[House Hearing, 110 Congress] [From the U.S. Government Publishing Office] THE FEDERAL AVIATION ADMINISTRATION'S OVERSIGHT OF FALSIFIED AIRMAN MEDICAL CERTIFICATE APPLICATIONS ======================================================================= (110-60) HEARING BEFORE THE SUBCOMMITTEE ON AVIATION OF THE COMMITTEE ON TRANSPORTATION AND INFRASTRUCTURE HOUSE OF REPRESENTATIVES ONE HUNDRED TENTH CONGRESS FIRST SESSION __________ JULY 17, 2007 __________ Printed for the use of the Committee on Transportation and Infrastructure U.S. GOVERNMENT PRINTING OFFICE 36-735 WASHINGTON : 2008 _____________________________________________________________________________ For Sale by the Superintendent of Documents, U.S. Government Printing Office Internet: bookstore.gpo.gov Phone: toll free (866) 512-1800; (202) 512�091800 Fax: (202) 512�092104 Mail: Stop IDCC, Washington, DC 20402�090001 COMMITTEE ON TRANSPORTATION AND INFRASTRUCTURE JAMES L. OBERSTAR, Minnesota, Chairman NICK J. RAHALL, II, West Virginia JOHN L. MICA, Florida PETER A. DeFAZIO, Oregon DON YOUNG, Alaska JERRY F. COSTELLO, Illinois THOMAS E. PETRI, Wisconsin ELEANOR HOLMES NORTON, District of HOWARD COBLE, North Carolina Columbia JOHN J. DUNCAN, Jr., Tennessee JERROLD NADLER, New York WAYNE T. GILCHREST, Maryland CORRINE BROWN, Florida VERNON J. EHLERS, Michigan BOB FILNER, California STEVEN C. LaTOURETTE, Ohio EDDIE BERNICE JOHNSON, Texas RICHARD H. BAKER, Louisiana GENE TAYLOR, Mississippi FRANK A. LoBIONDO, New Jersey ELIJAH E. CUMMINGS, Maryland JERRY MORAN, Kansas ELLEN O. TAUSCHER, California GARY G. MILLER, California LEONARD L. BOSWELL, Iowa ROBIN HAYES, North Carolina TIM HOLDEN, Pennsylvania HENRY E. BROWN, Jr., South BRIAN BAIRD, Washington Carolina RICK LARSEN, Washington TIMOTHY V. JOHNSON, Illinois MICHAEL E. CAPUANO, Massachusetts TODD RUSSELL PLATTS, Pennsylvania JULIA CARSON, Indiana SAM GRAVES, Missouri TIMOTHY H. BISHOP, New York BILL SHUSTER, Pennsylvania MICHAEL H. MICHAUD, Maine JOHN BOOZMAN, Arkansas BRIAN HIGGINS, New York SHELLEY MOORE CAPITO, West RUSS CARNAHAN, Missouri Virginia JOHN T. SALAZAR, Colorado JIM GERLACH, Pennsylvania GRACE F. NAPOLITANO, California MARIO DIAZ-BALART, Florida DANIEL LIPINSKI, Illinois CHARLES W. DENT, Pennsylvania DORIS O. MATSUI, California TED POE, Texas NICK LAMPSON, Texas DAVID G. REICHERT, Washington ZACHARY T. SPACE, Ohio CONNIE MACK, Florida MAZIE K. HIRONO, Hawaii JOHN R. `RANDY' KUHL, Jr., New BRUCE L. BRALEY, Iowa York JASON ALTMIRE, Pennsylvania LYNN A WESTMORELAND, Georgia TIMOTHY J. WALZ, Minnesota CHARLES W. BOUSTANY, Jr., HEATH SHULER, North Carolina Louisiana MICHAEL A. ACURI, New York JEAN SCHMIDT, Ohio HARRY E. MITCHELL, Arizona CANDICE S. MILLER, Michigan CHRISTOPHER P. CARNEY, Pennsylvania THELMA D. DRAKE, Virginia JOHN J. HALL, New York MARY FALLIN, Oklahoma STEVE KAGEN, Wisconsin VERN BUCHANAN, Florida STEVE COHEN, Tennessee JERRY McNERNEY, California VACANCY (ii) Subcommittee on Aviation JERRY F. COSTELLO, Illinois, Chairman BOB FILNER, California THOMAS E. PETRI, Wisconsin LEONARD L. BOSWELL, Iowa HOWARD COBLE, North Carolina RICK LARSEN, Washington JOHN J. DUNCAN, Jr., Tennessee RUSS CARNAHAN, Missouri VERNON J. EHLERS, Michigan JOHN T. SALAZAR, Colorado STEVEN C. LaTOURETTE, Ohio DANIEL LIPINSKI, Illinois FRANK A. LoBIONDO, New Jersey NICK LAMPSON, Texas JERRY MORAN, Kansas ZACHARY T. SPACE, Ohio ROBIN HAYES, North Carolina BRUCE L. BRALEY, Iowa SAM GRAVES, Missouri HARRY E. MITCHELL, Arizona JOHN BOOZMAN, Arkansas JOHN J. HALL, New York SHELLEY MOORE CAPITO, West STEVE KAGEN, Wisconsin Virginia STEVE COHEN, Tennessee JIM GERLACH, Pennsylvania NICK J. RAHALL, II, West Virginia MARIO DIAZ-BALART, Florida PETER A. DeFAZIO, Oregon CHARLES W. DENT, Pennsylvania ELEANOR HOLMES NORTON, District of TED POE, Texas Columbia DAVID G. REICHERT, Washington CORRINE BROWN, Florida CONNIE MACK, Florida EDDIE BERNICE JOHNSON, Texas JOHN R. `RANDY' KUHL, Jr., New ELLEN O. TAUSCHER, California York TIM HOLDEN, Pennsylvania LYNN A WESTMORELAND, Georgia MICHAEL E. CAPUANO, Massachusetts MARY FALLIN, Oklahoma DORIS O. MATSUI, California VERN BUCHANAN, Florida MAZIE K. HIRONO, Hawaii JOHN L. MICA, Florida VACANCY (Ex Officio) JAMES L. OBERSTAR, Minnesota (Ex Officio) (iii) CONTENTS Page Summary of Subject Matter........................................ vi Committee Report on Falsification of Airman Medical Certificate Applications................................................... x TESTIMONY Boyer, Phil, President, Aircraft Owners and Pilots Association, Frederick, MD.................................................. 23 Garber, Mitchell A., M.D., M.P.H., M.S.M.E., Medical Officer, National Transportation Safety Board........................... 3 Sabatini, Hon. Nicholas A., Associate Administrator for Aviation Safety, Federal Aviation Administration, accompanied by Frederick E. Tilton, M.D., M.P.H., Federal Air Surgeon, Director, Office of Aerospace Medicine, Federal Aviation Administration................................................. 3 Scovel, III, Hon. Calvin L., Inspector General, U.S. Department of Transportation.............................................. 3 PREPARED STATEMENTS SUBMITTED BY MEMBERS OF CONGRESS Costello, Hon. Jerry F., of Illinois............................. 27 Matsui, Hon. Doris O., of California............................. 30 Mitchell, Hon. Harry E., of Arizona.............................. 33 Oberstar, Hon. James L., of Minnesota............................ 36 PREPARED STATEMENTS SUBMITTED BY WITNESSES Boyer, Phil...................................................... 40 Garber, Mitchell A............................................... 61 Sabatini, Nicholas A............................................. 107 Scovel III, Calvin L............................................. 119 SUBMISSIONS FOR THE RECORD Boyer, Phil, President, Aircraft Owners and Pilots Association, Frederick, MD, responses to questions from the Subcommittee.... 55 Garber, Mitchell A., M.D., M.P.H., M.S.M.E., Medical Officer, National Transportation Safety Board, responses to questions from the Subcommittee.......................................... 66 Sabatini, Hon. Nicholas A., Associate Administrator for Aviation Safety, Federal Aviation Administration, accompanied by Frederick E. Tilton, M.D., M.P.H., Federal Air Surgeon, Director, Office of Aerospace Medicine, Federal Aviation Administration, reponses to questions from the Subcommittee.... 112 Scovel III, Hon. Calvin L., Inspector General, U.S. Department of Transportation, responses to questions from the Subcommittee... 131 ADDITIONS TO THE RECORD Federal Aviation Administration's 2006 Survey of Satisfaction with the Aviation Medical Examination Process.................. 138 Federal Register, Department of Transportation, Federal Aviation Administration, 14 CFR Parts 61 and 67......................... 140 James R. Vanderpool, ANM-700, Northwest Mountain Division Manager (Retired), written statement................................... 150 [GRAPHIC] [TIFF OMITTED] T6735.001 [GRAPHIC] [TIFF OMITTED] T6735.002 [GRAPHIC] [TIFF OMITTED] T6735.003 [GRAPHIC] [TIFF OMITTED] T6735.004 [GRAPHIC] [TIFF OMITTED] T6735.005 [GRAPHIC] [TIFF OMITTED] T6735.006 [GRAPHIC] [TIFF OMITTED] T6735.007 [GRAPHIC] [TIFF OMITTED] T6735.008 [GRAPHIC] [TIFF OMITTED] T6735.009 [GRAPHIC] [TIFF OMITTED] T6735.010 [GRAPHIC] [TIFF OMITTED] T6735.011 [GRAPHIC] [TIFF OMITTED] T6735.012 [GRAPHIC] [TIFF OMITTED] T6735.013 [GRAPHIC] [TIFF OMITTED] T6735.014 [GRAPHIC] [TIFF OMITTED] T6735.015 [GRAPHIC] [TIFF OMITTED] T6735.016 [GRAPHIC] [TIFF OMITTED] T6735.017 [GRAPHIC] [TIFF OMITTED] T6735.018 HEARING ON FAA'S OVERSIGHT OF FALSIFIED AIRMAN MEDICAL CERTIFICATE APPLICATIONS ---------- Tuesday, July 17, 2007 House of Representatives Committee on Transportation and Infrastructure, Subcommittee on Aviation, Washington, DC. The Subcommittee met, pursuant to call, at 10:00 a.m., in Room 2253, Rayburn House Office Building, the Honorable Jerry F. Costello [Chairman of the Subcommittee] presiding. Mr. Costello. The Subcommittee will come to order. The Chair will ask all Members, staff, and everyone to turn their electronic devices off or on vibrate. The Subcommittee is meeting today to hear testimony on the FAA's oversight of falsified Airman Medical Certificate applications. The Chair will give a brief statement, recognize Mr. Petri, the Ranking Member, and any other Member that wants to make a statement, and then we will introduce our witnesses today. I welcome everyone here today to this hearing on the FAA's oversight of falsified Airman Medical Certificate applications. In July 2005, the Department of Transportation's Inspector General found egregious cases of pilots failing to disclose debilitating medical