician is only declaring at the time of
the examination that he or she is not aware of any medical condition that, as presently
treated, could interfere with the individual’s ability to safely operate an aircraft. If a
physician has reservations regarding an airman’s current or future health status, he or she
should discuss the concerns with the airman and use clinical judgment to determine
whether he or she should sign the CMEC"

If the patient lies on the BasicMed form, they are breaking the law, but that doesn't absolve you from the above 'is not aware'. You are aware of a condition that COULD interfere. The guy could go doctor shopping and omit the past history... but that's not on the doctor unless there are signs of an unreported condition like a surgical scar etc.

https://www.faa.gov/licenses_certificates/airmen_certification/basic_med/media/basicmed_faq.pdf

The safe bet is deny and save yourself the hassle of a possible suit for allowing them to fly with a known condition.

 

[Salty]

Seems like having that heart to heart with the pilot about your concerns would also be a good idea.

 

[Rcmutz]

The reality is there are folks flying under class 3 that should not be either…it’s clear they have buddies that are AMEs. I’ve met several pilots with class 3 that absolutely are not fit to fly by any measure.

Back in the earlier 2000’s, I knew a 135 pilot that when a bunch of us were sitting in the FBO chewing the fat, he would say something, one or two others would chime in, and when you looked back at this guy, he would be asleep. We called him sleepy. And he flew 135 flights! Yikes!

 

[Half Fast]

The safe bet is deny and save yourself the hassle of a possible suit for allowing them to fly with a known condition.

Safe how? That might have the lowest risk of litigation against this physician, but is that the objective? It doesn't sound like a lawsuit was at the top of the OP's worry list. Denial might be more dangerous to the pilot if it would prompt him to go to another doctor for the CMEC signature, a doctor who might be unaware of the conditions @Rockymountain is worried about.

As you quoted above,

If a physician has reservations regarding an airman’s current or future health status, he or she​

should discuss the concerns with the airman and use clinical judgment to determine​

whether he or she should sign the CMEC.​

To me, it seems like such a discussion would be the best course, and then the good doctor can exercise his own judgment.

 

[idahoflier]

I don't see a "?" in your post. Are you looking for validation or other's thoughts and opinions as it pertains to BasicMed?

I have a lot of thoughts about BasicMed and FAA Aerospace Medicine in general. That said, I'll offer up the following without giving you a chance to answer my question:

From what you described it sounds like the pilot isn't on a SI. If that's the case and given he is dealing with cardiopulmonary issues then he would need an SI anyway for BasicMed. If he is on a SI and his condition has changed (for the worse), wouldn't that be a new diagnosis and thus require a new SI anyway? Sure seems to me Sport Pilot is the way to go for this pilot...

 

[idahoflier]

Absolutely. But the reality is that there is a large segment of those flying under BasicMed - are using it because they can't or no longer able to. Even after getting an initial one at some point.

Would you have a source for this assertion?

 

[StraightnLevel]

Would you have a source for this assertion?

Why else would someone elect to use BasicMed instead of Class 3?

Both require a visit to the doctor. If you believe you are fit to fly, why wouldn't you expect to be able to pass a Class 3 exam?

 

[Mark K]

Depending on the nature of the complex cardiopulmonary issue, I don't think I'd sign the form. The problem with BasicMed as far as the doc is concerned is that--under the standard FAA process, the FAA certifies your fitness. In BasicMed, I indeed am responsible.

"...he or she is not aware of any medical condition that, as presently
treated, could interfere with the individual’s ability to safely operate an aircraft...and use clinical judgment to determine
whether he or she should sign the CMEC"
"

In this case, a complex cardiopulmonary condition "could" interfere, and you knew about it when you signed the form. Now when the victim's attorney asks you why you signed the form, given that you know the pilot has a condition that the average physician might consider a condition that could interfere with safe flight, what is your answer?

I know pilots sometimes think BasicMed is an end run around the "stupid FAA rules." And, well, sometimes it is. If I have a patient with stable afib, has had an SI, is controlled on treatment, then there is no medical need to see a cardiologist and having a 24 hour monitor annually. Going down the BasicMed path gets them out of unnecessary an maybe costly testing. I am confident in vouching for their medical fitness for flight. As stated, for this person, not so much.

The problem really is that wording of the statement above. It doesn't say would interfere, it just says could interfere... And it doesn't say discuss and sign, it says discuss and use clinical judgment. I'm stuck with some liability risk on this one...

