HIMS “step down”

jstone

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jstoney
What does the FAA Step Down Plan really mean?
September 20, 2020
The FAA just issued a “Step Down” procedure for HIMS participants. Is this a concession to the objections many HIMS participants have raised about the FAA’s announcement that they would be forced into lifetime monitoring?


Answer: To quote Hertz, “not exactly.” Instead, the memo details a series of steps requiring successively less monitoring, BUT:

(1) The FAA is under no obligation to approve reduced monitoring, meaning that a pilot would be subjected to onerous and invasive monitoring for his or her entire career;

(2) By all reports, any pilot who applies for the step down gets his or her SI date arbitrarily reset; and

(3) That is if the airman even realizes the step down option is available, since the FAA has apparently decided that it is a procedure you don’t need to know about.

Below is the analysis submitted by attorney Joseph LoRusso, whose information can also be found the legal resources section of this site.

MEMORANDUM

RE: FAA Step Down Program


DATE: September 19, 2020

On April 1, 2020, the FAA made the decision to grant a thirteen-year-old request by the NTSB, thus appeasing the Board, which resulted in the institution of lifetime monitoring for all pilots who have been “diagnosed” with substance dependency.[1] At the time, the FAA’s decision to institute lifetime monitoring was just that: a single pronouncement devoid of any guidance regarding how lifetime monitoring would be administered or overseen.

160 days later, on September 8, 2020, the Administration put forth a series of memoranda, which briefly outlined how lifetime monitoring would progress for those currently enrolled in a HIMS program. The Administration’s plan is officially referred to as the “HIMS Step Down Plan.” [2]

Facially, the HIMS Step Down Plan appears to be a concession by the FAA to periodically reduce the objectively strict HIMS requirements in exchange for lifetime monitoring privileges. For example, past Special Issuance Authorizations often required psychiatric visits every six months. The HIMS Step Down Program drops that requirement after one (1) year of monitoring. Just like the psychiatric visits, other traditional requirements are reduced or removed as the airman progresses through the program until he or she has completed seven (7) years of monitoring. At that time, the airman should only be subjected to the monitoring requirements of a HIMS AME who is chosen by the airman.

Practically, however, there are still many questions about the Program that require answers. Most notably, the FAA describes the HIMS Step Down Program as “nominal” and only represents an “uncomplicated progression of recovery.”[3] As a result, the plan “may be modified on a case-by-case” basis.[4] The obvious questions that follows are: 1) who has discretion to determine what constitutes a complicated progression of recovery; and 2) who has the ability to modify the airman’s plan?

It should also be noted that although such a plan may be modified, the Administration makes it quite clear in its guidance that it may only be modified to provide additional monitoring requirements and, cannot, in any way, be modified to reduce requirements for pilots, due to the fact that, “Requests for ‘early’ Step Down will not be considered.” [5]

Another issue that I find to be troubling is to whom these memoranda where addressed or, more accurately, to whom they were not addressed. The memorandum which specifically details the HIMS Step Down Program was addressed to AAM-200, AMCD, and Regional Flight Surgeons. The memorandum which discussed the implementation of the Program also added HIMS AMEs to that list of recipients. Neither memorandum was addressed to pilots in the program or the pilot community at large.

Are we to assume from this that pilots cannot be privy to the Administration’s “care” and oversight plan, which is disguised as a gentle monitoring program? Based on the Administration’s careful dissemination of this new Program, we are left to presume that the FAA intends to send the message that pilots are not meant to be made aware of the Program, as the Administration’s implementation of the same requires a HIMS AME (as opposed to the airman, as has occurred in the past) to specifically request a new Special Issuance Authorization that aligns with the plan. Consequently, if a HIMS AME fails to disseminate the memoranda to his or her airmen, the pilot would not be afforded the benefit of reduction in monitoring requirements that the Program theoretically provides. Again, we are left to assume that not all pilots will be given access to this Program.

In summation, while those of us in the industry are encouraged to see some guidance in response to the FAA’s legally questionable implementation of lifetime monitoring, I am leery to say the least, based on the foregoing. Unfortunately, if the FAA is set on placating the NTSB, we are forced to rely on time to expose the benefits and shortcomings of the HIMS Step Down Plan.



[1] This alone is problematic, as substance dependency no longer exists in a clinical setting and, therefore, cannot be diagnosed.

[2] The FAA developed the HIMS Step Down Plan “in consultation with the airline HIMS chairs.” The plan ostensibly and practically fails to provide consideration for those Part 91 pilots and Part 135 who are held to HIMS standards of “care and treatment” but are not afforded the same financial support as Part 121 HIMS pilots. See Footnote 3.

[3] August 17, 2020 (Revised to September 8, 2020) Memo from Penny M. Giovanetti to AAM-200, AMCD, Regional Flight Surgeons re HIMS Step Down Plan.

[4] Id.

[5] This mirrors one of the issues with the HIMS Program itself, as the plan fails to consider the clinical degrees of severity associated with a diagnosis of a substance use disorder.
 
You're reading only semi-accurately.

The first stepdown simply eliminates the costly HIMs psychiatrist visit (assumes all is going well).
It's after 4 years of issuance when we lose the monthy HIMS Peer sponsor letter and the Chief Pilot letters and there is a urine testing decrement.
After 7 years there are no requriements, only that he go to the HIMS AME of agreement between himself, and the agency. And if it's someone else, that has a formal transfer process so the receiving HIMS AME has all the data. The way it's set up however, the year 7 transfer will be all responsibility and no benefit to the receiving HIMS AME.
The required items are a minimum.

