FAA to Reassess Medical Certification Rules

The requirement for pilots to be certified fit to fly by a medical doctor is a universal feature of aviation regulatory bodies. The International Civil Aviation Organization sets the standard, which individual states can modify. According to ICAO, “To become a professional pilot or an air traffic controller, an applicant must be in normal good health (including normal hearing, normal vision and normal color perception).”

In the U.S., the issue of whether all pilots should require medical certification was raised when the FAA published the regulations governing manufacture and operation of light sport aircraft (LSA). Although glider and balloon pilots aren’t required to have a medical, the FAA has resisted efforts to permit other types of pilot to fly without a medical. Yet the LSA rules allow pilots with valid driver’s licenses to fly LSA, which are basic two-seat airplanes with hard limitations on speed and maximum weight.

The question of whether pilot medical certification is ultimately beneficial is difficult to answer. Asked about why private pilots require medical exams, for example, FAA Administrator Randy Babbitt said that the requirement keeps people who obviously would not qualify away from piloting. In Babbitt’s view, then, were anyone allowed to learn to fly without medical certification, the sky would welcome an unacceptably high number of health-compromised pilots.

This is an interesting viewpoint. The safety of the skies is indeed compromised by pilot health issues. However, this is despite the comprehensive system in place that regularly recertifies pilots as healthy to fly.

Witness the seemingly regular number of pilots who die in airplanes every year, prompting copilots or suddenly capable passengers to take over the controls and land the airplane safely. In every one of these cases, the incapacitated pilot had a current and valid medical certificate. Does this mean that the system is working or is Babbitt right that there would be more such problems–and accidents–if pilots didn’t have to be medically certified?

Unfortunately, there are no studies that attempt to answer these questions. The FAA’s Office of Aerospace Medicine released a study on airline pilot incapacitation in 2004, “In-Flight Medical Incapacitation and Impairment of U.S. Airline Pilots: 1993 to 1998.” It should be noted that every case mentioned in the study involved pilots with current medical certificates.

According to the study, “We found 39 incapacitations and 11 impairments aboard 47 aircraft during the six-year period. The in-flight medical event rate was 0.058 per 100,000 flight hours. The probability that an in-flight medical event would result in an aircraft accident was 0.04. The most frequent categories of incapacitation were loss of consciousness, cardiac, neurological and gastrointestinal. Safety of flight was seriously impacted in seven of the 47 flights and resulted in two nonfatal accidents.”

A search of the NTSB database found 30 accidents and incidents in which the word “incapacitation” was cited. Some found that there was no evidence of pilot incapacitation. The remaining accidents and incidents cover the gamut of medical certification issues, with a few involving pilots who kept flying despite not having a current and required medical certificate. Others involved pilots who collapsed or appeared to have been medically compromised, and in these cases most had valid and current medical certificates, although it is clear that some pilots lied on their applications to hide disqualifying conditions.

In what became a heralded incident on April 12, 2009, Joe Cabuk, the pilot of a King Air 200, became incapacitated shortly after departing from Marco Island, Florida. Cabuk held a current third-class medical certificate, although he had been treated for “heart or vascular” trouble and had a stent in his right coronary artery. Doug White, the owner of the King Air, was sitting in the right seat and was able to take over and land the airplane. White is a private pilot with single-engine land rating. Cabuk was pronounced dead after White landed the King Air in Fort Myers, Fla.

The NTSB records of incapacitation-related accidents and incidents include 12 in which the pilots had valid medical certificates yet still suffered incapacitation. In four other cases, the pilots did not have a current medical, yet they were still flying.
The NTSB faulted the FAA in a Sept. 7, 2007 accident in which the pilot of a North American SNJ2 died after practicing a formation aerial demonstration. According to the NTSB, the pilot had heart problems and received a special issuance medical certificate 14 months before the accident. The NTSB noted, “Following his most recent medical certification, in the six months before the accident, the pilot had experienced increasing symptoms (treated by increases in his beta-blocker dose), and had received at least one new diagnosis (pulmonary hypertension).

Additionally, the pilot had visited his cardiologist three days before the accident, complaining of multiple episodes of atrial fibrillation over the previous three months with fatigue and shortness of breath lasting anywhere from several hours to up to 36 hours at a time. No restrictions were placed by the FAA on the pilot with regard to aerobatic flight, though records submitted to the FAA clearly noted the pilot’s participation in aggressive flying at airshows.”

The Safety Board determined the prob­able cause of the accident to be “the pilot’s inability to maintain control of the airplane due to physiological incapacitation. Contributing to the accident was the failure of the [FAA] to deny or restrict the pilot’s medical certification, and the pilot’s improper decision to perform the flight given his recent history of worsening symptoms.”

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