RANDAZZO and CIVIL AVIATION SAFETY AUTHORITY
[2011] AATA 375
•1 June 2011
Administrative Appeals Tribunal
DECISION AND REASONS FOR DECISION [2011] AATA 375
ADMINISTRATIVE APPEALS TRIBUNAL )
) No 2010/4074
GENERAL ADMINISTRATIVE DIVISION ) Re SAMUEL RANDAZZO Applicant
And
CIVIL AVIATION SAFETY AUTHORITY
Respondent
DECISION
Tribunal Ms G Ettinger, Senior Member
Dr M E C Thorpe, MemberDate1 June 2011
PlaceSydney
Decision 1) The Tribunal sets aside the decision under review of CASA dated 13 September 2010, and in substitution decides that Mr Randazzo should be issued with a Class 2 medical certificate for 12 months from the date of this Decision.
2) The Class 2 medical certificate shall be issued with the following conditions:
a) Concerning Mr Randazzo’s atrial fibrillation; from the date of this Decision, he must provide CASA with progress reports every three months from his cardiologist detailing:
· any occurrence of atrial fibrillation;
· any symptoms;
· results of stress ECG including rate control;
· 48hr Holter;
· echocardiogram;
· treatment, response to treatment and side effects;
· confirmation of diagnosis; and,
· prognosis, including risk of adverse sequelae (including thromboembolism).
b) Concerning Mr Randazzo’s GIST; from the date of this Decision he must provide CASA with a (three monthly) report from his oncologist every three months updating:
· the diagnosis;
· results of any investigations (blood tests, scans, etc);
· treatment, response and any side-effects;
· prognosis; and,
· follow-up plan.
3) When Mr Randazzo’s Medical Certificate becomes due for renewal, in addition to the standard renewal medical examination report, he must provide CASA:
a) a progress report regarding the GIST from his oncologist including results of recent staging investigations, treatment, side-effects and prognosis;
b) a progress report regarding the atrial fibrillation from his cardiologist including results of recent staging investigations, treatment, side-effects and prognosis;
c) a copy of his GP medical records and reports for the previous 12 months.
4) Mr Randazzo will be responsible for the costs of all the reports.
5) Mr Randazzo’s aviation medical certificate is to be endorsed Renew by CASA Only. This alerts the Designated Aviation Medical Examiners that only Aviation Medicine can revalidate the certificate after assessment of the required reports.
..............................................
Ms G Ettinger
Senior Member
CATCHWORDS
CIVIL AVIATION – private pilot of 40 years standing - Class 2 medical certificate – various health conditions – GIST and atrial fibrillation of particular concern to the Respondent – Applicant 73 years old – Tribunal satisfied with medical reports – Applicant can fly alone with conditions – decision under review set aside and substituted.
Civil Aviation Act 1988 (Cth): ss 9A, 28BA, 28BB
Civil Aviation Safety Regulations 1998 (Cth): rr 67.010, 67.015, 67.150 (Item 1.5 and Item 1.6), 67.180, 67.195 (Item 2.1 and Item 2.9), 67.205
Re Hall and Civil Aviation Safety Authority [2004] AATA 21
Re Mulholland and Civil Aviation Safety Authority [2007] AATA 1952
Shi v Migration Agents Registration Authority (2008) 235 CLR 286
Hogan v Ors and Civil Aviation Safety Authority (2004) 84 ALD 707
REASONS FOR DECISION
1 June 2011 Ms G Ettinger, Senior Member
Dr M E C Thorpe, MemberSUMMARY
1. Mr Samuel Randazzo, who is 73 years old, has held a private pilot’s licence since 1963 – that is, for approximately 46 years. When it came to the Civil Aviation Safety Authority’s (CASA) attention that on renewing his licence, Mr Randazzo had not disclosed various health conditions to it over a period of time, his application for a Class 2 medical certificate was refused. That was on 13 September 2010. Following that, on 2 December 2010, CASA issued a Class 2 medical certificate for the period of 12 months with various conditions, including the condition that Mr Randazzo only fly with a safety pilot.
2. The medical conditions about which CASA is particularly concerned are the possibility of recurrence of a gastrointestinal stromal tumour (GIST) which Mr Randazzo suffered in late 2009, and episodic atrial fibrillation which he has suffered since 1998.
3. The CASA imposed condition with which Mr Randazzo is most dissatisfied, is that he is required, since CASA’s ameliorating decision on 2 December 2010, to fly with a safety pilot.
4. We were satisfied from the evidence, including the medical evidence, and applying the relevant legislative provisions, including the Civil Aviation Safety Regulations 1998 (CASR), that Mr Randazzo should, from the date of this Decision, be permitted to fly without a safety pilot for a period of 12 months until the next renewal of his medical certificate will become due, and for certain other conditions to apply.
5. We have made Orders reflecting that Decision. Our reasons follow.
ISSUES
6.In order to make the correct or preferable decision in relation to this matter the Tribunal must decide:
(a)whether Mr Randazzo meets the medical standard for the issue of a Class 2 medical certificate; if not,
(b)whether the extent to which Mr Randazzo fails to meet the standard is likely to endanger the safety of air navigation; and, if so,
(c)whether any conditions could be imposed upon a Class 2 medical certificate that would ameliorate the threat posed to air safety by Mr Randazzo’s failure to meet the medical standard.
THE LEGISLATIVE ENVIRONMENT
7. CASA’s role, pursuant to section 9A of the Civil Aviation Act 1988 (the Act), is to ensure the safety of air navigation. Accordingly, the Tribunal, when carrying out this review and exercising powers under the Act and the CASR must treat the safety of air navigation as the most important consideration.
8. A pilot must, pursuant to the relevant regulations, hold a current medical certificate appropriate for the licence sought. In this case, the relevant medical certificate is that referred to under the regulations as Class 2.
9. Regulation 67.180 provides for the issuing of medical certificates. Regulation 67.195 allows CASA to issue a medical certificate to a person subject to any condition that is necessary in the interests of the safety of air navigation, having regard to the medical condition of the person.
10. Regulation 67.180 prevents the Respondent from issuing a medical certificate unless the Applicant meets the relevant medical standard or, if the Applicant does not meet that medical standard – the extent to which the Applicant does not meet that standard is not likely to endanger the safety of air navigation.
11. For the purposes of Part 67 of the CASR, a medically significant condition is safety-relevant if it reduces, or is likely to reduce, the ability of someone who has that condition to exercise a privilege conferred or to be conferred, or perform a duty imposed or to be imposed, by a licence that he or she holds or has applied for.
