The post Are You Ready for Your Next Medical? appeared first on Plane & Pilot Magazine.

I took my son to his first air show when he was just 4 years old, about 12 years ago. He absolutely loved it. He sat up attentively, pointing at the sky and looking back at me to make sure I didn’t miss any of the colorful planes looping through their smoke trails. I had secured the perfect spot for our blanket on the lawn, right at the front of the Oshkosh flight line. From that glorious day, Joey was bitten and smitten by the aviation bug. I was sure he would become a private pilot someday, just like me.

Just a month after his 16th birthday, we made a doctor’s appointment with an aviation medical examiner, or AME for short. Our goal was to get Joe his third-class medical certificate so he could begin flying lessons. He had done well obtaining his driver’s license, passing on his first attempt, and doing it driving a six-speed manual transmission, no less! He is a competent and proficient driver. Before his medical exam, we completed all the required forms together on the MedXPress website. The exam with the AME went smoothly, or at least that is what we thought. The physician had access to Joe’s complete medical record, including medication history and diagnosis, including depression and attention deficit hyperactivity disorder. She performed the routine exam and never mentioned that he might have a problem getting his medical certificate. She just said, “You will hear from the FAA in about three weeks or so,” and that was it. Joe and I were so excited about getting him started with flight training. We had an instructor all lined up. It was March, the Wisconsin winter snow had melted, and spring was in the air.

In April, we received a letter from the FAA. We were both so excited that Joe could finally get going on his flight training. Hooray! We sat down and opened the letter together. Much to our dismay, the letter was not an approval.

Dear Mr. Moran:

We have received your electronically transmitted application for medical certification from your Aviation Medical Examiner (AME). Based upon our initial review of this information, we are unable to establish your eligibility to hold an airman medical certificate at this time.

Please note that your medical certificate has not been denied: however !

It pained me to see the look on Joe’s face as we read on. He had gone from elation to anguish in a matter of minutes. So had I. I reassured Joe that this was just a “bump in the road,” and we would work with the AME to get the FAA the additional information it requested in the letter, as follows:

1. An updated detailed current history and clinical examination from your treating physician regarding your history of ADHD treated with medication. The report should address diagnosis with etiology, history and symptoms, treatment plan, a complete list of medications (name, dosage, frequency of use and side effects) if no longer taking include date of discontinuance, and prognosis. Include the results of any current testing deemed appropriate.
2. An updated detailed current history and clinical examination from your treating physician regarding your history of Depression treated with medication. The report should address diagnosis with etiology, history and symptoms, treatment plan, a complete list of medications (name, dosage, frequency of use and side effects) if no longer taking include date of discontinuance, and prognosis. Include the results of any current testing deemed appropriate.

The very next day we forwarded the FAA letter to the AME. A few days later she replied by email that it was not her responsibility to provide the additional information the FAA had requested. We would have to obtain this from Joe’s primary care physician (family doctor). I thought this was odd, since that AME and Joe’s doctor worked at the same clinic. The AME had access to his complete medical record electronically, just as his family doctor did. I was disappointed with the way the AME just “washed her hands” from the matter. She had been paid, out-of-pocket, too, since insurance would not cover an aviation medical exam. Furthermore, she is supposed to be the expert in these matters, not the family doctor.

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Joe has had the same doctor his whole life. She is our family pediatrician and has treated Joe and his older sister since they were babies. At 20, my daughter still sees her. She is simply an excellent physician. She also has a military background, having taken the Army route for her medical training. We provided her with the FAA letter requesting more information, and within two weeks she had written an extremely thorough and detailed two-page report addressing Joe’s ADHD, depression, medications and treatment plans.

The report was inspiring and a testament to her skill and ability. She even included personal information about Joe’s character as an excellent student and his involvement with school activities. She could say these things because not only is she the kids’ family doctor, but she is also a neighbor. We thanked her for submitting the information requested with such diligence, which was truly above and beyond what was needed. Joe and I were confident this would be resolved soon.

In June, Joe received another letter from the FAA. The letter came via certified mail and noted that it was sent regular mail as well. “Finally, I can get going on my flight training,” he said as he eagerly opened the letter. He read it aloud as I listened intently.

Dear Mr. Moran:

Consideration of your application for airman medical certification and report of medical examination completed on March 5, 2018, discloses that you do not meet the medical standards as prescribed in Title 14 of the Code of Federal Regulations (CFR), Section 67. Specifically under paragraph!treated with the use of the Aeromedically disqualifying medications Methylphenidate LA and Bupropion ER.

