Subdural hematoma: physician obligated to inform FAA when patient is a pilot?

OP if you do this, send photo copies of the mailing and the proof of receipt to that doc along with directions to a nearby body of water and jumping instructions.
Agreed. The reason I don't want to do this is that it would reset my medical date and require me to either drive quite a distance to my regular AME in a different state (since I won't be able to fly myself, but preferable, since he's very good, if a bit expensive); or else find a good AME here, something I've been unable to do yet. This is a fairly remote, rural state, with very few local resources for pilots.
 
Let me relate this story which might shed light on the FAA's attitude towards self-grounding vs. turning in your medical.

I went to the FSDO to renew my CFI a couple years ago while I was on medical leave. The inspector who helped me was our POI. He asked me, "Do you still work at ____?" I told him yes, but I haven't flown in 4 months because I am on medical leave, which is why I didn't get a letter from the Chief Pilot and did the online renewal instead. He didn't ask me what my condition was. He could see that I held a first class medical (by then, only second class privileges) by reading the application. He didn't ask if my doctors had told the FAA or if I had told the FAA myself...
 
The laws don't apply to government.

The problem isn't the reception by the government, it's the disclosure by the doctor. The law sure as heck applies to them EXCEPT where they are specifically required to report specific conditions, such as mental state issues, domestic abuse, gunshot wounds, etc.

Disclosures to the FAA have not been in any of the laws that I've recently read. Not withstanding the above and similar conditions, a doctor independently reporting a transient medical condition is over the line. If you suffer harm because of your doctor's disclosure, you are entitled to relief from them.
 
Agreed. The reason I don't want to do this is that it would reset my medical date and require me to either drive quite a distance to my regular AME in a different state (since I won't be able to fly myself, but preferable, since he's very good, if a bit expensive); or else find a good AME here, something I've been unable to do yet. This is a fairly remote, rural state, with very few local resources for pilots.

Your third option, which might be the best, would be invest in the travel costs to go see Dr. Bruce.

Since he will continue to be familiar with your case, advising you on what actions to take, and what documentation to get, restarting with him will be much easier and near 100% chance of success than having to start cold with a different AME. His "let us get the submission to where the FAA can approve before we go official" approach is why us pilots turn to him when we have a difficult case.
 
Your third option, which might be the best, would be invest in the travel costs to go see Dr. Bruce.

Since he will continue to be familiar with your case, advising you on what actions to take, and what documentation to get, restarting with him will be much easier and near 100% chance of success than having to start cold with a different AME. His "let us get the submission to where the FAA can approve before we go official" approach is why us pilots turn to him when we have a difficult case.
Thanks Mike, but like I said, my guy is pretty good too. Also a difficult case AME with a lot of devoted pilot clients. The game changer would be someone of the same caliber locally, but such an animal does not seem to exist. :(

Dr. Bruce can no longer get approval from the FAA before the exam is live. Check the stickies at the Red Board. This one is from last summer, I believe (2014, that is). (It's not specifically him, it applies to all AMEs doing 3rd class exams.)
 
Make it very clear that this asshat does not have a professional obligation to report your medical status to the FAA. He is not an AME, and he does not act as an agent of the FAA. As such, such a disclosure is not covered under the mandatory reporting allowances under HIPAA. If he persists in making such a disclosure make it very clear that you will not only consider the company liable, but you will come after HIM, PERSONALLY.

And make sure he knows that inappropriate disclosure carries the risk of personal sanctions by the federal government. This would fall under the category of "willful neglect" and carries the risk of $50,000 fine and criminal sanctions.. TO HIM personally... Not only the company. Likewise, violating HIPAA in such a brazen manner is grounds for reporting to CMS (medicare and medicaid) as well as the local and state health authorities. EACH has the option to trigger their own investigation as well as AUDIT the facility "for cause" as the result of credible complaints. Any professional license he has in healthcare can also be probated or suspended (MD, RN, Therapist, Social worker..etc)... You can already make such complaints to professional boards and agencies just on his stated intent to violate your privacy.

