When certification is questioned, the AME has several options. Dr. Reinhart noted that some AMEs simply send in their findings and let the FAA inform the pilot what additional tests are needed. However, when everything is left up to the FAA, the process takes longer.
"A lot of pilots have been grounded unnecessarily, or it's taken months and months to get them certified," Dr. Reinhart said. When the AME knows what further tests the FAA will require, Dr. Jackson said, "the examiner can send his paperwork to the FAA and tell the pilot to get certain tests done and send them to the FAA. They'll meet up in Oklahoma City. The FAA will review the medical reports. If they decide to issue a ticket, they'll send it in the mail to the applicant."
Suppose test results do not meet First Class standards but do meet those for Second or Third Class. The pilot can ask the AME to issue a lesser certificate immediately, which can be upgraded to First Class if and when further tests prove the applicant is qualified.
"The standards for Second and Third Class are much more generous than the standards for First Class," Dr. Jackson said. "For example, the blood pressure standards for Class II and III are a maximum of 170/100 at all ages."
Dr. Reinhart said the major difference for vision is that "the FAA is going to look at vision more carefully for a First Class."
Audiometric standards for hearing are basically for First Class only; a pilot has to distinguish the doctor's whispered voice at just eight feet, rather than 20, to meet Class II standards.
A Second Class medical certificate is good for one year. A First Class ticket that is not renewed after six months automatically lapses to a Second Class for the following six months.
Probably the most expeditious way to speed First Class certification is for the AME to perform or order the required retesting. In a simple case, such as a positive glucose test, Dr. Jackson said, the doctor can send the pilot to a laboratory that day or the next for a repeat urine test and several blood tests. If these results rule out diabetes, the AME can then issue a First Class certificate right away.
If a specialist is needed to perform tests, such as for a possible heart murmur, Dr. Reinhart suggested, the process can be streamlined if the AME refers the pilot to a colleague, attaches the subsequent results to his report, and perhaps talks directly with an FAA doctor regarding the application. (The doctor may ask the pilot to ground himself during this process if a significant medical problem is suspected.)
For quickest results, Dr. Reinhart recommended that pilots choose the physician most willing to work with the pilot. Dr. Reinhart pointed out that FAA medical regulations are open-ended, with few absolutes. "While the regulations have remained the same, the interpretation of the significance of medical problems, what medications are acceptable, changes every day," he said. "Flexible regulations give the FAA discretion to look at each individual."
Even with vision and blood pressure, where standards have been quantified, he explained, "If we can prove everything is all right, the FAA will accept it."
ALPA's Aeromedical Office
ALPA members with medical or medical certification problems can ask their local aeromedical consultant for help. At the national level, the union's Aeromedical Office employs three knowledgeable, full-time physicians who advise pilots on how to maintain medical certification or get recertified.
Pilots usually are asked to have their AME forward the records from the Class I exam to the Aeromedical Office. An ALPA doctor will then discuss the findings with the pilot in terms of qualification for FAA medical certification.
The ALPA doctors, who (unlike many AMEs) are well-versed in what further tests the FAA will require, may then refer the pilot to other physicians for further evaluation. The office works with some 400 highly qualified specialists, often professors in medical schools or doctors affiliated with large clinics. "You need that kind of medical horsepower to turn the FAA around sometimes," Stone said.
The specialists send their reports back to the Aeromedical Office, which prepares and sends the pilot's application directly to the appropriate FAA personnel in Oklahoma City. In most instances, the FAA discusses the case with the Aeromedical Office and, through the office, recertifies the pilot.
ALPA can be helpful even in very unusual cases. Stone told of one pilot who was grounded for five weeks while his application sat in the FAA mailroom; his FAA doctor had not addressed and stamped his application correctly. ALPA's head physician, Dr. Richard Masters, called Oklahoma City and had the pilot's certification released that afternoon. "We handle about 1,200 cases a year," Stone added. "If pilots get to us quickly enough, they normally will not get grounded needlessly, because our doctors know so well how to work inside the system."
The Aeromedical Office can be invaluable when the FAA changes medical policy. "If the FAA is suddenly approving people on oral hypoglycemic agents for diabetes, for instance, we know about it within hours," Stone said. "We will tell pilots who are on those that we're going to turn the paperwork around and get them certified."