I have to tell you however that the person who makes the decision is the HIMS AME, with the written consent of the agency, and he IS IN A POSITION to know and to recommend. And we do in every case consider and argue the severity. After all, we read EVERY evaluation, read every peer + Chief letter, interview the spouses, and see the pilots one way or another every 3 months if need be.

LoRusso is in it to create sales. All this posturing about DSM5 isn't worth a hill of beans nor affects federal relevancy. And Shame on AOPA for promoting him......and his commentary reflects that he is on the outside looking in...per his comment #(1). Under FAA definitions it sure does exist. And I've seen it and agree with FAA: the disease is forever. I guess "Doctor" LoRusso (atty. at law) thinks he is an authority who can "revise" that....Totally irrelevant but grabs space on talk boards.....
 
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Why is the faa hiding this information from airmen? They demand complete transparency from all pilots (especially HIMS pilots) yet they are the least forthcoming. I did not write any of what I previously posted, but so far in my brief experience with LoRusso I got the feeling that he just wants to help pilots and believes this new lifetime monitoring is just going to decrease aviation safety because pilots will no longer admit they have a problem because who wants to be monitored their entire life? He’s also the only person I have come in contact with so far that did not demand a $1500-$3000 retainer before even talking to me. He didn’t charge me a dime and actually provided more help then I have gotten from another attorney and a couple HIMS Ames. And the others were charging me A LOT of money and didn’t care at all about my end goal of getting a medical.
 
How does this effect 3rd class medical certification? Is it a step down also or will I be completely released from HIMS after a couple of years? Was considering becoming an airline pilot, but with this new lifetime policy and now the pandemic I don’t think it’s worth it anymore. This is not what I signed up for and I hope that this policy changes.

Who was actually responsible for enacting this new lifetime monitoring policy? Was it the office of the Federal Air Surgeon or was it directly from the FAA Admin office?
Thanks
 
It’s not hidden. It’s published. After the 7th year it’s at the discretion of the person who knows you situation- the HIMS AME who’s been seeing you for seven years.

My experience, has been “I’m uncomfortable with this one, he’s a ‘square filler’ and still lets slip that he thinks he might not be alcoholic - I want discretion for every item...”...and that’s what arrives in the letter.

....or, i have no concerns and all I want is The authority to occasionally test his pee.... and that’s what arrives in the letter.

Both of these are real case dispositions, and they’re dead on.

Shame on AOPA for promoting this c_ap. First of all Lo Russo doesn’t appear to understand that FAA has been given the authority to regulate on behalf of system safety by CONGRESS (“on best available external medical advice”, and his statement that there is no dependency DENIES that it’s by definition, a LIFELONG disease, apparent or not. So Dr. LoRosso’s logic by extension says if you aren’t clutching you chest there is no apparent coronary disease. SHEESH. FAA’s definition is very modern. ALL the experts know this is a lifelong disease.

That’s why I have previously posted, that AOPA doesn’t know much about HIMS, and that is evident by their promoting this c-ap.

I’m thinking of one guy 60+ SWA Captain, in remission 10 years. Y’ know how I knew he was in remission? His ex told me that I was too late. He had once again become the man that she had married years ago, and that the daughters actually look forward to the weekends with dad......and where the H was I in 2010 (I had’t met him yet!).

Shame on AOPA.

I guess we’ve never discussed. Funny, my contact info is on every post, and to the best of my knowledge I’ve answered EVERY message.
 
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The Management Council has received a number of anonymous replies to posts in the Medical Topics within the past few days. Just a reminder that while anonymous postings are allowed, they must be conducted per the RoC.

Posts made anonymously in response to such posts will be deleted unless the content of the response requires anonymity.
 

Dr Bruce (bbchien) and Dr Fowler are two of the most knowledgable and generous HIMS AMEs with their time. An email to Dr B about your specific scenario will get a response to what you can expect and it won’t incur any expense.

If you both agree to engage him, his fees are more reasonable than my local AME charges for any work. You can find out how to contact him at http://www.aeromedicaldoc.com/how-to-start.html.
 
How does this effect 3rd class medical certification? Is it a step down also or will I be completely released from HIMS after a couple of years? Was considering becoming an airline pilot, but with this new lifetime policy and now the pandemic I don’t think it’s worth it anymore. This is not what I signed up for and I hope that this policy changes.

Who was actually responsible for enacting this new lifetime monitoring policy? Was it the office of the Federal Air Surgeon or was it directly from the FAA Admin office?
Thanks
This policy isn't going to change. FAS Mike Berry was under tremendous pressure from the NTSB (and from the nanny components of the legislature, to comply with NTSB), and he decided he had to do so.

As to your situation, it depends, LuvtoFly. I don't follow individual airmen on this board. If your current SI is for dependency, you will be monitored for life though after year 7 it can be as little as your HIMS AME quizzes you a bit and issues your certificate. But THE FAA is insisting that it be a HIMS AME with your full background and that the has taken full HIMS responsiblity for your situation. I have a 3rd class guy who every time I see him, I do a urine ETG, and it's always negative, and I reissue him. He's got the great I.T. security job at the bank, the great spouse, the home and he's "now fully grown up". I have no reason to expect him to revert.

He was one of the first to get "disappointed" (this spring). But he decided he would like to have the option to go higher and faster and larger, and even after disappointment maintains his third...and it's very little work.

It's all cases.
 
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