Finally, this guy has to have a boss. Find out who it is, and have that person made aware what this asshat thinks he's going to do. And make it clear what you will do if he does.

Lastly, I've not read the past couple pages of comments so my apologies if this has already been covered ad-nauseum

Edit to add: Get well soon:yesnod:
 
Dr. Bruce can no longer get approval from the FAA before the exam is live.

Sorry, slight miscomm. I know about the prohibition against pre-approving SI's for thirds.

What I meant was he would use his knowledge/expertise to get all items needed so that when it did go live, both of you know it will go through with no pushback from OKC. Until then, no live exam, consultative action only.

As opposed to other pilots who present with a difficult case, are unprepared, go live, then try to deal with the scramble after the jeopardy clock starts ticking.
 
Edit to add: Get well soon:yesnod:[/QUOTE]
Dave, thanks.

One thing that may not have been clear in my OP is that he is apparently not just doing this on his own initiative, but has been advised by the rehab agency's lawyers to do it. As such, I'm not sure that threats from me against him personally are going to carry much weight. I need, at the very least, good legal representation.

According to Yodice's latest communique, the best way to find a qualified attorney from the panel list is to ask a few local attorneys on the list for references. There is exactly one (1) local attorney on the list. :(
 
To the OP, were I you I probably would not speak to their lawyers unless it is to say that they do not have permission to be discussing your medical history, nor does the head of the rehab and if any more disclosures are made you are going to sue. They are going to argue and try to convince you to cover their asses. Tell them you are recovering from a major health setback and you don't need their crap and they and the rehab guy should mind their own business. It's your information to decide what is to be done with, not theirs.

Edit:

The rehab guy initiated the lawyer discussion, there is no way a lawyer reviews each case to decide whether the FAA should be notified.
 
One thing that may not have been clear in my OP is that he is apparently not just doing this on his own initiative, but has been advised by the rehab agency's lawyers to do it. As such, I'm not sure that threats from me against him personally are going to carry much weight. I need, at the very least, good legal representation.

According to Yodice's latest communique, the best way to find a qualified attorney from the panel list is to ask a few local attorneys on the list for references. There is exactly one (1) local attorney on the list. :(
Does something Dr. Bruce or some other AME has said lead you to believe the FAA is going to revoke your medical even if they find out you currently have a disqualifying condition? Maybe they don't care as long as you are not going flying when you shouldn't. I can understand you not wanting to take that chance, though. Is Dr. Bruce is suggesting you turn in your medical voluntarily so that you can claim that it was never revoked or denied?

It will be interesting what you find out but I think your doctor and the lawyers are full of...
 
To the OP, were I you I probably would not speak to their lawyers unless it is to say that they do not have permission to be discussing your medical history, nor does the head of the rehab and if any more disclosures are made you are going to sue. They are going to argue and try to convince you to cover their asses. Tell them you are recovering from a major health setback and you don't need their crap and they and the rehab guy should mind their own business. It's your information to decide what is to be done with, not theirs.
I will probably end up saying just that but first I want to know what legal basis they are going by, if for no other reason than to be able to discuss it with my own lawyer, once I have one. I do respect your point though, that I have to be very careful not to give them anything they can use against me.
The rehab guy initiated the lawyer discussion, there is no way a lawyer reviews each case to decide whether the FAA should be notified.
:confused: Not sure what you are driving at here.
 
Does something Dr. Bruce or some other AME has said lead you to believe the FAA is going to revoke your medical even if they find out you currently have a disqualifying condition? Maybe they don't care as long as you are not going flying when you shouldn't. I can understand you not wanting to take that chance, though. Is Dr. Bruce is suggesting you turn in your medical voluntarily so that you can claim that it was never revoked or denied?
It's mostly that I don't want to take the chance. If they send a letter requesting "more information" with a deadline, I am pretty well screwed, unless I send in my medical.

