Does the signoff BASIC-MED physician have the authority to determine what medications are LEGAL to fly under?
- Thread starter timotb
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Absolutely. I don't think there is specific case law since it's never been challenged, nor would I expect it to be.
Lindberg
Final Approach
Can you be more specific? The FAA has a list of no-fly medications. You cannot legally fly while taking those medications regardless of what your doctor says, whether you're on basic med or an FAA medical. However, some medications may be PRN, and you could fly while not taking them even if prescribed.
midlifeflyer
Touchdown! Greaser!
No case precedent, but there’s nothing prevention a physician from withholding their signature on a BasicMed application. I’d say for any reason at all.
If you are talking about the opposite, “it’s ok with me if you fly while taking OxyContin,” (assuming and physician would actually say that), it’s also the same since it’s ultimately the pilot’s responsibility to determine whether they are safe to fly that day.
If you are talking about the opposite, “it’s ok with me if you fly while taking OxyContin,” (assuming and physician would actually say that), it’s also the same since it’s ultimately the pilot’s responsibility to determine whether they are safe to fly that day.
Lindberg
Final Approach
I assume you mean that the physician could say that, not that it would make flying on oxycontin legal. The prohibitions in 61.53 still apply.
Half Fast
Touchdown! Greaser!
I don’t believe that’s correct. The list of no-fly meds is guidance, not a regulation, AFAIK. 61.53 merely says the pilot can’t fly when the pilot:
Is taking medication or receiving other treatment for a medical condition that results in the person being unable to meet the requirements for the medical certificate necessary for the pilot operation.
The “requirements for the medical certificate” can’t apply to Basic Med because Basic Med is not a medical certificate; it’s an alternative to holding a medical certificate. The only thing Basic Med requires is that a physician review the pilot’s meds. If the physician judges that the pilot is okay to fly, he signs the form and that’s it.
See https://www.aopa.org/go-fly/medical-resources/medications-database .
Lindberg
Final Approach
That's not all 61.53 says.
And the FAA's position is that flying while taking impairing medications violates 61.53.
Is it really your position that a pilot on basic med can legally fly while tripping on prescription drugs?
Half Fast
Touchdown! Greaser!
Not at all. We merely disagree on where the decision authority lies; with Basic Med it does not lie in OKC.
It's my position that it's the decision of the examining physician, not OKC, what medications a pilot can use on Basic Med. I don't think a physician would approve such, and certainly a pilot is still prohibited from flying while under any sort of impairment, but the FAA has no means and no authority to tell a non-AME physician whether or not he may approve a Basic Med form. Physicians should use the FAA's med list for guidance, but they're under no regulatory obligation to adhere to it.
Brad Z
Final Approach
61.53(a), which you quoted above, doesn’t apply to BasicMed at all. 61.53(b) does.
While the DNF/DNI list doesn’t apply to BasicMed, the underlying condition and the effects of the medication does. Even if a doc signs you off for BasicMed, the FAA could find you in violation of 61.53(c)(2) if your inability to safely operate an aircraft was due to your medical condition at the time of the flight. This would most likely occur as a result of an accident or incident that attracted the attention of the FAA. Obviously, like many of parts of the regs there’s a fair amount of ambiguity in what defines “a medical condition unable to operate in a safe manner”. An authorization to fly from a doc certainly helps the pilot’s defense, but it is still ultimately the responsibility of the pilot, not the doc, to comply with 61.53.
Ultimately this is no different than a sport pilot or a glider pilot flying with a medical condition.
Lindberg
Final Approach
I'm not talking about signing off on basic med, I'm taking about flying. Are you saying that a basic med pilot's physician can tell him that it's ok to fly while under the influence of prescription narcotics, and that makes it legal?
Half Fast
Touchdown! Greaser!
Agreed.
The main point I was trying to get across (and apparently botching it) is exactly what you wrote: the DNF/DNI list does not apply to Basic Med.
Certainly anything that impairs a pilot’s ability to fly safely prohibits him from flying, but if he and his doctor conclude he can fly safely while taking some med he’s not automatically prohibited just because that med is on the FAA’s no-no list.
Just like Sport Pilot, as you say.
Half Fast
Touchdown! Greaser!
You’re not reading what Brad and I wrote.
The pilot using Basic Med is legally prohibited from flying when he’s impaired, not just because he took some med on the list. Whether some med impairs any particular pilot enough to prevent safe aircraft operation will depend on the underlying condition, the dosage size and interval, and the individual’s own reaction to the med. And that’s to be evaluated by the physician.
Similarly, he can’t take some med that causes impairment and fly even if the med is NOT on the bad med list.
The standard is safe operation of the aircraft, not a medication go/no-go list.
dbahn
Pattern Altitude
Who believes that?
Ambien (sleep) is a prescription drug which is not prohibited by the FAA, but flying while under the influence of Ambien violates 61.53, as is the case with many other prescription and non-prescription drugs.