12. The relevant medical standard applicable to the Applicant is the following part of the Criteria for medical standard 2 (in relation to a Class 2 medical certificate):
67.155 Who meets medical standard 2
(1) Subject to subregulations (2) to (7), a person who satisfies the criteria in table 67.155 meets medical standard 2.
Table 67.155 Criteria for medical standard 2
Cardiovascular system
2.1 Has no safety-relevant condition of any of the following kinds that produces any degree of functional incapacity or a risk of incapacitation:
(a) an abnormality;
(b) a disability or disease (active or latent);
(c) an injury;
(d) a sequela of an accident or a surgical operation.
…
2.9 Has no safety-relevant heart abnormality
…
2.13 Is not suffering from a safety-relevant defect of the digestive system or its adnexae, nor from any safety-relevant effect of disease or trauma of, or an operation on, the digestive system or its adnexae
Regulation 67.015, sets out the meaning of ‘safety-relevant’:
For the purposes of this Part, a medically significant condition is safety-relevant if it reduces, or is likely to reduce, the ability of someone who has it to exercise a privilege conferred or to be conferred, or perform a duty imposed or to be imposed, by a licence that he or she holds or has applied for.
THE REVIEWABLE DECISION
13. We are mindful that section 31 of the Act defines reviewable decision, and that regulation 201.004 of the CASR provides for an application to be made to this Tribunal for review of certain decisions, including, relevantly, decisions refusing medical certificates or imposing conditions on medical certificates.
14. The Tribunal derives thus, its jurisdiction to review certain decisions made by CASA.
15. In Mr Randazzo’s case, CASA (per Dr David Fitzgerald), made a reviewable decision dated 13 September 2010, refusing to issue Mr Randazzo with a Class 2 medical certificate. It gave him notice of his appeal rights to the Administrative Appeals Tribunal (AAT), which he exercised on 27 September 2010.
16. On 2 December 2010, CASA (per Dr Alan Drane), conducted an internal review and issued a Class 2 medical certificate to Mr Randazzo subject to certain conditions, including that he only fly with a safety pilot. Dr Drane did not give reasons in his decision, and he did not advise Mr Randazzo of his appeal rights to the AAT. Mr Randazzo has not formally appealed that ameliorating decision to the Tribunal.
17. Mr B Levet, counsel for Mr Randazzo, was critical of what he termed the collegiate or collegial decision making process at CASA which he characterised as less than optimum. Ms G Bennett, CASA’s Principal Lawyer, Legal Branch, submitted that the Applicant was given ample time to raise those matters prior to the Tribunal hearing, and had chosen not to do so.
18. Dr Fitzgerald and Dr Drane, who both hold the position of Senior Medical Officer at CASA, and are decision-makers, gave evidence to the Tribunal about the process of CASA’s decision-making, which may be interesting, but is not under review here. We do not intend to discuss the process further, except to note that Dr Fitzgerald and Dr Drane reminded us they had a clear mandate in regard to the paramount importance of aviation safety. That is undisputable of course.
19. As Mr Levet’s submissions regarding CASA’s decision making do not directly relate to the Tribunal’s decision making in this case, and because our decision is de novo, taking into account all the evidence before the CASA decision-makers, and any later evidence available, we do not intend to discuss those submissions further here.
20. However, because the decision of Dr Drane was not appealed by Mr Randazzo, we needed to clarify the situation with regard to the Tribunal’s jurisdiction, and raised that with the parties. The transcript of the hearing on 29 April 2011 at pages 2 – 5 reflects the submissions of the parties on that point.
21. We agreed with the submissions the parties made, and have concluded that the decision CASA made on 13 September 2010 is the reviewable decision as ameliorated in favour of Mr Randazzo on 2 December 2010. As stated above, and pursuant to Shi v Migration Agents Registration Authority (2008) 235 CLR 286 at 289, we are making a de novo decision taking into account all the evidence before the CASA decision-makers, and all later relevant evidence.
BACKGROUND
22. Mr Randazzo is 73 years old and has held a Class 2 single pilot licence since 1963. He has a number of health conditions which he did not disclose to his Designated Aviation Medical Examiner (DAME), either on diagnosis, or at the subsequent medical examination. Dr Fitzgerald listed them in his decision, as follows (Exhibit R3, paragraph 17):
·Obstructive sleep apnoea;
·Type 2 Diabetes Mellitus;
·Ischaemic Heart Disease;
·Dilated Aortic Root;
·Right Renal Calculus;
·Cataract Extraction and intraocular Lens Placement;
·Admission to Hospital with Chest Pain in 2006;
·Various medications including Sotalol.
23. When asked why he did not disclose the conditions, Mr Randazzo said that he did not think he had to.
24. The health conditions of most concern to CASA, and which caused CASA to refuse to issue Mr Randazzo’s Class 2 aviation medical certificate on 13 September 2010, were his GIST and his atrial fibrillation.
25. Following Mr Randazzo’s application to this Tribunal and a reconsideration of the medical evidence by CASA, which followed a discussion between Dr Drane and Professor David Goldstein, Mr Randazzo’s medical oncologist, he was, on 2 December 2010, issued with a Class 2 medical certificate valid for 12 months. In it, CASA stipulates that he can only fly with a safety pilot, and has imposed various other health checks as conditions.
26. We understand that at the date of the hearing, CASA accepts that Mr Randazzo’s health issues, other than his GIST and atrial fibrillation, do not presently impact upon the issue of a Class 2 medical certificate with the conditions which, on 2 December 2010, they issued to Mr Randazzo for a period of 12 months. In connection with that understanding, we noted the exchange at page 35 of the transcript of hearing, dated 29 April 2011, between Senior Member Ettinger and Ms Bennett:
Senior Member: You’ve also mentioned all the other conditions and the fact that the whole total person is taken into account, the fact that age comes into it, but it seems that CASA is satisfied that those other conditions, including diabetes which I asked about specifically are under control …
Ms Bennett: Yes
27. We were mindful that Ms Bennett did not have instructions to resile from including the GIST. However, as a result of the availability of further medical evidence, and the discussions Dr Drane had with Professor Goldstein, its significance in regard to being a risk to aviation safety was diminished during the proceedings.
28. We noted in addition, that Mr Randazzo’s aviation medical certificate is endorsed ‘Renew by CASA Only’ which alerts a DAME conducting a review of Mr Randazzo that only Aviation Medicine can revalidate the certificate following assessment of the required reports as listed in the decision of 2 December 2010.
