AIRLINE PILOTS, DOCTORS AND LAWYERS (with malice to none)

Srianee (Bunter) Fernando Dias' youngest brother Gihan, is a retired Singapore Airlines and Sri Lankan Airlines Captain. This article was published in the ‘Island' newspaper about 5 years ago, but since aviation issues are currently dominating the news,  a re-read would be interesting. Gihan frequently writes to the ‘Island’ about aviation issues.

by Capt. G.A Fernando

Airline pilots and surgeons work in a high-risk environment. In the case of airline pilots, they themselves are potentially at high risk. In the case of the surgeons it is the patient who is at the high-risk end – although in some countries noted for their high levels of litigiousness, surgeons could be sued for making grave mistakes. While aviation has improved in leaps and bounds in the last 100 years, and aircraft and equipment have got more and more reliable, the human element with all its fallibility has remained the same. The human is the weakest link in the scheme of things, and the corollary of that is that a chain is as weak as its weakest link.

Accordingly, regulations decree that airline pilots must undergo semi-annual medical checkups. But not only medical checks; three times a year they must also demonstrate to the regulator that they have the knowledge, experience, and the skill, in a simulated environment, to fly with such anomalies as critical engines failed, navigational, hydraulic, and electrical systems inoperative, landing gear not working, or taking off and landing in low visibility, flying solely with reference to instruments, etc. It is also regulated that once a year airline pilots must demonstrate that they have the knowledge to operate safety equipment and carry out emergency procedures with regard to carriage of dangerous goods, ditching, and crash landings. In addition to all this it is regulated that the airline pilot demonstrates to his/her employer that he/she carries out Standard Operating Procedures (SOPs) according to the ‘book’ (the Operations Manual), and is capable of being a good ‘team person’.

The manual itself is regularly perused by the regulator to be in compliance with the 19 Annexes to the ICAO convention. These Annexes were made the law of the land (in Sri Lanka) in 1969 by Mr. E. L. B. Hurulle, the then Minister of Communications. I believe that no other career or profession is as heavily regulated as that of the airline pilot. As can be seen, it is not all glamour and glory, because an individual could be failed at any time if he/she doesn’t measure up to the required standards. Employers also have the opportunity to use these checks to get rid of ‘difficult elements’ from the system.

Being a more recent discipline, airline pilots are more affected by medicine and law. For instance, a doctor could rule a pilot unfit to fly. A colleague of mine once went for a routine medical check a few days after the Martinair DC-8 crash at Maskeliya in December 1974. He was ruled as unfit to hold a Commercial Pilots’ Licence (CPL) as his voice was hoarse; the ENT surgeon conducting his medical examination had read in the newspapers that it was probable that the captain of the ill-fated aircraft was misheard by the duty air traffic controller at the Bandaranaike International Airport, Katunayake. (The rumor was that “forty miles from the airport” as given by the pilot in command was interpreted as “fourteen miles” by the air traffic control officer). The pilot’s protest that his voice had been raspy from his young days fell on deaf years.

It subsequently took this pilot over ten months to prove that he was fit to hold a CPL. To resolve the problem, he had to go to an adjoining room and telephone the president of the Medical Board to prove that his voice comes through ‘loud and clear’. There was nothing medically wrong with him. A contributing factor was that the original ENT surgeon who failed him was the brother of a powerful minister in the coalition government, and no other doctor wanted to override him. As soon as the coalition was disbanded the Pilots’ Medical Board gave him a hearing.

Then there was the case of another colleague who went to the Colombo Eye Hospital for the eyesight examination for his CPL. When testing for colour blindness the surgeon had used a faded set of Ishara plates. These are charts with coloured dots that comprise various numbers, the numbers or patterns being clearly identifiable only by those without colour blindness. Ideally, these charts must be kept away from sunlight to prevent fading, which in turn could lead to faulty readings by those being tested. However, the charts given to my colleague were faded due to regular exposure to sunlight, so he was unable to discern the numbers ‘hidden’ amongst the sea of coloured dots. During a retest on a subsequent day he read them properly, but the doctor accused him of memorising the charts! After a further delay to prove that he had not done, he had to trace the numbers with his finger!

Because of the many variables in an airline pilot’s career, once he/she joins a reputed airline, a pilot is insured against ‘loss of licence due to medical reasons’. In the old days when a pilot was medically grounded, the lawyers of the Insurance Corporation declared that said pilot was capable of alternative employment and did not make good the full settlement as indicated in the policy! In those days, insurance was a one-horse race. At one time there were as many as five airline pilots working for the national carrier who were affected by such unfair and seemingly illogical decisions. The Pilots’ Guild at that time attempted to explain that the airline pilots have overlearnt a skill that is useless anywhere else. It took many years and a government change for these airline pilots to get their full insurance. It is to be hoped that the situation in Sri Lanka has changed since then.

