Medical Ignorance

[Unregistered]

Here's a good one for the Doc.

I know a pilot who started flying in 1986. SEL and Instrument. Flew for about 4 years and was forced to hang up the spurs by the then incumbent wife. He finally grew some and shed the incumbent wife.

Had sleep studies in 2005 and was diagnosed with Sleep Apnea. Started dating later that year and GF says hey, you need to get back into flying I can tell you miss it. Started flying again and out of ignorance did not bring up the sleep apnea thing during the physical because he didn't know it was disqualifying or even noteworthy.

This guy purchased an airplane about a year and a half ago and at about the same time discovered the the SI requirement for 3rd class and sleep apnea while watching an AOPA webinar.

So:

Since the sleep study was not listed on the Medical form he will be in violation for not disclosing whether intentional or not if it is mentioned or found out.

Individual has no issues with staying awake during the day and probably only uses the Bi-Pap 25% of the time. Irrelevant he knows!!!

He has thought about initiating a new sleep study as a brand new condition to get legal.

Any advice for him to get things legal and ethical as quickly as possible. He really wants to do the right thing but doesn't want to loose flying status.

 

[poadeleted20]

One thing he needs to do is not fly in any capacity requiring a medical certificate until the issue is resolved. That would show good faith even if he was in operating violation before he learned the truth. I'll leave the medical certification side for Bruce.

 

[comanchepilot]

So what part of list all medical visits was unclear? He never had any follow ups for the sleep apnea? This really does not fall into the inadvertent failure IMHO . . .

 

[bbchien]

Here's a good one for the Doc.

I know a pilot who started flying in 1986. SEL and Instrument. Flew for about 4 years and was forced to hang up the spurs by the then incumbent wife. He finally grew some and shed the incumbent wife.

Had sleep studies in 2005 and was diagnosed with Sleep Apnea. Started dating later that year and GF says hey, you need to get back into flying I can tell you miss it. Started flying again and out of ignorance did not bring up the sleep apnea thing during the physical because he didn't know it was disqualifying or even noteworthy.

This guy purchased an airplane about a year and a half ago and at about the same time discovered the the SI requirement for 3rd class and sleep apnea while watching an AOPA webinar.

So:

Since the sleep study was not listed on the Medical form he will be in violation for not disclosing whether intentional or not if it is mentioned or found out.

Individual has no issues with staying awake during the day and probably only uses the Bi-Pap 25% of the time. Irrelevant he knows!!!

He has thought about initiating a new sleep study as a brand new condition to get legal.

Any advice for him to get things legal and ethical as quickly as possible. He really wants to do the right thing but doesn't want to loose flying status.

MAny here will tell him to "lawyer up" but that is not the answer.

He needs to present a complete passable file for certification in one pass, and that needs be presented to the agency by someone who is skiled in doing so.

There is no excuse for wanton ignorance. But I have never had an airman referred for enforcement against his PILOT certificate if the presentation and new exam at the time of presentation, finds him eligible for an on-the spot SI issuance. There are much bigger fish to fry, and the referral to the FAA counsel costs the medical officer a good bit of work

Youre "friend" needs some good help on this, to keep it doctor-to-doctor, rather than attorney to attorney. Besides, most of the attorneys who guys have hired actually cause more problems than they solve. VERY few are good working Federal administrative law, they are mostly all state court litigators.....

 

[Unregistered]

When the sleep study was performed a Dr was never seen. There was a Dr involved somewhere in the background for sure, but all communication was with the technician that administered the study. He was sent to the store to pick up his cpap and never heard from the sleep center again. Unhappy with the follow through from the sleep center the cpap has sit most of the time since getting it.

The pilot has hypertension which is under control and had a very uncooperative GP that would not provide the information needed to verify BP was under control so he basically fires that Dr and found a new one that is in the same practice as his AME. This has greatly simplified the process as the GP can share records with the AME.

From what I am reading the best thing to get resolution would be to present a complete package to the AME.

What needs to be included in this package? Since there has been no contact with the original sleep center in 7 years would it be a good idea to just start this all over again, as in attend a new sleep study and get the right care? Would it be best to simply work with the present GP so records are clean, realizing that the pilot must self ground till this is all taken care of? Should the AME be informed and involved in the process?

For the critics out there; till the aopa webinar it had never crossed his mind, and this is an attempt to make things right.

 

[Jaybird180]

 

[Unregistered]

He wasnt diagnosed, it was a STUDY, and god knows those arnt biased lmao

People get all bent of shape on these forums about medicals, it's as big of a deal as people want to make it.