29. As to Mr Levet’s criticism of CASA’s decision-making process; we are mindful that we are not reviewing that process.
THE EVIDENCE REGARDING THE GIST AND THE ATRIAL FIBRILLATION
30.Dr Fitzgerald and Dr Drane are CASA’s Senior Medical Officers who are responsible, with others, including the Chief Medical Officer, Dr P Navathe, for licensing some 40,000 pilots in Australia and assessing reports submitted by the DAMEs. The two Senior Medical Officers are both medical practitioners who also hold various other qualifications, certain of which follow. Dr Fitzgerald is a pilot, and holds qualifications in aviation medicine. He is also a Fellow of the Australian Faculty of Occupational and Environmental Medicine, Royal Australasian College of Physicians. Dr Drane has been a general practitioner in Australia and in New Zealand, and holds, amongst others things, qualifications in occupational medicine, and a Masters in Aviation Medicine. Pursuant to normal practice, neither examined Mr Randazzo in connection with this matter. However both formed their opinions on the medical evidence available, and made decisions as published to the Applicant, dated 13 September 2010 and 2 December 2010 respectively.
31. The medical evidence in this matter, particularly that impacting on Mr Randazzo’s Class 2 medical certificate relates primarily to his GIST and atrial fibrillation.
GIST
32. Mr Randazzo gave evidence that in November 2009, while on a golfing holiday in New Zealand, and taking Naprosan, he suffered malaena or intestinal bleeds, which, following testing, led to a diagnosis of GIST.In January 2010, he underwent laparoscopic surgery to excise the tumour, which was carried out by Dr Gregory Keogh.
33. Professor Goldstein, who has reviewed Mr Randazzo, wrote in his report of 10 February 2010 that Mr Randazzo had a resected but potentially curable GIST. However, based on the histology, it was a high risk tumour. It is for that reason that Mr Randazzo was put on a regime of Glivec for a year following the surgery, which he has now completed.
34. Dr Fitzgerald indicated that with the GIST, Mr Randazzo risked a recurrence, haemorrhaging, and collapse, the effect of which is enhanced when piloting an aircraft alone as contrasted with being able to obtain assistance quickly if he were on the ground. However, Dr Fitzgerald acknowledged that since Dr Drane’s discussions with Professor Goldstein, CASA had revised its views, and accepted that the risk of recurrence of the GIST was low. He agreed that if the GIST was Mr Randazzo’s main condition, he would be issued a Class 2 medical certificate with conditions for follow-up specified, but would not necessarily be required to fly with a safety pilot. Dr Fitzgerald stated that the main issue in this case now concerns Mr Randazzo’s atrial fibrillation.
35. Dr Drane spoke to us about Mr Randazzo’s GIST, stating that since he had conferred with Professor Goldstein, he had formed the view that the risk of recurrence was present, but that the risk of a catastrophic event occurring was low.
ATRIAL FIBRILLATION
36. Mr Randazzo told the Tribunal that his atrial fibrillation commenced a few years ago. When it was pointed out to Mr Randazzo that the first episode, as recorded by Dr Anthony Freeman, a cardiologist, was in 1998, he acknowledged that may have been so.
37. His description of how it manifested itself was that approximately five years ago he felt his heart was not beating normally, and he thought he was having a heart attack. He told us that he walked to his car and drove to his doctor, who referred him to Dr Freeman. Mr Randazzo said that he associated the episodes of atrial fibrillation which he has suffered, with drinking two to three beers and a cup of coffee after a golf game. He said that for the last 12 months he has drunk no coffee, and only has one beer from time to time, and has not suffered an episode of atrial fibrillation except in February 2010.
38. Mr Randazzo said that the symptoms he suffers when he has atrial fibrillation are that he is somewhat tired, but only to the extent that he cannot walk as fast as usual. Mr Randazzo denied ever having fainted or feeling lightheaded, although Dr Simon Eggleton’s reports indicated that he reported feeling lightheaded on two occasions. Mr Randazzo told us that the duration of the atrial fibrillation could be a few hours, or overnight.
39. Mr Randazzo told us that he has been taking Sotolol for the last three to four years, and takes half a tablet in the morning.
40. We next considered the questions to be answered in this case, the first being, as follows.
WHETHER MR RANDAZZO MEETS THE MEDICAL STANDARD FOR THE ISSUE OF A CLASS 2 MEDICAL CERTIFICATE
41. The safety of air navigation is the most important consideration in the exercise of the powers and the performance of CASA’s functions pursuant to the Act and the CASR. As this Tribunal stands in CASA’s shoes in reviewing its decision, we are similarly concerned.
42. As previously stated, a pilot must, pursuant to the relevant regulations, hold a current medical certificate appropriate for the licence he or she seeks. In this case, the relevant medical certificate under the CASR, is a Class 2. Pursuant to regulation 67.180, the Respondent, and therefore the Tribunal, is prevented from issuing a medical certificate unless the Applicant meets the relevant medical standard.
43. CASA, and therefore the Tribunal can, pursuant to regulation 67.195, issue a medical certificate to a person subject to any condition that is necessary in the interests of the safety of air navigation, having regard to the medical condition of the person. We are mindful that Mr Randazzo suffers several medical conditions as listed in the paragraphs above. The main two on the basis of which he was refused a Class 2 medical certificate on 13 September 2010, and then subsequently, on 2 December 2010 granted that certificate with conditions, were his GIST and atrial fibrillation.
44. Regulation 67.155 encompasses the tests for a Class 2 medical certificate. Items 2.1 and 2.9 of the Table are concerned with the cardiovascular system, and are relevant to Mr Randazzo experiencing atrial fibrillation. Item 2.13, is concerned with the digestive system, and is relevant to Mr Randazzo suffering a GIST.
45.Regulation 67.015, sets out the meaning of safety-relevant.
For the purposes of this Part, a medically significant condition is safety-relevant if it reduces, or is likely to reduce, the ability of someone who has it to exercise a privilege conferred or to be conferred, or perform a duty imposed or to be imposed, by a licence that he or she holds or has applied for.
46.In the paragraphs below, we have considered whether Mr Randazzo meets the medical standard for issue of a Class 2 medical certificate.
GIST
47. As to the GIST; Mr Levet submitted that based on the evidence of Professor Goldstein and Dr Fitzgerald, the GIST was no longer an issue. He submitted that as Professor Goldstein’s evidence was not objected to, it should stand. Mr Levet also submitted that the evidence of Dr Fitzgerald was that, given the surgical remediation, given Professor Goldstein’s opinion, and given the review and proposed surveillance regime, he would not have withheld a certification on the basis of the GIST, and he would not have imposed a co-pilot condition. Mr Levet also submitted that following Dr Drane’s initial hesitation, when informed of Dr Fitzgerald’s views on the GIST, he was in agreement.
