DAME/DAO Newsletter - March 2000
Contents
Acknowledgment
Distribution
Correspondence to Director of Aviation Medicine (and
other staff)
New Medical Records System (Nu-MRS) developments
Aviation Reference Numbers (ARN)
Taxation and eligibility of services for Medicare benefits
New opportunities in aviation medicine
General updates
Continuing difficulties affecting medical examination
forms
Feedback
Formal Appointment: Director of Aviation Medicine
Acknowledgment
DAMEs / DAOs should confirm receipt of this Newsletter per return email to <urban_ma@casa.gov.au> Alternatively, please fax confirmation of its receipt to CASA AvMed at (02) 6217 1640.
Distribution
DAMEs / DAOs should read and digest the contents of this Newsletter, retain it for future reference, and make relevant sections of it available to staff members who have dealings with CASA on behalf of practice principals.
Correspondence to Director of Aviation Medicine (and to other staff)
Much routine correspondence received by AvMed is addressed to the Director of Aviation Medicine, sometimes by name. AvMed’s routine office procedures are such that mail received here - several hundred items per day - is opened in bulk and directed for action to wherever the clerical officer on the mail desk that day believes it should go. Consequently, DAMEs and other correspondents are sometimes annoyed when I have not personally seen or dealt with some item addressed to me. Similarly, I have several times been embarrassed by the system’s failure to direct to me material which I wished to deal with personally.
To overcome this problem, DAMEs / DAOs who wish a matter to be dealt with personally by the Director or other particular member of staff should mark their correspondence ‘FOR PERSONAL ATTENTION OF [NAME]’, ‘TO BE OPENED ONLY BY [NAME]’, or some such formula.
New Medical Records System (Nu-MRS) developments
Migration of stored data from the former MRS is now almost complete. Unfortunately, numerous unexpected software and programming problems have delayed Aviation Medicine Section’s ability to benefit from the new system’s capabilities as rapidly as anticipated. However, by the time DAMEs / DAOs receive this Newsletter, Version 2 of the new system will be operational, with most of the so-far identified problems resolved. (Or so our I/T folks assure us).
Legal cover for the extension of the system’s full interactive benefits to DAMEs / DAOs is imminent and work on this aspect of Nu-MRS will begin as soon as the internal system is fully operational. At this stage, Aviation Medicine Section anticipates that electronic lodgement of medical examinations and reports will be a reality before the end of FY 99/00.
Aviation Reference Numbers (ARN)
Despite repeated requests by AvMed, there is still not available any simple means for DAMEs / DAOs who do not already have an ARN to obtain one. At this stage, it is still possible to obtain an ARN by mailing or faxing a written request on your letterhead to Ms Margaret Urban, DAME Liaison Officer.
While it is still possible for medical examination and report forms to be lodged for applicants who do not possess an ARN and for AvMed to arrange for allocation of an Aviation Reference Number to these applicants, this will change when all medical forms are lodged electronically. DAMEs and DAOs will be notified well in advance of the introduction of the mandatory requirement for applicants to possess ARNs prior to examination.
Aviation Medicine Section acknowledges that a number of DAMEs have submitted requests for issue of ARN but have still not been notified of an allocation. This delay has arisen from the press of other business and from the ‘slippage’ of full deployment of interactive Nu-MRS. Rest assured: all DAMEs who have lodged an application will be allocated an ARN in due course and well ahead of needing it to lodge Nu-MRS medicals electronically.
Taxation and eligibility of services for Medicare benefits
The Australian Medical Association has proposed to the Australian Taxation Office that all medical examinations for aviation medical certification, life insurance etc should be GST-exempt. A ruling on the matter is expected by the end of this month and will be publicised to DAMEs / DAOs when available.
DAMEs, DAOs and applicants continue to be confused over the eligibility of certain aviation medical examinations, investigations and reports for Medicare benefits. In January 2000, the Health Insurance Commission provided the following advice in order to explain these matters.
