T HE ST ANDARD OF CARE AND L E GAL L IABIL IT Y OF - PowerPoint PPT Presentation

T HE ST ANDARD OF CARE AND L E GAL L IABIL IT Y OF PHYSICIANS UNDE R “Ba sic Me d” L ORNE B. SHE RE N, MD, JD

 Se nior a via tion Me dic a l E xa mine r sinc e 1980  Boa r d c e r tifie d a ne sthe siolog ist a nd Inte r nist  5000 hour AT P r a te d pilot  Pa st Pr e side nt Ame r ic a n Bona nza Soc ie ty  JD Se ton Ha ll Unive r sity Sc hool of L a w (Ne wa r k, NJ) 2005 Ma g na Cum L a ude

WHAT IS BASIC ME D?  An a lte rna tive me dic a l c e rtific a tio n me tho d pa sse d b y Co ng re ss July 2016 a s pa rt o f F AA F unding Bill fo r pilo ts a c ting a s pilo t in c o mma nd o f a c o ve re d a irc ra ft  14 CF R 68 ra the r tha n 14 CF R 67  Administe re d b y F lig ht Sta nda rds (No t Me dic a l Bra nc h)

What is a Cove r e d Air c r aft?  L e ss tha n 6,000 po unds c e rtifie d ma ximum c e rtific a te d ta ke o ff we ig ht  Ce rtific ate d a t no mo re tha n 6 o c c upa nts (inc luding re q uire d flig ht c re w)  Ope ra te d a t le ss tha n 250 kts  F lo wn b e lo w 18,000’ MSL  No t fo r hire

Othe r Re quir e me nts  Ho ld a va lid drive rs lic e nse a nd c o mply with a ny limita tio ns the re o n  Ha ve he ld a va lid me dic a l c e rtific a te (a ny c la ss) issue d a fte r July 15, 2006 (10 ye a r lo o k b a c k pe rio d).  Spe c ia l issua nc e OK  Ha ve a CE MC (Co mple tio n o f Me dic a l E duc a tio n Co urse ) c e rtific a te issue d within the pa st 24 mo nths  Ha ve a c o py o f physic a l e xa mina tio n fo rm sig ne d b y a lic e nse d physic ia n within the pa st 48 mo nths

CE MC  Ava ila b le o n line thro ug h AOPA a nd o the r so urc e s  No c o st  Co ve rs va rio us to pic s re la ting to me dic a l sa fe ty o f flig ht  Co mple tio n is se nt to F AA  Inc lude s a sta te me nt a g re e d to b y a pplic a nt tha t sta te s: “I unde rsta nd tha t I c a nno t a c t a s pilo t in c o mma nd, o r a ny o the r c a pa c ity a s a re q uire d flig ht c re w me mb e r, if I kno w o r ha ve re a so n to kno w o f a ny me dic a l c o nditio n tha t wo uld ma ke me una b le to o pe ra te the a irc ra ft in a sa fe ma nne r.”

Pilot Comple te s Me dic al Histor y F or m This image cannot currently be displayed.

E xamining Physic ian Signs E xamination She e t and Ce r tific ation

Any L ic e nse d Physic ian E xamine s Applic ant and Signs Ce r tific ation

What About Spe c ial Issuanc e s?  Spe c ia l Issua nc e pro c e ss a llo ws a n a irma n to b e c e rtifie d o n a c a se b y c a se b a sis in spite o f the pre se nc e o f disq ua lifying me dic a l c o nditio ns  Initially issue d b y the F AA (CAMI) a fte r a spe c ifie d wa iting pe rio d  Co nditio ns o f issue a re spe c ifie d in Spe c ia l Issua nc e L e tte r  U sua lly a nnua lly

Can an Air man F lying Unde r a Spe c ial Issuanc e F ly Unde r Basic Me d?  YE S!  No spe c ific te sting re q uire me nts; te sting is a t the disc re tio n o f the e xa mining physic ia n  No re sults a re sub mitte d to the F AA fo r re vie w

CACI Pr ogr am  Co nditio ns AME Ca n Issue  Se t o f c o nditio ns fo r whic h F AA pub lishe s c rite ria whic h, if me t, a llo w fie ld issua nc e o f me dic a l c e rtific a tio n witho ut prio r re vie w b y F AA  Sa ve s F AA a nd pilo ts time a nd mo ne y  Pro g ra m is e xpa nding

F r om a Basic Me d Standpoint Spe c ial Issuanc e s and CACI Conditions ar e Handle d in a Similar Manne r  T e sting a t the disc re tio n o f the e xa mine r  No re sults se nt to F AA fo r re vie w

Bac k to 1L … … …

E le me nts of a Ne glige nc e T or t  Duty  Bre a c h  Ca usa tio n  Da ma g e s

Me dic al Inc apac itation is an E xtr e me ly Rar e Cause of Aviation Ac c ide nts  Is this b e c a use o f e xte nsive me dic a l re vie w o f pilo ts?  3 a c c ide nts pe r 1000 re sult fro m inc a pa c ita tio n o f a ny c a use US study)  0.64% o f fa ta l a c c ide nts (Austra lia n study)  Mo st c o mmo n c a use - g a stro e nte ritis. T he n he a rt a tta c k (mo re like ly to re sult in fa ta lity ho we ve r)