48. The surveillance regime proposed was that Mr Randazzo would have a form of imaging on a three monthly basis, and that the reports from the appropriate specialist would be made available to CASA. Mr Levet also submitted that with those arrangements in place, notwithstanding the GIST could recur, it was unlikely to incapacitate Mr Randazzo to such a degree as to inhibit the safe operation of an aircraft.
49. Ms Bennett submitted that she had not received instructions on what had been proposed, and was unable to withdraw the Respondent’s reliance on the GIST to maintain the conditions imposed on Mr Randazzo’s certification. However, when pressed she simply stated that she would rely on Dr Fitzgerald and Dr Drane for guidance.
50. We have noted the evidence of Professor Goldstein, and take from his report of 10 February 2010 that Mr Randazzo’s GIST was excised in January 2010, that it was at high risk of recurring, and that he subsequently underwent adjuvant treatment with Glivec.
51. We noted Dr Fitzgerald’s comment on the seriousness of GIST both in his written report and in his oral evidence. However, following Dr Drane’s discussions with Professor Goldstein, Dr Fitzgerald accepted that had Mr Randazzo only suffered the GIST, given that it had been surgically removed, and given the follow-up regimes proposed, it alone would not have warranted the condition requiring a safety pilot to fly with Mr Randazzo. He explained that the decisions made by the Senior Medical Officers such as he and Dr Drane, do rely in part on the advice of senior clinical specialists in the various fields of medicine. That would include the frequency of screening and testing.
52. We are satisfied with Dr Fitzgerald’s opinion that given the surgical remediation, Professor Goldstein’s opinion, and the review and proposed surveillance regime, Dr Fitzgerald would not have withheld certification on the basis of the GIST alone, and that he would not have imposed a co-pilot condition on the basis of the GIST alone.
53. Accordingly, having reviewed the medical evidence of Professor Goldstein and Dr Fitzgerald and Dr Drane, we are satisfied that Mr Randazzo, has suffered an illness of the digestive system, but that this has been treated surgically and followed up by a year of taking Glivec. We are satisfied from Dr Drane’s discussions with Professor Goldstein, that recurrences or metastases would be unlikely to pose a risk of acute bleeding and acute incapacity. Both Drs Fitzgerald and Drane agreed that but for the atrial fibrillation, they would agree that with certain other conditions and monitoring in place, Mr Randazzo could fly without a safety pilot.
54. We have reviewed Item 2.13 of regulation 67.155, and find that Mr Randazzo has suffered a defect of the digestive system.
2.13Is not suffering from a safety-relevant defect of the digestive system or its adnexae, nor from any safety-relevant effect of disease or trauma of, or an operation on, the digestive system or its adnexae
55.We note also that regulation 67.015 sets out the meaning of safety-relevant:
For the purposes of this Part, a medically significant condition is safety-relevant if it reduces, or is likely to reduce, the ability of someone who has it to exercise a privilege conferred or to be conferred, or perform a duty imposed or to be imposed, by a licence that he or she holds or has applied for.
56.From the medical evidence before us, from Professor Goldstein, Dr Drane and Dr Fitzgerald, we conclude that Mr Randazzo suffers GIST which is a medically significant condition which can be safety relevant. We are mindful that whilst it may recur, that with a suitable regime of monitoring it will not lead to incapacitation whilst flying.
57.Accordingly we are satisfied that with the relevant monitoring and surveillance in place, the GIST, will, for purposes of this Part, not be safety relevant to the extent that it would be likely to endanger the safety of air navigation. However the imposition of conditions on the Class 2 medical certificate would be appropriate and we have imposed those. That does not include a condition requiring Mr Randazzo to fly with a safety pilot.
The Atrial Fibrillation
The Applicant’s Submissions Regarding the Atrial Fibrillation
58. As to the atrial fibrillation; Mr Levet reminded the Tribunal of the evidence that many persons in the community suffer the condition and that many pilots fly aircraft with atrial fibrillation and without co-pilots.
59. Mr Levet also reminded the Tribunal of the evidence that Mr Randazzo had suffered atrial fibrillation approximately six monthly for the past 11 years. His last episode was prior to February 2010, some 14 months ago, and perhaps associated with the removal of the GIST. He also emphasised Mr Randazzo’s evidence that due to the fact he found alcohol and caffeine had contributed to episodes of atrial fibrillation, he had now ceased intake of caffeine, and reduced his alcohol consumption to an occasional beer.
60. Mr Levet submitted that Mr Randazzo’s episodes of atrial fibrillation were mild in that they caused him some reduction in exercise tolerance, that is, he was unable to walk quickly without tiring, even though he walked to his vehicle and drove himself to hospital when he felt he was fibrillating. He had also felt some palpitations, and only two recorded instances of light-headedness, which caused no incapacity, and perhaps were not, according to Dr Eggleton, associated with the atrial fibrillation.
61. Mr Levet acknowledged the medical evidence that atrial fibrillation does not decrease with age.
62. Mr Levet submitted in summary that Mr Randazzo had changed his lifestyle, had not suffered an episode of atrial fibrillation for 14 months, had not suffered any periods of incapacity as a result, and that Associate Professor Mark Maguire stated in his report that the chances of incapacitation were almost certainly less than one in a thousand per year.
63. Mr Levet also submitted that Mr Randazzo relied on Dr Freeman’s opinion. He submitted that Mr Randazzo was content to accept a twelve monthly certification renewal and undergo three-monthly tests and reports from the relevant specialists in relation to his GIST and his atrial fibrillation which would be submitted to CASA.
The Respondent’s Submissions Regarding the Atrial Fibrillation
64. Ms Bennett relied on her written submissions. She submitted that CASA in its decision-making had to consider the whole person including Mr Randazzo’s age being 73 years and his many other conditions, apart from the GIST and atrial fibrillation, which, she conceded, appear to presently be controlled.
65. Ms Bennett referred also to the evidence of Dr Fitzgerald and Dr Drane that the symptoms of atrial fibrillation increase as altitude increases. She dismissed the submissions of the Applicant that he had oxygenated aircraft on the basis that he need not always have the oxygen on, and the fact that Mr Randazzo has suffered atrial fibrillation when on the ground which he could also suffer in the air with the oxygen either on or off.
66. Ms Bennett referred to the undisputed history of Mr Randazzo suffering symptomatic episodic atrial fibrillation, causing fatigue, palpitations, and impaired exercise tolerance, which at best would be distracting to the safe conduct of aerial navigation.
