State of Maryland, State Police, Aviation Command
CC# 201100302: - From Michael W. DeRuggiero, Trooper First Class, Safety Management Officer, Aviation Command: In an effort address NTSB recommendation A-09-134, the MSPAC has partnered with the University of Maryland Sleep Disorder Center (UMSDC), located in Baltimore, Maryland. The MSPAC, in conjunction with the Dr. Steven Scharf, the Director of the UMSDC, is in the process of developing a departmental policy that will mandate the following:
- All pilots, flight paramedics, maintenance technicians and flight dispatchers receive Obstructive Sleep Apnea (OSA) training on an annual basis.
After satisfactorily completing the mandated OSA training, all pilots, flight paramedics, maintenance technicians and flight dispatchers will receive:
- An OSA “screening package” to assist each employee in accessing their individual risk of having OSA.
- Instructions on how to obtain a clinical evaluation to rule out a diagnosis of OSA
- For pilots diagnosed with OSA, information on how to petition the FAA for a “Special Issuance of Medical Certificate” under Title 14 CFR § 67.401.
The mandatory annual OSA training will be delivered as an on-line training program. The training will include recognition of the symptoms and detrimental health effects of OSA and the available treatment options for those diagnosed with OSA.
After receiving the mandated OSA training, all pilots, flight paramedics, maintenance technicians and flight dispatchers will be provided with an OSA “screening package”. The OSA screening package will include the “Stop-Bang” and the “Berlin” questionnaires, as well as the “Epworth Sleepiness Scale” to help each employee access their individual “risk” of having undiagnosed OSA. Completion the questionnaires contained within the OSA screening package will not be mandated by the MSPA. However, all pilots, flight paramedics, maintenance technicians and flight dispatchers will be encouraged to utilize the OSA screening tools provided and to receive the appropriate clinical evaluation if they believe they are at risk of having undiagnosed OSA, based on the information obtained from completing the OSA screening questionnaires.
Instructions on how to obtain a clinical evaluation for OSA at the UMSDC will also be part of the OSA screening package. If a MSPAC pilot, flight paramedic, maintenance technician or flight dispatcher believes that he or she may be at risk of having undiagnosed OSA, or another sleep disorder, the employee can voluntarily (and anonymously) schedule a clinical evaluation at the UMSDC to confirm or rule out the presence of OSA. If, after a clinical evaluation, a diagnosis of OSA (or the presence of another sleep disorder) is confirmed by a physician, it will be the responsibility of MSPAC pilot, flight paramedic, maintenance technician or flight dispatcher to maintain compliance with the OSA treatment prescribed.
All MSPAC pilots diagnosis with OSA (or the presence of another sleep disorder) will be expected remove themselves from “active flight duty” in compliance with 14 CFR 61.53(1), maintain compliance with the OSA treatment prescribed and receive a “Special Issuance of Medical Certificate” from the FAA under Title 14 CFR § 67.401, prior to returning to active flight status for the MSPAC.
Under Title 14 CFR 67, a diagnosis of OSA is considered a disqualifying physical deficiency for all FAA certificated pilots. While OSA is a disqualifying medical condition, OSA screening is not required by the FAA for the issuance of any Airman Medical Certificate issued under Title 14 CFR 67. Even though the MSPAC currently conducts all flight operations under the applicable statutory provisions of 49 USC 40125 as a “public aircraft” operator, all pilots employed by the MSPAC are required to be FAA certificated commercial pilots and to hold and maintain a valid Second-Class Airman Medical Certificate issued by the FAA under Title 14 CFR 67.
Considering that the FAA Second-Class Airman Medical Certification process does not require that a certificated pilot submit to an OSA screening, the Director of the Maryland State Police Human Resource Section has ruled that the MSPAC cannot mandate that the certificated pilots within their employ submit to OSA screening as a condition of their continued employment or to maintain an “active flight” status within the organization. However, the MSPAC can mandate that its pilots, and other employees assigned to job functions that could have a direct impact on flight safety, receive OSA training on an annual basis to educate them on the adverse health effects of having untreated OSA. Once the OSA training has been completed, the MSPAC can provide each pilot, as well as other employees assigned to job functions that could have a direct impact on flight safety, with the aforementioned OSA screening package designed to assist each individual in voluntarily assessing their individual risk of having OSA. However, the MSPAC cannot mandate that pilots within its employ (or any prospective pilot applicants) complete the questionnaires and/or submit to a clinical screening for OSA.
As should be evident in MSPAC’s proposal to address NTSB recommendation A-09-134, it is the hope of the MSPAC that once all pilots within its employ are educated on the signs and symptoms of OSA, the detrimental health effects of OSA, and the treatment options available to treat OSA, that they will voluntarily and conscientiously complete the OSA screening tools provided and seek a clinical evaluation, if warranted. However, at this time, the MSPAC cannot mandate that current or prospective MSPAC pilots submit to OSA screening without the FAA making the appropriate changes in the Second-Class Airman Certification requirements outlined in Title 14 CFR 67, as previously recommend by the NTSB.
On August 17, 2009, as a result of an incident that occurred on February 13, 2008 where both the captain and first officer fell asleep during a flight and over flew their destination, the NTSB made the following recommendations to the FAA:
- 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.” (A-09-61)
- 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. (A-09-62)
As you know, the FAA’s responses to the above recommendations were classified “Open - Unacceptable Response” by the NTSB and both recommendations were subsequently placed on the NTSB’s “most wanted” list. If the FAA decides to embrace the above recommendation(s) and change 14 CFR 67 as appropriate, the MSPAC’s proposal for addressing NTSB recommendation A-09-134 will become a moot point. Until that time, the MSPAC believes that its proposal described here within is a good faith effort to meet NTSB recommendation A-09-134.
Attached to this document you will find the following:
- A draft of the policy design to specifically address NTSB recommendation A-09-164.
- The Epworth Sleepiness Scale, Berlin and STOP-Bang Questionnaires to be used in the OSA screening package.
Once completed, a copy of the mandated OSA training program will also be provided. We will keep you informed of our progress on this safety recommendation.