Designated
Aviation Medicine Examiner/Designated Aviation Ophthalmologist
DAME
Newsletter
June 2003
Principal Medical Officer's column
DAMEs and DAOs - new and resigned
Acknowledgement
DAMEs/DAOs should confirm receipt of this Newsletter, noting their DAME stamp number, per return email to powell_t@casa.gov.au. Alternatively, please fax confirmation of its receipt to CASA AvMed on (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 other staff members who have dealings with CASA on behalf of practice principals.
PMO's Column
Administrative Matters
'Email from the Hang Gliding Federation of Australia'
Subject: HGFA Medical Examinations
I write regarding a problem that has arisen regarding the process of having members of the Hang Gliding Federation of Australia (HGFA) verify to the federation that they satisfy the medical requirements of the HGFA Operations Manual.
By way of background information, please note that pilots of HGFA aircraft are required by CAO 95.8 and CAO 95.32 to operate in accordance with the CASA approved HGFA Operations Manual. One of the requirements of that Operations Manual is that to gain a passenger carrying endorsement, a pilot must "forward a medical statement indicating that he or she is medically fit to an equivalent standard to that required for the issue of a Private Pilot Licence in Australia".
For many years the HGFA has asked members to undergo a medical examination with a CASA approved DAME to ensure that the doctor is aware of the "standard required for the issue of a PPL".
Evidence of having undergone this medical examination is provided to the HGFA in either of two ways: by having a HGFA Passenger Carrying Endorsement Application Form signed and stamped (with the DAME stamp) by the DAME; or by lodging application to CASA for a CASA Medical Certificate.
This latter means is taken by some HGFA members as they intend to progress to other forms of aviation. However, the former system is most often used and is deemed preferable by the HGFA as it does not impact on CASA's resources.
The problem that has arisen is the refusal of a doctor in Fremantle, West Australia to sign an HGFA Application Form, reportedly on advice from CASA Central Office that this is inappropriate.
Could you please advise if there has been a change to CASA policy regarding having DAMEs sign off HGFA pilots. If this is the case, the federation will seek to have CASA and the HGFA address the issue with the aim of re-establishing the system of using DAMEs to verify the health standard of our members.
XXXXXXXX
General Manager, Hang Gliding Federation of Australia
From: WILKINS, PETER
Subject: HGFA Medical Examinations
Dear Sir
I refer to your following email.
I have been CASA's Director of Aviation Medicine since August 1998 and had no knowledge until 31 March 2003 of the practice you describe as having a HGFA Passenger Carrying Endorsement Application Form signed and stamped (with the DAME stamp) by the DAME - if I had, I would NOT have condoned it!
In my view, the only appropriate way to demonstrate that an applicant meets the class 2 medical standard is for him / her to undergo a class 2 medical examination and be issued with a class 2 medical certificate. CASA Aviation Medicine usually processes about 32,000 medical certificate applications annually, so the likely increase in workload and impact on the Authority's resources if all your applicants were duly examined and certificated would be trivial.
The advantages of this procedure are several and include the following.
(1) Applicant has a dated medical certificate, incorporating an expiry date and specifying any restrictions (such as requirement for visual correction when exercising privileges).
(2) Applicant has a legal responsibility not to exercise the privileges of any licence if he / she develops a medical condition potentially incompatible with aviation safety unless first cleared by a DAME.
At least by implication, use of the DAME stamp in other circumstances (such as you have described) may involve CASA in future legal actions if persons 'semi-certified' by DAMEs as you described were to be involved in flying accidents. I am not comfortable with use of the DAME stamp for any processes not fully under CASA's control. Accordingly, I intend formally to direct that DAME stamps are to be used ONLY for CASA-related purposes. Since this issue has arisen, I intend to clarify it for DAMEs in a forthcoming DAME Newsletter.
If HQFA finds the requirement for class 2 medical certification onerous, it has the option of introducing an alternative (lower) standard, such as certification by any GP. However, I consider it likely that the Federation may well conclude that the additional benefits of all applicants meeting the class 2 medical standard are sufficient to require them to demonstrate that they do meet that standard in the usual manner.
I hope this clarifies the situation for you.
Yours sincerely
(Dr) Peter S. Wilkins
Director of Aviation Medicine and
Principal Medical Officer
Civil Aviation Safety Authority of Australia
wilkins_ps@casa.gov.au ______________________________________________________________
From: EMONSON, DAVID
CASA Deputy PMO
Subject: RE: HGFA Medical Examination
I was previously unaware of the process of medical certification process
utilised by the Federation.