conditions on their applications for Airman Medical Certificates. The U.S. Attorney's Office prosecuted more than 40 cases, but hundreds more could have been pursued if adequate resources had been available. The Department of Transportation Inspector General made three recommendations in that report, and the FAA is actively pursuing those recommendations. In April 2007, the FAA began working to implement a strategy and system to coordinate with the Social Security Administration to verify information on Airman Medical Certificate applications. Further, the FAA is revising its application form to explicitly ask the applicant if they are receiving medical disability benefits. Both are important changes, and I am interested in hearing more from Mr. Sabatini and Mr. Scovel on this development. The FAA has some of the strictest medical requirements in the world. By taking the necessary steps to improve the process, by establishing a way to verify medical information reported to the FAA, we can continue to ensure the safety of the pilot and the flying public. I am also pleased that Mr. Boyer, Phil Boyer, is here today to testify from AOPA. AOPA is the largest civil aviation organization in the world, and they have developed a four-point plan of action to educate pilots to address this problem. I am interested in hearing more about the plan from Mr. Boyer when he testifies. I have repeatedly said that, while the United States has the safest air transportation system in the world, we cannot rely on or be satisfied with our past success. We must work together to ensure the highest level of safety for the traveling public. Before I recognize Mr. Petri for his comments or opening statement, I ask unanimous consent to allow two weeks for all Members to revise and extend their remarks, and to permit the submission of additional statements and materials by Members and witnesses. Without objection, so ordered. At this time, the Chair recognizes the Ranking Member, Mr. Petri. Mr. Petri. Thank you very much, Mr. Chairman. I would like to join you in welcoming the witnesses this morning and saying that I look forward to learning more about the Department of Transportation's Office of the Inspector General investigation into falsified FAA Airman Medical Certificate applications. I guess they are called Operation Safe Pilot. The vast majority of pilots are law-abiding citizens. However, the Inspector General's investigation indicates that, whether knowingly or not, some pilots have made false statements on their Airman Medical Certificate applications. These applications are used to evaluate a pilot's physical and mental fitness to fly. Of the 40,000 pilot samples considered in Operation Safe Pilot, the Inspector General prosecuted 45 of the most egregious cases, ultimately resulting in criminal penalties and the revocation of pilots' licenses. Forty-five pilots whose cases were brought to prosecution were receiving Social Security Administration medical disability benefits for disqualifying conditions without reporting those medical conditions on the application for a medical certificate. There may have been more criminal cases, but resource limitations prevented the U.S. Attorney's Office and the Inspector General from expanding the investigation. It is important to note that the true nature of the problem is still not clear. Regardless, I look forward to hearing from our panelists on how we can address these issues in a manner that is appropriate to the level of risk these types of omissions pose to the safety of the system and to the public on the ground. It is my understanding that the FAA is considering a revision to the application for the Airman Medical Certificate. Changes to the application will make questions clearer so that a pilot could not justify an omission based on the wording of a question. I am interested to hear the progress on this effort, as well as an estimate of the cost of reviewing and evaluating medical conditions. About 20 years ago, the FAA offered a brief amnesty period to allow both commercial and recreational fliers the opportunity to come forward and report ailments without being subjected to criminal penalties for the omission. I am interested in hearing from our panel as to whether allowing another brief amnesty period would make sense. Amnesty only works when there is some threat of enforcement