 

[AggieMike88]

When the sleep study was performed a Dr was never seen. There was a Dr involved somewhere in the background for sure, but all communication was with the technician that administered the study. He was sent to the store to pick up his cpap and never heard from the sleep center again. Unhappy with the follow through from the sleep center

This describes my first encounter with a sleep study and lab. Ab-SO-lutely hated the way this was handled.

Fortunately, my second go around was waaaay better (needed to do 2nd go because first was "out of date" by FAA standards). Met with the top doc all the way through the process and came away the polar opposite of the first study. I really felt like I was given a very high level of care.

So if you're in the Dallas area and need a really good sleep doc, go see Dr. John Debus in Plano.

 

[Doggtyred]

He wasnt diagnosed, it was a STUDY, and god knows those arnt biased lmao

People get all bent of shape on these forums about medicals, it's as big of a deal as people want to make it.

A Cpap is a medical device and a prescription is required. A doctor somewhere prescribed it. That means there was a diagnosis. Period. Let's not argue pedantic nits when it won't change the facts at hand.

My suggestion is follow doc Bruces advice or even better, consult him on a professional basis. He's already said it can be resolved if approached properly. The key is to DO IT PROPERLY.. By the numbers.

More importantly if you were recommended to use a Cpap for sleep apnea you need to be using it. Religiously. Untreated sleep apnea does really nasty things to your heart. Own your medical. Or tell your friend to.

 

[bbchien]

When the sleep study was performed a Dr was never seen. There was a Dr involved somewhere in the background for sure, but all communication was with the technician that administered the study. He was sent to the store to pick up his cpap and never heard from the sleep center again. Unhappy with the follow through from the sleep center the cpap has sit most of the time since getting it.

Of course there was a doc of record. Insurance paid for the study. Of course there was a diagnosis, insurance wouldn't have paid for CPAP. This all sounds like very lame excuse-makeing.

The pilot has hypertension which is under control and had a very uncooperative GP that would not provide the information needed to verify BP was under control so he basically fires that Dr and found a new one that is in the same practice as his AME. This has greatly simplified the process as the GP can share records with the AME.

From what I am reading the best thing to get resolution would be to present a complete package to the AME.

Most states are at least a "seven year medical records" state. So the facility will have the original sleep study.

What needs to be included in this package?

Record of the diagnostic sleep study, Current status letter from the doc (GP will do if he says (1)Compliant with CPAP, (2)Appears well rested, (3)No tendancy to fall asleep beyond normal (4) No gross findings of right heart failure. and a CPAP complaince printout from the machine showing usage >75% of night at >=6 hours. If your machine is old and doens't have the chip, you need to GET ONE THAT DOES because this file needs to be PERFECT. Insurance companies don't pay for it they don't consider it necessary. It costs several hundred- and yes, Uncle Sam is IN YOUR BEDROOM.

Since there has been no contact with the original sleep center in 7 years would it be a good idea to just start this all over again, as in attend a new sleep study and get the right care?

You could do that, or you could just hold the original sleep center to the statute and Obtain the record. The GP can guide you to the right adjustements if needed.

Would it be best to simply work with the present GP so records are clean, realizing that the pilot must self ground till this is all taken care of?

Yes, and someone knowledgeable about the FAA process needs to review the documents before you tweak the bear.

Should the AME be informed and involved in the process?

Well, if he's the guy you turst to review the stuff, wait until you have it all. Make sure when he's looking at it he can be trusted not to just "send it in and see what they say". And don't have an exam pending (MedXpress) unless it is the PDF of the application with the download code cutoff the bottom. 'Cause if he opens the file with the #, you are live, and then if the documents aren't adequate, you get denied. And maybe even enforced against.

For the critics out there; till the aopa webinar it had never crossed his mind, and this is an attempt to make things right.

I have fixed several airman, mostly from Georgia who maintained, "well my AME asked me if I was on CPAP. Then he said, "so do you have the disease anymore?" That is grounds for decertification of the AME.

He wasnt diagnosed, it was a STUDY, and god knows those arnt biased lmao

People get all bent of shape on these forums about medicals, it's as big of a deal as people want to make it.

...reflects total naievete as to how the FAA crushes that mentality. Beware the Bear. Get straight and get serious. Don't minimize your culpability. Your Pilot Ticket can be pulled in a flash if this doesn't go right.

lmao

" ....NOT

 

[AggieMike88]

Since there has been no contact with the original sleep center in 7 years would it be a good idea to just start this all over again, as in attend a new sleep study and get the right care?

You could do that, or you could just hold the original sleep center to the statute and Obtain the record. The GP can guide you to the right adjustements if needed.

