Aviation Medical System to be Changed

20 February 2001

Sweeping changes are being made to New Zealand's aviation medical system after an independent study found an alarming rate of errors by doctors conducting pilot assessments.

The independent investigation by Professors Sir John Scott and Des Gorman was called for by the Director of Civil Aviation, Kevin Ward, last June. Mr Ward was concerned about the quality of the assessment of pilots' medical fitness to fly following: audits by the CAA of some Aviation Medical Assessors (AMAs); results of a review of 100 medical high risk files originally assessed by the AMA responsible for about a third of the 8000 pilot assessments conducted each year in New Zealand; a fatal air accident near Taumarunui; and a Dunedin district court judgment that said the CAA lacked legal authority with respect to a particular medical checking process.

Mr Ward released the Professors' report today.

The Professors found that New Zealand's aviation medical certification processes were at marked variance from international best practice in that assessments are carried out by AMAs who are private doctors working outside the CAA. This decentralised system, introduced in 1992, does not exist in other leading aviation nations. The Professors recommend a system closely aligned with those nations, particularly Canada, Australia and the United States, where a core of doctors within the aviation authority would undertake assessments and issue the medical certificates.

They also noted that the Director of Civil Aviation's safety powers, which apply to the rest of aviation, did not extend to the aviation medical process, where he had no powers.

The Professors found there was an average error rate in pilot medical assessments five times higher than the maximum tolerated in the United States. An error rate of 10 percent in the United States would see a doctor counselled or struck off the approved medical examiner list. Those New Zealand AMAs audited were found to have clerical, procedural and clinical error rates of between 21 and 86 percent, with a mean error rate of 55 percent.

(A further independent check conducted by Dr Jim Wallace, a senior overseas medical expert, confirmed the extent of errors. He identified that 7 percent were serious and a further 10 percent were moderately serious. He said that his review of special examinations by the CAA had been conducted correctly.)

The Professors found some AMAs were appointed despite failing to meet the initial criteria set for passing the CAA appointment examination. These AMAs have been responsible for many thousands of pilot certifications.

The report noted one AMA said he was not competent to read ECGs, yet this was primary to the assessment of pilots. Other cases were passed as normal when the pilots had severe medical conditions.

They also found fault in the CAA's processes, saying that the CAA had inadequately audited the AMAs until 1999.

The Professors said public safety and the international credibility of New Zealand's licensing procedures meant urgent legislative and administrative changes were needed.

Mr Ward has accepted the report's findings. The urgent legislative action was introduced to Parliament today by Transport Minister, Mark Gosche.

"The process of assessing the medical fitness of pilots and air traffic controllers is critical to flight safety and public safety. The CAA, the industry and the public must have assurance that we use the right model, and that it works well," Mr Ward said.

"The current system does not consistently meet the standards we should accept. Aviation safety relies heavily on professional personnel acting properly. There is now considerable evidence that the results of some medical assessments were well below standard.

"The report makes clear that some doctors tended to become advocates for the pilot rather than fulfil the safety role for the Director and the public. The decentralised assessment system has flaws. There has been an unacceptable error rate and a lack of legal powers to do something about it. I can't do my job for the public in that situation.

"The formal establishment of a medical advisory panel for complex or borderline cases will bring the New Zealand system into line with the rest of the world.

"For pilots little will actually change. They will go along to their Designated Medical Examiner (a specially trained practitioner) as always. The primary change is that the DME's report will go to doctors working in a collegial way at the CAA, rather than to an individual AMA working alone," Mr Ward said.

Further action includes:

  1. The Minister has proposed a special review team to review the medical standards contained in Civil Aviation Rule Part 67. The review will also embrace an assessment of the so-called 1 percent rule covering risk of sudden incapacitation. This trigger mechanism for further medical assessment has caused considerable disquiet among pilots and industry. Mr Ward said the CAA will change the rule if necessary based on analysis of best practice.
  2. The issues of doctor performance will be forwarded to the Medical Council.

The full report is now available on the CAA website on www.caa.govt.nz, or from the CAA's Safety Education and Publishing Unit. Summaries are being mailed to the aviation industry today.



Kevin W. Ward
Director of Civil Aviation