Up in the air
The right of confidentiality is bound by the Privacy Act but, as doctors, you can disclose patient information in certain circumstances. One such area is aviation safety. Dr Dougal Watson explains your obligations
Many doctors have pilots and air traffic controllers as patients. Few doctors are aware that in certain circumstances they also have public safety obligations to advise the aviation safety regulator – the Civil Aviation Authority (CAA) – concerning their patients. Even fewer doctors understand that those public safety obligations – to advise the CAA – are very well protected and are not overridden by privacy obligations.
This article explains some of the obligations and protections that apply to medical practitioners who have pilots and air traffic controllers as patients. This article also explains how those public safety obligations override your obligations under the Privacy Act.
As a medical practitioner, you will be aware of the potential for medical conditions to degrade aviation safety. Clearly it would be inappropriate for an epileptic patient to be flying an airliner carrying dozens, or hundreds, of passengers. What is not always clear, is just where the medical safety line lies.
Epilepsy is relatively straightforward, along with some serious mental health problems, but what about migraines? What about after a myocardial infarct, head injury, or malignant disease? What about any of the many medical conditions that you routinely see in your day-to-day practice? What about prescribed medications?
It would not be reasonable to expect every medical practitioner to also be expert in the field of aviation medicine, or to also understand the safety thresholds that are applied by the CAA. To allow for this, and to help maintain aviation safety, the civil aviation legislation (Civil Aviation Act 1990) includes requirements for medical practitioners to report certain cases to the CAA.
Those statutory requirements have a very low threshold for action, offer robust protection to the reporting medical practitioner, and ensure that it is the CAA’s aviation medicine experts that make any final decisions concerning aviation medical safety. Your obligations to report Section 27C(3) of the Civil Aviation Act describes the circumstances and, if those circumstances are met, places a reporting obligation upon medical practitioners.
There are three elements to the circumstances described: subject to General Directions issued by the Director of Civil Aviation; reasonable grounds to believe the patient is a pilot or air traffic controller; and reasonable grounds to suspect the patient has a medical condition that may interfere with aviation safety.
The first circumstance is very straightforward. The Director of Civil Aviation has not issued any General Directions that specifically relate to medical practitioners’ responsibilities under this legislation.
The second circumstance simply requires the medical practitioner to have reasonable grounds to believe that the patient is a pilot or air traffic controller. In most cases that information will have come to your awareness from the occupational or recreational aspects of the history you’ve taken. In some other cases you may have been told by family members or others. If you suspect your patient may be a pilot or air traffic controller, but are not satisfied you have “reasonable grounds to believe” then you can always contact the CAA to check.