The Basic Med physician may very well not sign off an applicant who abuses a specific drug (including alcohol), but that's not the same as using that same drug with sufficent time for the a drug to be metabolized. I think the FAA guidance is based on the half life of the drug, which as I recall makes Benadryl (non-prescription) require a longer period of abstinence than Ambien (prescription). Ironically, the sleep medicine Ambien wears off sooner than the antihistamine Benadryl. (I believe the guidance is to wait for five times the half-life of the drug before operating.)
"Tripping" is the operative there. Whether you associate it with LSD or with Benadyl, you can't fly while under the influence of either one, prescription or non-prescription. That rule applies with Basic Med or with an FAA medical certification.
Lindberg
Final Approach
Half Fast said 61.53 doesn't apply to basic med pilots.
Actually, the FAA lists "all currently available sleep aids" on its Do Not Fly list, which, again some believe doesn't apply if you're on basic med, and specifically requires 24 hours between taking Ambien and flying.
The wait time for Benadryl is 60 hours.
The question in the OP asks about it being legal to fly. I took that to mean fly, not get a signature.
91.17 also prohibits a pilot from flying "While using any drug that affects the person's faculties in any way contrary to safety." The FAA has published a list of some such drugs. I don't know why someone on basic med could ignore that list.
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dbahn
Pattern Altitude
Some of 61.53 doesn't apply to Basic Med, notably (a), which applies only to operations that require a medical certificate. Below that (b) applies to Basic Med, since operations require a driver's license. But the standards are different, i.e. one applies to "meeting the requirements of the medical certificate" and the other applies to being able to "operate the aircraft in a safe manner".
There's a big difference between certification and operation, with Part 61 covering certifications and Part 91 covering operations.
§ 61.53 Prohibition on operations during medical deficiency.
(a) Operations that require a medical certificate. Except as provided for in paragraph (b) of this section, no person who holds a medical certificate issued under part 67 of this chapter may act as pilot in command, or in any other capacity as a required pilot flight crewmember, while that person:
(1) Knows or has reason to know of any medical condition that would make the person unable to meet the requirements for the medical certificate necessary for the pilot operation; or
(2) Is taking medication or receiving other treatment for a medical condition that results in the person being unable to meet the requirements for the medical certificate necessary for the pilot operation.
(b) Operations that do not require a medical certificate. For operations provided for in § 61.23(b) of this part, a person shall not act as pilot in command, or in any other capacity as a required pilot flight crewmember, while that person knows or has reason to know of any medical condition that would make the person unable to operate the aircraft in a safe manner.
(c) Operations requiring a medical certificate or a U.S. driver's license. For operations provided for in § 61.23(c), a person must meet the provisions of—
(1) Paragraph (a) of this section if that person holds a medical certificate issued under part 67 of this chapter and does not hold a U.S. driver's license.
(2) Paragraph (b) of this section if that person holds a U.S. driver's license.
On the other hand, 91.17 (c) prohibits operating while using any drug contrary to safety, which includes Benadryl and other over-the-counter drugs as well as opiods, hallucinogenics, and other obvious candidates for that restriction.
§ 91.17 Alcohol or drugs.
(a) No person may act or attempt to act as a crewmember of a civil aircraft—
(1) Within 8 hours after the consumption of any alcoholic beverage;
(2) While under the influence of alcohol;
(3) While using any drug that affects the person's faculties in any way contrary to safety; or
(4) While having an alcohol concentration of 0.04 or greater in a blood or breath specimen. Alcohol concentration means grams of alcohol per deciliter of blood or grams of alcohol per 210 liters of breath.
Clip4
Final Approach
Finally someone got around to 91.17. I suppose there are some who will argue meds on the prohibited list don’t affect the pilots faculties in any way contrary to safety.
Half Fast
Touchdown! Greaser!
No it doesn’t. It asks about the legal authority of the Basic Med doc in regard to medications. Here’s the question:
You gave an answer based on the FAA’s prohibited medication list, and several of us have been trying to explain that the list does not apply legally to Basic Med.
Half Fast
Touchdown! Greaser!
Irrelevant to the question asked by the OP, but....
It is possible that certain dose sizes and intervals for certain pilots might not render the pilot unable to operate an airplane safely (and that’s the standard, not “in any way contrary to safety”). Under Basic Med, that’s a determination for the physician to make, rather than rigid adherence to the FAA list.
The question in this thread is about the legal authority of the Basic Med doc regarding medications. That physician is not under the authority of the FAA.
midlifeflyer
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Nice FAR technicality vs reality discussion.
Half Fast
Touchdown! Greaser!
Agreed, but the OP was a technicality sort of question.
midlifeflyer
Touchdown! Greaser!
I dunno. There's technicality and technicality.
Pretty clearly, the BasicMed doc is not an FAA agent and is not bound by the AME Guide, nor the FAA's choice of prohibited medications.
