Aviation

Sudden Death of a British Airways Pilot – Medical, Legal And Human Aspects

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Death is the handmaiden of the pilot. Sometimes it comes by accident, sometimes by an act of God. ~ Albert Scott Crossfield ~ Medical Aspects

On 11 March 2023 an article in the U.S. Sun reported that “a British Airways pilot collapsed and died shortly before he was due to captain a packed jet. He had been preparing to fly from Cairo in Egypt to Heathrow Airport but had a heart attack in the crew’s hotel”.

Infrequently, one hears news of such a sad event:  of sudden pilot incapacitation and death, both while flying an aircraft and otherwise. The World Health Organization reported in 2020 that “in 2019, the top 10 causes of death accounted for 55% of the 55.4 million deaths worldwide. The top global causes of death, in order of total number of lives lost, are associated with three broad topics: cardiovascular (ischaemic heart disease, stroke), respiratory (chronic obstructive pulmonary disease, lower respiratory infections) and neonatal conditions – which include birth asphyxia and birth trauma, neonatal sepsis and infections, and preterm birth complications”. Of this, cardiovascular disease is one of the most prominent in occurrence.

Reports of pilot deaths, particularly while piloting aircraft, sometimes appear in media reports. Aviation,  Space, and Environmental Medicine in 2012 recorded that  “In 2004 there were 16,145 UK/JAR professional pilot license holders. Of the notified medical events, 36 presented as incapacitations; half were cardiac or cerebrovascular… There were four sudden deaths. The type of incapacitation varied with age. A male pilot in his 60s had 5 times the risk of incapacitation of a male pilot in his 40s. The annual incapacitation rate was 40/16,145 = 0.25%”.

BBC on 6 October 2015 reported that “Capt Michael Johnston, 57, was flying the plane with 147 passengers and five crew on board when he “passed away while at work”, as per the announcement of the airline. It was also revealed that he had double bypass surgery in 2006.  Live Science of 27 September 2013 reported  “ A pilot’s heart attack turned a United Airlines flight to Seattle into a dramatic scene where passengers attempted to save the pilot’s life, and one helped the co-pilot make an emergency landing in Boise, Idaho. The pilot died at the hospital, according to news reports. A midair heart attack is a scary scenario for sure, but the incident last night (Sept. 26) was unusual — heart attacks on flights are rare, and deaths are even rarer. A study of medical emergencies on five major airlines over a nearly three-year period showed that, of the 12,000 passengers who experienced some form of medical emergency during a flight, 0.3 percent (38 people) suffered cardiac arrest, in which the heart stops. The number who died over the study period was 31, according to the study, which was published in May in the New England Journal of Medicine”.

Aviation, Space and Environmental Medicine in March 2004 went on to say “The Chicago Convention in 1944 to standardize practices where uniformity would improve air navigation. In subsequent annexes to the original convention, the regulations that standardize personnel licensing and rules of the air were established that guide the medical requirements for pilots and aircrew today. After evaluation of available data and the potential risks at different times during a flight, ICAO set a goal of less than 1% risk of pilot incapacitation per year to guide the standards for medical examinations. Gastrointestinal issues, earaches, faintness, headache, and vertigo are the most common causes of incapacitation. Less common but more dangerous debilitations such as alcohol intoxication and sudden cardiac death have been implicated in mishaps, so screening for these risks carries high importance”.

Medical assessments carried out periodically on pilots are generally indicative of a pilot’s health but are not a guarantee against unforeseen health conditions. 

The Aeromedical Office of the Airline Pilots Association reports that approximately 42 persons with rhythm disturbances contact the office annually. “Over one half of these persons have experienced syncopal episodes, with 5 to 10 in-cockpit syncopes per year. In a review of 102 syncopes over 5 years, less than half were attributed to ventricular arrhythmias. The majority of individuals with ventricular arrhythmias were permanently disqualified from flying, while most individuals with syncope believed to be bradyarrhythmic returned to flight after evaluation.

In Western Europe cardiovascular causes are the most common cause of loss of flying license, and the main cause for disqualification of pilots on medical grounds is cardiac arrhythmia  – frequent ventricular premature beats, nonsustained VT, and paroxysmal atrial fibrillation were the most common problem arrhythmias

The evidence suggests that the incapacitation risk limits used by some states, particularly for cardiovascular disease, may be too restrictive when compared with other aircraft systems, and may adversely affect flight safety if experienced pilots are retired on overly stringent medical grounds. States using the 1% rule should consider relaxing the maximum acceptable sudden incapacitation risk to 2% per year”.

