NZ New PPL Medical Standard

[Jaba-who]

12 hours ago, Arron25 said:

Can I ask the 'dumb question'.. Why haven't AvMed been pulled into the real world by the Mainstream medical fraternity?

The mainstream medical fraternity carries no legal weight. We all operate under the guidance of published data, accepted guidelines and modifications of the above based on experience, knowledge and “the art of medicine”.  We carry no capacity to dictate what the law should be and no capacity to dictate how a government arm wants to interpret or administer that law. 
 

There is ample evidence and experience of doctors of all levels disagreeing with CASA/AvMed, writing letters and reports etc and they simply ignore them. Since their decisions are outside  the accepted medical knowledge of mainstream medicine and into the realms of the law, real world doctors are essentially  powerless. 
 

Even when CASA says your doctor can approve your Basic Class 2 or your DAME approves your straightforward Class 2 they are being  disingenuous. 
In both cases the doctor is not saying you are fit to fly, the doctor is saying you meet a set of predetermined criteria set and overseen by CASA/AvMed and as such they can rubber stamp your medical. 

[pmccarthy]

And then CASA can reverse the decision of the examining DAME with no explanation.

 

[Ironpot]

On 08/03/2021 at 6:52 PM, Jaba-who said:

 

I honestly feel that there is still a lot more CASA scrutiny and oversight on the process than CASA is telling us. 

 

CASA make decisions based on Liability - they do not intend to incur any Liability directly or on behalf of the Australian Government on any issue. 

 

I had a well qualified instructor once who insisted that you should tell CASA nothing under any circumstances! Unfortunately that attitude plays into their hands because by withholding information the individual will incur the Liability in the event of any mishap.

 

Every decision that CASA/AvMed make will err on the side of caution in order that they dodge or cannot be held liable should anything happen no matter how unlikely. I now look at their actions through the lens of an Insurance underwriter and sometimes its easier to understand just why they make some of their judgements and proposals.  

 

Notwithstanding the AvMed stories, I still have problems trying to understand that taking photographs from an aircraft requires a a CPL/AOC etc etc. I'm afraid that unless there is a massive culture shift in CASA's attitude very soon the future of private aviation is not too bright.

[old man emu]

39 minutes ago, Ironpot said:

CASA make decisions based on Liability - they do not intend to incur any Liability directly or on behalf of the Australian Government on any issue. 

It would be very interesting to get the views of a legal eagle on just what degree of liability can be thrown onto a decision by a government body. Or it this attitude of "everyone must protect me", that seems to stem from the American legal system, giving rise to trivial litigation? Anyone with a pinch of common sense knows that using any means of personal translocation from walking to flying exposes us to risk. If a person decides to engage in that activity, surely they must accept the risk. Or is the liability of injury to someone through the actions of another so great that people must be prevented from acting?

 

Insurance companies have long employed people called actuaries who work out the risk to the companies of having to pay out money in the event of a a risk eventuating. It's simply the companies working out the gambling odds of losing a bet. From those odds, they workout how much money each insured party should put into the pot to cover the payout to a victim, plus enough to make profits. No different than a bookie.

 

CASA produces reports on accident rates. here is one: https://www.atsb.gov.au/media/32897/b20060002.pdf It seems from this report that the risks of injury or death whilst flying in Australia are incredibly lower than in most other countries where records are kept.

[Jaba-who]

18 hours ago, Ironpot said:

CASA make decisions based on Liability - they do not intend to incur any Liability directly or on behalf of the Australian Government on any issue. 

 

I had a well qualified instructor once who insisted that you should tell CASA nothing under any circumstances! Unfortunately that attitude plays into their hands because by withholding information the individual will incur the Liability in the event of any mishap.

 

Every decision that CASA/AvMed make will err on the side of caution in order that they dodge or cannot be held liable should anything happen no matter how unlikely. I now look at their actions through the lens of an Insurance underwriter and sometimes its easier to understand just why they make some of their judgements and proposals.  

 

Notwithstanding the AvMed stories, I still have problems trying to understand that taking photographs from an aircraft requires a a CPL/AOC etc etc. I'm afraid that unless there is a massive culture shift in CASA's attitude very soon the future of private aviation is not too bright.

I think history proves you partially incorrect on this. 
As I said the likelihood of some of the medical risks are statistically provable to be  way way less than 1% but CASA claims it uses the 1% rule. 
in many cases DAMEs and specialists in the field write long,complex and multiple reports stating the risks of a specific pilot are so low that the risk is negligible. 
 

If CASA’s sole criteria was to cover their rear ends legally they would have an easy out in the case of a inflight medical mishap. “The risks were deemed to be low, multiple doctors who KNOW the patient attested to this. The real world statistics show the risk to be low. Therefore CASA/AvMed approved the medical. “ 

 

But we all know that’s not what happens. Going against all the evidence can only be construed that delusional or malicious intent were involved. One opinion could be that AvMed/CASA are the workplace bully. The stripping of a pilots medical and thus control over that pilot  being the source of a feeling of power and the use of the unassailable excuse “safety” ( despite proof they contribute nothing to that safety) is used to make the perpetrator feel safe in doing it. 