after the amnesty period closes. Given the resources available in the budget, would it be possible for the FAA to audit all of the 600,000 commercial and recreational pilot applications, or would such action divert resources away from higher risk safety initiatives? Perhaps the FAA could audit a percentage of the applications each year. That way there is always the risk that, if you falsify, you could get caught. It works for the IRS. Why not FAA? In any event, I would like to thank our witnesses for participating in today's hearing, both our government witnesses and one of the user groups, the Aircraft Owners and Pilots Association. AOPA is one of our great partners in the effort to keep the skies safe, and I appreciate their participation in today's hearing. With that, I yield back the balance of my time. Mr. Costello. The Chair thanks the Ranking Member and, at this time, would first welcome our witnesses and thank you all for being here today. Let me introduce our first panel. First, the Honorable Calvin Scovel III, who is the Inspector General for the U.S. Department of Transportation, who has testified before this Subcommittee many times and who shared tenure as the IG; Dr. Mitchell Garber, who is the Medical Officer for the National Transportation Safety Board; the Honorable Nicholas Sabatini, who is the Associate Administrator for Aviation Safety with the FAA, and Mr. Sabatini has testified many times before the Subcommittee; and Dr. Frederick Tilton, who is the Federal Air Surgeon for the Director of the Office of Aerospace Medicine with the FAA, who is accompanying Mr. Sabatini here this morning. The Chair, at this time, would recognize Mr. Scovel for your testimony. TESTIMONY OF THE HONORABLE CALVIN L. SCOVEL III, INSPECTOR GENERAL, U.S. DEPARTMENT OF TRANSPORTATION; MITCHELL A. GARBER, M.D., M.P.H., M.S.M.E., MEDICAL OFFICER, NATIONAL TRANSPORTATION SAFETY BOARD; THE HONORABLE NICHOLAS A. SABATINI, ASSOCIATE ADMINISTRATOR FOR AVIATION SAFETY, FEDERAL AVIATION ADMINISTRATION, ACCOMPANIED BY FREDERICK E. TILTON, M.D., M.P.H., FEDERAL AIR SURGEON, DIRECTOR, OFFICE OF AEROSPACE MEDICINE, FEDERAL AVIATION ADMINISTRATION Mr. Scovel. Mr. Chairman, Ranking Member Petri, Members of the Subcommittee, we appreciate the opportunity to testify today regarding falsification of the FAA's application for Airman Medical Certificate. Our testimony today is primarily based on an investigation called Operation Safe Pilot, which we conducted with the Social Security Administration's Office of Inspector General and U.S. Attorney Offices in California. The investigation focused on pilots who represented to FAA that they were medically fit to fly, while at the same time claiming medical disability benefits. Today, Mr. Chairman, I would like to discuss three key points, as we see them, for mitigating the safety risks posed by airmen who falsify their Airman Medical Certificate applications. First, it is important to recognize that the Airman Medical Certification Program is an essential safeguard to ensure that pilots are medically fit to fly. FAA requires that each pilot have a valid medical certificate before being allowed to operate an aircraft. To receive a medical certificate, pilots must complete an Airman Medical Certificate application and be examined by an FAA-designated Aviation Medical Examiner. Those who meet the appropriate medical standards based on an in- person medical examination and an evaluation of medical history are issued a medical certificate. As of June 2007, FAA's database showed there were over 625,000 pilots with current Airman Medical Certificates. The Federal Air Surgeon has identified certain medical conditions that specifically disqualify an individual from receiving a medical certificate because those conditions could compromise a pilot's ability to safely operate an aircraft. These conditions include neurological and psychiatric disorders. Second, our investigation, Operation Safe Pilot, disclosed a potential systemic problem regarding falsification of medical certificates that requires greater attention and oversight by FAA. In 2003, our office initiated Operation Safe Pilot to determine whether a scheme uncovered in 2002 reflected a systemic problem. In the 2002 case, we determined that a pilot in California had defrauded both FAA and Social Security by making false statements to doctors for