Legal and Regulatory Aspects

Legally, a pilot is in a special category: the same as a surgeon who is in charge of a person’s health and a can driver or bus driver in charge of a passenger’s security.  Only, a pilot has to ensure the safety of hundreds of passengers all at once.  Inasmuch as an airline would be guilty of negligent entrustment in handing over a plane full of passengers to an improperly licensed pilot, a pilot would be guilty of gross negligence – the highest form of negligence –  if she jeopardizes the security and safety of the passenger in her charge. 

The International Civil Aviation Organization addresses the issue of pilot’s health requirements under Annex 1 (Personnel Licensing) to the Chicago Convention of 1944 and provides further guidance in  Procedures and requirements for the assessment of medical fitness which  are contained in the Manual of Civil Aviation Medicine (Doc 8984). The International Air Transport Association (IATA) – the trade association of airlines – in its guidelines for flight crew requires the following: the absence of any medical condition or any suspected medical condition that may lead to any form of acute functional incapacity; the absence of any existing or former medical condition – acute, intermittent or chronic – that leads or may lead to any form of functional incapacity; the absence of any use of medication or substances which may impair functional capacity; minimal requirements to the necessary functions such as vision and hearing.

ICAO’s Annex 1 provides that, to satisfy the licensing requirements of medical fitness for the issue of various types of licenses, the applicant must meet certain appropriate medical requirements which are specified as three classes of Medical Assessment:  Third Class: This is the most basic of the medical exams. It is required for those attempting to earn a student pilot license, recreational pilot license, and private pilot license.; Second Class: This one is required for anyone attempting to earn their commercial pilot license; First Class: A first class medical certificate is required in order to earn a airline transport pilot certificate.

The United States Federal Aviation Administration states that the main differences between these is how in depth the exam gets and how often you have to have it done. Much of the 3 tests are very similar although the first class medical exam is required to be done annually and includes an Electrocardiogram test if the applicant over the age of 40.

.Recommendation 1.2.4.2 of Annex 1 suggests that from 18 November 2010 States should apply, as part of their State safety programme, basic safety management principles to the medical assessment process of licence holders, that as a minimum include: routine analysis of in-flight incapacitation events and medical findings during medical assessments to identify areas of increased medical risk; and continuous re-evaluation of the medical assessment process to concentrate on identified areas of increased medical risk. This is followed by the recommendation that the period of validity of a Medical Assessment must begin on the day the medical examination is performed.

Here, validity means acceptance as truth or fact which would go towards recognizing a pilot’s suitability to fly an aircraft. An air carrier which wet leases an aircraft to another carrier would be guilty of negligent entrustment.  So would any air carrier who employs pilots without checking if the pilot has a valid license.

Human Aspects

Although we tend to glamourize those in aviation, from the confident captain to the glamourous cabin attendant even down to the humble chap in overalls who helps put he aircraft in the sky, they are all human, like the rest of us, subject to the vulnerabilities of humanity.  When the I was working at ICAO I once had a meeting with an airline pilot who had been commanding a flight from Europe to Asia.  His young first officer, just 38 years old, had been complaining about a pain in his back on the onward flight to Europe.  He had informed the captain that it was “just a backache” and that he would get it checked by his brother who was practicing medicine in the city they were bound for.  On the return flight the next day, over Zurich, the first officer had mentioned to the captain that his back ache had returned and that he would leave the flight deck for a few minutes to rest.  A few minutes later a visibly upset cabin crew member had rushed into the flight deck and told the captain that the first officer had died.

The captain had been grief-stricken as the first officer was a good friend as well as a trusted colleague  He had to fly alone the rest of the flight, with mental acuity and equanimity, and when I asked him how he managed the flight he said the worst feeling was the feeling of loneliness in the flight deck, which was overwhelming.  The flight deck is a lonely place, even if there are two persons in it. Dr. Vivek Murthy, one time Surgeon General of the United States writing in the Harvard Business Review said: “Loneliness is a growing health epidemic. We live in the most technologically connected age in the history of civilization, yet rates of loneliness have doubled since the 1980s. Today, over 40% of adults in America report feeling lonely, and research suggests that the real number may well be higher”.

