A new federal aviation law known as BasicMed gives all licensed Indiana primary care physicians the power to evaluate a private pilot’s health and declare that patient fit to fly an aircraft.
Until last year, recreational pilots were required to get a third-class medical certification from a specially trained Aviation Medical Examiner (AME), a physician certified by the Federal Aviation Administration. For third-class pilots under age 40, certification was re-evaluated every five years and then every 2 years after that.
BasicMed, which Congress passed in 2016 and went into effect on May 1, 2017, allows private pilots to see any state-licensed physician — it doesn’t need to be their longtime doctor or an AME — every four years and complete an online course every two. Pilots aren’t required to submit the exam results to the FAA or present them when flying, but simply file them in their personal records. Only private pilots (don’t fly for compensation) who’ve obtained a medical certificate from an AME in the past 10 years, and who haven’t been previously denied a medical certificate or had a pilot license revoked, qualify for BasicMed.
Dr. Robert Habig, an experienced AME and private pilot from Indianapolis, worries this medical reform exposes local doctors without aviation experience to liability risk if the pilot has an accident or experiences a medical event while in the cockpit. He also thinks it could jeopardize the licensing of some private pilots if they unknowingly take prohibited medications or are diagnosed with a health condition restricted by the FAA and don’t follow proper protocol for reporting such issues.
Habig says BasicMed makes the skies more unsafe by loosening the medical examination standards of some pilots, essentially allowing them to pilot an aircraft on a valid driver’s license. More than 35,000 pilots now fly under BasicMed.
So we asked Habig, known to patients and colleagues as Dr. Bob, what advice he gives fellow doctors and pilots when giving talks at local airports or when they call his office at Westfield Premier Physicians to ask about BasicMed and FAA regulations. Here’s what the family practitioner had to say about aviation health.
Why is it important for Indiana physicians to be aware of the new BasicMed law?
I’ve spoken to several physicians groups already to get them prepared, because they will start encountering patients who are pilots and want them to sign this BasicMed medical questionnaire declaring that it’s okay, from a medical standpoint, to keep flying. They haven't come to them for a past pilot exam, because they were required to go to an AME before.
There are several health conditions and medications that pilots must report to the FAA and may require monitoring to make sure they’re safe to fly, so you need to know what those are and what’s not allowed by the FAA.
What health conditions prevent or restrict a pilot from getting licensed?
Epilepsy would be one example. If someone is prone to seizures, even though medicines control that, they shouldn’t be piloting an aircraft.
Any mental or head injuries, such as a history of a stroke or a ministroke called a TIA, are troublesome and take some testing and surveillance, and perhaps a visit to a specialist. The FAA wants assurance there’s a very low risk of it happening again.
Most blood pressure medications are okay, as long as they don't cause side effects. If you’re a heart patient and had blocked arteries repaired with bypass surgery, stents or ballooning, the FAA takes a very close look at those cases to make sure the patient is stable and won’t continue to experience cardiac problems.
Patients with active kidney stones or migraine headaches are forbidden to fly, simply because of the debilitating nature of those conditions. If you’ve had a history of kidney stones but they're quiet, or you passed one and haven’t had one since, it’s usually not a problem and the FAA simply wants to know if it happens again.
Unfortunately all cancers, if in active treatment of any kind, prevent pilots from flying an aircraft, even if they have a license and their medical certificate is up to date.
Which prescription medications are pilots prohibited from taking?
Taking some medications disqualify you from piloting an aircraft, period. For instance, anyone on what the FAA calls “mind-altering medications” cannot fly. That would include anxiety medications such as Valium.
The area concerning antidepressants has changed recently. Up until approximately five years ago, the FAA disallowed any antidepressants. They now allow four basic antidepressants on a case-by-case basis to treat mild to moderate depression: Prozac, Celexa, Lexapro, and Zoloft (and the generic versions of each). No other antidepressants, or any anti-anxiety or antipsychotic medications, are allowed in aviation.
I see a lot of 17 or 18 year olds who want to pursue an aviation career. They must first obtain their medical certificate, which is required by flight schools so students don’t waste time and money if they have a medical condition that disallows them to pilot an aircraft.
More and more of these youngsters going into aviation training take ADHD medications, but that’s a no-go for flying because the FAA says you cannot be on these medicines, even as a private pilot. We can work through the issue though. If your physician thinks it's safe enough for you to be off the medicine, you can still become a licensed pilot. The FAA doesn't make that call, your doctor does. The FAA just says you cannot fly while taking this type of prescribed medication.
What other health issues should pilots consider when deciding whether it’s safe to fly?
There’s a lot of personal responsibility when it comes to aviation. The FAA can't watch each and every one of us. For example, if somebody suffers from bad allergies and they take Benadryl. You may think because it’s an over-the-counter drug, there’s no harm in taking it. Not so. As we all know, Benadryl can cause some drowsiness or sleepy side effects.
We as pilots take on that personal responsibility to not fly an aircraft if we are on any medicine that causes side effects or if we are sick, even with a bad cold. If your head is all stuffed up, you’re achy and so forth, it’s our responsibility — while not strictly forbidden — to not pilot an aircraft if we’re less than 100-percent healthy.
As an AME, have you ever denied a pilot’s medical certification?
There are three things I can do when a pilot comes in. No. 1 is issue their medical certificate if they meet all the requirements. No. 2 is to defer. If they have a health problem that's come up, such as sudden migraine headaches or they recently had a heart stent put in, those are things that are mandatory for an AME to defer. That means the person doesn't walk out of my office with a fresh medical ticket. Their medical exam is deferred to Oklahoma City, which is the FAA headquarters, and we have to submit all of the necessary paperwork explaining why we're holding back their medical certificate so the FAA can take a closer look at the case.