Seriously, you guys don't pay me enough to sign the form if you have any conditions that "could" affect safe flight... Yes, there is someone out there who will likely sign the form, but, I think they need the $150 more than I do!

 

[nauga]

Why else would someone elect to use BasicMed instead of Class 3?

Both require a visit to the doctor. If you believe you are fit to fly, why wouldn't you expect to be able to pass a Class 3 exam?

For the same reason I didn't get a Class 1 when all I needed was a 2 or 3. Just because you believe you are fit to fly and expect to be able to pass a class 3 exam doesn't mean your AME will feel the same way. The consequences of a failed exam are much worse for a class 3 than for BasicMed, so if BasicMed meets your needs why take the chance?

Nauga,
risk-averse

 

[Half Fast]

Why else would someone elect to use BasicMed instead of Class 3?

Both require a visit to the doctor. If you believe you are fit to fly, why wouldn't you expect to be able to pass a Class 3 exam?

Because renewing my SI class 3 would have required medically unnecessary testing at my own expense every 12 months, and carried a risk of delay or even denial. Basic Med does not, and the exam is good for 4 years.

 

[bbchien]

I am always less than amused when nonphyicians tell the doc, "you shouldn't have any problem with this....".

 

[idahoflier]

Why else would someone elect to use BasicMed instead of Class 3?

In my case it's because I no longer wanted to jump through the BS hoops to get a medical because I received a somewhat dubious OSA diagnosis. I never had "classic" OSA symptoms like drowsiness, etc, but during a routine yearly exam with my PCP I offhandedly mentioned that my wife said I snored. Fast forward a few months of hoop jumping and I ended up going through the SI process and couldn't fly for three months while waiting for FAA Aerospace Medecine to process the paperwork. Fine. My LOA and SI was for a Second Class Medical and when I decided Third Class would be fine I tried to get that. But No, my LOA was for a Second Class. If I wanted a Third Class I would have to get a new LOA. Absolutely ridiculous!

I'm never going back through the FAA medical process, and not at all because I'm worried I wouldn't be able to successfully obtain a medical certificate...

 

[Kenny Phillips]

Would you have a source for this assertion?

This very forum seems to indicate that the assertion is true.

 

[Lindberg]

Would you have a source for this assertion?

Anecdote: My AME used to offer Basic Med exams. He stopped because, paraphrasing, everyone who came to him for Basic Med had something wrong that they knew would prevent them from getting a Third Class, and he was uncomfortable with that. This is an AME who loves GA and does what he can to keep pilots flying, but he felt he had to draw a line.

 

[Salty]

I know an A&P that is uncomfortable with me doing work on my experimental without getting a sign off from an A&P. Similar situation and likely a similar reason for the discomfort.

 

[Lowflynjack]

Why else would someone elect to use BasicMed instead of Class 3?

Both require a visit to the doctor. If you believe you are fit to fly, why wouldn't you expect to be able to pass a Class 3 exam?

Very simple answer. I'm 52 years old and have no health issues. I use basic med because after age 40 you have to get a Class 3 every two years. Basic med gives me four years, with having to take the online test every two years. That alone made me switch.

 

[Stewartb]

I’ve had my share of jughead physicians and AME’s with government enforcer attitudes. My current BM doc is a senior AME. He has BM himself because for the average private pilot it’s easier to manage and maintain. My cardiologist is also a pilot and very aware of the FAA regs. My PCP is a PA working in a clinic with several MDs to confer with, and for matters of my heart he fully defers to my cardiologist, who I see annually. Nobody cares more about my health than me. Nobody is better positioned to determine my ability to fly than me. Self-assessment is the rule we all live by, whether in a class medical or Basic Med. Do some guys cheat? Sure, in both categories. Some guys fly without any medical status.

I’m not a fan of the FAA aeromedical process for private pilots. It’s a great example of government overreach and over regulation. Watching my son-in-law deal with them over old history of SSRIs is a perfect example. Old guys enforcing old attitudes. AME’s practice regulation compliance, not medicine. Aeromedical policy for private operators needs to be overhauled.

 

[Brad Z]

Anecdote: My AME used to offer Basic Med exams. He stopped because, paraphrasing, everyone who came to him for Basic Med had something wrong that they knew would prevent then from getting a Third Class, and he was uncomfortable with that. This is an AME who loves GA and does what he can to keep pilots flying, but he felt he had to draw a line.