Heart attacks often come from nowhere, with no prior warning.  However, what must be borne in mind, in the case of pilots is that pilots have negative factors that affect them that other professionals may not have, such as crew fatigue due to overscheduling, disturbance of sleep cycles caused by night flying and missing family events and celebrations, not to mention being away from home constantly.  The overbearing loneliness factor may add to this.

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Flight MH 370 – 9 Years On

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“The loss of MH370 points us to an immediate need. A large commercial airliner going missing without a trace for so long is unprecedented in modern aviation. It must not happen again”. ~ Tony Tyler, Director General, International Air Transport Association (2014)

Just after  midnight on 8 March 2014 A Boeing 777 Malaysian Airlines aircraft operating Flight MH 370 took off from Kuala Lumpur on its  way to Beijing. 227 passengers and 12 crew were on board. A short time later, the aircraft was lost on radar between the air traffic control areas of Kuala Lumpur and Ho Chi Minh City.  Neither the aircraft nor the passengers or anything related thereto has been found so far except for a part of a wing and a few other pieces seemingly coming from the aircraft which were found off the coast of the French Reunion islands, Madagascar, and Mozambique, spawning theories that the plane could have veered off to somewhere in the Indian Ocean – a fact claimed to have been supported by data driven evidence. 

All that is known is that at around 1.01 a.m. the aircraft had reached an altitude of 10,700 meters. The source of data transmission in the aircraft –  The Aircraft Communication Addressing and Reporting System (ACARS) – on the performance of the aircraft had  send its last transmission at 1.07 am and blipped off at around 1:19 A.M. and at 1.21 the last communication from the crew had been recorded whereupon   the plane’s communication between the aircraft and air traffic control ceased.  This was  when the transponder that communicated with the air-traffic control had got switched off just prior to Flight MH 370 entering Vietnamese airspace over the South China Sea. 

The Theories

Theories – unsubstantiated by cogent proof  – abound.  Netflix last week came out with a three-part series which had three theories.  One was that it was the pilot who veered off into the Indian Ocean from the designated flight path and crashed the plane in the sea after it ran out of fuel. The second theory was that someone or some people hijacked the aircraft and flew it perhaps to Kazakhstan.  The third theory was that the plane was carrying dangerous cargo (which had been loaded in Kuala Lumpur under armed escort) bound for China which was effectively precluded from getting there, perhaps by someone carrying out  an armed attack on the plane in mid air.

The three theories came “supported” by some incredible facts.  With regard to the first theory, the pilot in command – a seemingly respectable and respected family man who had tons of experience as a pilot with no history of professional irregularity, could have knocked off the electronics, thus making the aircraft invisible to radar; de pressurised the cabin; and put all persons on board to sleep (while he had put on a long lasting oxygen mask and despatched the First Officer out of the flight deck and locked the door), just to trash the aircraft in the Indian Ocean when the fuel tanks emptied.  This drastic theory was based on the fact that the pilot had applied  a similar deviating route (of going way South into the Indian Ocean) on his home simulator for fun. Thankfully, all concerned ruled out the pilot theory, when the other two theories saw light.

The second theory was that there could have been a Russian connection, as three Russians were on board. One was in first class where here was a “trap door” on the floor, unlocked, which led down to the computer centre of the aircraft.  One of these three, it was surmised,  could have surreptitiously gone down and disabled all electronic functions of the aircraft, disabled the flight crew and taken the aircraft to say, Kazakhstan.

The third theory – interception – was that someone thought the huge consignment of dangerous and sensitive cargo should not have been allowed to get into the hands of the Chinese, therefore two large aircraft (with huge dishes of some sort fixed on them that could disrupt electronics on any object below them) flew over MH 370 and somehow and possibly “blew up” the aircraft when the captain of MH 370 refused the commands from above to land in some place like the Andaman Islands in the Indian Ocean. Or the aircraft may have landed somewhere in the Indonesian Islands and that is why there is no debris flying around.

Reparation for Loss

Watching this series, I felt intensely sorry for the families left behind who were interviewed. All of the above do not help the grieving father and husband who had lost his wife and two children; a wife whose husband left for Beijing for a job; and a young wife whose husband was a member of the cabin crew on the flight. They never returned.

