Hired Guns: Aeromedical Services

by Charles Davidson

What a great year. Thanks to your airplane, efficient business travel has made your business grow 100 percent in the last two years. And now comes the reward: Youve just inked the paper to trade your old starter airplane on a new Cirrus with a glass panel. Life is good. But a routine appointment with your Aviation Medical Examiner (AME) knocks the edge off your euphoria. The doc says youre blood pressure is not just high but really high and he sends you off to the family doctor for evaluation. The news get worse. You now learn that you have elevated blood glucose and cholesterol levels and your ECG shows signs of a possible heart attack some time in the past.

A follow-up with your AME yields the not-too-surprising word that hell have to defer issuance of your medical certificate to the FAAs Aeromedical Certification Division (AMCD). He says hell have to monitor how your blood pressure and elevated glucose meds are working for two months and adds that youll get a letter from the FAA telling you how to get your medical re-issued.

When will you get this letter from the FAA? What if the pills dont work? What numbers for blood pressure and glucose will the FAA accept? Where do you turn for answers and assistance?

In this case the AME deferred the issuance of the medical, leaving further evaluation to the AMCD in Oklahoma City. Certification denial is usually not a decision made at the AME level. Because deferral of certification by the AME is hardly uncommon, theres a niche market for companies that propose to act as the pilots agent, focusing their medical and bureaucratic expertise on helping pilots get back into the FAAs good graces, medically.

Researching the Web and popular aviation magazine advertising, we found three companies who offer medical certification assistance: ARMA, Pilot Medical Solutions and Virtual Flight Surgeons. But before even considering these, know this: With prodding from the alphabet groups, the FAA has dramatically improved its turnaround time on special issuances. Its much easier than it used to be.

Risser informs the client early on that he has no medical training or background, but he has researched the information openly available with regard to certification requirements. Rissers background includes about 35 years designing computer-based systems for manufacturing companies as a director of information services. He contends that his knowledge of large and complex administrative systems, the minute attention to detail and data gathering required in systems design and the ability to present a plan to senior management all relate directly to the process of steering a special issuance medical through the FAA maze.

Risser says he discusses the case with the pilot and can provide an assessment of how successful his efforts are likely to be in getting the pilot his certificate. He turns down about 50 percent of potential clients because he doesnt believe that their money will be well spent and that FAA approval is unlikely due to their medical situations.

If a pilot decides to employ ARMA to assist, the company charges a flat fee of $990 for all services. Risser says this fee covers his services throughout the process, even if it carries through to an appeal to the NTSB, which is usually the court of last resort for pilots seeking re-issuance. Risser says the small staff and home office allow ARMA to keep its costs down and therefore theyre able to contain the fee to the client. He says there are no circumstances where they go back to the client for more money.

The PMS staff includes a clinical advisor, Dr. C. Joseph Wine, who is board certified in otolaryngology-head and neck surgery–and who provides assistance in specific examinations. Theres also an expert witness staff and several members of an administrative staff in Oklahoma City. PMS retrieves, reviews and submits documentation directly to the FAA for pilots worldwide. PMS has an informative Website with several tools for the pilot in reference to choosing an AME and posts answers to frequently asked questions.

In the hypothetical case we posited here, Hale explained that PMS would “quickly retrieve the essential records and petition the FAA to get the pilot flying fast.” Hale states that while third-party reimbursement is often available, the client is billed directly. A fee is determined after initial consultation and before the company begins work on the case. Fees vary with the service provided. PMS offered no typical prices.

Dr. Phillip Parker is vice president of military and general aviation safety and like the other VFS physicians, his background includes years of experience in aerospace and/or military medicine. He told us that although the majority of the companys business comes from contracts with pilot unions and aviation associations, the individual client business is growing. Some 9000 aviation professionals seek direct assistance from AMAS yearly. At present, about 20 percent of their business is from individual airmen not associated with a group or union.

VFS handles several hundred phone calls and e-mails each day. They guarantee response within one to two days, although they say the vast majority of inquiries are returned within a few hours. The client may speak with a VFS physician each time they call, if necessary. They emphasize that each case is prepared by a VFS physician, reviewed to address aeromedical concerns and subsequently presented directly to the FAA physician staff on an as-needed basis.