And Doc Bruce did say that sending it in would be a way to avoid any "action", I believe was his word. Not sure why he would say that unless there was a chance they could revoke it. My understanding is they can do so at any time, if they believe they have reason. I don't know under what conditions they might consider that they have reason.
 
I will probably end up saying just that but first I want to know what legal basis they are going by, if for no other reason than to be able to discuss it with my own lawyer, once I have one. I do respect your point though, that I have to be very careful not to give them anything they can use against me.

:confused: Not sure what you are driving at here.

My point about the lawyer is that the rehab guy must have contacted him about contacting the FAA, otherwise the lawyer would not have known about you or the question of the FAA. Sounds like the lawyer is trying to take the heat off the rehab guy, I would keep the heat up on the rehab guy as your medical info should be guarded not distributed to lawyers and the FAA because someone misunderstands or misdirects their obligations.

That said, sounds like you are contacting pros to help you, so please take my advice with a grain of salt.

I've had to deal with rehab people many times for relatives in the past few years and all in all they are great people. But sometimes the need a boot in the ass because they can do stupid stuff. This seems like some of that stupidity to me.
 
Paul, gotcha on that. Yes, it's clear that he has to have been the one to bring the issue to the lawyers' attention. But he's an administrator, a director (of rehab), and was probably thinking as one from the get-go. I.e., this is a driver, I have to reveal the driver's medical condition to the state DMV. Knowing that this is a pilot, do I have some obligation to reveal the pilot's medical condition to the FAA? It might be the first time he's ever been in this situation, so he went to the lawyers. I can understand his taking the initiative and talking to them before doing anything further. I can also understand his feeling he has to follow their advice. Heck, I respect that he informed me of his intentions ahead of time.

What I can't understand is the lawyers' willingness to violate HIPAA... unless it isn't really a violation, or more likely, they think they can get away with it if he does it. I need to find a way to convince them they won't.
 
OP here. The rehab agency's lawyers claim to have case law to support their position. The director promised me a printout of the case. Stay tuned...
 
OP here. The rehab agency's lawyers claim to have case law to support their position. The director promised me a printout of the case. Stay tuned...

No way to just let this go and move on? Is continued bear poking warranted?
 
No way to just let this go and move on? Is continued bear poking warranted?
I think that once they say they are reporting it, you don't have anything to lose by following up.

Even if FAA doesn't follow up (and that may be anyone's guess), there may very well be "a note in your file". And that's something that's probably best to avoid.
 
No way to just let this go and move on? Is continued bear poking warranted?

I think these people need to be ***** slapped. It is none of their business and it is a violation of the OP's right to privacy. These bureaucrats get away with this crap because they are generally dealing with people too weak or too out of it to stick up for themselves and it is not right.
 
I think that once they say they are reporting it, you don't have anything to lose by following up.

Even if FAA doesn't follow up (and that may be anyone's guess), there may very well be "a note in your file". And that's something that's probably best to avoid.

Then the voluntary turn in of the certificate might be worth more consideration. If that was done before the doc and lawyers notified the agency, then the agency might say, "he does not hold a certificate.... so we see no problem"
 
Then the voluntary turn in of the certificate might be worth more consideration. If that was done before the doc and lawyers notified the agency, then the agency might say, "he does not hold a certificate.... so we see no problem"

All the more reason to nip this in the bud. The doc has no business bypassing the OP and going straight to the feds.
 
No way to just let this go and move on? Is continued bear poking warranted?
What bear poking? This was in response to my question about their legal basis for reporting directly to the feds. I've talked to a lawyer (got back to me this afternoon) who is equally interested to know the case they are basing their position on.

As far as just moving on, it's not a done deal yet that they will report. The director sounds receptive to legal arguments on the other side. I think he just wants to do the "right thing" and has never faced a situation like this before.
 