the purpose of maintaining his FAA private pilot certificate while obtaining Social Security benefits. For approximately 14 years, this pilot had used two different doctors, one to conclude that he was in good physical health in order to maintain his Airman Medical Certificate, and one to diagnose him with a disabling disease in order to fraudulently receive Social Security benefits. He was ultimately convicted of fraud and sentenced to serve a 21 month prison term and pay nearly $200,000 in restitution. Operation Safe Pilot began with a universe of about 40,000 pilots residing in Northern California. We focused our investigative efforts on a smaller group of 48 pilots who were receiving Social Security disability benefits. At our request, the FAA Regional Flight Surgeon reviewed case files for those pilots and determined they would not have passed the airman medical examination had the examining physicians known about the pilots' disqualifying medical conditions. The U.S. Attorney's Office initiated criminal prosecutions against all 48 pilots, 45 of whom were convicted of making false statements to FAA. In all 48 cases the pilots failed to notify FAA about their well documented, severe, pre-existing medical conditions. Many of those pilots had multiple disqualifying conditions, with the most common condition being some type of mental disorder such as schizophrenia. In addition to Operation Safe Pilot, both the NTSB and FAA have published reports showing that pilots often did not disclose serious medical conditions which sometimes resulted in accidents and fatalities. For example, a May 2006 FAA research report of post-mortem toxicology for 4,143 pilots who died in aviation accidents between 1993 and 2003 found that nearly 10 percent were taking some type of psychotropic, cardiovascular, or neurological medication not reported on their Airman Medical Certificate applications. The report's authors essentially concluded that pilots who took certain types of medications and were involved in fatal accidents rarely reported those medications and their underlying medical conditions to FAA. Third, FAA can take several actions to ensure that disabled pilots do not circumvent the medical certification process. In July 2005, we sent a memorandum to the DOT Secretary and FAA Administrator highlighting the results of Operation Safe Pilot. We pointed out that FAA did not have a mechanism for identifying certificated pilots who were receiving medical disability benefits. We recommended that FAA work with the Social Security Administration and other Federal disability providers to, one, develop and implement appropriate checks and take enforcement actions; and, two, consider revising its application for Airman Medical Certificates to require applicants to explicitly identify whether they are receiving medical disability benefits. In April 2007, FAA initiated discussions with Social Security to match the FAA database of pilots against relevant Social Security databases. Both agencies have been discussing how such a process could be structured under the Privacy Act to ensure compliance with law. FAA has also expressed its intention to revise the application for Airman Medical Certificate to explicitly ask about the receipt of medical disability benefits. These are appropriate first steps. In our opinion, FAA should also consider two additional measures: one, conduct an education and outreach effort to ensure pilots are fully aware of their responsibilities for accurately disclosing their medical histories on the Airman Medical Certificate application; and, two, offering a grace period to pilots who self-identify previously undisclosed medical conditions. FAA, however, would need to make it absolutely clear that all medical conditions disclosed would be evaluated and, unless pilots were found at that time to be medically fit to fly, their Airman Medical Certificates would be subject to revocation. That concludes my statement, Mr. Chairman. I would be pleased to address any questions you or other Members of the Subcommittee may have. Mr. Costello. The Chair thanks you and recognizes Dr. Garber for his testimony. Dr. Garber. Good morning, Chairman Costello, Chairman Oberstar, Ranking Member Petri, and Members of the Subcommittee. Thank you for allowing me the opportunity to present testimony on behalf of the National Transportation