67. Ms Bennett commented that Associate Professor Maguire had not been called to give evidence, and that the statistical basis of the assessment of less than one in a thousand was not clear. She also queried the use of the term incapacitation, submitting it could mean total incapacitation, or whether it was intended to mean mild or subtle incapacitation.
68. In its written closing submissions, the Respondent made further submissions in relation to the Applicant not meeting the Class 2 medical standard.
The Tribunal’s Deliberations and Conclusions
69. We must consider the medical evidence and the criteria in Table 67.155 in particular Items 2.1 and 2.9.
Table 67.155 Criteria for medical standard 2
Cardiovascular system
2.1Has no safety-relevant condition of any of the following kinds that produces any degree of functional incapacity or a risk of incapacitation:
(a)an abnormality;
(b)a disability or disease (active or latent);
(c)an injury;
(d)a sequela of an accident or a surgical operation.
…
2.9Has no safety-relevant heart abnormality
…
70. We are mindful it is agreed that many pilots who suffer atrial fibrillation are certified to fly without safety pilots. We are also mindful of the Applicant’s situation in relation to his atrial fibrillation, the fact that the risk of suffering it increases with age (Dr Eggleton and Dr Drane), and that that the symptoms of atrial fibrillation increase as altitude increases (Dr Fitzgerald and Dr Drane). It is not in dispute that he has suffered the condition for some 11 years, and that he has not had an episode for approximately 14 months.
71. We reviewed the medical evidence in regard to Mr Randazzo’s atrial fibrillation in order to come to a decision regarding whether he meets the medical standard for the issue of a Class 2 medical certificate.
Dr A Freeman, Cardiologist
72. We noted that Dr Freeman’s report of 1 December 1998 records that he reviewed Mr Randazzo following discharge from hospital after developing symptomatic atrial fibrillation. He recorded that coronary angiography revealed only minor coronary artery disease with no significant stenosis.
73. Almost a year later, on 9 February 1999, Dr Freeman reported on Mr Randazzo undertaking 24 hour ambulatory ECG monitoring and concluded that: Sinus rhythm throughout the monitored period and no significant arrhythmias or conduction disturbances identified.
Dr S Eggleton, Cardiologist
74. We had before us in the T-documents (Exhibit R1 & R2), several reports of Dr Eggleton, who is Mr Randazzo’s treating cardiologist. Dr Eggleton also gave oral evidence by telephone. In his 4 March 2008 report, he said that he first looked after Mr Randazzo at St George Hospital in January 2006. He recorded: Since then (2006), he has remained well. He remains asymptomatic from the atrial fibrillation. He denies chest pain. He did have an episode of dizziness lasting several hours last week with no associated symptoms and it gradually improved.
75. Dr Eggleton told the Tribunal that Mr Randazzo underwent a non-invasive angiogram in 2006 which showed minor coronary artery disease which was not significant. He said that the echocardiogram showed a border line position.
76. Dr Eggleton also reported on Mr Randazzo’s various conditions in all his reports, and considered the interaction of the medication for each.
77. Dr Eggleton noted that Mr Randazzo suffered paroxysmal atrial fibrillation of a day’s duration, with minimal symptoms such as minor palpitations, a reduction in exercise tolerance, fatigue, and episodes which occurred every three to six months prior to the last episode in February 2010. Dr Eggleton opined that the likelihood of future episodes was high, but that the episodes were short and mild, and caused no major incapacity. He emphasised that Mr Randazzo had been flying with the risk of suffering a mild episode since 1998, and that he had had no episodes of incapacity in that time. He stated that he had recorded that Mr Randazzo suffered one dizzy spell in his report of 4 March 2008 and a brief episode of light-headedness, lasting a few seconds, in his report of 26 May 2009.
78. In the report of 26 May 2009, Dr Eggleton recorded three episodes of atrial fibrillation over the previous 12 months, all lasting approximately one day, relieved with up titration and self-administration of Sotolol. Dr Eggleton noted the association Mr Randazzo made between the occurrence of atrial fibrillation and alcohol and caffeine, and the fact, on Dr Eggleton’s recommendation, he had altered that consumption. Dr Eggleton explained that a change in alcohol and caffeine consumption could reduce, but would not eliminate, the risk of Mr Randazzo suffering atrial fibrillation.
79. A report of 3 February 2010 was the result of an unscheduled consultation in which Mr Randazzo reported having suffered atrial fibrillation lasting 48 hours (with the usual mild symptoms he reported as noted above), four days following surgery for GIST, and after his return home from hospital.
80. Dr Eggleton’s report of 15 June 2010 reported that Mr Randazzo had undergone a stress echocardiogram in response to a request by CASA. Dr Eggleton reported that the results were exceptionally good, to the extent that he felt a check was necessary, and recommended an exercise myocardial perfusion scan. On 28 June 2010, Dr Eggleton reported that Mr Randazzo had a scan which revealed no evidence of reversible myocardial ischaemia. The resting SPECT gated images revealed normal LV size and systolic function. The calculated LVEF was 52%.
81. On 21 June 2010, Dr Eggleton reported that Mr Randazzo had informed him of his failure to meet the standards for a Class 2 medical certificate. In response, on 21 June 2010 and 3 August 2010, Dr Eggleton wrote:
As outlined in my previous correspondence Sam has experienced paroxysmal atrial fibrillation over the past 11 years with episodes every 6 months or so. His symptoms are mild, complaining mainly of fatigue, palpitations and reduction in exercise tolerance. Importantly there have been no presyncopal or syncopal events. There has been no significant change over the past 12 months to suggest he is at a higher risk of incapacitation than previously. Importantly he has normal resting left ventricular function and CT coronary angiogram 4 years ago revealed only minor atherosclerosis. He has exceptional exercise capacity at 9 minutes.
Whilst his symptoms are mild they do not produce any degree of functional incapacity. In summary, from a cardiac perspective there has been no significant change in his condition over the past 12 months.
82. Dr Eggleton concluded his oral evidence by explaining that:
People who are having a coronary occlusion or a myocardial infarction can present with atrial fibrillation, but in my opinion Mr Randazzo’s atrial fibrillation is distinctly different to that associated with myocardial infarction.
83. Dr Eggleton also confirmed that over the past two years, Mr Randazzo was compliant with his advice regarding alcohol consumption and the treatment he recommended. However we noted that although Dr Eggleton prescribed 40 milligrams of Sotolol, that is, half a tablet twice a day, Mr Randazzo told us that unless he forgot, or did not have it handy, and did not take it at all, he took half a tablet once a day.