Therefore, pursuant to the authority delegated to me by the Administrator of the Federal Aviation Administration (FAA), your application for issuance of an airman medical certificate is hereby denied.

The rest of the letter again contained the legal warnings not to exercise airman privileges unless you hold an appropriate medical certificate and the Pilot’s Bill Of Rights Written Notification.

I must say that with the denial letter, I had lost hope. Joe had not. He asked me, “Dad, you’re a pharmacist. How can the FAA deny my medical certificate simply because I am taking an anti-depressant medication that is clearly helping me? You saw how I was before the medication. I couldn’t get out of bed in the morning. And without methylphenidate, I couldn’t concentrate, but now I can. I have straight A’s, a 4.0 GPA, with AP classes. I’m sure I couldn’t achieve this without these medications.” He was right. I didn’t know what to say. Helpless. What I did know is that I would not want Joe to be flying with untreated depression or ADHD affecting his concentration. How ironic. Joe still wasn’t ready to give up. He felt wronged. He identified a sentence in the latest letter and, like a skilled chess player, planned his next move. The sentence read:

This denial does not constitute an action of the Administrator under 49 USC 44703 and is subject to reconsideration by the Federal Air Surgeon (FAS) of the FAA.

I was moved by Joe’s resolve and assisted him in writing a letter to the Federal Air Surgeon. The letter started out summarizing the exam, the additional information provided as requested, and the request for Special Issuance with the two medications. The most touching parts of the letter were the next two paragraphs:

I am 16 years old and greatly want to proceed with flight training to obtain my private pilot certificate. I am responsible, well mannered, and doing great with managing my depression and ADHD. I have completed my sophomore year of high school and have straight A’s so far (GPA 4.0). Obviously, this would be difficult for someone to achieve if their depression and ADHD was not controlled and well managed.

My father is a private pilot and supports my desire to move forward with flight training. He has also been a practicing pharmacist for the past 25 years. He understands the importance of ensuring pilots are not impaired by disease and/or medications to fly safely.

We mailed the letter by certified mail.

A month went by with no response. I called about it weekly, and the same tired FAA staffers would say, “Your application is under review!we do not have a response yet.”

It was the end of July. Joe and I were camping at Oshkosh for AirVenture 2018. We decided to attend an educational session at the Forums on Medical Certificate Issues. How appropriate. The FAA Office of Aerospace Medicine had a strong presence at the show. One of the presenters, an FAA physician, agreed to meet with us back at the FAA Pavilion after the presentation to review our case. Could Joe finally get his Special Issuance? We had hoped we could finally get this resolved face-to-face with the doctors making the decisions. Hooray! We anxiously waited our turn in line and eventually sat down with an FAA staffer, who pulled up Joe’s file on his computer.

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He told us, “His medical certificate has been denied because he is using Aeromedically disqualifying medications Methylphenidate LA and Bupropion ER.” I thought to myself, “Okay, tell me something I don’t know.” “I’m sorry, but there is nothing more we can do.” I asked to speak with the FAA physician we met earlier at the Forum talk. The staffer pointed the doctor out, and we strolled over. At this point, I was at the end of my rope. We had not heard back from the Federal Air Surgeon (we still haven’t). I began questioning the FAA physician with something like, “I have been a hospital pharmacist for 25 years. My son is taking two medications: one for depression that keeps him happy and allows him to get out of bed in the morning, and the other for ADHD, which allows him to concentrate and do well in school.

“He wants to become a pilot, go to college and major in aerospace engineering. Why can’t he proceed with a Special Issuance?” The physician’s response was perhaps the most disheartening thing he could have said. “I’m sorry, that’s just the way it is. Perhaps someday he will outgrow the ADHD and not need Ritalin. He could also try one of the approved anti-depressants.” I told him that Joe had tried sertraline (Zoloft), and it failed miserably. Bupropion ER is the best medicine for his depression. I am not only a pharmacist but also his dad. I see it every day.

Joe is now in his junior year of high school. He still has a 4.0 GPA, plays varsity tennis and is planning on attending college. We still go flying together occasionally and enjoy watching movies starring the actor/pilots I idolize like Harrison Ford, Morgan Freeman, Tom Cruise and John Travolta. I recently asked him if he was still interested in aerospace. He smiled and replied, “Not really; I want to go into the automotive industry.” I can’t help but feel that over the past year, the FAA has possibly displaced the next Wright brother. On the brighter side, the automotive industry may have picked up the next Elon Musk.

Let me close by adding that last week, I chaperoned a bus trip for Joe’s high school automobile class from Madison to Chicago.

We went to the auto show.

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