Safety Board regarding Federal Aviation Administration's oversight of falsified Airman Medical Certificate applications. It is a privilege to represent an agency that is dedicated to the safety of the traveling public. On June 17th, 2002, an aircraft operated by a commercial- rated pilot performing wolf survey flights under contract to the Michigan Department of Natural Resources descended at high speed into terrain. The pilot and his personal physician, who later became his aviation medical examiner for many years, had concealed from the FAA information regarding the pilot's multiple, serious medical conditions on seven applications for Airman Medical Certificates. The pilot's physician had denied knowing the pilot when the FAA was investigating a report that the physician was treating him for these conditions. At the time of the accident, the pilot's physician had been decertified as an aviation medical examiner for failure to complete required training, and the pilot did not have a current medical certificate, having been deferred for certification by a new aviation medical examiner who noted some abnormal heart rhythms on examination. The Safety Board concluded that the accident was caused by the incapacitation of the pilot and that a contributing factor was the pilot and his physician providing false information on the pilot's medical applications. A recent staff review of over 20,000 aviation accidents investigated since 1995 found 327 in which impairment, incapacitation, or a medical condition were identified as causes or factors. Medications and substances of abuse were each found in over 100 of these cases. In 26 of these cases, it was determined that a pilot with a current medical certificate and a known medical condition had information regarding that condition that was not revealed to the FAA at the time of the most recent application for medical certificate. It is important to note that these numbers are certainly an underestimate of the extent to which this issue is involved in accidents. In many cases, there is insufficient evidence available to completely evaluate the possibility of impairment or incapacitation. The Safety Board is fortunate to benefit from the resources of the FAA Toxicology Laboratory at the Civil Airspace Medical Institute, likely the finest toxicology laboratory in the world for analysis of specimens for accident investigations. We are, therefore, often able to determine that a pilot used a specific substance in the hours or days preceding the accident, most frequently a substance that was not reported to the FAA. The Safety Board has been concerned for many years regarding the inappropriate use of certain medications by pilots and other vehicle operators and, in 2000, issued comprehensive recommendations on this topic to the Department of Transportation, the Food and Drug Administration, and modal agencies to improve information provided to such operators regarding the use of appropriate medications while engaged in vehicle operations. Although some modal agencies have taken responsive actions, the overall response to date from the DOT and the FAA has been limited, and the majority of the recommendations on this topic have not been implemented. The Safety Board has also noted that, with many accidents due to a pilot's intoxication by alcohol, illicit substances, or large amounts of potentially addictive medications, the FAA was or should have been aware of information that would have led them to conclude that the pilot was substance dependent and would have restricted issuance of a medical certificate. In particular, the Board has noted a number of instances in which the FAA did not request details of an identified DUI conviction in order to determine the circumstance of that violation. Additionally, the Board has found that the information available to the FAA on potentially substance-dependent pilots was often not provided to individuals evaluating the pilots for possible substance dependence. Furthermore, the Board is concerned that, unlike other chronic conditions, the FAA does not now routinely require that pilots with substance dependence be followed for the condition for the period that they hold their medical certificate. The Board has recently issued several recommendations to address these deficiencies. Finally, the Safety Board notes that, unlike many other countries, and