[facthunter]

The rates they pay would not attract someone with the enough  Medical qualifications or suitability. regarding objectivity.. One they had, put you down as Psychologically Unstable if you disputed anything with him. On finding out some questionable comments on my medical file I asked for searches to find more. Suddenly My files went missing. Corrupt and not answerable for poor performance. They are untouchable and a Law unto them selves.

 Regarding the effectiveness of their requirement at predicting medical issues  there are many times a fatality has happened quite close to a recent renewal being passed.   Sometimes a Stress ECG (Bruces Protocol) may bring on a heart problem that may surface a few weeks later.

  We did get some progress in the late 80's with heart bypass patients regaining their ATPL's . Nothing (of significance) since then as far as I can see. Nev

[Jaba-who]

1 hour ago, facthunter said:

The rates they pay would not attract someone with the enough  Medical qualifications or suitability. regarding objectivity.. One they had, put you down as Psychologically Unstable if you disputed anything with him. On finding out some questionable comments on my medical file I asked for searches to find more. Suddenly My files went missing. Corrupt and not answerable for poor performance. They are untouchable and a Law unto them selves.

 Regarding the effectiveness of their requirement at predicting medical issues  there are many times a fatality has happened quite close to a recent renewal being passed.   Sometimes a Stress ECG (Bruces Protocol) may bring on a heart problem that may surface a few weeks later.

  We did get some progress in the late 80's with heart bypass patients regaining their ATPL's . Nothing (of significance) since then as far as I can see. Nev

Just wanting to clear something there. 

Doing a stress test/ecg carries small risk of a cardiac event but the statistics show if it’s going to happen it’s happens at the time of the test. Not weeks later.  There’s no, even theoretical,  reason why a workload event now with no negative  events would produce an adverse event in weeks time. 

[Yenn]

We will have this sort of problem forever in Australia. We have allowed the bureucrats to dominate government and they only want power. It does not matter about the relevance or sanity of their decisions. As long as they make the decisions they are happy and we have allowed them to get away with it for so long that we are lost.

[facthunter]

Jaba I know plenty of cardiac specialists who agree that the stress test can be quite dangerous in older patients.. I also know of a pilot having completed one a few weeks before, die walking to the carpark after a flight. Also of some dying during taxi after  a difficult let down in crook weather due too high a heart rate..  I was in a position to try to ascertain how effective these test were at predicting outcomes. The general view was not very. It's not just MY view.. Nev

[Jaba-who]

33 minutes ago, facthunter said:

Jaba I know plenty of cardiac specialists who agree that the stress test can be quite dangerous in older patients.. I also know of a pilot having completed one a few weeks before, die walking to the carpark after a flight. Also of some dying during taxi after  a difficult let down in crook weather due too high a heart rate..  I was in a position to try to ascertain how effective these test were at predicting outcomes. The general view was not very. It's not just MY view.. Nev

Hey Nev. I agree with your last wholeheartedly. A negative stress test doesn’t carry a lot of certainty that an event won’t happen. A positive stress test does carry more ( but not absolute) risk of an event happening. 
 

What I was referring to was the statement and only the statement that a  stress test can cause a cardiac event weeks later. 
This is NOT the case. 
 

Say a person has a negative stress test and then weeks later has a cardiac event. That does NOT mean the two events are related. In all likelihood the bad event was going to happen anyway irrespective of the stress test that was done weeks before. 
 

What you would have to do to show a link  say that is show that in two populations - one who had a stress test and one who did not that more people in the stress test group had an event weeks later than the group who did not do the stress test. Both groups could have coincidental cardiac events. The studies have to show a link. 
 

These studies have been done and the results are in. Having a negative stress test does not increase the chances that weeks later you will have a cardiac event. 

what it does show is that there is a small increase risk  in having a cardiac event AT THE TIME of the stress test if the patient is having the test for known symptoms suggestive of cardiac disease. However the risks are small, and the benefits of gaining specific information to direct treatment are significant enough to justify the risk:benefit ratio. 

If the patient is having a screening test eg pilot medical, insurance medical  ( and is thought to be well with no symptoms in the lead up AND has a negative stress test) the risks of events at the time of the medical are the same for both groups.
 

This logically has eliminated the test itself as cause of late (weeks later) events in everyone and for acute events ( at the time) in the otherwise fit and well well. 

[Jaba-who]

On 27/03/2021 at 7:57 AM, pmccarthy said:

And then CASA can reverse the decision of the examining DAME with no explanation.

 

Yep. And currently I have a mate who is in that exact predicament. In fact it’s a bit worse.
 

He initially for decades had a class 2. Then he got  a Basic class 2 and on the strength of continuing medical he bought a glassair. 
AVMED then sent him a letter saying “your medical was approved in error and we are removing your medical”. 
He has numerous cardiology reports with DAME  and specialists saying he is fit to fly. AvMed have said no. 