The physicians' obligations are laid out in FAR 68.5 and 68.7. Ultimately, before certifying they are "not aware of any medical condition that, as presently treated, could interfere with the individual's ability to safely operate an aircraft," the physician is required to
1. go through the CMEC;
2. "exercise medical discretion to address, as medically appropriate, any medical conditions identified, and to exercise medical discretion in determining whether any medical tests are warranted as part of the comprehensive medical examination"; and
3. "discuss all drugs the individual reports taking (prescription and nonprescription) and their potential to interfere with the safe operation of an aircraft or motor vehicle;"
So, assuming full disclosure by the pilot and a physician meeting those obligations, the BasicMed doc is determining whether the use of these medications by this pilot given this pilot's medical history, is OK (signs the CMEC) or not OK (doesn't sign the CMEC). Does that "technically" amount to determining the "legality" of a particular medication or not? I doubt it but I don't think it matters.
Half Fast
Touchdown! Greaser!
Yep, pretty much what I was trying to say (and probably poorly).
midlifeflyer
Touchdown! Greaser!
That's what happens with technicalities
Clip4
Final Approach
So just a little bit of Percocet is ok.
Salty
Touchdown! Greaser!
So, nothing he said even remotely indicated he held such a stupid belief.
Half Fast
Touchdown! Greaser!
Clipper, if you're not going to actually read and comprehend what I write anyway, why not just put me on ignore?
Clip4
Final Approach
I read what I you wrote, I just disagree with your statement. This may be an untested legal issue, but I would t want to be the precedent setter. There is no established safe dose for a prohibited medication.
Half Fast
Touchdown! Greaser!
There is no such thing as a “prohibited medication” in Basic Med.
Baked Potato
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I know that the FAA website is not the FAR, but how should we interpret the statement "You may not fly if you are taking any of these types of medications" on this page? Speaking only from a legal standpoint and not a safety or ethics standpoint:
Half Fast
Touchdown! Greaser!
As you say, it’s not a reg. It’s moot from a legal standpoint. But you didn’t quote the whole thing.
Look at the very next sentence:
You may not fly if you are taking any of these types of medications. If you aren't sure whether your medication falls into one of these categories, you should check with your AME:
There’s no AME for Basic or Sport. It’s only applicable to pilots flying with a medical certificate.
But don’t expect everything the FAA publishes to be consistent with its own regs. And remember, the FAA didn’t create Basic Med. Congress did. The FAA can’t make Basic more restrictive than what’s specified in the legislation.
Baked Potato
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Yeah, the context is important and I didn't exclude the next sentences to intentionally mislead. However the single sentence beginning with "You may not fly..." seems pretty definitive, especially as a private citizen reading that on a government agency website.
But that said, I'm not sure if there's any legal precedent where a federal agency contradicts (or oversteps) the actual code via statements outside of the regs (like on a website or other publication) and that statement ends up leading to an enforcement action.
It's all very confusing.
Half Fast
Touchdown! Greaser!
Yeah, but doesn’t “you” seem a bit ambiguous? Is “you” all pilots in this context, or is it ones with medical certificates?
It’s the FAA.
In this case “you” only applies to pilots that spend hours scrolling thru the FAA website to find “regulations” that the FAA made up and only published on the website.Yeah, but doesn’t “you” seem a bit ambiguous? Is “you” all pilots in this context, or is it ones with medical certificates?
It’s the FAA.
Baked Potato
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Or perhaps a Google search that took a few milliseconds
dbahn
Pattern Altitude
The problem is that 91.17 replies to ALL pilots regardless of medical certification, and from a regulatory standpoint leaves it to a judge to interpret, "No person may act or attempt to act as a crewmember of a civil aircraft . . . while using any drug that affects the person's faculties in any way contrary to safety."
That's a pretty vague threshold, but an administrative law judge gets to decide how to interpret it in any particular situation. But "any drug" and "any way contrary to safety" gives that judge a lot of leeway, and our opinions or arguments don't mean crap in that process.
That's a pretty vague threshold, but an administrative law judge gets to decide how to interpret it in any particular situation. But "any drug" and "any way contrary to safety" gives that judge a lot of leeway, and our opinions or arguments don't mean crap in that process.
Half Fast
Touchdown! Greaser!
Lindberg
Final Approach
I'm confused. You said the OP doesn't ask about it being legal to fly on medication, and then you quoted the sentence from the OP where it literally asks, "Does the basic-med signoff physician have the authority to determine what medications are LEGAL to fly under?"
It doesn't ask, "Does the basic-med signoff physician have the authority to determine what medications I can be on and eligible for Basic Med?" But that seems to be the question you want to answer.
There's no FAA "prohibited medication list." There is a Do Not Issue list and a Do Not Fly list. You can get a medical certificate if you take meds on the DNF list, you just can't fly while taking them. And you can be on Basic Med if you take meds on the Do Not Issue list if your physician is OK with it. But either way, you can't legally fly while under the influence of any impairing drug. And the FAA is on record saying that everything on the DNF list is impairing. You want to make the argument that your basic med physician can clear you to fly while taking oxycontin because he knows better than the FAA? You go for it. I'll bet a nickel you lose.
Lotta dickering around the OP’s question.
We’ve hit the bottom line on multiple occasions; whether certified or BM, the pilot is ultimately responsible for determining his/her individual airworthiness prior to any given flight.
We’ve hit the bottom line on multiple occasions; whether certified or BM, the pilot is ultimately responsible for determining his/her individual airworthiness prior to any given flight.