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Excessive alcohol consumption case-based scenario
Bad habits threaten to put Leo in the drink
Leo didn't really take the medical certification process seriously when he first embarked on an aviation career. His casual indifference ended once AvMed expressed serious concern about his drinking habits, and his two driving under the influence convictions threatened to stymie his ambitions. Happily, his determination to take up flying gave him the motivation and resolution he needed to clean up his act.
Leo has always enjoyed life and used to love playing sport. His focus for the first few years of his adult life was on furthering his career as a professional sportsman, playing both AFL and cricket. He was devastated when, on the cusp of selection for the state cricket side, he sustained a career-ending injury to his shoulder. After trying various jobs Leo decided to try his hand at aviation.
"Some friends from high school who were interested in flying helped me select a flying school where I could start my training," he says. "I had a ball during my initial training, but I was so busy with my study and flight training that I never found time to see a Designated Aviation Medical Examiner (DAME).
"Anyway, if the truth be told, I really didn’t fully understand what all the regulations meant until my instructor gave me the contact details of the DAME that he used and advised me to make an appointment."
Leo didn’t even know what class of Medical Certificate he wanted to apply for when he presented for his appointment. When he explained to the desk receptionist that he planned to fly professionally she consulted the practice nurse. Together they determined that Leo would need to apply for Class 1 and 2 certificates. The practice nurse managed to get some measurements and an ECG done before the appointment with the DAME was due to start.
"I felt really confident answering the questions the DAME asked about my health because, despite my sporting injuries, I had always been very fit," he says. "I was taken aback when the DAME starting quizzing me about alcohol and illicit drugs.
"Then the DAME explained that over the last several decades, substance abuse had been the major medical cause of airline accidents."
A little shamefacedly, Leo admitted that he had two convictions for driving under the influence of alcohol. The DAME in turn warned him that AvMed would likely be very interested in this history, given that United States research shows that for general aviation pilots, a history of driving under the influence could be shown to have led to a 43 per cent greater risk of crash involvement.
The DAME completed a physical examination and submitted the application on-line. Leo left the appointment feeling very unhappy about the whole process and planning to do some research of his own.
Contact from AvMed
A few days after seeing the DAME Leo received a letter from AvMed asking him to provide a copy of a National Police Certificate and to undertake some blood tests.
"I’d never even heard of the National Police Certificate," he says. "I had to search online to find out how to get the document from my State Police Service.
"Then, when I got it, there it was in black and white – my two driving under the influence convictions with all the grisly details about dates and alcohol concentrations. I was only 18 when I got the first, which is 11 years ago, so if that was the only one I might have thought: ‘fair enough.’ The trouble was the second was only two years ago, incurred after driving home from a drunken party. I’d called myself an idiot when I got the conviction, and had vowed never to drink and drive again, but after hearing from AvMed, I started to wonder whether all that money I’d spent on flight training to date might end up being wasted."
Somewhat nervously, Leo emailed the report to AvMed and booked an appointment for some blood tests. The delays associated with getting the police report and waiting for the blood test results had completely derailed Leo’s flying training and he now wished he had started the medical process before spending money on the training.
The tests showed that Leo’s liver enzymes were elevated and that his red blood cells were showing damage consistent with excessive alcohol consumption.
"I was stunned to hear that the blood tests were abnormal because I felt well and didn’t think my drinking was that much different to my friends."
His DAME forwarded the test results to AvMed. AvMed in due course sent a letter asking Leo to see a drug and alcohol specialist for review. Leo’s DAME referred him for this appointment. When Leo attended the appointment he was asked a long series of questions and once again examined by the specialist. The specialist also reviewed the blood test results and police certificate.
When all of this was done, the specialist explained to Leo that his current pattern of alcohol consumption was doing him some harm and putting him at higher risk of accident and injury. On the positive side, the specialist didn’t feel that Leo had an alcohol dependency or required a ‘detoxification’ program.
The specialist was particularly pleased to hear that Leo was now aware of the recommended national guidelines, knew that he should never operate aircraft while affected by alcohol and also that Leo had abstained from alcohol since seeing his DAME for the initial medical without any ill effects. The specialist ordered some more blood tests that day and in due course sent his report to AvMed and the DAME.
The accumulated reports and the initial application were considered at a special meeting of doctors at AvMed. The meeting concluded that there was evidence of problematic use of alcohol in Leo’s history. On the positive side the latest blood tests had normalised and the specialist report provided a favourable opinion regarding Leo’s prospects for improved health.
The specialist made some recommendations regarding how Leo could be supported and monitored over the next 12 months. The recommendations of the specialist were, in most part, adopted by AvMed with some modification.
Leo was issued his certificate but was required to have regular reviews with his DAME and some blood tests along the way.
"I always knew that the tests would be normal because I had made some big lifestyle changes and was back exercising the way I did when I was younger," he says.
At the end of his first certificate he saw the specialist again. Based on all the information now available, AvMed subsequently renewed his certificates without restrictions. Not only was Leo happy to have this all behind him, he felt healthier too.