When the FAA reports back to the pilot, I always get a duplicate a letter. It often asks for additional information like reports from the treating physician or a specialist, or hospital records if it was a cardiac condition or stroke. FAA committees meet to look at each individual case and ascertain whether those pilots will need to go through a waiting period for that condition. Or, they can decide to issue their medical certificate and mail it directly to the pilot.
The third option as an AME is to deny the pilot’s medical certificate. I don't like to take that approach. I like to give some glimmer of hope to every pilot who comes in here. In most cases, the FAA works with pilots to get just about every person who really wants to fly up in the air. It's really only in the most severe cases, like I said before about epilepsy or some major condition which isn’t likely to improve, that the FAA can't issue a medical certificate.
I’ve never denied a pilot, but I've advised quite a few of them. I tell them, this is probably not going to go through unless we defer it. Let the FAA take a look and maybe they can find a way to work through the issue to get you in the air. But in some cases like a terminal health condition or serious cardiac issue, they just can’t. Most everyone can get through with a medical certificate or at least get a deferral.
What advice do you give to pilots who seek your professional guidance?
I always say the FAA is the judge, the jury, and unfortunately in some cases, the executioner. They have tremendous power, but if you think about it, that’s a good thing because we all want the skies to be safe. We want to be safe when we fly commercially. We want the small airplanes as they fly over our neighborhoods and schools to have safe pilots. So, the FAA is basically the rulemaking body of aviation, other than when a rule is mandated by Congress like in the case of BasicMed.
The FAA makes the rules and they stick to them. I advise pilots when I visit local airports or have informal talks with pilot groups and answer questions. One of the things I stress to them is what I call the “truths and consequences” section of my talks.
When a pilot comes in for their medical certificate exam, what would prevent them from not disclosing a medicine or health condition that’s non-discoverable? If a patient had stents put in their coronary arteries, even on a full exam, I can't tell that by looking at them. If I asked them if they ever had a heart condition and they said no, I would pass them not knowing they really do have an underlying cardiac condition.
That's fraud and the FAA can be very, very strict if they find out. The pilot can be fined up to $250,000 and put in jail for up to five years for not telling the truth. My advice to pilots: Tell it all. They often respond, “But I may not get my medical if I do that.” The consequences for not being upfront with the FAA are very powerful.
What if the FAA never found out? That's possible, and there are probably pilots out there flying without a legal medical certificate. They're taking tremendous chances if they are inspected or caught, or if there's an accident, God forbid, and it’s discovered during the investigation that they were not medically cleared to fly.
That’s double trouble, because now the pilot’s insurance can actually walk off and say that because the pilot wasn’t a legally licensed pilot, they don't have to cover you. If you've committed some type of liability, personal injury or damage, you may not even have insurance backing you, so it's very risky business.
As a pilot, it’s our responsibility to immediately report to the FAA any changes in medicine, whether it’s a new medicine or a change of dosage, or even stopping a medication. That's how the FAA under the new BasicMed rules hopes to catch mistakes, such as a primary care doctor unknowingly prescribing a medicine that’s not permissible for pilots.
If the pilot files a change in medication and the FAA doesn’t allow it, the agency will often communicate with the pilot, and sometimes ask an AME to work with the primary care physician, to see if there’s a workable solution that will allow the pilot to continue flying.
Commit to tell it all, even if your medical certificate gets deferred. I work with those pilots, and the FAA works with them to really try and get as many pilots back in the air as possible.
What advice would you give primary care physicians who examine BasicMed pilots?
If there’s a question, pick up the phone and give me a call at my office. I think most AMEs are more than happy to answer questions about whether a pilot patient should start or stop a medication, whether the drug is permissible or whether a certain medical condition is permissible.
Please reach out. You could very well, even as an excellent physician but not knowing aviation medicine, put a pilot on a medication that's disqualifying and that could lead to some real problems for the pilot and your career.
Why is aviation health such a passion for you?
I probably examine 500 pilots a year. Pilots call me every day. Our conversations are completely off the record — there's no reporting of any kind when I’m just giving advice.
As a direct primary care physician, I give patients my full attention and spend time during each visit to get to know all about their lives, interests and hobbies. Those insights help me better evaluate a potential pilot’s fitness to fly and address any potential health concerns before they become serious problems that end their flying career.
I enjoy every part of aviation and love talking to fellow pilots. I even have an exam room outfitted with my aviation paraphernalia, which is fun to share with pilots who come in. My staff knows I like to spend a lot of time with patients who are pilots, even if we’re just talking about planes and aviation.
Whether you’re a pilot or physician, a patient of mine or not, it makes no difference. I’m happy to answer your questions anytime. Contact us at Westfield Premier Physicians and I’d love to talk aviation and help you navigate the new BasicMed rules.
My goal, not only as a physician but as a pilot, is to keep the skies as safe as possible. I want to be safe when I’m up there, and I want other pilots to be safe as they travel with family, friends, and other passengers. I want to make sure they’re at the top of their game and 100-percent healthy.
Hopefully I've got a lot of years left to fly myself, but even if my flying career comes to an end, I hope to be an AME for years to come. Aviation health truly is a passion of mine.
Dr. Robert Habig is a family practitioner born and raised in Indianapolis. He’s a graduate of North Central High School, Notre Dame, and IU School of Medicine. He completed his family medicine residency at Methodist Hospital before starting Westfield Premier Physicians in 1980.