84. Notwithstanding Mr Levet’s submissions, we were mindful of Dr Eggleton’s opinion that the light-headedness reported by Mr Randazzo on 26 May 2009 was associated with his atrial fibrillation, but noted further that Dr Eggleton could not be certain in relation to the episode reported on 4 March 2008.
Associate Professor M Maguire, Cardiologist
85. Dr Eggleton referred Mr Randazzo to Associate Professor Maguire who reported on 3 November 2010:
Mr Randazzo has not had severe symptoms from atrial fibrillation and rarely has attacks. The chances of incapacitation from atrial fibrillation are almost certainly <1 in 1000 per year.
86.We agree with Dr Fitzgerald that we are not certain on what basis Associate Professor Maguire made that calculation.
87. Associate Professor Maguire also stated: I do not believe the atrial fibrillation is a contraindication to him holding this licence.
Dr D J P Fitzgerald, Senior Medical Officer, Aviation Medicine Section of CASA
88. Dr Fitzgerald’s qualifications have been noted in the paragraphs above. He is one of several Senior Medical Officers of CASA. His report was Exhibit R3. He was present throughout the hearing, and gave oral evidence before the Tribunal. He noted that Mr Randazzo was likely to suffer light-headedness, palpitations, fatigue and chest pain during an episode of atrial fibrillation. His opinion was that this may be tolerable when on the ground, but that altitude during flying and hypoxia enhanced those symptoms. He said that accordingly, cognition would be impaired, and palpitations could, putting it at their lowest, be distracting. In the air, the consequences could be catastrophic. He acknowledged that atrial fibrillation varied from person to person and that it could be asymptomatic.
89. In regard to questions about Mr Randazzo’s reduction in consumption of alcohol and cessation of caffeine, Dr Fitzgerald thought that regardless of those stimuli, the morphology in the heart predisposes an atrial fibrillation sufferer to it.
90. Dr Fitzgerald was referred to Associate Professor Maguire’s report in which he regarded Mr Randazzo’s atrial fibrillation as not being a contraindication to granting him a licence to fly. Associate Professor Maguire also opined that Mr Randazzo had not had severe symptoms from atrial fibrillation, and rarely had attacks. He stated that the chances of incapacitation from atrial fibrillation were almost certainly less than one in a thousand per year. Dr Fitzgerald confirmed his view that it was not a matter of incapacitation, but that Mr Randazzo could pass out, so that the concern for impairment was present.
91. Mr Randazzo’s good results in relation to exercise tolerance were referred to Dr Fitzgerald, who replied that exercise tolerance was only one factor in the decision making process, and that during an episode of atrial fibrillation, when fatigue took over, that became irrelevant.
92. Mr Levet appeared to truncate his cross-examination of Dr Fitzgerald due to pressure he felt in relation to the availability of Dr Eggleton to give his evidence. The Tribunal made it clear (transcript of 28 April 2011 at pp 51 and 52), that it would afford Mr Levet as much time as he required to complete his cross-examination but clearly could not tell him how to run his case. Mr Levet replied: I have made a forensic decision – due to the circumstances of the case in which I find them – to stop asking questions.
Dr A Drane, Senior Medical Officer, Aviation Medicine Section of CASA
93. Dr Drane, whose qualifications are noted above, gave evidence before the Tribunal by telephone. He made a decision on 2 December 2010 in which he varied Dr Fitzgerald’s decision of 13 September 2010. He issued Mr Randazzo with a Class 2 medical certificate valid for 12 months, with conditions, including that he must fly with a safety pilot.
94. In his oral evidence, Dr Drane said that he had considered Mr Randazzo’s overall health situation, which included several serious conditions and multiple risk factors. He then noted in particular, the atrial fibrillation and the GIST. His views about the GIST and the impact upon the risks to, and safety of aviation have been discussed above.
95. Dr Drane noted that Mr Randazzo had a chronic history of atrial fibrillation with multiple occurrences, stating that age increased the risk, and that altitude reduced oxygen supply and increased the risk of atrial fibrillation occurring. Dr Drane referred to Dr Eggleton’s reports, in particular the report of 26 May 2009 in which he recorded that Mr Randazzo suffered three episodes of atrial fibrillation over the previous 12 months, all lasting approximately a day, relieved with up titration and self-administration of Sotolol.
96. Dr Drane explained that notwithstanding that Mr Randazzo had not suffered atrial fibrillation for over 14 months at the time of the hearing; his chances of suffering it again were 100 percent. When asked about Associate Professor Maguire’s statement that the chances of Mr Randazzo suffering incapacitation from atrial fibrillation were almost certainly less than one in 1,000 per year, Dr Drane said that the reply would depend on what Dr Maguire had been told.
97. The common symptoms were fatigue, palpitations, and light-headedness, he said. He agreed that the alcohol and caffeine consumption could influence the occurrence of atrial fibrillation, but stated that an episode of dizziness could cause considerable incapacity, and was almost impossible to predict. Dr Drane said that good results for the exercise tolerance test were encouraging, but the fact Mr Randazzo felt fatigue had different and more drastic consequences in the air from those during an attack suffered on land.
98. When asked for his view about the three monthly scans proposed for Mr Randazzo, Dr Drane said that he would not specify surveillance or testing intervals as this was up to specialist treating clinicians.
99. When asked how he reacted to Mr Randazzo’s proposition that he owned two aircraft, both fitted with oxygen, Dr Drane said that was mitigation in his favour, but not determinative, and it would depend on other factors, including where Mr Randazzo was flying, and a variety of other considerations.
100. In summary, Dr Drane agreed ultimately, that the atrial fibrillation was the condition which he considered warranted the condition of Mr Randazzo flying with a safety pilot.
101. We have outlined in the paragraphs above, a summary of the relevant medical reports relating to Mr Randazzo’s atrial fibrillation. We now note as follows.
·As the treating cardiologist, Dr Eggleton has prescribed the many tests Mr Randazzo has undergone, and he has had access to the Applicant and the reports. We accept Dr Eggleton’s opinion, as stated in his reports of 21 June 2010 and 3 August 2010.
As outlined in my previous correspondence Sam has experienced paroxysmal atrial fibrillation over the past 11 years with episodes every 6 months or so. His symptoms are mild, complaining mainly of fatigue, palpitations and reduction in exercise tolerance. Importantly there have been no presyncopal or syncopal events. There has been no significant change over the past 12 months to suggest he is at a higher risk of incapacitation than previously. Importantly he has normal resting left ventricular function and CT coronary angiogram 4 years ago revealed only minor atherosclerosis. He has exceptional exercise capacity at 9 minutes.
