DAME Newsletter - October 2000
Contents
Acknowledgment
Distribution
DAME Handbook Updates
New Medical Records System (Nu-Mrs) developments
Reciprocity with New Zealand
Initial and continuation training requirements for DAMEs
Taxation and eligibility of services for Medicare benefits
Frequency of required medical examinations for ATPL
holders aged over 40 years
Case history - inappropriate revalidation of a medical certificate
Miscellaneous matters
Forthcoming events
General notices
Feedback
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 locums or to other staff members who have dealings with CASA on behalf of practice principals.
DAME Handbook updates
Administrative changes (particularly reflecting ICAO requirements) were published electronically during August. Clarification of the aeromedical management of medical certificate holders during pregnancy was also included. A review of the cardiological standards has been completed and new requirements formulated - this revised material should be available as a new chapter 2 very soon. Notable changes include: reduction in acceptable BP upper limits to 150/90; acceptance of angiotensin II receptor antagonists for treatment of hypertension; reduced requirements for repeated studies after successful treatment of most conditions; acceptance of alternative investigational modalities; and further advice on arrhythmias.
New Medical Records System (Nu-MRS) developments
Slow progress has continued on enhancements to the system within CASA. A contract should soon be concluded for development of the interactive software required to permit real-time lodgment of medical examinations and reports by DAMEs and DAOs. As mentioned elsewhere in this Newsletter, other developments will maintain the pressure for the early deployment of such a system. Currently, a "best guess" would expect it to be operational during the second half of 2001.
Reciprocity with New Zealand
Some readers will know that the Australian and NZ parliaments have enacted complementary legislation to give effect to Trans-Tasman Mutual Recognition Acts intended to facilitate commerce between the two nations. One result is an agreement between CASA and the Civil Aviation Authority of New Zealand (CAANZ) to collaborate on rewriting of legislation and regulations affecting aviation in both countries so as to maximise commonality. Part 6 - Medical of existing CARs will be affected by this decision. Many readers will also be aware of recent controversies concerning medical certification for pilots in New Zealand. One consequence of the continuing investigation into NZ medical certification by CAANZ has been NZ government appointment of Professor Sir John Scott and Professor Des Gorman to report on local existing certification practices and to recommend any changes required to ensure that international best practice standards are achieved. Their forthcoming report clearly will have implications for Australian practices and should ensure that the full development and deployment of interactive Nu-MRS occurs sooner rather than later.
Initial and continuation training requirements for DAMEs
ICAO demands that DAMEs shall have had, or shall receive, relevant training in aviation medicine. For some years, it has been normal CASA practice to require that intending DAMEs should, as a minimum, complete Monash University’s two week Australian Certificate in Civil Aviation Medicine (ACCAM) course. CASA has compiled a list of all routinely accepted training and does not intend to make new DAME appointments unless applicants have completed adequate training. The forthcoming development of modular aviation medicine courses at Griffith University should improve future accessibility of training, as may other proposals under development elsewhere.
All Australian medical practitioners are now accustomed to being required to undertake and to provide evidence of approved continuing medical educational activities in connection with maintained specialist accreditation, Vocational Registration, etc. CASA has not funded DAME seminars for several years now, so has not enforced the requirement for DAMEs to undertake relevant and approved CME activities. However, the return of approved one day (weekend) seminars should be anticipated from early 2001.
The legitimate expectations of professional registration authorities, consumer groups, the ACCC, TTMRA reciprocity arrangements and other factors will henceforth require stricter observance of ICAO and community standards for initial and continuing education by both DAMEs and CASA. Certainly, reappointment of non-compliant DAMEs will become increasingly problematic.
Taxation and eligibility of services for Medicare benefits
Some DAMEs and DAOs remain exercised over the liability of aviation medical examinations for GST. The matter obviously is complex. The most complete advice available is at <www.ama.com.au> (see under ‘taxable services’).
In an attempt to clarify the Medicare rebatability of professional services rendered or required in connection with CASA medical assessments, CASA PMO will meet HIC Senior Medical Advisers during November. Any new information derived will be published in a later Newsletter.
Frequency of required medical examinations for ATPL holders aged over 40 years
For several years, CASA has only required this group to undergo routine medical examinations annually. This arose from a compromise when use of the American Heart Association’s Coronary Heart Disease Risk Factor Prediction Chart was introduced as a regular component of Class 1 and Class 3 medical assessments. The ICAO standard remains 6-monthly assessments for this group, which has caused some confusion among affected ATPL holders. Australian (CASA) certification rules are sovereign throughout Australian airspace. However, if ATPL holders operate internationally, they are required to observe the requirements of the regulators in whose airspace they fly. The "default option" which CASA suggests to ATPL holders aged more than 40 who operate internationally is for them to comply with ICAO’s specified requirements. DAMEs need to be aware of this as they may some applicants will present for examination more frequently as a result of CASA’s advice.
Case history - inappropriate revalidation of a medical certificate
(Text of message from a Flying Operations Inspector to Aviation Medicine Section during October 2000).
During recent surveillance I encountered licence holder X operating in a Commercial capacity carrying charter passengers with an operator, having done so for some three weeks.