At the end of the day what difference does it make whether they do or don't report it? You haven't done anything wrong so there's no looming threat from the FAA, right?

Read the back side of your pilot medical. It spells out the conditions of use. If you can't meet the conditions, don't fly. That's all you need to do.
 
At the end of the day what difference does it make whether they do or don't report it? You haven't done anything wrong so there's no looming threat from the FAA, right?

Read the back side of your pilot medical. It spells out the conditions of use. If you can't meet the conditions, don't fly. That's all you need to do.
It's not at all clear to me that they won't take action. For one thing, I own an airplane. From what I've read, that's one of the criteria for emergency revocation, particularly given the information is coming from a third party (and presumably that third party has an urgent reason for reporting, right? since this is not done routinely). For another, as I said in the OP, I just don't want the stress of back and forth with OKC at this time, if they ask me for further info.
 
What bear poking? This was in response to my question about their legal basis for reporting directly to the feds. I've talked to a lawyer (got back to me this afternoon) who is equally interested to know the case they are basing their position on.

As far as just moving on, it's not a done deal yet that they will report. The director sounds receptive to legal arguments on the other side. I think he just wants to do the "right thing" and has never faced a situation like this before.

God save us from do-gooders...

Rich
 
For me this is a case of just how much and to whom should a hospital be allowed to divulge medical information. I have had hospital staff refuse to tell me things about elderly relative who have specifically instructed that I be told everything. I nipped it in the bud immediately and forcefully with these people. Yet on the other hand some of these people feel obligated to tell all to the government because of some misplaced sense of duty?

The OP has shown no sign that he will fly without proper clearance from his AME and the inference from these bureaucrats that he will would **** me off no end were I in his shoes.
 
It's not at all clear to me that they won't take action. For one thing, I own an airplane. From what I've read, that's one of the criteria for emergency revocation, particularly given the information is coming from a third party (and presumably that third party has an urgent reason for reporting, right? since this is not done routinely). For another, as I said in the OP, I just don't want the stress of back and forth with OKC at this time, if they ask me for further info.

I respect your position. If I was in your hospital bed and was concerned with the situation I'd call me regional flight surgeon's office or OKC Aeromedical and ask them a direct question to get a direct answer. You won't be required to provide your name but whomever you speak with will provide theirs. I've done it a few times when I had my own disqualifying health issues and always found the FAA staff to be friendly and helpful. Sometimes the best way to get the answers is to go to the source.

Get well.
 
At the end of the day what difference does it make whether they do or don't report it? You haven't done anything wrong so there's no looming threat from the FAA, right?...

In the opening post, he said "My understanding is that if OKC demands my certificate, that is effectively a denial or at least a revocation, and forecloses the Sport Pilot option."
 
I understand the notion but can't find a shred of evidence that the FAA has ever revoked an airman's medical because he was injured or became ill. There are cases of DUI and withheld information that led to revocations. The pilot was issued a medical certificate after meeting the physical standards. Because he becomes ill during the term of the medical is not a violation. I'm interested in this point and I guess I'll call the FAA and ask about it.

I was diagnosed with a disqualifying condition while I held a medical. After surgery and once recovered I did the required testing and applied for an SI without needing to see an AME or fill out a new 8500-8 form. How did I know I could apply for the SI without getting a new flight physical and seeing an AME? The regoinal flight surgeon's office told me. The RFS used my existing medical issue date and AME exam and amended it by adding an SI onto it. Clearly they knew I'd had the disqualifying condition for the 9 months prior. They didn't ask whether I'd self grounded and I didn't offer. I'd like to know where this expectation of revocation comes from. Anyone have experience with a revocation based on a healthy pilot getting sick?
 
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The way I see it, it's a different situation if the FAA becomes aware of the illness from the pilot himself. This is not about the FAA taking action because a pilot gets sick. A third party says I have information about a licensed pilot who is not fit to fly. The info comes from a credible source (physician). Are you 100% sure that will not result in FAA action?
 