Whilst his symptoms are mild they do not produce any degree of functional incapacity. In summary, from a cardiac perspective there has been no significant change in his condition over the past 12 months.
·We note from Associate Professor Maguire’s opinion that Mr Randazzo has not had severe symptoms from atrial fibrillation and rarely has attacks. The chances of incapacitation from atrial fibrillation are almost certainly <1 in 1000 per year. We agree with Dr Fitzgerald that we are not certain on what basis Associate Professor Maguire makes that calculation.
·We noted Associate Professor Maguire further statement: I do not believe the atrial fibrillation is a contraindication to him holding this licence. We do not put weight on that statement as we are not aware of the Professor’s qualifications in aviation, neither whether he knows what aircraft nor under what conditions Mr Randazzo flies.
·We are mindful of Dr Fitzgerald and Dr Drane’s warnings that any symptoms of light-headedness, palpitations, fatigue and chest pain during an episode of atrial fibrillation may be tolerable when on the ground, but that altitude during flying, and hypoxia enhanced those symptoms. We note that cognition can be impaired, and palpitations could, putting it at their lowest, be distracting, and that the air, the consequences could be catastrophic.
·We are mindful of Dr Fitzgerald’s opinion that the morphology in the heart predisposes an atrial fibrillation sufferer to it regardless of the stimuli of caffeine and alcohol.
·We are mindful that Mr Randazzo has suffered atrial fibrillation for approximately 11 years. However, he has not had an episode for at least 14 months. We are mindful also that with age, atrial fibrillation could be expected to intensify rather than reduce in occurrence and intensity (Drs Fitzgerald and Drane), and that whilst Mr Randazzo’s episodes of atrial fibrillation have been mild, the chances of recurrence are high.
102. We find in the application of the criteria in Table 67.155 and Items 2.1 and 2.9, that Mr Randazzo suffers atrial fibrillation which is a relevant condition.
103. We are satisfied on the basis of the medical evidence that because Mr Randazzo fails to meet the standard for issue of an unrestricted medical certificate, per Items 2.1 and 2.9 of regulation 67.155, as a result of his atrial fibrillation, we must consider the extent to which he fails that standard, and is likely to endanger the safety of air navigation if he is permitted to fly without conditions.
WHETHER THE EXTENT TO WHICH MR RANDAZZO FAILS TO MEET THE
STANDARD IS LIKELY TO ENDANGER THE SAFETY OF AIR NAVIGATION
104. We have noted above that the history of Mr Randazzo’s GIST, and its significance for the safety of air navigation. We are satisfied that Mr Randazzo’s atrial fibrillation is the more critical condition in relation to aviation safety, and it is our task to consider whether the extent to which Mr Randazzo fails to meet the standard is likely to endanger the safety of air navigation.
105. Mr Levet’s main concern on behalf of Mr Randazzo has been that he not be required to fly with a safety pilot, and in that context he has proposed a three monthly testing and reporting regime on behalf of Mr Randazzo both in relation to the GIST and the atrial fibrillation.
106. We are mindful that Drs Fitzgerald and Drane have come to the view if the GIST were the main illness under consideration, and if conditions to monitor it were in place, they would no longer require Mr Randazzo to fly with a safety pilot.
107. We are also mindful that the doctors who have been involved in this case have noted that Mr Randazzo has not suffered an attack of atrial fibrillation for at least 14 months, but consider that the risk of atrial fibrillation recurring is real. Both Drs Fitzgerald’s and Drane’s view is that the risk of incapacitation from atrial fibrillation is a risk to the safety of air navigation.
108. Ms Bennett submitted that in cases such as Re Hall and Civil Aviation Safety Authority [2004] AATA 21 and Re Mulholland and Civil Aviation SafetyAuthority [2007] AATA 1952, the fact that the risk in percentage terms of the Applicant actually having a safety-relevant event whilst at the controls of an aircraft in flight may be relatively small, it is largely irrelevant. What is to the point is the very real possibility that the Applicant remains at greater risk than the rest of the aviator population of suffering such an event.
109. Ms Bennett submitted further, that the requirements of section 9A(1) of the Act dictate that a suitably cautious approach must be taken to assessing the risks posed to the safety of air navigation by the Applicant’s medical history. Accordingly, she submitted, the Tribunal cannot be satisfied to the requisite standard, that the Applicant’s failure to meet the Class 2 medical standard is not likely to endanger the safety of air navigation.
110. In coming to a decision about whether the extent to which Mr Randazzo fails to meet the standard is likely to endanger the safety of air navigation, we have taken into account the guidance given in cases such as Re Hall and Civil Aviation Safety Authority and Re Mulholland and Civil Aviation Safety Authority. In Re Hall and Civil Aviation Safety Authority, the Tribunal noted at [45] that:
As the Tribunal stated in Re Windows (supra), the assessment of what is “likely” cannot be based on statistical likelihood. In this context, it is a matter of weighing up the requirements of air safety with the applicant’s interest in the safe exercise of the privileges and performance of the duties associated with holding a private pilot’s licence.The Tribunal’s view is that in June 2003, given the medical information available to CASA, a decision to impose a condition on Mr Hall’s Class 2 Medical Certificate was reasonable given the risks associated with his heart condition when considered in the context of air safety. In terms of the medical standard in Schedule 1, Part 1 of the old regulations, and whether his heart condition was likely to interfere with the safe exercise of his privileges or performance of his duties associated with his holding a private pilot’s licence, there was a real risk, albeit a small one. When issues of air safety are under consideration, a small risk may be sufficient to trigger the need to take appropriate action to address the risk. This was the case here.
111. In Re Mulholland and Civil Aviation Safety Authority, the Tribunal at [65] to [67] said that:
Whether Mr Mulholland has a high risk or a low risk of losing consciousness while flying an aircraft is simply irrelevant. The fact is that he has a risk of incapacitation which is significantly different to the remainder of the aviator population who do not suffer from syncope or any other safety-relevant medical condition. In our view the risk of incapacitation is real and not an imaginable or fanciful risk nor is it a remote risk.
Whatever the risk may be of Mr Mulholland suffering a syncopal attack whilst flying, it is not to the point that it can be shown statistically that the risk is small. Dr Nilsson contended that the evidence does not support a finding that the frequency of syncope episodes is increasing. This is not a relevant test under the legislation. What is important is whether Mr Mulholland meets the requirements for the issue of a Class 1 or Class 2 medical certificate. If he does not, the only question remaining is whether CASA should issue to Mr Mulholland medical certificates with conditions in accordance with regulation 67.195 of the CASR. Any conditions imposed on a medical certificate must be necessary in the interests of the safety of air navigation, having regard to the medical condition of the person.
