Director of Aviation Medicine resigns

[dazza 38]

Mark Skidmore was/is well liked when I was in the RAAF. We shouldbe in good hands.

 

 

[DonRamsay]

for most DAMEs it appears to be a, very, part time job. I am not betting on the AVMED people but AVMED is their full time day job and they have opinions which should be respected as much as those of narrow Specialists or broad based GPs.

Lost all faith in Av Med when they perverted the concept of Drivers Licence Medical and made it more difficult than a Class 2. A Claytons DL Medical.

Quoting myself "Choke riddance" - got to love iPhone editor!

 

Should have been "Good riddance" of course. Not really interested in choking anyone, not even an AvMed official.

 

 

[DonRamsay]

It is interesting that old mate resigns not long after Skid is announced as the new CASA boss. Coincidence ?

I hope it is not a coincidence but the start of a large culture shift a shift of paradigm proportions.

 

My main concern is the new Director has very little experience in the world of business. Can't question his aviation credentials. Aviation (incl medical) standards for combat are an awful lot higher than old farts need to maintain in single engined light aircraft pottering around in Class G. I hope he can distinguish those different levels of risk.

 

The last Director had commercial experience but that didn't do us any good. I wonder how being an airliner Captain with one employee fits you out to be the Chief Executive of a bureaucracy the size of CASA? At least the new Director has experience of managing and motivating men and, from what you say Dazza, was good at it.

 

I don't envy Skidmore of the massive challenge he faces and do wish him all the luck in the world (except for that of the Irish).

 

 

[Chocolate]

At some point the cost of running avmed will factor in the new director casa thoughts. It is so obviously a cost saver if the decision is with a casa trained DAME with online updating to avmed.

 

Yes I am one of those who have casa costing them a small fortune in unnecessary specialist visits just to get a letter saying what the gp has already said to the DAME and the DAME has already assessed for himself. Living in a country area the specialist visit is a 600 km round trip. What really irks is the knowledge and embarrassment of so obviously wasting the valuable specialist time that would've been better spent on treating someone in need of urgent treatment.

 

Here's hoping the new director is more pragmatic and stops sending well people for endless medical testing.

 

 

[facthunter]

Don , we can't blame avmed for the RPL medical. the decision wasn't made by them. My information is McCormick made the decision . He has threatened to sue in the past so I will leave it at that. Nev

 

 

[DonRamsay]

Thanks Nev. I didn't know that.

 

It stands to reason that it couldn't have got through without McCormick's express approval but not obvious it was his idea. But it does fit with his early action to stop all advances in RA. It seems we were very close to get a MTOW increase just before he became Director and also transit through CTA.

 

 

[facthunter]

IF you followed all comments made by him from the outset , it was quite obvious he was uncomfortable with the whole concept of person built cheap flying, from when he first came along. I doubt there was any change from that attitude. If there was I saw no evidence of it. CASA haven't helped the RAAus. Au Contraire, they seemed to obstruct it. I would like the truth to come out on all this, because it might explain a lot of things. I don't claim we didn't have a few problems, but did they assist in sorting them out?. Taking 3 of our most skilled staff wouldn't help would it?

 

 

[kgwilson]

Does the new director have all of the qualities as per recommendation 7 of the Forsyth report namely?

 

7. The next Director of Aviation Safety has leadership and management experience and

 

capabilities in cultural change of large organisations. Aviation or other safety industry experience

 

is highly desirable.

 

It would appear that he fits with the second sentence.

 

 

[Downunder]

Thanks Nev. I didn't know that.It stands to reason that it couldn't have got through without McCormick's express approval but not obvious it was his idea. But it does fit with his early action to stop all advances in RA. It seems we were very close to get a MTOW increase just before he became Director and also transit through CTA.

I remember that. 760kg? RAA talking like it was signed sealed and delivered, just waiting for the rubber stamp.

I think we had a change of federal government?

 

 

[cooperplace]

I still have to wonder why the AMA do not stamp on this type of behaviour from Non Specialist Doctors, when a specialist has made a diagnosis?

it's not within their power to do so, nor would they want to, nor are they the responsible body.

 

 

[Downunder]

Taking 3 of our most skilled staff wouldn't help would it?