Technically, as both Malaysia and China have ratified the Montreal Convention of 1999, the dependants are entitled to compensation for death or injury of the passengers on board (not the crew as they were under an employment contract with the airline).  But there is a snag.  The passengers are not proven to be dead or injured. This compensation would come from the insurers of the airline.  As for Malaysia, as the aircraft bore the nationality of the State,  some accountability would have to accrue.  The BBC reported in 2014 that “the families of passengers on the missing Malaysian passenger plane have begun to receive initial compensation payments of $50,000 (£30,000). So far six Malaysian families and one Chinese family have received the money, and insurers are assessing the claims of 40 more Chinese families. Relatives of all 239 missing passengers can claim up to $175,000 each”.  How this was computed was not revealed, although in the context of Malaysian Airlines, the Montreal Convention is clear – that once death or injury is established, there will be a preliminary sum of 100, 000 Special Drawing Rights (around 132,720 US $) which is paid with no questions asked.  The plaintiffs can claim more than this amount but beyond the 100,000 SDRs the carrier can circumvent a claim for a higher amount if the carrier proves that: (a) such damage was not due to the negligence or other wrongful act or omission of the carrier or its servants or agents; or (b) such damage was solely due to the negligence or other wrongful act or omission of a third party.

There is also a provision – Article 28 – which admits of advance payments or upfront payments if required by national law, where the carrier should make advance payments without delay to a natural person or persons who are entitled to claim compensation in order to meet the immediate economic needs of such persons. Such advance payments do not presuppose a recognition of liability and may be offset against any amounts subsequently paid as damages by the carrier.  

My Take

This absolute mystery at this time of sophisticated technology available through the application of satellite tracking cries out the question “why can’t we have a system of global tracking of any aircraft wherever they are”? Admittedly, on the face of it this is a simple enough question. However, for there to be global tracking of airborne aircraft (or aircraft under the sea or anywhere in the world for that matter) there would have to be some sort of reporting apparatus installed in an aircraft. Of course, one size might not fit all types of aircraft and such a system might take years to perfect.

Whatever the cause might have been for us to believe “beyond reasonable doubt” that there are no survivors; or whether the aircraft disappeared as a result of human intervention or technical malfunction, it is not for us to question our faith in whatever religious doctrine we believe in. As someone crudely put it: “shit happens”. 

Ultimately it boils down to the grief-stricken relatives who are still waiting for an answer from the authorities. There is no point in blaming divine intervention. We bring these things upon ourselves. Rabbi Kushner has some wise words to say in his book When Bad Things Happen to Good People: “The painful things that happen to us are not punishments for our misbehavior, nor are they in any way part of some grand design on God’s part. Because the tragedy is not God’s will, we need not feel hurt or betrayed by God when tragedy strikes. We can turn to Him for help in overcoming it, precisely because we can tell ourselves that God is as outraged by it as we are”. Rabbi Yitzchok Kirzner, in one of his articles alludes to the possibility that : “not everything that takes place in the world has a purpose or comes from God. Efforts to reconcile the existence of evil and suffering in the world with God’s justice are a waste of time because they proceed from the false premise that everything that takes place in the world comes from God and has a purpose”.

I believe it is definitely not appropriate to ascribe the disappearance of the aircraft to an inadequacy of divine intervention. As the Dalai Lama once said: “According to the Latin root of the word “religion” would mean “to bind again”. Now how does the concept of binding or tying up come to be applied as the common term for all our various teachings? The common enemy of all moral precepts laid down by the great teachers of mankind is selfishness of mind. For it is just this which causes ignorance, anger and passion which are at the root of all the troubles of the world”.

Perhaps it all boils down to randomness, which seems to leave me with no alternative but to accept Rabbi Kushner’s wise words: “If you have been brave enough to love, and sometimes you won and sometimes you lost; if you have cared enough to try, and sometimes it worked and sometimes it didn’t; if you have been bold enough to dream and found yourself with some dreams that came true and a lot of broken pieces of dreams that didn’t, that fell to earth and shattered, then you can look back from the mountaintop you now find yourself standing on, like Moses contemplating the tablets that would guide human behavior for a millennia, resting in the Ark alongside the broken fragments of an earlier dream. And you, like Moses, can realize how full your life has been and how richly you are blessed. ”

This is how I see the passengers of Flight MH 370 to whom these thoughts are lovingly dedicated. I am still hoping  they will come back to us.