To be fair, BasicMed puts AMEs in a tough situation compared to other physicians. They know enough to know that many of the BasicMed applicants are folks they’d otherwise be deferring to AMCD for further review. A non AME does not have that perspective. I could see why AMEs might not want to a BasicMed for an applicant that they’d other wise defer under part 67.

 

[Lindberg]

To be fair, BasicMed puts AMEs in a tough situation compared to other physicians. They know enough to know that many of the BasicMed applicants are folks they’d otherwise be deferring to AMCD for further review. A non AME does not have that perspective. I could see why AMEs might not want to a BasicMed for an applicant that they’d other wise defer under part 67.

Precisely. The physician has to apply some standard to whether he'll sign off on Basic Med. An AME may feel that if he applies a standard lower than third class, he may have to answer for that at some point. A regular doc doing Basic doesn't have that curse of knowledge.

FWIW, I'm on Basic Med because I see my PCP twice a year regardless, and my AME is an hour away. If I needed a second class again, I wouldn't hesitate to go to the AME, and I have have no doubt he'd issue me since everything is PRNC....

 

[Stewartb]

Government regs, or in this case, law, is exactly what it says on paper. No more, no less.

 

[UTLonghorn_1979]

I’m likely the odd man out, but I totally disagree that the average MD isn’t as capable as an AME in determining fitness to fly. The last class three medical exam I had was almost exactly the same as an annual physical, actually less stringent than an annual physical as my last physical includes an EKG, airmen exam did not.

Also, every person that sits on a passenger jet undergoes the same physiological stresses, changes in pressure, etc. that the pilots do, so the argument that AMEs are somehow better suited and more knowledgeable in the physiological aspects needed to be fit is a farce. For those specific aspects, the passenger is just as fit to fly as the pilots. Hell, one could argue its more mentally and physiologically stressful being the passenger than the pilot!

The real differences are the mental aspects, clearly you don’t want people with severe mental disorders piloting as they might be unpredictable or mentally unable to meet the stresses of the job. But we’re talking about class 3 and BM, so the bar should clearly be lower in most respects to act as PIC for non commercial or ATP operations.

Just my 2 cents regarding class 3 and BM operations.

 

[Let'sgoflying!]

Where possible, I like to look at history to help decide the correct direction to take.
Being involved in science, I prefer to use valid data to analyze the aforementioned history.

1. What % of BM pilots crashed as a result of poor health, causing harm to the public or their property?
Anyone know? I don't mean 'there is this crash here, that one last year etc' - I said valid data ....and that is anecdote.
(As a control, I believe we'd need the same numbers, for Class III medicals.)
I would love to see good numbers.
(If opinions are allowed to obfuscate facts, I'd say it's exceedingly low. (which feels like the whole concern is overblown)

2. Same for legal concerns of MDs signing off on BMs. Has anyone even heard of any form of come-back on the MD, when a BM pilot wrecked?
Sometimes I think we are good at dreaming up mountains when molehills exist.

 

[Skip Miller]

The real differences are the mental aspects, clearly you don’t want people with severe mental disorders piloting as they might be unpredictable or mentally unable to meet the stresses of the job. But we’re talking about class 3 and BM, so the bar should clearly be lower in most respects to act as PIC for non commercial or ATP operations.

Since Congress has given the FAA the responsibility to ensure the safety of flight (all flight, not just commercial ops), are you suggesting that pilots whose operations requiring only a third class medical not be examined for mental fitness under stress?

I think Congress would slap that notion down hard. UTL, be careful not to advocate throwing the baby out with the bath water…

-Skip

 

[EdFred]

Why else would someone elect to use BasicMed instead of Class 3?

Both require a visit to the doctor. If you believe you are fit to fly, why wouldn't you expect to be able to pass a Class 3 exam?

I still get a Class 3 because, Canada, and flying above 18000 might be in my near future. But after dealing with the FAA, I can see why people would go BM over Class 3. FAA wanted to ground me over heartburn. HEARTBURN! Which was only caused by an NSAID I stopped taking 20 years ago. But it showed up in my notes for a separate issue, and the "doctor" that raised the fuss, well I guess, she didn't have enough windows to lick that day.