And using them against us............

 

 

[Chird65]

it's not within their power to do so, nor would they want to, nor are they the responsible body.

The AMA:

 

• Promotes and advances ethical behaviour by the medical profession and protects the integrity and independence of the doctor-patient relationship;
   
   
  
• Promotes and advances the public health;
   
   
  
• Protects the academic, professional and economic independence and the well being of medical practitioners; and
   
   
  
• Preserves and protects the political, legal and industrial interests of medical practitioners.
   
   
  

 

 

In their mission statement they support the industrial interest (of DAMEs), the independence of the doctor - patient relationship, and finally promotes the advancement of ethical behaviour. Is it ethical for anyone to change an outcome without any real explanation? All of this says they are the body that should support this. Incidently; to be a doctor you have to be in the AMA, therefore if a medical diagnosis is being made/changed they would be the place to start before legal avenues.

 

 

[Guest Andys@coffs]

The closest equivalent would likely be the medical staff within life insurance company's. A normal Doctor has one role and that's to make you as well (or worst case as comfortable) as you can be by diagnosis and action. As a result they will have a completely different outlook to a specialist risk manager, who has medical training.....One is all about you, the other is all about what can go wrong and what that will do to someone within everyone else......same string just opposite ends

 

 

[Gnarly Gnu]

Incidently; to be a doctor you have to be in the AMA

Yes, they are a cartel. Should be banned.

 

 

[Jaba-who]

Chird65 wrote " to be a doctor you have to be in the AMA"

 

I don't know where you got your information but its categorically wrong!

 

I am a doctor, a specialist, director of local specialist group, senior lecturer at a medical school, on multiple committees at hospitals I work at. I trained in Queensland, worked in two states and for 28 years since have been a practicing clinical doctor.

 

I'm not a member of AMA and have never been a member of AMA.

 

The AMA is essentially a doctors lobby group with both an economic and a medico-political role.

 

It has no role in training doctors or specialists, it has no role controlling what doctors can ethically do and certainly has no capacity to censure any doctor for things they do whether clinical, ethical, legal or not. That is the role of AHPRA ( registration board) and the specialist colleges to some degree.

 

As a group the AMA has been given representative capacity by the members ( probably the majority of doctors but by no means all) they have an opinion on many things in those areas of medical economics, politics and some broad community fields and their option is usually correct or at least justified. Their opinion carries a lot of weight and they do have the respect of governments etc. in those fields. The government and AHPRA has adopted some AMA opinions in the codes of conduct etc but these were subject to external oversight before being adopted.

 

 

[Jaba-who]

On the other note of specialists vs non specialist diagnosis and management etc. I would like to offer some insights to the assembled masses.

 

Despite my being a specialist and I really would like to right every time etc etc. - the idealised concept that a specialist must be right and a non specialist must be wrong if they disagree is also wrong.

 

I'm afraid doctors are like all other humans and pilots :-) . There are some good ones there are some bad ones. Specialists are sometimes good, sometimes very good and sometimes a few should have hung up their stethoscope or scalpel a long time ago.

 

Some keep up and are highly skilled while some become narrowed and lose skills in the broader picture just like artisans in any field. These days colleges all have some form of continued professional development and education and there are requirements on completing that to stay registered. But we all know some who manage to work around the system while not keeping fully up. Or just because their skills are superb in one area they attract a referred common caseload which lessens their exposure and currency in other areas.

 

I know some brilliant GPs ( who by the way should really be called Family Physicians or something similar because most now do a long "specialization" in family medicine. If your GP has FRACGP in his post nominals then he-she is a "specialist equivalent" in family medicine) despite the often down-played term of general practitioner.

 

A specialist is more likely to be right when covering subjects in his field of specialization but he may know less than a GP about things outside his field while some specialists have state of the art knowledge of even things that fall way outside their main area of expertise.

 

There is no rule or law that stops anyone suggesting that someone else's diagnosis or management is in error no matter what their ranking is. As long as you have the knowledge and can justify on clinical grounds then you can stand on your diagnosis. I have seen cases of the lauded senior professor being wrong while the young junior house doctor or GP got it right. Usually that's not the case but i have seen it enough times to remain humble when someone suggests I have something wrong.

