The Aeromedical Panel is a panel of medical experts in various fields, including but not limited to neurology, cardiology, ophthalmology, psychiatry, and other specialties. The panel is convened only once a month, as all these specialists have to take a day out of their calendars to be present at the meeting, where the cases are presented. The cost to the CAA is not less than R50 000 per panel sitting, as each specialist gets paid for the day that they are out of their practice.
The panel meetings are usually held on the third Tuesday of every month, with the exception of December and also possibly during the Easter holidays. It is necessary to have all documentation for a panel case submitted 7 WORKING days before the panel. The normal route for submitting documentation is to get it to the DAME who then submits it to IAM. The doctors at IAM then draw the files and put forward all the cases to be heard to the CAA.
The names of the doctors on the panel are not made “public”, purely for the fact that if an applicant (the term the CAA use for a pilot applying for a medical) consults one of the specialists personally on their case, that specialist must then recuse him- or herself from the panel meeting, due to conflict of interest. Therefore the members of the panel keep themselves out of the mainstream of consulting to pilots/aviation professionals, so that they may be objective when a case is presented at panel. Thus you could consider that they are turning work away, further financially disadvantaging themselves.
The reason that the panel sits in its entirety, and not have each individual case emailed to each specialist, is to encourage robust discussion, and cross-pollination between the specialties. Quite often there is a spill-over between specialties, for example, diabetes not only affects blood sugar levels, but the eyes and the nervous system. For that reason, each specialist needs to be included in the discussion, to ensure that the ICAO Flexibility and Accredited Medical Conclusions are met.
World best practice for pilots at present is the 1% rule – in a nutshell, the rule states that a 1% per annum risk of medical incapacitation is the threshold between acceptable and unacceptable (ie. pilot incapacitation should cause an accident no more often than one in a 1000 million flying hours). So in order to achieve this standard, the aviation medical fraternity needs to consider many factors before coming to a conclusion, including side effects of medications and treatments, world best practice, ICAO recommendations, etc etc. This is not a hit-and-miss affair. The doctors involved are highly qualified and highly skilled in their specialties, and are cognisant of the requirements for aviation medicine.
As for the outcome of cases at the SACAA Aeromedical Panel, the reason the decision is not communicated to the applicant immediately after the panel sitting, is that the decision needs to be verified, and the verification and administration process takes between 7 and 10 days.
Should an applicant feel aggrieved by the outcome of the panel, he/she is entitled to appeal the decision. There is a fee attached to the appeal, and this is levied to cover costs associated with the process. The applicant will supply all the relevant documentation to the SACAA, and inevitably, the case will be re-presented to the original Aeromedical Panel to ascertain whether there is new evidence, or whether the panel may reconsider their original decision.
If the original decision is upheld, the SACAA then constitute an “Appeal Panel” – they will appoint a team of specialists in the area being discussed, to review the material supplied, and thus to come to an independent decision on the case. The entire process can take up to 3 months.
When it comes to medical procedures for which there is no SACAA protocol or ICAO recommended practice, or treatments that are new, the process may take much longer while the procedure, side effects, and implications for aviation are considered. This is especially important for procedures which are new, experimental, or about very little is known. Much research is required to determine that the treatment will not affect the pilot to an extent that the 1% rule may be compromised.
It is acknowledged that this process is extremely frustrating to the applicant, especially considering that quite possibly treatments as explained by the treating physician is the “cure all”, but it needs to be borne in mind that the SACAA is not considering the individual applicant, but the traveling public.
The closest the South African aviation community has come to a medical fatality in aviation was the pilot who, realising that something was seriously amiss during his flight, turned around and returned to Bloemfontein, landed, was taken to hospital and subsequently died from a stroke. The outcome for the pilot was tragic, but his decision to turn around and land back averted a potential disaster.
In the next issue we will discuss the Mood Disorder Protocol – keep an eye out for that.