 

[Half Fast]

1. What % of BM pilots crashed as a result of poor health, causing harm to the public or their property?
Anyone know? I don't mean 'there is this crash here, that one last year etc' - I said valid data ....and that is anecdote.
(As a control, I believe we'd need the same numbers, for Class III medicals.)
I would love to see good numbers.
(If opinions are allowed to obfuscate facts, I'd say it's exceedingly low. (which feels like the whole concern is overblown)

Have you read the FAA report on the effectiveness of Basic Med? https://www.faa.gov/sites/faa.gov/f...rtification_Certain_Small_Aircraft_Pilots.pdf

Further, the FAA study found no difference in accident risk between flights conducted by pilots ​

operating under BasicMed and flights conducted by pilots holding third-class medical certificates.​

.​

.​

.​

• No difference was found in the risk of BasicMed and third-class airmen having an aviation​

accident from the start of BasicMed in 2017 through the end of 2019.​

• No difference was found between accident-involved BasicMed and third-class airmen in the​

phase of flight in which their accident occurred.​

• No difference was found between accident-involved BasicMed and third-class airmen in fatal​

versus non-fatal outcomes.​

• No difference was found between fatally injured BasicMed and third-class airmen in autopsy​

findings.​

 

[UTLonghorn_1979]

Since Congress has given the FAA the responsibility to ensure the safety of flight (all flight, not just commercial ops), are you suggesting that pilots whose operations requiring only a third class medical not be examined for mental fitness under stress?

I think Congress would slap that notion down hard. UTL, be careful not to advocate throwing the baby out with the bath water…

-Skip

To be clear, they don't test for mental fitness, that's self reporting. Only then does the FAA test for mental health.

The stats clearly show that airline pilots aren't reporting mental health for fear of the FAA's somewhat punitive response.

Mental health should absolutely be evaluated, but it's also up to the pilot, again, to self report and admit unfit to fly if certain life events happen. The FAA should also not put the person with GAD or other, what I'll call minor "mental health" conditions the same way as someone with bipolar or serious depressive disorders.

My point is there's a way to be safe, and actually make it safer, by allowing pilots to deal and work through real world stress events while not causing creating the huge and real FAA reprisal actions taken by the FAA's current means of addressing.

 

[Kiddo's Driver]

Why else would someone elect to use BasicMed instead of Class 3?

Both require a visit to the doctor. If you believe you are fit to fly, why wouldn't you expect to be able to pass a Class 3 exam?

Because there is nothing that I fly or how I fly that requires me to have a Class III. Basic Med covers it.
If, IF, MOSAIC ever gets put into play, and my plane falls under it, I'll fly under Light Sport.

 

[rwellner98]

Very simple answer. I'm 52 years old and have no health issues. I use basic med because after age 40 you have to get a Class 3 every two years. Basic med gives me four years, with having to take the online test every two years. That alone made me switch.

Yep. That.

Plus my AME moved to Peoria.

Plus I moved to the US and wanted to get a PCP relationship established in this country.

 

[Half Fast]

Regarding the study I posted above and the reasons to use Basic Med - if Basic provides as much safety as a Class 3 (it does), and if Class 3 requires unneeded and onerous tests and doctor visits (it does), and if Basic doesn't require me to maintain an SI (it doesn't), and if Basic will allow me to do everything I need/want to do (it does), and if there's no risk of "failing" a Basic Med exam (there isn't) but there is a risk with with Class 3 (there is), and if I can have any doc do Basic Med (I can) without having to hunt up an AME, why on earth would I ever play FAA Medical roulette again?

 

[UTLonghorn_1979]

Regarding the study I posted above and the reasons to use Basic Med - if Basic provides as much safety as a Class 3 (it does), and if Class 3 requires unneeded and onerous tests and doctor visits (it does), and if Basic doesn't require me to maintain an SI (it doesn't), and if Basic will allow me to do everything I need/want to do (it does), and if there's no risk of "failing" a Basic Med exam (there isn't) but there is a risk with with Class 3 (there is), and if I can have any doc do Basic Med (I can) without having to hunt up an AME, why on earth would I ever play FAA Medical roulette again?

Don't go using logic and the idea that anyone that's sane will go the path of least resistance that meets their needs on us!

 

[Lindberg]

Hell, one could argue its more mentally and physiologically stressful being the passenger than the pilot!

One could argue that. One could argue just about anything. And many things one could argue would rightfully result in one being ridiculed.