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India’s growing civil aviation industry sees greater scope for growth

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India’s aviation industry has grown by leaps and bounds over the past two-and-a-half decades, as air travel has come within the reach of the middle class, which till early 2000s was considered a luxury exclusiveness only to the rich and upper class.

Over the years, air travel has become accessible to those with an annual income bracket of roughly 8,536-14,500 U.S. dollars, i.e. the middle class, and even the next strata of Indian society down the line, the lower-middle class.

Most people belonging to the middle class are government employees who have begun opting for air-travel for family vacations while availing the Leave Travel Concession (LTC) offered by the government. Besides, practitioners in lucrative industries such as Information Technology (IT) and Telecommunications are increasingly taking to air travel instead of the traditional road or rail transport means.

This ever-expanding strata of Indians, who all the more choose flights for domestic travel, has given impetus to the consistent growth of civil aviation in the country.

According to the Indian government’s data, domestic air traffic has more than doubled from around 61 million passengers in the 2013-14 financial year to around 137 million in 2019-20. International passenger traffic has jumped from 47 million in 2013-14 to around 67 million in 2019-20 with an annual growth of over 6 percent.

The number of daily domestic air passengers in India was 398,579 during pre-COVID-19 years. Whereas this year, nearly 445,000 people boarded flights on Feb. 19, the maximum number ever, said Civil Aviation Minister Jyotiraditya Scindia.

The phenomenal growth is also driven by factors including the explosive growth in IT sector accompanied with high incomes, constantly decreasing gap between train tickets and air fares for long distances, significant rise in incomes of the salaried class (particularly of government employees by way of regular pay commissions), the West’s attraction towards the Indian civil aviation market, and a forward-looking civil aviation policy laid out by the Indian government, according to aviation experts.

In terms of civil aviation infrastructure, India has witnessed a marked improvement since the early 2000s, particularly over the past decade. The number of airports in the South Asian country has doubled to more than 140 in the past eight years, with Karnataka state’s newest Shivamogga Airport just inaugurated on Feb. 27.

As per an estimate, India is currently the 7th largest civil aviation market in the world, and is expected to become the third-largest civil aviation market within the next decade.

Renowned civil aviation expert Harsh Vardhan told Xinhua that the robust growth of the Indian economy due to liberalisation and privatisation policies shows there is a greater scope for growth in civil aviation in the coming years, as the number of aircraft and flyers per day of India still lags behind the developed nations.

Indians’ income growth over the years entails a shift in their work culture and traveling habits, encouraging them to fly instead of having prolonged travel by train or road. Meanwhile, with the cut-throat competition among the private airlines leading to low-cost flying, the paying-capacity of Indians has risen manifolds, which left a positive cumulative effect leading to an immense growth of the Indian civil aviation, said Vardhan.

Talking about the recent orders placed with Boeing and Airbus by Air India for 840 new aircraft, he said, “With the healthy competition in the aviation market up there, we can surely expect such big orders from other private airlines too. No doubt India’s civil aviation industry is destined to grow at a faster pace in the years ahead.”

The National Civil Aviation Policy 2016 aims to create an ecosystem to make flying affordable for the masses and witness 300 million domestic ticketing by 2022 and 500 million by 2027, and enable international ticketing to rise to 200 million by 2027. Similarly, cargo volumes should increase to 10 million tonnes by 2027.

It also aims to provide safe, secure, affordable and sustainable air travel for passengers and air transportation of cargo with access to various parts of India and the world. Besides, it plans to establish an integrated ecosystem which will lead to an significant growth of the civil aviation, which in turn will promote tourism, increase employment and lead to a balanced regional growth.

Finance Minister Nirmala Sitharaman recently allocated 31 billion Indian rupees (around 376 million U.S. dollars) for the civil aviation ministry in the Union Budget for the 2023-24 financial year (April 2023 – March 2024). “Fifty additional airports, heliports, water aerodromes and advance landing grounds will be revived for improving regional air connectivity,” the minister said in her Budget speech earlier this month.

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