Medicare benefits are not payable for health screening services. Section 13.3 of the Medicare Benefits Schedule outlines the definition of a health screening service as ‘a medical examination or test that is not reasonably required for the management of the medical condition of the patient’.
Medicare benefits are payable, however, for health screening services where a patient has a medical condition that requires monitoring or treating to maintain the patient’s state of health. In such cases medical examinations and tests are considered necessary according to the circumstances of the patient.
If you require further information, please contact the Medicare Claims Section on (02) 6124 7707.
New opportunities in aviation medicine
Unlike some other countries, Australia does not define medical fitness standards for staff employed as cabin crew on RPT aircraft. Airlines set their own standards in this area, generally loosely aligned with the Class 2 medical standard. Because of a changed emphasis in the work of its medical department, one of Australia’s major airlines now directs applicants for flight attendant positions in the company and existing staff employed in those positions to DAMEs for company-required examinations, rather than continuing to perform such examinations ‘in house’. The company provides detailed advice on standards required (this will normally be brought by the examinee). The company considers DAMEs’ experience in aviation medicine and in performing CASA medicals should suit them well to undertake these new examinations on behalf of the company. Obviously, it will be up to individual DAMEs who perform such work to negotiate appropriate fees with the airline concerned. CASA is pleased that its DAMEs have received this new recognition and have the opportunity to exercise their special skills in assessment of fitness for another group which is critical to aviation safety in RPT operations.
General updates
The CASA website contains an index of contents for this Newsletter and for those of August 1999, October 1999 and December 1999. This feature is provided to assist DAMEs / DAOs to locate specific notes / other information more readily.
A proposal for extension of additional delegations to DAMEs has been prepared and is awaiting approval by the CASA Executive. These additional delegations are necessary in order for CASA, DAMEs / DAOs and applicants all to obtain the greatest benefit available from investment in the Nu-MRS.
A revision of the DAME Handbook has been completed. The new text should be available through the CASA webpage within the next week- just follow this path: http://www.casa.gov.au/manuals/regulate/dame/index.htm
Changes have been made to the DAME Handbook which reduce ambiguity, eliminate misspellings and align CASA’s procedures with ICAO Standards and Recommended Practices wherever appropriate. Significant changes have been made to the following sections of the Handbook, which should be reviewed by all DAMEs and DAOs:
1.1.4
1.3.1
1.3.4
1.3.5
1.3.6
1.4.1
1.4.4
1.4.6
2.1.2
2.1.3
2.1.15
2.7.7
2.8.3
2.12.6
2.14 (new section).
A change to the DAME Handbook which is NOT new but which has caused confusion for some DAMEs and applicants since its introduction several years ago concerns the required frequency of ophthalmic examinations for Class 1 and Class 3 medical certificate holders aged 60 years or more. These checks are required every two years. (See DAME Handbook, Section 1.4.6, flowchart at page 19).
A new CASA medical certificate was introduced in January. After considerable criticism of it was received from medical certificate holders, a revised and improved version has now been introduced. The new medical certificate is designed to match new licences and endorsement certificates (to be introduced later in 2000) in size, type and format, and all these documents are intended to be carried together in a new shirt pocket-sized licence folder.
Per ICAO Standards, the new medical certificates contain a field for the holder’s nationality. CASA has not previously sought information concerning this, but will do so hereafter in order to comply with ICAO’s requirements. The new electronic medical examination form will require DAMEs to make an appropriate entry, but until it is deployed, DAMEs are requested to enter each applicant’s nationality in the ‘Comments’ section of the existing examination forms.
As mentioned in the October 1999 and December 1999 Newsletters, AvMed wishes to hear from any DAMEs who have applicants with insulin dependent diabetes mellitus and who wish to undergo an in-flight assessment of their condition per the test protocol developed by Drs Chris Jambor and Hal Leaver. Disappointingly, only two such inquiries have been received so far.
Continuing difficulties affecting medical examination forms
(Extract from the DAME Handbook, Version 2.1: July 1999 1.3.5 Assessments other than pass assessments)
The DAME may only (re)certify an applicant as "pass" (ie meeting required medical standards). If an applicant does not meet the required medical standard(s) for (re)issue of the medical certificate, a "doubtful" assessment is then appropriate.