I'll try to find out tomorrow morning. I have my RFS on speed dial. I figure the FAA works for me and I have no qualms with picking up the phone and asking them questions.
 
I'll try to find out tomorrow morning. I have my RFS on speed dial. I figure the FAA works for me and I have no qualms with picking up the phone and asking them questions.

Not all RFS are created equal. It will be interesting to hear what yours says.
 
I'm interested too (OP), but I have to say, I agree with what Matthew says. I've heard of lots of cases where different RFS offices disagree. Mine directed my first AME to defer me for one reason, but the eventual SI was for something entirely different and the initial reason was never mentioned again. Even the customer service people at OKC (who are the only ones you actually talk to) often give me answers qualified by "probably" and "might be". And that's when talking openly about MY case. I wouldn't expect them to do too well with a hypothetical, just too many variables.
 
I'm interested too (OP), but I have to say, I agree with what Matthew says. I've heard of lots of cases where different RFS offices disagree. Mine directed my first AME to defer me for one reason, but the eventual SI was for something entirely different and the initial reason was never mentioned again. Even the customer service people at OKC (who are the only ones you actually talk to) often give me answers qualified by "probably" and "might be". And that's when talking openly about MY case. I wouldn't expect them to do too well with a hypothetical, just too many variables.

I asked Doc Chien a question years ago, he said it could be handled at the RFS level instead of OKC. When he found out who my RFS was, he said, "Nevermind".

--

Since the OP doc said he's reporting him to "FAA", I will assume he will call OKC and not the RFS. Maybe that's not the case.
 
I asked Doc Chien a question years ago, he said it could be handled at the RFS level instead of OKC. When he found out who my RFS was, he said, "Nevermind".

--

Since the OP doc said he's reporting him to "FAA", I will assume he will call OKC and not the RFS. Maybe that's not the case.

That brings up another angle, if it gets reported to the 'wrong' person at the FAA it might not go anywhere. Play friendly say you agree with their plan and understand them covering their buts, tell them you looked into it too and have the FAA number- give them a buddy's # and have him answer the phone as 'FAA medical' for a week.:lol::rolleyes2: Or more seriously find a real FAA office most likely to drop the ball and forward their contact info.:wink2:
 
Thanks Mike, but like I said, my guy is pretty good too. Also a difficult case AME with a lot of devoted pilot clients.

If he's all that, what does he offer as guidance? He should be in your cadre of experts.
 
I have the case printout. It is not very long and has mostly to do with state case law. The name of the state and case citation are redacted as there are so few POAers from this state that it would be identifying if I revealed it.

It is well settled under "state" case law (xxx v. yyy) that physicians have a legal duty to "exercise reasonable care" to protect individuals and the general public from a serious risk of harm. The Court ruled that disclosure of the risk is not prohibited by the physician-patient privilege established by "state" statute. Basically, if MD has reasonable cause to believe that a patient presents a serious risk of harm to others, they have a "Duty to Warn" by notifying the individual or agency who is in the best position to minimize the risk. In this case, that would clearly be the FAA.

Additionally, the federal privacy law, HIPAA permits health care providers to disclose health information to a third party without the patient's consent or even over the patient's objection, if the provider believes, in good faith, that the disclose is necessary to prevent or lessen a serious threat to the health or safety of a person of the general public. Section 164.512(j) of HIPAA.

So there you have it, the rehab director believes I present a threat to public safety purely because I am a pilot and own an airplane and am currently unfit to fly. However, the wording of the HIPAA exception implies that the only reasonable interpretation on the part of the FAA, when they see the rehab report, is that I'm a rogue pilot who has expressed an intent to continue flying despite the injury.

That's emergency revocation territory. :(

My lawyer is out of the office until late this afternoon, so no word from him yet on whether or how this can be fought, or whether I should be thinking seriously about sending in my medical for cancellation.
 