 

End of rant!

 

 

[RKW]

That's not a rant. It's a frank and honest assessment of things medical. Thanks For your insight, Jaba.

 

 

[Chird65]

... That is the role of AHPRA ( registration board) and the specialist colleges to some degree..

Happy to be corrected. thank you

So on that basis who is the body that should question the unethical over ruling of a specialist report without review?

 

I agree on the GP front that some are worth my life, but that is not who I have the issue with it is the unseen bureaucrat who without observation but with evidence to the contrary makes a determination to affect someone's job. I just have a hobby but there are others who rely on this system.

 

regards

 

Chris

 

 

[Jaba-who]

That is a question I don't know for sure.

 

The problem is that CASA and the AvMed make an aviation decision based on a medical report but don't actually make a medical decision nor provide medical treatment.

 

Maybe the only grounds I see something could come of it is they demand you undertake a medical procedure that you don't want to do. Sort of a coerced assault.

 

But I think you would have to prove that say that the risks of the procedure, say maybe demanding you took a test that involved use of drugs or maybe XRay contrast media that you had an allergy to, and because you refused they withheld your license. But here I think there would have to be other options that were safe and were as reliable in giving the information required.

 

But I'm being very speculative.

 

I guess that you could make a complaint to AHPRA against the AvMed doctor that you believe he is not competent. Any member of the public can do this. There is a webpage with forms and advice on how to do it.

 

But again since he is not actually practicing medicine rather interpreting a set of rules on something far removed from medical treatment. I suspect it would be tenuous. But It might be interesting to see the results if a lot of people did it. AHPRA is not a law unto itself as is CASA.

 

Regardless of whether there was an eventual case against the AvMed doctor AHPRA would do some investigating and ask the doctor for his opinion or some explanation and it would put pressure on the doctor to perhaps reassess his interpretations. Of course his hands may be tied as well if he is just following on a set of rules. It may be more an issue if the doctor already has some complaints about him from his previous medical life. Not saying anything about the incumbent but in some cases government bureaucratic positions like the AvMed job are the last resort of the person who can't make it in the real world and who has had previous complaints about themselves and can't get a job anywhere else. Again I am not saying that about the guy that has just resigned - I don't have any idea - just saying that AHPRA might take it more seriously if a previous history of incompetence existed.

 

I can't say any of it would work and based on history CASA is likely to target a complainant for other issues - drag you in and scrutinize everything aviation about you looking for a way to get you. They do this - several people here in Cairns who have made a complaint about something only to have a letter arrive saying CASA wanted to inspect all their logbooks, all their maintenance releases etc and went through with a fine tooth comb till they found errors and then fined them. A local guy here had his plane trashed by the rescue helicopter hovering over it. Made a complaint for compensation and CASA ended up finding he had anomolies in his maintenance and bookwork. Fined him more than the repair costs, which they eventually paid but he lost out in the end.

 

But if you are going to lose your license anyway it might be worth a shot.

 

 

[Chird65]

See Jabba-Who, you have bought up my main issue, there seems to be unethical practices going on. It is a no win situation for the pilot, owner or DAME, what is needed is for a body that is not affected by the governing body (CASA) to take them to task. As you say this may not be AHPRA, that is why I thought AMA as a political body that represents a lot of medical professionals who has the ear of politicians and are seen as at least reasonable when it comes to medical process.

 

I also would not have a problem if the rules were applied evenly, or that the rules were actually known and published. At least then there would be an argument.

 

 

[facthunter]

I think you would find the AUTHORITY being entrusted with the job of maintaining SAFETY would oppose (successfully) an attempt to weaken it's authority. It uses that excuse for it's failings often. TRUST US. Yeah right..

 

. Let's hope the last 6? years can be left behind and move on to something MUCH better. (It could hardly be worse) Nev

 

 

[poteroo]

I'm afraid doctors are like all other humans and pilots :-) . There are some good ones there are some bad ones. Specialists are sometimes good, sometimes very good and sometimes a few should have hung up their stethoscope or scalpel a long time ago.Some keep up and are highly skilled while some become narrowed and lose skills in the broader picture just like artisans in any field. These days colleges all have some form of continued professional development and education and there are requirements on completing that to stay registered. But we all know some who manage to work around the system while not keeping fully up. Or just because their skills are superb in one area they attract a referred common caseload which lessens their exposure and currency in other areas.

