AINsight: Can I Fly?

 - June 14, 2019, 8:29 AM

What determines if a pilot is “legal” to fly medically on any given day? A pilot’s responsibility to “self-assess” is an ongoing and never-ending process. Remember, the AME’s decisions in regard to a pilot’s airworthiness are binding (hence, in essence, “regulatory”) only on the day that an actual FAA exam is done. Most of the responsibility falls to the pilot at all times between FAA exams.

Where is this self-assessment responsibility defined? Please refer to FAR 61.53. This is a regulation so important to the FAA that reference to it is printed on every medical certificate. While the “Conditions of Issue” used to be printed on the back side of the old typed FAA medical certificate, these days it is printed on the same side of the page when the certificate is printed electronically. Pilots often complain that keeping the Conditions of Issue page attached to the medical certificate adds undesired bulk to their wallets. Understood, but it’s a relatively minor inconvenience. The FAA and ICAO policy is to keep the Conditions of Issue page physically attached to the actual medical certificate. In other words, cutting that side of the page off and keeping it in the flight kit just doesn’t appease an FAA inspector. Technically the pilot has adversely altered the certificate. Word to the wise: just keep it attached. Why get into an argument at the very beginning of a ramp or line check?

The statement relevant to pilots is that they must “Comply with the standards relating to prohibitions on operation during medical deficiency.” Reference is then made to FAR 61.53. This FAR reinforces that a pilot shouldn’t fly when any “medical condition” or “medication” might interfere with safe flight operations by stating that the regulation applies when the pilot may become “unable to meet the requirements for the medical certificate necessary for the pilot operation.”

As with reading most of the FARs, at this point, the pilot’s brain has gone into the “blah blah blah” mode, which is entirely understandable. However, this regulation is of utmost importance, as a pilot’s medical status not only determines if the privileges of a medical certificate can be exercised on any given day but also is often one of the first things researched in accident investigations. Therefore, the ongoing self-assessment of airworthiness is an important responsibility for a pilot.

FAR 61.53, itself, is a short, brief regulation, without the lengthy subparts of so many of its FAR cousins. If it’s so important, why then aren’t there more specifics stated? In reality, it simply must be written a bit nebulously, as it would be impossible for a single regulation to list every medical condition, every medication, and every nuance of any combinations and interactions thereof. Having it written broadly and nebulously prevents boxing anyone into an arbitrary corner (pilot or FAA). Further, it permits wide leeway in interpretations of actual medical conditions, medications, and their impact on the safety of flight.

If FAR 61.53 is so important, where can the pilot at least find some useful guidance on how to comply with it? Is that guidance in the FAR/AIM? Nope. There’s not much there other than the regulation itself. What about on the FAA website? If a pilot goes to www.faa.gov and follows links to “medical certification” there will be a reference to a few areas that provide, at best, minimal help to pilots for any specific questions. The link refers pilots to the Guide for Aviation Medical Examiners, for example, which primarily discusses the AME protocols regarding what data needs to be submitted for a pilot to obtain an FAA ruling on a medical condition. However, there is little to no guidance about a “What do I do today?” type of decision that a pilot must make.

In a previous blog discussing medications, I referenced the section in the AME Guide on Pharmaceuticals, Do Not Issue-Do Not Fly. This is a useful link, as it can sometimes assist a pilot in making a time-sensitive medication decision.

Other than those sometimes nebulous and incomplete references, there really is no specific guidance for FAR 61.53. As I noted above, it would be impossible to write a medical regulation or the guidance for it that discusses every aspect of anything and everything that may happen medically during the extended time periods between FAA medical exams.

The bottom line, therefore, is that the pilot will have to use some judgment. While the final decision as to whether it’s safe to fly does rest with the pilot, obtaining advice at times of medical uncertainty is a good idea. Many airlines and some corporate operations have specific aeromedical consultants on call to answer questions. Some AMEs also provide between-exam advice for their pilots. That said, remember that FAR 61.53 doesn’t list my name, your personal AME’s name, your airline’s consulting physician, AOPA, ALPA, etc., as the final word. The final decision as to whether to get into a cockpit on any given day rests with the pilot. In essence, FAR 61.53 is the medical equivalent of the pilot’s operational responsibilities noted in FAR 91.3 (which is also a succinctly written regulation with highly significant implied responsibilities). The pilot-in-command, therefore, has the final responsibility, both medically and operationally.

Can a pilot ask the FAA directly about a medical condition that was discovered between the times of the formal medical exams? Of course, and in reality, the FAA medical staff does a pretty good job of trying to help out. The answers are not typically blanket, “Don’t even think about getting near an airplane!” warnings that pilots fear. They are usually helpful discussions about what a pilot can or cannot do in a given situation. And yes, sometimes the answer indeed will be that the pilot shouldn’t fly until things get sorted out medically. Even still, at that point, the onus of responsibility and ethics in regard to FAR 61.53 remain with the pilot until if/when the FAA follows up with a formal letter. At that point, the provisions of the FAA letter would be controlling.

Another point to remember is that there are no emergencies in aviation medicine. Whether stated or not, that’s the implied policy position of the FAA. There is nobody at the FAA available to discuss medical issues after hours, on weekends, or on holidays. The FAA expects the pilot to use appropriate judgment, and to make the final decision as to whether to fly on any given day. A pilot can always choose not to fly until there is better understanding and resolution of medical conditions. And, as noted above, a pilot can and often should seek advice from an aeromedical consultant if there is any question about fitness to fly.  A very appropriate example is the case of an airline pilot with medical concerns while on an overnight at an out-station. In the spirit of safety-first, that pilot can often discuss a medical situation with the airline’s consulting aeromedical experts before deciding whether or not to serve as a required crewmember. No pilot wants to call in sick at an out-station, but sometimes that’s inevitable. Similar scenarios are applicable to corporate pilots. Safety always comes first. 

In the next blog, I will discuss more of the actual nuts and bolts of what a pilot must do once a new medical condition is experienced, how to best report it, and what (if any) kind of documentation may be required afterward. Once FAR 61.53 has been complied with, there is sometimes additional homework that might be required before the next scheduled FAA medical exam.