An eruption of anger from pilots, air traffic controllers and aviation associations greeted the revelation by FAA Federal Air Surgeon Fred Tilton that pilots with a body mass index (BMI) of 40 or higher will automatically be required to be evaluated for obstructive sleep apnea (OSA).

Tilton revealed the new policy in a recent issue of the Federal Air Surgeon’s Medical Bulletin (Vol. 51, No. 4). But he neglected to mention where this effort originated.

After both pilots flying a Bombardier CRJ as go! Flight 1002 (operated by Mesa Airlines) fell asleep during a Feb. 13, 2008 flight from Honolulu to Hilo, Hawaii, the issue of pilots and OSA gained attention. According to the NTSB, the captain was diagnosed with severe OSA three months after the incident, although his BMI was only 32.1.

As a result of that incident, the NTSB made the following recommendations:

• Modify the Application for Airman Medical Certificate to elicit specific information about any previous diagnosis of obstructive sleep apnea and about the presence of specific risk factors for that disorder.
• Implement a program to identify pilots at high risk for obstructive sleep apnea and require that those pilots provide evidence through the medical certification process of having been appropriately evaluated and, if treatment is needed, effectively treated for that disorder before being granted unrestricted medical certification.
• Develop and disseminate guidance for pilots, employers and physicians regarding the identification and treatment of individuals at high risk of obstructive sleep apnea, emphasizing that pilots who have obstructive sleep apnea that is effectively treated are routinely approved for continued medical certification.

While we understand that OSA could be a critical problem for pilots, it is also clear that Federal Air Surgeon Tilton didn’t consult with the FAA’s public-relations department before launching his policy memo. Obviously, the policy responds specifically to the NTSB recommendations, but Tilton failed to take into account how the implementation of his policy will frighten his “customers,” the pilots (and eventually air traffic controllers) who will be forced to obtain an OSA evaluation by a specialist, simply because they meet the BMI and neck-size criteria. Tilton also plans to move the BMI target even lower, to 30. The FAA has a great group of public-relations specialists, and I’m certain they could have helped Tilton craft a more reasonable approach to dealing with the OSA issue.

The reason this is so unsettling for so many pilots is because a referral to a specialist means that their airman medical certificate is on hold until they are cleared by the specialist. And if the pilot has an OSA problem, he will find that getting his medical certificate is going to take a long time, time during which he will not be able to fly. For a career pilot, this is a serious issue.

Right now, Tilton’s policy offers zero incentive for pilots to confess that they might have an OSA problem. This is not new; pilots have never had an incentive to admit a physical problem to their AME, because it might mean that they will be grounded. And so they are extremely careful to tread that fine line between necessary treatment and what actually gets put on the medical certificate application. Obviously no pilot wants to let, say, a heart problem go untreated, but will that pilot be willing to tell his cardiologist that he has been feeling occasional twinges in the heart area?

If Tilton really wants to help pilots with OSA and also provide a satisfactory response to the NTSB recommendations, then he should figure out a better way to diagnose and treat pilots with OSA. No pilot who simply meets the OSA criteria should be automatically referred to a sleep specialist. What should happen is that pilots need to be encouraged to come forward with any concern, in a way that doesn’t threaten their livelihood. The FAA has done an outstanding job in this regard with alcoholism. The Human Intervention and Motivation Study (Hims) program (which was started by the Air Line Pilots Association and later transferred to the FAA) has helped thousands of pilots successfully overcome alcoholism and return safely to the cockpit.

Maybe there needs to be a Hims program for all medical issues. Pilots need to have an incentive to report health issues without being automatically penalized.

AIN is working on a story about OSA and the impact of the FAA policy on commercial pilots, to be published in the January 2014 issue. If you have experienced OSA or are worried that the new FAA policy will catch you and possibly cost you your job, please contact me at mthurber@ainonline.com or (310) 306-4039. We will not reveal your name or any other identifying information.