inconsistent with the International Civil Aviation Organization recommendations, there is no requirement for the reporting of medical conditions in between periodic examinations. This significantly increases the complexity of establishing that a condition was concealed from the FAA, since it may not have become apparent until after the most recent medical examination. The FAA has recently proposed increasing the interval between medical examinations for certain pilots and the Safety Board has noted in its comments to that NPRM that a reporting requirement in between examinations would be desirable. This concludes my prepared statement, and I would be happy to answer any questions. Mr. Costello. Thank you, Dr. Garber. The Chair recognizes Mr. Sabatini. Mr. Sabatini. Good morning, Chairman Costello, Chairman Oberstar, Congressman Petri, and Members of the Subcommittee. I am pleased to appear before you today to discuss the Federal Aviation Administration's oversight of the Airman Medical Certification application process. Let me assure you that the FAA takes this matter seriously, and we are very concerned about any falsification of information on Airman Medical applications. Let me also say that the vast majority of our nation's pilots are honest, dedicated, and have contributed significantly to our current unprecedented safety record. FAA agrees with the recommendations of the Inspector General on falsified Airman Medical applications, and we are taking steps to implement those recommendations, as I will discuss. We are also taking other proactive steps regarding this issue, which I will also discuss. As you are aware, the Department of Transportation Inspector General issued a report in 2005 describing the results of an investigation known as Operation Safe Pilot. I will not spend time discussing the details of the IG's findings; they are already well known to you. However, I will discuss the IG's recommendations and the FAA's response to those recommendations. The Inspector General recommended that FAA work with the Social Security Administration and other disability benefits providers to develop and implement a strategy to conduct checks of applicants for Airman Medical Certificates with the databases of those disability benefits providers and take appropriate enforcement actions where falsifications are found. The IG also recommended that FAA consider revising our application for Airman Medical Certificate to require applicants to explicitly identify whether they are receiving medical disability benefits from any provider. I am pleased to inform you that the FAA is moving forward to implement both of the IG's recommendations. FAA is working to develop a program in cooperation with the Office of the Inspector General for the Social Security Administration to cross-check randomly selected applicants for FAA Airman Medical Certificates with the Social Security disability database to determine if any applicants are receiving disability from the Social Security Administration. I must emphasize that we are still working with the Social Security Administration's IG's Office and the Social Security Administration itself to determine what information they are willing to grant us access to and then develop a framework for how such checks will be conducted. We hope to start by cross- checking applicants to the Social Security Administration databases because, to receive Social Security disability benefits, an individual must be totally disabled. Thus, virtually any applicant who is receiving Social Security Administration disability benefits will necessarily have a condition that would disqualify the applicant from holding an Airman Medical Certificate from the FAA. While it is premature to discuss any future expansion of the cross-checking of applicants to disability databases other than the Social Security Administration, we would have to carefully consider the potential resources required to conduct investigations and make medical determinations regarding an applicant's disability and whether that condition disqualifies the applicant from holding an Airman Medical Certificate before taking such a step. In order to proceed with cross-checking applicants for Airman Medical Certificates against the Social Security Administration disability database or any other database, FAA must first make a change in the policy