As I have previously indicated (in the strongest of terms) I do not support the certification of pilots flying in Australian airspace to a standard lower than the class 2 medical standard. I note that my position is clearly supported by the Federation in its operations manual in relation to passenger carrying operations with the statement that "to gain a passenger carrying endorsement, a pilot must "forward a medical statement indicating that he or she is medically fit to an equivalent standard to that required for the issue of a Private Pilot Licence in Australia".
In my opinion the only way to ensure that a pilot meets the Class 2 medical standard is for them to have a DAME medical and be subsequently issued a Class 2 medical certificate. Having a DAME (a CASA delegate) apply his stamp or his number to a document other than a CASA document clearly has potential adverse legal implications, and CASA should not support it. I agree with your proposal to formally to direct that DAME stamps are to be used ONLY for CASA-related purposes.
Ophthalmological Examinations
Contacts are required at ophthalmological examinations to ensure that measurement of visual acuity can be performed with and without correction.
Issue of Medical Certificates
Since 2002, the Office of Aviation Medicine has reduced the average time taken from receipt of a completed medical to the issue of a medical certificate from 17 days down to 11 days. Medical certification requires more time if incomplete medicals are submitted, please ensure that all examination results are included and all relevant questions are answered before submitting medical forms.
Medical Examination Forms
Please remove the top of the medical examination forms and keep the pages together by paperclip, as AvMed staff now spend considerable time completing this task to prepare the forms for scanning.
Please submit medical examinations forms within 14 days of the date of examination. If follow up tests are required, the results can be forwarded to CASA at a later date.
DAME Correspondence
Please include your DAME or DAO number on all correspondence to CASA.
Stationery Orders
CASA no longer provides stationery, which is available from J S McMillan using the order form.
Please order forms in advance, as it may take a few days for orders to be processed and dispatched.
ARN Needed for Medicals
The new online medical records system (MRS) to be introduced in the next few months relies on a person presenting for a medical examination to have an ARN (Aviation Reference Number) issued by CASA before the medical.
To facilitate the transition to the new system and to allow CASA to accurately identify all license holders (additional to that required for a medical), CASA would encourage you to ensure that an ARN is held before conducting the examination. This could be ascertained at the time a booking is made for the medical.
Once the new system is online, it will not allow you to conduct/enter medical details without the person having an ARN.
An ARN Application (form 1162) can be downloaded from the CASA website and the completed form with supporting documents submitted to the nearest CASA office.
AMSANZ Annual Conference and Scientific Meeting
The AMSANZ Annual Conference and Scientific Meeting will be held from 18 to 21 September at Hamilton Island. Information is available from the CASA web site, under Information for DAMEs and DAOs.
ECGs
Full calibration or standardisation peaks are required for all ECGs.
Examination of sensitive areas
From time to time applicants contact CASA to inquire or complain about being examined on sensitive areas when they don't expect it as part of the standard medical assessment. When examining areas such as breasts and scrotum, extra efforts should be made to communicate the reason for the examination. Whilst such examination are not listed on the report form, they often form a legitimate part of a full and comprehensive clinical examination. Any recommendation about including or excluding such examinations routinely will be wrong in the view of some. The applicant's perception of the appropriate medical assessment is often different from the examiner's, with many applicants expecting just enough done 'to pass the examination' and no more. On the other hand, some applicants will expect these examination to be included because of public awareness campaigns on breast cancer, testicular cancer etc. In this age of heightened sensitivity certain common sense precautions are highly recommended:
- When examining the opposite sex, always have a chaperone. Don't offer it as a choice, make it compulsory.
- If a chaperone is absolutely unavailable for kilometres, ensure that more than 3 minutes is spent on explaining that your examination will involve these areas and the reasons for the particular examinations before you begin. It is sensible to stand on the opposite side of the room, away from the examination couch with your arms folded, or behind a desk when talking about such examinations . Tell the applicant he/she can decline these particular examinations and record the offer and the refusal in such cases.
Any internal examination (PR or PV) should be avoided at the time of examination, and equal time given to considering the indications for such examinations. Better still, make a separate appointment for this procedure, if appropriate, after eliciting and documenting the indications for it.
If you consider this advice is a hassle, try dealing with a sexual harassment/assault claim!
MRS Online - Project Manager's Update
Status and Schedule
MRS Online has now been available for review through the CASA website for the last two-three months. We are happy with the extent to which it has stabilised over the past month, and we are currently gearing up to begin live use of the system to conduct medicals.
Our timetable is expected to be:
- July 2003 Commence live use of the system in parallel with the existing procedures. This will begin with only a few DAMEs, and with no capacity to send or receive attachments. After we have demonstrated to everyone’s satisfaction that the system can operate consistently, it will be extended to include attachments and be opened up to everyone.
- July - October Continue to operate both the current and new systems in parallel, making the MRS Online system available to an increasing number of DAMEs.
