Opinion ID: 411856
Heading Depth: 2
Heading Rank: 2

Heading: Appellant's Applications for Medical Certification

Text: 8 Appellant, D. Ross Beins, began flying for United Air Lines in December 1966. He held a first-class airman medical certificate from 1966 through April 29, 1971. When appellant reapplied at that time for a first-class certificate the FAA declined to act until it could evaluate his hospitalization on May 8, 1970, for what appeared to have been a generalized seizure. 9 Physicians involved in appellant's case--then and since--have disagreed about the precise cause of the 1970 incident, and these differences have played a critical role in their conflicting views on both appellant's later hemorrhage in 1974 and his overall fitness to be a pilot. Appellant was taken to the hospital early in the morning on May 8, 1970, after his wife, noticing that he was perspiring heavily and shivering, was unable to wake him. Appellant remained in the hospital for five days. The examining neurologist described appellant as having a tonic-clonic contraction. The treating physician wrote in appellant's discharge summary that the patient had suffered a syncopal episode of excessive muscle contractions; amnesia; stridulous breathing; etiology undetermined. Beins v. United States, No. 79-3322 (D.D.C. Aug. 5, 1981) mem. op. at 2, reprinted in Appendix (App.) at 1, 2 [hereinafter cited as District Court Opinion]. 10 Nonetheless, on October 15, 1971, after evaluating the 1970 incident, the FAA issued appellant a first-class medical certificate with operational restrictions. On October 5, 1972, the FAA granted appellant an unlimited first-class medical certificate. The FAA renewed the unlimited certificate for 1973 and 1974. 11 On November 19, 1974, appellant suffered a spontaneous intracerebral hemorrhage. The major symptom of appellant's hemorrhage was loss of his entire right field of vision in both eyes. Appellant's physicians promptly placed him in a hospital and administered an arteriogram (an X-ray photograph of arteries). The arteriogram showed one vascular malformation in the left rear of the brain, and suggested another smaller one in the left front region. 12 Dr. S.R. Winston performed a craniotomy on appellant. He removed a blood clot that was about two and a half inches inside the occipital lobe (located in the left rear of the brain). Dr. Winston also took out a smaller subdural hematoma (a swelling containing blood close to the brain surface) in the same area. Since Dr. Winston did not perform surgery in other regions of the brain, he could neither confirm nor deny the existence of other vascular malformations. In his summary diagnosis, however, Dr. Winston mentioned a possible left frontal microangioma (a small tumor composed chiefly of blood vessels) and a suspect right parietal (upper posterior wall) microangioma. After surgery, appellant had only a fifty percent field of vision on his right side. This improved in the following months, until by June 1975 his loss was only twenty-five to thirty percent. His condition appears to have stabilized at that point. 13 On November 11, 1975, appellant applied to an AME for a first-class airman medical certificate. After denial by the AME, appellant requested reconsideration by the Federal Air Surgeon. Appellant gave the FAA the hospital records relating to the surgery in 1974, medical documentation of the improvement in his field of vision, and authorization forms for the release of other information. Prior to acting on appellant's application, the Air Surgeon sought the opinion of Dr. Sam Hunter, a neurosurgeon and an FAA consultant. Dr. Hunter recommended denial. On March 25, 1976, the Air Surgeon denied appellant's application. The Air Surgeon's letter to appellant explained that the decision was based on appellant's intracranial hemorrhage and surgery, which resulted in a visual field defect, and appellant's current use of anticonvulsant medicine. Appellant did not appeal the Air Surgeon's denial to the NTSB. 14 On August 30, 1976, appellant applied again for an airman medical certificate, but this time he sought only a third-class rating. The Air Surgeon once more consulted Dr. Hunter, who again recommended denial. On March 10, 1977, the Air Surgeon denied appellant's application because: (1) he had had an intracerebral hemorrhage requiring surgery; (2) he had a visual field defect; (3) there was a continued risk of post-operative seizures; and (4) diagnostic studies revealed the presence of other vascular malformations, presenting the risk of further bleeding episodes. District Court Opinion at 4. Appellant again did not appeal this decision to the NTSB. 15 On June 20, 1977, appellant petitioned the FAA for an exemption from a