Covers pilot proficiency perfectly. happy days,

 

 

[Jaba-who]

See Jabba-Who, you have bought up my main issue, there seems to be unethical practices going on. It is a no win situation for the pilot, owner or DAME, what is needed is for a body that is not affected by the governing body (CASA) to take them to task. As you say this may not be AHPRA, that is why I thought AMA as a political body that represents a lot of medical professionals who has the ear of politicians and are seen as at least reasonable when it comes to medical process.I also would not have a problem if the rules were applied evenly, or that the rules were actually known and published. At least then there would be an argument.

The problem is that you are saying that a legally accepted practice is unethical, whereas CASA would say he is doing his job.

 

CASA makes the rules about what medical conditions it will allow a pilot to fly with. It has the authority to decide and it is not asking either the DAME or the specialist whether they think you can fly with the condition. In reality they are are asking your DAME and the specialist to diagnose the problem and maybe provide all the data they used to make that diagnosis. They also want to know what treatment the various doctors have put a pilot on and whether the condition is stabilised.

 

CASA then makes the decision based on that data and, as we know , doesn't give a s..t about whether the doctor has also given an opinion about the pilots fitness to fly. He might as well be giving an opinion about the likelihood of whether it will snow at the north pole. In the eyes of law and CASA, giving an opinion on your fitness to fly is not the DAME or specialists job. They are just there to collect data and CASA then make that decision based on that data.

 

Even when you go to a DAME and he fills in the forms and passes you on your medical, he is really seeing how you stack up against a list of possible findings already provided to him by CASA. If you fit an appropriate number of ticks in the appropriate boxes you pass. The DAME Doesn't pass you fit to fly based on his knowledge. Although it may not seem like it, he tells you he has done an examination and found you fit the criteria set by CASA and therefore CASA says you're fit to fly.

 

So there in lies the problem. I think it will be very hard to claim a CASA employee who is not really acting as a doctor at all is practicing unethical medicine. I suspect AHPRA would say he's practicing CASA administration. He happens to be a doctor and is required to have aviation medical knowledge to get the job but his job is administration.

 

 

[cooperplace]

The AMA:

 

• Promotes and advances ethical behaviour by the medical profession and protects the integrity and independence of the doctor-patient relationship;
   
   
  
• Promotes and advances the public health;
   
   
  
• Protects the academic, professional and economic independence and the well being of medical practitioners; and
   
   
  
• Preserves and protects the political, legal and industrial interests of medical practitioners.
   
   
  

 

 

In their mission statement they support the industrial interest (of DAMEs),

 

Incidently; to be a doctor you have to be in the AMA, therefore if a medical diagnosis is being made/changed they would be the place to start before legal avenues.

That's not right. Their website says they represent 27000 doctors, but the ABS says there are over 70000 in Australia. The AMA is not the relevant body here. It would seem that the majority of doctors query the relevance of the AMA.

 

 

[cooperplace]

Chird65 wrote " to be a doctor you have to be in the AMA"I don't know where you got your information but its categorically wrong!

I am a doctor, a specialist, director of local specialist group, senior lecturer at a medical school, on multiple committees at hospitals I work at. I trained in Queensland, worked in two states and for 28 years since have been a practicing clinical doctor.

 

I'm not a member of AMA and have never been a member of AMA.

 

The AMA is essentially a doctors lobby group with both an economic and a medico-political role.

 

It has no role in training doctors or specialists, it has no role controlling what doctors can ethically do and certainly has no capacity to censure any doctor for things they do whether clinical, ethical, legal or not. That is the role of AHPRA ( registration board) and the specialist colleges to some degree.

 

As a group the AMA has been given representative capacity by the members ( probably the majority of doctors but by no means all) they have an opinion on many things in those areas of medical economics, politics and some broad community fields and their option is usually correct or at least justified. Their opinion carries a lot of weight and they do have the respect of governments etc. in those fields. The government and AHPRA has adopted some AMA opinions in the codes of conduct etc but these were subject to external oversight before being adopted.

he's right.