Reason is his ECG has a change in one small segment that has been present since at least he was in his 40s ( since his first ECG ever) according to him. He is now late 60’s.  This single ( probably genetic) change has probably been lifelong and as such is irrelevant. But it doesn’t fit AVmeds inflexible rule of no ECG changes. He originally got his medicals because the old wording was something like “no new changes since last medical” or something  but now is just “no changes”. 

Edited March 28, 2021 by Jaba-who

[old man emu]

1 hour ago, Jaba-who said:

This single ( probably genetic) change has probably been lifelong and as such is irrelevant

Just like mine. I bet it's genetic. Is his ancestry strongly Irish, Cornish or Welsh? 

 

My uncle dropped dead at the cardiac specialist's desk immediately after a stress test.

[spacesailor]

I,m due to ge a referral from my  GP, this week, for a stress test !.

The first one was to check if l could survive my hip operation.

That tirst test was without any stress, as l couldent walk, let alone run on a treadmill, just a halter cardiac checker.

NOW SHOULD l indulge in helping to give casa & cohorts a reason to stop me dreaming of flying.

Never had a test !, should  be a srandard reply to their medical requirements.

spacesailor

[Jaba-who]

40 minutes ago, spacesailor said:

I,m due to ge a referral from my  GP, this week, for a stress test !.

The first one was to check if l could survive my hip operation.

That tirst test was without any stress, as l couldent walk, let alone run on a treadmill, just a halter cardiac checker.

NOW SHOULD l indulge in helping to give casa & cohorts a reason to stop me dreaming of flying.

Never had a test !, should  be a srandard reply to their medical requirements.

spacesailor

I’m a bit confused.

Do you have to have a stress test or not for your aviation medical?
 

Unless you absolutely have to have one for real medical management, or if the rules have said you must then don’t have one.  

Absolutely do not, ever, never never have a test for your medical that you are not required absolutely to have.  
You should do only that which AvMed says you must. 

 

Trouble is that once CASA knows about it then you have to get on the hamster wheel if you want to go forward. 
unless you want to fly without a medical, which paradoxically as a result of CASA there are many doing just that. 

Edited March 28, 2021 by Jaba-who

[spacesailor]

Annual routine check up.

Just the medical practise trying to get revenue.

spacesailor

[facthunter]

IF they don't do anything when you present , they get issues on duty of care.   IF you don't like what you get in Australia compare it with what you get in other places,( Like the USA in Particular) Nev

[Jaba-who]

1 hour ago, facthunter said:

IF they don't do anything when you present , they get issues on duty of care.   IF you don't like what you get in Australia compare it with what you get in other places,( Like the USA in Particular) Nev

Not sure I follow. If you present for a medical they only need to do what the medical requires. But the catch is YOU have to be part of this deal and ONLY give informed consent for what is required in the medical. If YOU allow the doctor to extend the examination or tests then it’s “your fault.” 

when you present for an aviation medical you obviously have to tell the GP or DAME it’s for an aviation medical. 
two reasons: 

Firstly your own benefits so they don’t do too much. 
Secondly he/she  is not allowed to charge Medicare for that visit. (If they does it’s Medicare Fraud )

In terms of your own benefit you MUST tell the doctor you are having a medical and you only want examinations and tests that are required for your medical.

Doctors are neither stupid nor cold hearted. If you say you are required to have just the examination and tests asked for in the medical and CASA are known for overextending and taking peoples medicals off them unnecessarily and they will be on your side. 
 

It is false economy to go to your GP for a basic class 2 and say “can you give me a “normal” check up while I’m here as well. If you do,  he assumes a duty of care to you in an overall manner. And when/if he finds something it will have to go on the medical report. If your GP is also a DAME you should go to another GP or another DAME for your normal medical health care or for your medical. 
If you go to your GP for a class 2 basic it’s  far better to come back later for a “real” visit for your real medical care. In fact it is better that  you never go near your own doctor for any aviation medical. 

This might sound antithetical but it’s sadly the fact. Passing a  medical is not needed for your aviation medical safety except if you have one of a couple of very defined and severe medical conditions. For the vast majority of pilots including those who have lost their medical That’s proven and absolute. 
 

The medical is purely so CASA will let you keep your medical certificate. so only play the game in the manner CASA says you must. Don’t give them any ammunition. 

[pmccarthy]

My friend was required by CAsA to have a stress test for his Class 2. He did it against the advice of his cardiologist. He had a coronary event during the test. He was never the same and died of it some time later.

[walrus]

Just so you guys know...... At least one state -Victoria, has legislation where a GP can refer a car driver for a medical review of their  drivers licence  after an accident or injury, even if the injury is not related to driving a vehicle.

 

My friends in the Police tell me that the pass rate for such reviews is effectively zero. The answer is almost always NO to keeping your licence. This is basically the avoidance of liability by the reviewing medical authority.

 

Draw your own conclusions about the effect of this behaviour and Avmed's on the creation and maintenance of an effective safety culture.