neurological requirement, 14 C.F.R. Sec. 67.17(d)(2)(ii) (1982), and for the issuance of a third-class airman medical certificate. The Air Surgeon referred appellant's file to Dr. Thomas Auth, a neurologist and an FAA consultant. Dr. Auth concluded that appellant should not be certified for four reasons: a persisting electroencephalogram (EEG) abnormality in the left temporal lobe; risk of seizures; risk of rebleed; and the visual field defect. The Air Surgeon then forwarded appellant's petition and file to a panel of consultants. The panel also recommended against certification, and on August 31, 1977, the Air Surgeon denied appellant's request for an exemption. Appellant did not appeal to the NTSB. 16 In December 1977 appellant underwent an extensive physical examination, including a second arteriogram and a CAT Scan. The arteriogram was normal. The CAT Scan revealed an area of atrophy where the blood clot had been removed. Dr. Benjamin Boshes, the examining neurologist selected by appellant, reviewed these tests and others and concluded that appellant was not qualified for certification. Dr. Boshes believed that the ongoing spiking activity on the EEG's over a period of seven years indicated a risk of seizure. 17 On April 21, 1978, appellant once again requested a first-class certificate. The Air Surgeon consulted Dr. Harold Stevens, a neurologist who is board-certified in electroencephalography. Dr. Stevens reviewed a report on the December 1977 CAT Scan, the reports of the various EEG's, and the medical records pertaining to the 1970 and 1974 incidents. Dr. Stevens concluded that appellant's request for certification should be denied because of both a pattern of abnormal EEG's and the surgical scar in his brain. Dr. Stevens believed that the scar was a potential epileptogenic focus that presented a risk of seizure. On July 7, 1978, the Air Surgeon denied this fourth request for certification. The Air Surgeon's denial cited appellant's seizure disorder in 1970 and the scar from the hemorrhage and surgery in 1974. The Air Surgeon stated that the scar and the manipulation of the brain enhanced the probability of future seizures. Appellant did not appeal to the NTSB. 18 Appellant made his final application to the Air Surgeon for a first-class certificate on August 21, 1978, within two months of the fourth denial. The Air Surgeon denied the request on September 11, 1978. The Air Surgeon noted the same two reasons he had given in the previous denial, and added that appellant continued to have a visual field defect. 19 Appellant appealed this fifth denial to the NTSB. On February 19, 1980, after a hearing, the Administrative Law Judge found that appellant had met his burden of proving that he met the safety standards for third-class certification. He concluded: Though Petitioner may not be entirely beyond the realm of some risk of future seizure activity, in view of his medical history, his age, and the absence [of] subsequent seizure activity and the relevant time duration thereof, it is the judgment here that such risk is minimal. Defendant's Exhibit No. 1 at 83-84. 20 The FAA appealed the Administrative Law Judge's decision to the NTSB. After a hearing de novo, the NTSB affirmed the initial decision on October 17, 1980. 5 On January 22, 1981, the Air Surgeon made a special issuance of a second-class certificate to appellant, thereby permitting him to resume work as a commercial pilot. 21 Appellant filed this action for damages under the FTCA on December 7, 1979, after his hearing before the Administrative Law Judge, but before the Administrative Law Judge reversed the FAA's denial of appellant's petition for certification. Appellant alleged that the FAA had negligently denied him airman medical certificates on five occasions, thereby preventing him from working as a commercial airline pilot. In particular, appellant claimed that the FAA had negligently failed to provide adequate information to its consultants, and failed to use and analyze appropriate medical evidence in its own evaluations. The government moved to dismiss and later moved for summary judgment on the ground of lack of subject matter jurisdiction because (1) the courts of appeals have exclusive jurisdiction to review orders of the FAA, and (2) the claim was barred by the discretionary function exception to the FTCA. 6 These motions were denied without opinions. After a nonjury trial 7 on June 15-17, 1981, the district court issued a memorandum opinion containing the court's findings of fact and conclusions of law. The district court concluded that plaintiff has not proven negligence and has not proven a case under the Federal Tort Claims Act, and entered judgment for the government. District Court Opinion at 11-12.