Ar e F AA De signate d Me dic al E xamine r s Immune fr om Civil Suit Unde r T he F e de r al T or t Claims Ac t?  No .3d 407 (9 th Cir. 1997).  Cumming s vs. Smith, 106 F  Cumming s, a n a irline pilo t, sue s Smith, a n AME , a fte r Smith se ize s he r Airma n Me dic a l Ce rtific a te a fte r Cumming s suffe rs fro m dizzine ss a nd pa rtia l lo ss o f c o nsc io usne ss. Cla ims da ma g e s unde r Bive ns. (Bive ns v. Six U nkno wn Na me d Ag e nts Of F e de ra l Bure a u o f Na rc o tic s, 403 U .S. 388 (1971) (e sta b lishing da ma g e s re me dy fo r pe rso ns who se c o nstitutio na l rig hts ha ve b e e n vio la te d b y fe de ra l a g e nts).)  De c ide d a g a inst Cumming s fo r la c k o f sta nding ; the Co urt ho lding tha t sinc e she wa s me dic a lly ine lig ib le fo r the c e rtific a te the re wa s no impro pe r “ta king ” b y the AME .

 Dic ta in the disse nt sta te s, “Smith is no t e ntitle d to q ua lifie d immunity, a nd q ua lifie d immunity is no t a va ilab le to a priva te pa rty e ng a g e d in a fe de ra l a c tio n.” F .E . T ro tte r, Inc . v. Wa tkins, 869 F .2d 1312, 1318 (9 th Cir. 1989)

 Se e a lso Unite d Sta te s v. De Ma ria 11 th Cir. 2016 (unpub lishe d). F AA b ring s e nfo rc e me nt a c tio n fo r fa lsific a tio n unde r 18 U.S.C. 1001(a )(2) a fte r a nswe ring in the ne g a tive q ue stio ns re g a rding a histo ry o f fa ile d drug te sting .  “T he Go ve rnme nt a lso o ffe re d e vide nc e tha t the AME is no t a n F AA e mplo ye e a nd do e s no t ha ve a c c e ss to a pilo t’ s pre vio us a nswe rs to fo rm 8500…..”

 F AA de sig na te s ma ny c a te g o rie s o f pro fe ssio na ls to pe rfo rm c e rtific a tio ns in lie u o f F AA pe rso nne l.  T he y a re g e ne ra lly re spo nsib le to pe rfo rm the ir func tio n in a c c o rda nc e with F AA sta nda rds  Ge ne ra lly, if a ll sta nda rds a re c o mplie d with lia b ility will no t b e g ro unde d.

 No c a se s whe re a n AME ha s b e e n fo und lia b le fo r ne g lig e nc e in issuing a me dic a l c e rtific a te in a c c o rda nc e with the sta nda rds c o nta ine d in Pa rt 67.

Duty  T o who m?  Is the re a do c to r pa tie nt re la tio nship thus e sta b lishing duty?  Ca n duty b e e sta b lishe d in a ny o the r wa y?  Is the re a duty to third pa rtie s?

Br e ac h  Wha t wo uld a “re a so na b le ” physic ia n (flig ht surg e o n) do ?  E sta b lishe d b y e xpe rt te stimo ny (sinc e b e yo nd the ke n o f the a ve ra g e juro r)  Simila r to a ny o the r pro fe ssio na l lia b ility a c tio n

How Ar e Ac tions of a Re asonable Ce r tifying Physic ian De te r mine d?  No c a se la w o n this ye t  L ike ly c rite ria wo uld b e wha t wo uld the F AA ha ve re q uire d  So is this a g o o d de a l fo r the a pplic a nt? F o r the Do c to r?  Wha t if the c e rtifying physic ia n do e sn’ t kno w?

Doe s T his Inc r e ase a Doc tor ’s L iability ove r the L iability Inc ur r e d as a F AA De signate d AME ?  F AA de sig ne e ha s the b e ne fit o f tra ining re la ting to F AA c rite ria fo r c e rtific a tio n  F AA de sig ne e ha s b e ne fit o f F AA re vie w o f sub mitte d ma te ria ls  F AA de sig ne e c o uld b e re g a rde d a s a n “e xpe rt” in te rms o f me dic a l c e rtific a tio n  No ne o f this a pplie s to the no n-de sig na te d physic ia n sig ning o ff a n a pplic a nt.

Standar d of Car e  Mo st like ly will b e “Wha t Wo uld the F AA Ha ve Re q uire d”  F o r no n-spe c ia l issua nc e s, will re q uire c o mplianc e with e xisting Pa rt 67 Sta nda rds  F o r E xa mple : visio n, he a ring , me dic a l histo ry  F o r spe c ia l issua nc e s c o mple tio n o f a ny te sting the F AA wo uld ha ve re q uire d ha d the me dic a l b e e n issue d thro ug h the spe c ial issua nc e pro c e ss  F o r CACI c o nditio ns wo uld re q uire c o mplia nc e with CACI c rite ria

Doe s T he Ce r tifying Physic ian Have to F ollow the Spe c ial Issuanc e or CACI Cr ite r ia?  NO- b ut………

 In the e ve nt o f a c la im o f me dic a l inc a pa c ita tio n the c e rtifying physic ia n wo uld b e o n sha ky g ro und if Spe c ia l Issua nc e o r CACI c rite ria a re no t a dhe re d to .  So the kno wle dg e a b le physic ia n will o rde r the sa me te sting a s the F AA re q uire s  So wha t’ s the b e ne fit to the a irma n?

 Ca n the a irma n find a do c to r who is willing to “sig n him o ff” with le ss tha n the F AA re q uire d te sting ?  T he re is no o ve rsig ht b y the F AA, so no se c o nd g ue ssing o n the re sults o f te sting  U nle ss the re is a n issue - the n the re is lo ts o f se c o nd g ue ssing