Basically, if MD has reasonable cause to believe that a patient presents a serious risk of harm to others, they have a "Duty to Warn" by notifying the individual or agency who is in the best position to minimize the risk. In this case, that would clearly be the FAA.
I would not say the MD has "reasonable cause" to believe this unless he or she has evidence that you are trying to exercise the privileges of you medical certificate. You are self-grounding. But IANAL.

I also have problems believing the FAA would revoke your medical for this reason. Think of the thousands of pilots who self-ground for disqualifying conditions. We would have heard something if even a small number of these pilots had their medicals revoked for that reason.
 
I have the case printout. It is not very long and has mostly to do with state case law. The name of the state and case citation are redacted as there are so few POAers from this state that it would be identifying if I revealed it.



So there you have it, the rehab director believes I present a threat to public safety purely because I am a pilot and own an airplane and am currently unfit to fly. However, the wording of the HIPAA exception implies that the only reasonable interpretation on the part of the FAA, when they see the rehab report, is that I'm a rogue pilot who has expressed an intent to continue flying despite the injury.

That's emergency revocation territory. :(

My lawyer is out of the office until late this afternoon, so no word from him yet on whether or how this can be fought, or whether I should be thinking seriously about sending in my medical for cancellation.

In addition to the lawyer, you might also try and have a conversation with Dr. Bruce before taking action. Most likely, any report to the FAA will depend on how it's worded: For example, if the rehab doc states that he thinks you will go out and fly, endangering others, regardless of what you tell him, that will be taken more seriously than "he had a hematoma and is currently recuperating, he has indicated he will remain grounded until fully cured".

What is clear to me is that this entire case is prima fascia evidence as to why (1) you should not use your regular doc as your AME, and (2) why you should not disclose your pilot license/plane to anyone that could use it against you in the future. Yes, I love to fly, but I'm very circumspect as to whom I discuss that with in any detail.
 
I would not say the MD has "reasonable cause" to believe this unless he or she has evidence that you are trying to exercise the privileges of you medical certificate. You are self-grounding. But IANAL.

I read this the same way. Where is the "reasonable cause"?

This sure seems like a CYA episode. And, yeah, in order to justify reporting this, the paperwork probably will say, "xxx, MD, has reasonable cause to believe that Mr. yyy presents a serious risk to others..."

Maybe FAA looks at it and tosses it into the shredder. But if that doesn't happen, that report ends up somewhere, and it's probably going to be attached to the OPs medical file. What FAA does with it after that, who knows, but now there is a record that an MD, somewhere, thinks the OP is a serious risk to others.

Your question back might be: "Since you are aware that I am a pilot, then you must also be aware that I am subject to self grounding and self reporting. At what point do I present a 'serious risk' that would force you to report this to FAA?" But a lawyer, especially a hungry one, might have some other thoughts.
 
I would not say the MD has "reasonable cause" to believe this unless he or she has evidence that you are trying to exercise the privileges of you medical certificate. You are self-grounding. But IANAL.
Bingo. And if they report, they are declaring reasonable cause to believe, which I would interpret exactly the same way you do, that they think I am trying or will try to exercise the privileges of my medical cert.

Maybe the best tack would be a letter from my lawyer declaring that I am self-grounding and don't plan to return to flying without FAA clearance. To forestall the "good faith" argument.

I also have problems believing the FAA would revoke your medical for this reason. Think of the thousands of pilots who self-ground for disqualifying conditions. We would have heard something if even a small number of these pilots had their medicals revoked for that reason.
Not for self grounding, but for (implied) NOT self grounding. Read the post again. Physician informs FAA under good faith belief that a threat to public safety exists, which doesn't make sense if pilot if self-grounding. You wouldn't expect to see many cases like this in the literature because the number of care providers who would blab to the FAA under these circumstances is vanishingly small.
 
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