Guest Post: Has AOPA’s position on medicals contributed to these accidents?

aopa medical accidents
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Guest Post by John Shewmaker, DO

JDA neither endorses nor has assessed the accuracy of the opinion/assertions/facts as expressed by Mr. Shewmaker. A previous post here (AOPA’s Unusual Critique Of The NTSB Might Be Addressed By SMS) presented AOPA’s views. Fairness makes it appropriate to post this contrary view. Mr. Shewmaker is neither employed by nor affiliated with JDA. 

Further commentary is welcomed!!!

[unedited as to form or substance]

A recent letter from an executive with the AOPA regarding the NTSB gave me pause to reflect upon the events leading up to both the light sport class rule and also the Basic Med “reform”.

Specifically, the AOPA representative referred to two recent “Probable Cause Reports”.

“In two cases, accidents CEN15LA195 and CEN15FA281, death was attributed by medical examiners to blunt force injuries. However, the accidents occurred in airport traffic patterns in scenarios typically associated with loss of control—a scenario consistent, in one case, with an eyewitness account.”

In the first place, all incapacitating events will cause loss of control,  so the second sentence is completely meaningless as the loss of control occurs as part of the accident not as it’s cause. Second, AOPA is ignoring that in both cases non-NTSB medical examiners stated medical issues were likely contributory to causing the crashes.

Further, focusing on the cause of death being “Blunt force” trauma is a red herring. When a drunk driver hits a tree, an autopsy might say death was from “blunt force” trauma, but, drunkenness was the cause.  AOPA appears strangely and/or conveniently confused on the definitions of CAUSE and EFFECT.

The AOPA’s does make a valid point that the NTSB has often been hasty to reach judgments in their probable cause reports.  If you carefully review past NTSB dockets and narratives, you quickly realize they are usually far less thorough in collecting all available records needed to do an investigation.  They were far more thorough in their record gathering with each of these two accidents.

The AOPA’s position is that the NTSB should not assign a medical cause to an event unless there is definitive evidence of medical cause.  That would negate the whole concept of “probable cause” and is quite ironic since they chose to highlight two accidents that were definitively medically caused.  These two accident investigations are rare not by their findings, but by how thorough they were.

So, why was AOPA so right about the poor quality of NTSB reports, yet so tragically wrong in the presentation of the two cases that they actually are mentioning?

Perhaps AOPA feels some guilt. When the Light Sport rule came into effect in 2005, it was enacted by the pushing of “reforms,” led (in no small part) by AOPA.  AOPA’s position was that medical causes of accidents were rare, despite the fact that there had been practically no scientific inquiry on that particular question.

The sad part is that anyone who has carefully studied the NTSB reports knows that these reports are often based upon a paucity of any medical information or records.  Ofttimes, the NTSB doesn’t even get the full FAA medical records, which is shocking, since often these records will point them to the decedent’s family physician.

The NTSB (AOPA’s source) however has never made a finding that medical accidents are rare.  Not one single study of known accident causes has found that.  The NTSB does claim that a great many  accidents are caused by loss of control for unknown reasons.  Unknown is a word. It has meaning.  ‘Unknown’ means that the NTSB doesn’t know what causes a great many  fatal general aviation accidents.

So, what AOPA has done is take this information and misinterpret what it is saying.  They would have you believe that if you had 100 people in a room and 90 had their eyes closed, you would look at the 8 brown eyed people and 2 blue eyed people whose eyes were open and then you would claim that 8% of all humans have brown eyes.  That is precisely what AOPA is claiming by lumping “unknown cause” into the mix.  And it is patently wrong.

When we eliminate all the “unknowns” and just study the accidents with known causes (ie, when we actually do real science)  we get a much better sense that a lot of medical accidents are occurring among accidents with known causes and thus this predicts that many of the unknowns will also be medically related.  It’s basic scientific method applied.

The reason so many accident causes are unknown are for two reasons: the NTSB has often been quick to close the book before they even have the necessary information to begin an investigation and also the NTSB apparently has no working definition of “medically caused accident” which can consistently be applied.  Certainly sudden incapacitation would be one very small subset of “medically caused accident” but sudden incapacitation is only one of many ways in which medical accidents occur.

So, how might have AOPA caused the deaths in these accidents?  Let’s look at the two cases.

In the first case (CEN15LA195), the pilot had every reason to know that he had no business flying.  Under the light sport rule, he was responsible for not flying if he had reason to know of a condition that would ground him.

It was well established that he had severe heart disease.

If he was honest but lacked the cognition to realize he shouldn’t be piloting the airplane,  he is dead in no small part due to the efforts of AOPA and others to get him airborne despite a paucity of science on the topic of medical accident causation.  Make no mistake, medically, this pilot was in no position to react appropriately to the stressors of flight or altitude and that was demonstrable by the events which led to him dying.

The medical section of the NTSB report clearly spells out that this pilot was unfit to fly that day:

“A review of primary care and cardiology records from January 2012 until April 2015 revealed the pilot had a history of coronary artery disease treated with multi-vessel bypass surgery, high blood pressure, elevated cholesterol, and hypothyroidism. He also had diet controlled type 2 diabetes with peripheral neuropathy resulting in difficulty with balance and walking, as well as major depressive disorder with mild symptoms controlled with fluoxetine.

The Autopsy simply piled on to the already overwhelming evidence:

“…an enlarged heart, severe multi-vessel coronary artery disease with coronary artery bypass grafts and complete occlusion of two bypass vessels. …evidence of an old heart attack with scarring of the ventricular septum and active inflammation of heart muscle of the anterolateral wall of the left ventricle.”

We can also prove the accident was medically caused by the pilot’s doctor’s statements in the medical docket papers:

“The physician’s note stated “In terms of peripheral neuropathy, I encouraged him to go to physical therapy for strengthening of lower extremities, to help prevent falls. I told him walking on uneven ground should not happen anymore. He needs to have some kind of balance stick if he were, but again I strongly encouraged him not…” A neurologic examination was not conducted during this visit but an exam 8 month earlier documented decreased light tough and absent vibratory sensation in both feet.”

In the second accident (CEN15FA281), a non-ntsb medical examiner also decided medical issues were contributory.  And when the NTSB gathered further medical records this was confirmed:

“Since his last medical certification examination, an exercise stress test showed no significant changes but his coronary artery disease had progressed as demonstrated by a cardiac catheterization that showed 90 percent occlusion of the left anterior descending coronary artery with impaired blood flow to a part of the heart muscle.”  In other words, at rest, on the ground, his heart muscle wasn’t getting blood adequately. At altitude, or in a steep turn, or when stressed due to an unforeseen issue, he was at extremely high risk of not oxygenating his heart and subsequently suffering an ischemic event.

Cognitively, both of these pilots should have been fully aware that they were not healthy enough to be flying aircraft.  Even if heart issues were not the cause of these accidents, neither of these pilots should have ever decided that is was appropriate to fly on the day that they died.  Additionally,  under the third class medical certification process neither would have been eligible to have being doing so legally.

The light sport class and its evolution almost certainly contributed to these pilots deciding to fly despite medically having no business doing so.  One must consider then which entities are most culpable in their deaths.  Perhaps one of these entities is currently pressuring NTSB not to declare accidents as having medical causes, when in fact, these accidents weren’t just probably medically caused, they were definitively medically caused.

 


Cited

National Transportation Safety Board Docket Management System: CEN15LA195, CEN15FA281

Aircraft Owner’s and Pilot’s Association Letter to National Transportation Safety Board

Head in the Sand, Death in the Clouds, John Shewmaker, DO, Amazon, 2016.
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