In addition to drafting regulations, lawyers also get involved after an aviation incident or accident in more instances than in medicine, because there are devices that monitor the pilots’ actions. The so-called ‘black box’ consists of the Flight Data Recorder (FDR) and Cockpit Voice Recorder (CVR). They are not black either. They are a luminous orange! These sophisticated and invaluable items of electronic equipment should only be used as a tool to discover what happened and not to apportion blame or to institute legal action. But it seems to be easier said than done.

In June 1995 an Ansett New Zealand DHC Dash 8 turboprop aircraft crashed on its final approach to Palmerstone North in New Zealand. The Police, acting on legal advice, promptly impounded the black boxes and did not make them available to the accident investigator. Now it is law in New Zealand that the CVR and FDR cannot be used for prosecution of pilots! Sri Lanka does not have any such laws in place. Perhaps our administrators believe that ‘accidents only happen to others’, and air safety is assumed to be good until an accident occurs. Because of these issues, although they sit behind a bulletproof door and away from public scrutiny, airline pilots are well advised to always act as if the whole world is watching them, because in the event of an accident or incident, one day they will have to defend their actions in a court of law, and in front of the world, their friends, and loved ones. In some countries surgical operations too are video recorded. I do not know whether such recordings are accessible to the lawyers in the event of litigation. But consider this: when a surgeon makes a mistake, it is called ‘surgical misadventure’. When a lawyer makes a mistake it is a ‘miscarriage of justice’. But when an airline pilot is involved in an incident or accident, even through no fault of his/her own, it is almost automatically considered ‘pilot error!’

Over 2000years ago, the Roman philosopher Cicero said “To err is human.” The ability to make mistakes is on the flipside of the coin of intelligence. Medical deaths outnumber those caused by air crashes. A few years ago a report on the United Kingdom’s National Health Service (NHS) found that one in ten operations ended up with some sort of error. Some wags say that a doctor gets to bury his mistakes while an airline pilot’s mistakes bury him! Another unique challenge for the pilots is that he does not know the team he will be flying with until he reports for duty. In large airlines one might fly with a particular team member just once in a lifetime!

In World War I more pilots died of their own mistakes than enemy action. They were all flying single-pilot aircraft. Now, for the sake of redundancy there is a Pilot Flying and a Pilot Monitoring. We have shifted concept from ‘I’ to ‘We’. Over the last 100 years air safety has improved, and many processes have been put in place to minimise errors made by airline pilots: checklists, briefings, debriefings, standard call-outs, sterile flight decks, Crew Resource Management (CRM), to name a few. But all these operating procedures came at a price. Crashes occurred and blood was spilt before these reforms were introduced. Airline pilots and doctors work in real time unlike lawyers who can take out their diaries and postpone the case for another day. A pilot’s duty will finish when he parks his aircraft and goes home, while the surgeon has to carry out post-operative care for many days afterwards.

Is there any airline pilot or surgeon who can say that he does not make a single error when he is on the job? Is it now the time for surgeons to learn these error-reducing techniques from airline pilots, as in this ‘robotic and computer age’ both disciplines are fast becoming ‘hi-tech’? There are many relevant studies done on the human interaction with software, hardware and the working environment in incident/accident causation. One of the main reasons why hospital administrators all over the world are sold on the idea is that it will directly reduce potential for litigation. The new concept is known as Operating Room Management (ORM). A good pre-operative briefing will certainly cater to any anticipated emergencies, availability of equipment, and the plan of action of the surgeon along with allocation of each other’s area of responsibility. Knowing your team always helps. The air safety experts say, “Know yourself, know your team, know your equipment, know your objective and above all assess the risks.” As in aviation, the team leader sets the tone. Even the most junior crew member on a flight deck is encouraged to voice his concern, even at the point of being embarrassed if he is wrong.

Could we create the same type of atmosphere in the surgical team? For example, if a senior surgeon attempts to administer a drug that could induce a stroke and has forgotten this fact, will he be reminded by a junior team member or even an observing medical student? Checklists and standard call-outs will eliminate ambiguity; ensure a procedure is carried out correctly, every time, all the time. A sterile environment is regulated in the flight deck at critical phases, to minimise distractions and improve overall safety. The same could be carried out at critical areas of surgical operations. The debriefing will also address the question as to whether things could have been done better or differently. It could also involve thanking individual members of the team.

There is also a common thread that binds all doctors, lawyers and airline pilots. When they are exercising their chosen profession, they all feel that they are one step closer to God!

Postscript

A few years after this article was written, the writer was contacted by a private hospital. They acknowledged the fact that Aviation was in the cutting edge of ‘error management’ and the far eastern carrier the writer was working for was a leader in Crew Resource Management (CRM). They wanted to know whether he could speak to their surgeons on the methods used in aviation. Being a CRM facilitator himself, he requested that the surgeons give him a real life scenario where an operation was botched as a starting point for discussion. After many weeks he was told that surgeons don’t make mistakes! (True story)