His Class 1 Medical Certificate had expired on 2 February 2000 and he had continued "private" only flying until gaining commercial employment. He had a medical examination by DAME Y on 9 August 2000 (on gaining new employment), who "revalidated" his Medical Certificate to 9 October 2000. The applicant believed he had regained Class 1 status and proceeded to exercise those privileges immediately.
This is not in accordance with Cars Part 6. Because his Class 1 had expired it cannot be "revalidated" in this way, only the Aviation medicine Section can issue a new Class 1 medical certificate when the required documentation from the DAME has been received and assessed. Technically, the pilot and the operator were not legally covered until the new Class 1 Medical Certificate had been issued by Aviation Medicine Section [...].
Fortunately, on this occasion there were no adverse consequences from the inappropriate purported revalidation of an expired Medical Certificate. However, if the pilot concerned had been involved in an accident or incident during the period prior to receiving a new Medical Certificate from CASA, there would be a likelihood of civil and criminal actions against the pilot, the operator and the DAME involved.
If in doubt over any non-straightforward renewal, contact CASA Aviation Medicine Section for friendly advice.
Miscellaneous matters
Completion of of front pages of medical reports
CASA acknowledges the difficulty some DAMEs / DAOs have in accessing old-fashioned typewriters to complete this part of the form. This problem has been exacerbated by delayed introduction of interactive lodgment of reports. Accordingly, while typed front pages are still preferred, CASA will henceforth accept hand printed front pages, provided that they are completed in legible block capitals using a black fibre tipped pen. As previously, reports which are incomplete / illegible / unscannable (e.g. those completed in blue ink) will be returned to DAMEs for rectification.
Legibility of other information
Examiners are reminded of the need to use black ink and to print (block capitals) all information entered on medical forms.
Inappropriate use of "O" forms
Some DAMEs have been noted to use "O" forms when "R" forms are appropriately required. Please order stationery requirements early so as to avoid the need for this practice. "O" forms should never be completed to circumvent processing time for an applicant’s expired medical certification through issue of an initial interim "tear-off" certificate. Applicants unable to arrange to have medical examinations and associated investigations completed on a timely basis will benefit from the reflection enabled during the time taken to process their renewals.
Lodgment of medical forms
- Medical examination forms should always be sent within one month of initiation of medical processing, accompanied by an explanation or comment if the processing is still incomplete at that stage. For uncomplicated / straightforward medical reports, CASA anticipates receipt within 14 days of completion of the medical. DAMEs’ performance against these benchmarks is continuously monitored and recorded.
- When completing a medical assessment, the DAME / DAO acts as CASA’s delegate (see DAME Handbook). There have been instances where examiners have delayed submission of reports until payment was received or because an applicant’s cheque was dishonoured. This is not acceptable to the Authority, as CASA Aviation Medicine Section has been hectored by applicants over resulting non-issue of Medical Certificates when the reports concerned have not even been received. Fees are properly a matter between the examiner and the applicant, but completed medical forms must be lodged expeditiously, as detailed in (1) above.
Urinalysis for drugs
Examiners’ clinical discretion when examining an applicant who answers "YES" to Question 7A is respected. A distant past history of one or two experiments with cannabis may be of little moment for certification. However, there have recently been numerous instances where applicants have given histories of recent / continuing problematic use of substances, examiners have not immediately collected urine specimens from them and have issued interim certificates / revalidated existing certificates. Such practices contravene Australia’s international obligations respecting maintenance of the safety of air navigation. Any further occurrences will result in review of DAMEs’ continued delegations for those concerned.
When in doubt, collect urine and contact CASA Aviation Medicine Section for advice or discussion of the situation.
Forthcoming events
The Aviation Medical Society of Victoria will hold a scientific
meeting in conjunction with Airshows Downunder at Werribee and Avalon Victoria
from 16 - 18 February 2001 inclusive. Details are available from Anne Fleming
of AMSANZ - contacts:
PO Box 4022 Balwyn Vic 3103; tel 903) 9899 1686; e-mail <fleminga@ozemail.com.au>
The scientific program will incorporate elements sufficient to satisfy CASA’s requirements for periodic DAME continuing medical education referred to earlier in this Newsletter.
General notices
The CASA website contains an index of contents for this Newsletter and for those of August 1999, October 1999, December 1999, March 2000 and June 2000. This feature is provided to assist DAMEs / DAOs to locate specific notes / other information more readily.
As explained in the DAME Handbook and in the DAME / DAO application form, DAMEs / DAOs who practise in Australia and New Zealand are expected to join and to maintain their membership in the Aviation Medical Society of Australia and New Zealand (AMSANZ). This is regarded as an excellent means for DAMEs and DAOs to remain informed of matters of current general aeromedical interest and to receive information concerning relevant educational activities in their regions.
DAMEs / DAOs wishing to (re-)join AMSANZ should contact Ms Anne Fleming
c/- the Society Secretariat <fleminga@ozemail.com.au>
or write to
AMSANZ
PO Box 4022
BALWYN EAST VIC 3129
Feedback
Aviation Medicine Section has received many 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 from DAMEs and DAOs are welcome: all will be considered and acknowledged.
(Dr) Peter Wilkins
Director of Aviation Medicine / Principal Medical Officer