A visit to the VFS Website reveals a page for the pilot with questions to e-mail with a description of the medical problem, with the promise of a timely response. Theres an initial fee of $39.95 for this consultation. Subsequent charges are based on the complexity of the case and are clearly outlined in the initial discussion with the physician staff. As with PMS, fees depend on the service provided. For pilots trying to assess the chances of medical certification, VFS charges $400 for complete medical records review and aeromedical consultation. That fee is credited towards more comprehensive services if the would-be client moves forward with VHS. Fees range from $750 for administrative review issues to $2000 or more for ongoing sponsorship in drug and alcohol situations.

Conclusion
Are any of these services worth using to get back a medical thats hanging in the balance? Or are you better off letting your AME do the legwork? In our view, it depends on how badly and how quickly you want your medical back and how willing your AME is in going the extra steps in contacting the FAA and following up on your case. Some AMEs take advocacy for the pilot seriously and will go the extra mile (or few hundred feet) to make a simple call at the time of the pilot exam and avoid unnecessarily deferring a medical.

Delays in obtaining a decision on a deferred medical occur mainly at two levels: The time it takes to acquire the medical records needed by the FAA and the time it takes at the AMCD to process and review the case-usually by a single physician. This is a hands-on, time-consuming process.

Each case is reviewed on its own merits by some five physician reviewers at the AMCD and no two cases are alike. Thanks to new technology and online record sharing-not to mention a challenge from the newly appointed Federal Air Surgeon, Dr. Fred Tilton, to the FAA to use its regional air surgeons for special issuances rather than relying entirely on the AMCD, delays have been markedly decreased.

Further, at the end of 2005, Dr. Warren Silberman, AMCDs director, pushed to clear the backlog of special issuances, again, pressing the FAAs nine regional air surgeons to the task of sharing AMCDs review load. Also worth noting here is that the AMCD recently expanded the number of conditions that fall under its two-year-old AME Assisted Special Issuance (AASI) program.

The AASI program was instituted to expedite the re-issuance of certificates for certain medical conditions by encouraging the airman and his AME to collect the information required by the FAA. The AME reviews the case under standards established by the AMCD and if the pilot passes those standards, the AME may reissue the certificate on the spot. The initial certificate must be certified by the AMCD or Federal Air Surgeon, but thereafter, the pilot can have future exams under the AASI process.

In this context, do you really need help for a special issuance? Maybe. Or maybe not. As a minister once said about prayer, the answers are there, you just have to ask the questions. Sometimes, the issue can be resolved right in the AMEs office, if you know what questions to ask. And this is where you, as a medically disenfranchised pilot, have to take command of your own destiny.

Step one: Ask your AME if hell help. After all, he probably knows you and may have done your exams for years. But before pursuing this option, you should ask your AME if he has had experience with similar special issuance cases and whether hes willing to help you step through all of the hoops necessary to recertify. This will require lots of his time. (I once called a hospital lab four times before I received the correct information for an airman.) Some AMEs will do this work for no additional charge; others may find it fair to charge something for their time.

In this situation, you are your own best advocate. Learn all that you can about your medical condition. The Web is a marvelous tool and has copious information on almost every health problem imaginable, especially the medical section on AOPAs Web site. So even if you cant self-diagnose, you can learn enough to ask the right questions. That includes acquiring more than passing knowledge of FAA guidelines and stipulations concerning your specific medical condition. If youre considering using a medical consultation service-and there might be merit in doing this in some cases-before you agree to any fees or services, ask the company specifically how many cases it has seen and handled like yours? One or two? A dozen? And what were the outcomes?

No reputable firm in this field should be able to guarantee any outcome, but its reasonable to expect them to stipulate exactly what theyll do, how theyll do it and when theyll do it. Its not unreasonable to get this understanding in writing. And, as noted in the sidebar, if youre an AOPA member, your dues include access to a nearly like service, for free. Most pilots would not put a price tag on the value of their continuing to qualify as a pilot in command. Even though use of a company to assist in the paperwork or possibly act as an advocate with the FAA might be expensive, cost hasnt impaired the growth of these companies. As the baby boom population continues to age, we wont be surprised to see them continue to grow.

Contacts
AOPA, 800-872-2672, www.aopa.org/
ARMA Research, 920-206-9000, www.armaresearch.com/
Pilot Medical Solutions, 800-699-4457, www.leftseat.com/
Virtual Flight Surgeons, (phone for members only), www.aviationmedicine.com/

-Dr. Charles Davidson has been a pilot since 1977 and an AME since 1978. He lives in Kill Devil Hills, North Carolina.