I was thinking the old sleep lab would be tossed due to the recency requirement, requiring a new sleep study?

 

[AggieMike88]

Well, if he's the guy you trust to review the stuff, wait until you have it all. Make sure when he's looking at it he can be trusted not to just "send it in and see what they say". And don't have an exam pending (MedXpress) unless it is the PDF of the application with the download code cutoff the bottom. 'Cause if he opens the file with the #, you are live, and then if the documents aren't adequate, you get denied. And maybe even enforced against.

For Unreg's situation and all other airmen, the above bear's repeating... (have we got a bruin thing going here?) I've pulled this apart for additional emphasis.

"Make sure when he's looking at it he can be trusted not to just "send it in and see what they say".​

"And don't have an exam pending (MedXpress) unless it is the PDF of the application with the download code cutoff the bottom. 'Cause if he opens the file with the #, you are live, and then if the documents aren't adequate, you get denied. And maybe even enforced against.​

This applies to all of us. And might save you from stepping on a landmine of your own creation.

 

[bbchien]

I was thinking the old sleep lab would be tossed due to the recency requirement, requiring a new sleep study?

No, the recency requirement is from the CPAP readout and the doc's letter. The initial diagnosis is from the study. Kinna like the lymph node pathology from the case of lymphoma, which is now 3 years ago....They wanna know that you really have what they say you have.

 

[Unregistered]

Bruce, just for the record post #7 was not from the original poster of this thread.

I am in Ohio so IL wouldn't be very practical. Is this something that can be discussed via email or telephone so this gets handled correctly?

 

[JimNtexas]

...CPAP complaince printout from the machine showing usage >75% of night at >=6 hours.

I've been on a CPAP for 94 days. I haven't flown since I started with CPAP.

According to the machine data I've used it for 92 of the 94 nights.
With the compliance threshold set at 4 hours I'm 93% compliant. I've been careful to stay on the machine for more than four hours, since that is what the insurance wants. If I set the threshold at 6 hours my compliance drops to 56%.

Question:
I didn't know the FAA wanted six hours. Are they hard over about six hours?

In any case I plan to consult you early next year, my medical runs out in March, and I want to lose some weight before I attempt to renew it.

I had no trouble staying awake during the day before CPAP, the differences I've noticed is that I sleep better and have more energy, especially in the evenings.

There was never any danger of me falling asleep while flying!

 

[Unregistered]

I can't think of more than a handful of times my sleep duration has surpassed 6 hours in the last 40 years. I have never needed that much sleep and I have always functioned well on 4 to 5 hours.

So if I understand this right those that are on a CPAP must log machine use of 6 hours a night or more for the preceding 30 days at a rate of 75%. Those of us that are not on CPAP are not restricted to a minimum amount of sleep, or at least we don't need to prove it.

Doesn't really seem fair!!

Jim how does the 75% work is that .75 x 30 x 6 for the minimum total hours on the machine or is it 6 or more hours for .75 x 30 days? Just curious.

 

[bbchien]

To the last two posters, I have convinced them to accept 4 hrs, >75 % of nights on two occasions, but it's not a "slam dunk". The waiver guidance is written as 6 hrs. sigh....

Bruce, just for the record post #7 was not from the original poster of this thread.

I am in Ohio so IL wouldn't be very practical. Is this something that can be discussed via email or telephone so this gets handled correctly?

My email from this site does work. Just click on the link at the bottom of my post, or go to "UserCP" and turn on your email options. Mine is on again.

Ohio! That's nearby, by pilot standards. Tuesday I had a fellow from Waterloo, IA, one from Texas and one from Wilmington, DE. All were issued in the office because we had done our homework BEFORE hand.

 

[JimNtexas]

Jim how does the 75% work is that .75 x 30 x 6 for the minimum total hours on the machine or is it 6 or more hours for .75 x 30 days? Just curious.

I think the compliance number in the software I use (Sleepyhead) is the number of days you use the machine for more than the user set 'compliance level' divided by the number of days in the interval in question.

AFAIK Medicare and most insurance companies want 75% of the days to be more than four hours of CPAP, and the FAA wants 75% of the days to be more six hours.

 

[JimNtexas]

To the last two posters, I have convinced them to accept 4 hrs, >75 % of nights on two occasions, but it's not a "slam dunk". The waiver guidance is written as 6 hrs. sigh......

Thanks for that important clarification!

Another question, how far back in time does the FAA require the AME too look back at CPAP usage?

Is the 30 days prior to the flight physical, the entire time the applicant has used CPAP, or some other period?

Edited to add: Is the FAA interested in the CPAP machine generated apnea event index (AHI) number?