It is also important to understand that CASA must bear in mind the safety of persons other than Mr Mulholland, on the ground and in the air, and also their property. CASA’s principal concern must be the safety of air operations generally and this is clearly set out in s 9A of the Act which, relevantly, provides:
In exercising its powers and performing its functions, CASA must regard the safety of air navigation as the most important consideration.
112. We have considered the evidence regarding Mr Randazzo in this context. We are satisfied from the medical evidence that the extent to which Mr Randazzo fails to meet the standard and is likely to endanger the safety of air navigation, can be mitigated by the issue of a Class 2 medical certificate with conditions.
WHETHER ANY CONDITIONS COULD BE IMPOSED UPON A MEDICAL CERTIFICATE THAT WOULD AMELIORATE THE THREAT POSED TO AIR SAFETY BY MR RANDAZZO’S FAILURE TO MEET THE MEDICAL STANDARD
113. In imposing conditions on Mr Randazzo’s Class 2 medical certificate, we have not given weight to the fact that he did not report his medical conditions to his DAME, and therefore to CASA when applying for his medical certificate. We noted further that he did not disclose two episodes of dizziness although they are documented in Dr Eggleton’s reports. Those are matters for CASA.
114. We were also concerned that Mr Randazzo has not been compliant with medication in the past e.g. with dosages of Sotalol. However we accept Dr Eggleton’s evidence that in the past two years, Mr Randazzo has been compliant.
115. We are mindful that regulation 67.195 deals with conditions which can be imposed on medical certificates:
67.195 Medical certificate — conditions
CASA may issue a medical certificate to a person subject to any condition that is necessary in the interests of the safety of air navigation, having regard to the medical condition of the person.
In particular, CASA may issue a medical certificate subject to a condition that the period during which the certificate remains in force may be extended only by CASA.
A person must not contravene a condition subject to which his or her medical certificate is issued.
Penalty: 50 penalty units.
An offence against subregulation (3) is an offence of strict liability.
A condition to which a medical certificate is subject must be set out in the certificate.
116. We are satisfied, as noted above, that from what is now known about the GIST, it alone would not warrant the condition that Mr Randazzo fly with a safety pilot. However, we are satisfied that monitoring conditions should be imposed.
117. We are satisfied from the medical evidence that a threat posed to air safety by Mr Randazzo’s atrial fibrillation can also be dealt with by the imposition of periodic monitoring conditions, with the exclusion of the safety pilot.
118. We noted Ms Bennett’s submission that based on the authority of Hogan v Ors and Civil Aviation Safety Authority (2004) 84 ALD 1090, the Tribunal if minded to impose conditions, has nevertheless no jurisdiction to consider the time limit of the certificate. She also drew attention to regulation 67.205 which deals with the period that a medical certificate issued by CASA remains in force.
119. Mr Levet on the other hand, pointed out that the issue in Hogan concerned an air operator’s certificate, and sections 28BA and 28BB of the Act and were irrelevant to the present situation.
120. We are mindful that Hogan, where Justice Downes held that: …the term or length of operation of a certificate is not a condition of the certificate…, dealt with an air operator’s certificate. Further, we are satisfied that the Class 2 certificate which we are minded should be issued to Mr Randazzo with the conditions we have listed above, should, as CASA held, be valid for 12 months, and be endorsed ‘Renew by CASA Only’. In order to be perfectly clear, we order that the 12 months commence with the date of our Decision.
CONCLUSION
121. We have found that Mr Randazzo does not meet the medical standard for the issue of a Class 2 medical certificate. The extent to which Mr Randazzo fails to meet the standard is likely to endanger the safety of air navigation unless conditions are imposed to ameliorate that situation. We have accordingly imposed conditions, which do not include the condition that he fly with a safety pilot. The relevant conditions are in the following paragraph, under the heading ‘DECISION’. Those conditions include monitoring of Mr Randazzo’s GIST and atrial fibrillation. Although conditions such as Mr Randazzo’s diabetes may also require monitoring, no evidence was led about them, and we are therefore not in a position to make orders about such monitoring.
DECISION
122. 1) The Tribunal sets aside the decision under review of CASA dated 13 September 2010, and in substitution decides that Mr Randazzo should be issued with a Class 2 medical certificate for 12 months from the date of this Decision.
2) The Class 2 medical certificate shall be issued with the following conditions:
a) Concerning Mr Randazzo’s atrial fibrillation; from the date of this Decision, he must provide CASA with progress reports every three months from his cardiologist detailing:
· any occurrence of atrial fibrillation;
· any symptoms;
· results of stress ECG including rate control;
· 48hr Holter;
· echocardiogram;
· treatment, response to treatment and side effects;
· confirmation of diagnosis; and,
· prognosis, including risk of adverse sequelae (including thromboembolism).
b) Concerning Mr Randazzo’s GIST; from the date of this Decision he must provide CASA with a (three monthly) report from his oncologist every three months updating:
· the diagnosis;
· results of any investigations (blood tests, scans, etc);
· treatment, response and any side-effects;
· prognosis; and,
· follow-up plan.
3) When Mr Randazzo’s Medical Certificate becomes due for renewal, in addition to the standard renewal medical examination report, he must provide CASA:
c) a progress report regarding the GIST from his oncologist including results of recent staging investigations, treatment, side-effects and prognosis;
d) a progress report regarding the atrial fibrillation from his cardiologist including results of recent staging investigations, treatment, side-effects and prognosis;
e) a copy of his GP medical records and reports for the previous 12 months.
4) Mr Randazzo will be responsible for the costs of all the reports.
5) Mr Randazzo’s aviation medical certificate is to be endorsed Renew by CASA Only. This alerts the Designated Aviation Medical Examiners that only Aviation Medicine can revalidate the certificate after assessment of the required reports.
I certify that the 122 preceding paragraphs are a true copy of the reasons for the decision herein of Ms G Ettinger, Senior Member and Dr M E C Thorpe, Member
Signed: ............[sgd]...............................................
Associate
Dates of Hearing 28 & 29 April 2011
Date of Decision 1 June 2011
Applicant’s Counsel Mr B Levet
Applicant’s SolicitorMr D English, Paul A. Curtis & Co SolicitorsSolicitor for the Respondent Ms G Bennett, Civil Aviation Safety Authority, Principal Lawyer, Legal Services Group
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