- September Evaluate the outcome of the Pilot and identify any issues that need to be addressed before CASA switches over to only accepting online medicals
- November Assuming successful outcome of the Pilot, no more paper-based medical examination forms will be accepted from this month.
Tasks to do to ensure you are ready
The following are things that you should do right now, to ensure you are ready for the new system:
- Ensure you are signed up for the HIC's PKI, with an Individual Healthcare Certificate
- Apply for an individual healthcare certificate from the Health e-Signature Authority (HeSA). HeSA performs user identity checks before registering applicants for issue of Digital Certificates that allow secure online communications. Once registered, you receive a personal identification code (PIC) protected token, which contains the digital keys and certificates that allow you to 'sign' and 'encrypt' electronic transactions. MRS Online requires this token to be installed on any computer you use to access the application.
- Application forms can be found at http://www.hesa.com.au/apply.htm. Note that the application form will take at least 6-8 weeks to process, so if you do not already have your token (i-Key), you should apply for this as soon as possible. If you already have the i-Key, even if you did not apply for it specifically for MRS Online, you can use that same i-Key with MRS Online.
- Further information on PKI can be found at http://www.hic.gov.au/providers/online_initiatives/pki_security.htm or you can contact the PKI Customer Service Centre on 1300 660 035
- Check your computer’s operating system:
- MRS Online will run fine on any Windows operating system above Windows 95
- If you run Windows NT, there may be some problems with the i-Key. The i-Key plugs into the usb port on your computer, and not all versions of NT activate the usb ports. You can seek advice from the PKI Customer Service Centre on the number above.
- Review the test version of the MRS Online system to get used to how it operates.
- Note that this is still a test system, and we will be updating it from time to time, so you may need to reinstall the latest version. You will need to check the date the version was last updated on the website to ensure you have the latest version
- Note also that because this is in the Test environment, your ability to successfully connect through to CASA will be affected if there are changes being made, either to MRS or to other systems in CASA’s test environment. Please be patient, and you are welcome to contact me with any issues you are experiencing.
Demonstrations of the new system
I am attending all of the DAME seminars this year, as well as AMSANZ meetings in NSW and WA, to give an update on the project and answer any questions. I hope to meet many of you at these forums. I will have the most up-to-date version of the system with me, so anyone who has not yet been able to view and use the system is welcome to do so then.
Kind regards
Elenore Karpfen
Greetings from Tara and Netty
Welcome to the June 2003 Newsletter.
Tara
I have been doing training recently in project management to ensure I can provide the support and information that you need.
Netty
Please advise us of any change to your email or postal address by sending an email to powell_t@casa.gov.au or glasson_j@casa.gov.au.
DAMEs and DAOs - new and resigned
Dr Jonathon McKeon of Gunnedah, NSW, Dr David Reid of Wynyard, TAS, Dr Peter Joyner of Mannum, SA and Dr Sheilagh Cronin of Longreach QLD, have retired. Dr John Wenman of Coffs Harbour, NSW, has retired after 28 years as a DAME. Dr Ken Shepherd of Brighton, VIC, Dr Nigel Evans of Mudgeeraba, QLD, Dr Phillip House of Ardross, WA, Dr John Byrne of Wodonga, VIC, Dr Adrian Zentner of Frankston, VIC and Dr James Alexander of Grafton, NSW have all resigned. CASA acknowledges their contributions over many years.
Dr Timothy James McCullough has been appointed as a DAME
at Alice Springs, NT.
Dr Erika Nishimoto of Singapore, has been appointed as a DAME.
Dr Sally Edmonds has been appointment as a DAME in Broome, WA.
Dr Nigel Morlet has been appointed as a DAO in Mosman Park, WA.
Dr Rajeev Sharma has been appointed as a DAME in Eltham, VIC.
Dr Christopher Chesney has been appointed as a DAO in Mentone, VIC.
Dr Alan Reitsma has moved from Griffith, NSW to Broadbeach, QLD as a DAME.
Dr Elizabeth Livingstone has moved from Wagga Wagga to Edgecliff, NSW as
a DAO.
Dr George Crowe has moved from Mackay, QLD, to Whyalla, SA.
Dr Ross Peterkin of Alice Springs, NT, will be resigning on 30 October 2003. CASA acknowledges his contribution and thanks him for assisting in Alice Springs while we did not have a full time DAME appointed.
DAME and DAO Applications
There is a shortage of DAMEs and DAOs in several parts of Australia. If you know of a doctor or ophthalmologist who is interested in performing aviation medical examinations, and is prepared to meet CASA’s training and other requirements for appointment, please refer any such practitioners to CASA Av Med on (02) 6217 1642 or powell_t@casa.gov.au.