Although not explicitly therein stated, the intention of this statement was that DAMEs should revalidate medical certificates ONLY where applicants clearly meet the required medical standard(s). This allows the applicant to retain medical currency for up to two months, ample time for the medical report to be received and assessed by Aviation Medicine Section. In all other cases, the examination form, DAME comments and reports of appropriate further investigations, consultations etc should be forwarded to Aviation Medicine Section for determination of the applicant’s medical fitness. This requirement has been explicitly stated in the latest revision of the DAME Handbook.
Henceforth, DAMEs completing Section 6 of Forms O or R should have no doubt that a positive responses to either or both of questions 6.1 or 6.2
‘Do you consider there are any areas of concern in the applicant’s assessment which require specialist referral or counselling?’ (6.1).
‘Do you have any doubts that the applicant is fit to exercise the privileges of his/her licence?’ (6.2)
is inconsistent with a positive response to question 6.3 (‘Has the temporary certificate been issued / certificate been revalidated?’).
Interactive Nu-MRS lodgement, when available, will largely overcome this problem as it will prompt examining DAMEs to provide additional data before permitting form lodgement, as well as greatly reducing the requirement for revalidation of existing medical certificates. I t should also eliminate contretemps such as that caused by one DAME’s recent negative responses to questions 6.1 and 6.2, accompanied by revalidation of the medical certificate, for an applicant newly diagnosed with an astrocytoma.
As mentioned in earlier Newsletters, the interactive Nu-MRS also will not permit lodgement of incomplete medical examinations. Meanwhile, pending its deployment, DAMEs should continue to pay close attention to frequently overlooked boxes on the existing O and R forms. It is frustrating for DAMEs to have forms returned because a BP reading has been omitted, or the ‘positive identification of applicant’ box has not been checked. These simple mistakes also result in much avoidable clerical work for CASA staff and ensuing delays in issue of medical certificates to applicants.
Another cause of delays in issue of medical arises from unconscionably long delays between DAMEs completing medical examinations and dispatching them to CASA. This has the potential seriously to disadvantage applicants. DAMEs are reminded that a condition of appointment is their agreement to lodge completed medicals in a timely fashion. Other things being equal, AvMed believes that completed medical examination forms should be received by CASA no later than two weeks after the dates of examinations.
Of course, AvMed recognises that some applicants allow insufficient time for routine processing of their medical assessments, then harass DAMEs / DAOs involved, as well as CASA staff, to deal with them out of turn or as special cases so issues of their medical certificates is not delayed. This is yet another problem which should recede with the full deployment of CASA’s Nu-MRS. Meanwhile, to remind applicants of their responsibilities in the matter, AvMed has written a piece for Flight Safety Australia which exhorts applicants to think ahead and to make timely arrangements for their medical examinations and any associated tests / reports required.
A more prosaic but still significant cause of difficulty is the use of worn typewriter ribbons on the front page of medical examinations and /or use of pale pens to mark responses on forms. These practices result in medical forms with fields which are too light to scan successfully and which are therefore rejected by Nu-MRS as illegible. In order to avoid the return of such medical forms for amendment, DAMEs should think DARK & HEAVY when completing the present forms.
Feedback
Aviation Medicine Section has been pleased to receive a considerable number of constructive suggestions arising from the last few Newsletters. Some have already been implemented and others are under consideration or delayed pending the full deployment of Nu-MRS. As always, suggestions and comments are welcome.
Formal Appointment: Director of Aviation Medicine
I was formally appointed to the position of Director of Aviation Medicine at the end of February. As part of CASA’s continuing restructure, it intends to change the title for this position to ‘Principal Medical Officer’ in due course. However, since the existing title appears in Civil Aviation Regulations, it is necessary for these to be amended before this can be done. After 18 months ‘acting’, I look forward to the challenges of the substantive position.
Peter Wilkins
Director, Aviation Medicine