allowing routine use of private information. This will require publishing a notice of the proposed change in the Federal Register and a comment period before the change can be implemented and FAA could begin any cross-checking. This process might take six to twelve months to complete. However, we will immediately begin efforts to implement the IG's second recommendation, the addition of a question to the Airman Medical Certificate application regarding disability benefits. The FAA will propose to OMB the change to the application form to include the question. Upon approval from OMB, the new application form can be printed and distributed to Airman Medical Examiners nationwide. We are proposing to change the Airman Medical Certificate application to add a question specifically asking if the applicant is receiving any disability benefits. While this additional question appears straightforward, the investigative work will begin after a positive response to the question. Once an applicant indicates he or she is receiving disability benefits, FAA would then have to investigate to determine the disability benefits provider, the condition for which the applicant is receiving disability benefits, and the extent of the applicant's disability. FAA is also being proactive in other areas regarding falsification of data on Airman Medical Certificate applications. The FAA Civil Aerospace Medical Institute has now developed an integrated scientific information system that will provide a continuous monitoring of all Airman Medical Certification records compared to aviation accidents or incidents and post-mortem toxicology reports. The FAA will, therefore, have the capability of continuously monitoring any aircraft accidents and accessing any discrepancy between the information on the certificate and any post-mortem findings. This includes prescription and non- prescription medications and medical abnormalities that could affect the ability to safely perform duties permitted by the Airman Certificate and which are related to the National Transportation Safety Board causal accident factors. In 2006, the FAA's Office of Aerospace Medicine initiated a routine process analysis study to evaluate and improve the efficiency of airman medical certification within the FAA. The Airman Medical Examiner Airman Certification Quality Assurance Study evaluates the accuracy of AMEs in determining the suitability of Airman Medical certification. It is another tool that will assist the FAA in monitoring this issue. We are committed to expanding our efforts to review medical certificates and pursue appropriate enforcement actions when falsifications are discovered. Let me conclude, Mr. Chairman, by stating that the FAA's first priority always has been and always will be safety. Safety is our agency's mission, and we have dedicated our careers to promoting safety. It is a responsibility we do not take lightly. This concludes my statement, and I would be happy to answer any questions the Committee may have. Mr. Costello. The Chair thanks you, Mr. Sabatini. At this time, the Chair recognizes the distinguished Chairman of the Full Committee, Chairman Oberstar. Mr. Oberstar. Thank you, Mr. Chairman, for holding the hearing; and, Mr. Petri, for your participation, your support of this initiative; and our staff for their extraordinarily rigorous inquiry undertaken, beginning early this year, into this issue of falsified medical certificates. I read over, last night and early this morning, the testimony of all the witnesses, and I am very encouraged by what I see. The response of FAA to the issue is a positive one and encouraging. We do have the safest aviation system in the world. We do have the most complex aviation system in the world. But the fact that a number of certificated pilots have lied about grave medical conditions in order to retain their pilot's license is troublesome, worrisome, and in some cases, perhaps frightening. Surely, we can appreciate and be grateful for the statistics that the number of fatal accidents caused by medical incapacitation are low. But we shouldn't have to rely on the grace of God to get there. A single impaired, intoxicated pilot could cause extensive and widespread damage to the public through loss of life or property damage. That is what the FAA wrote in an earlier rulemaking. FAA does require pilots to undertake periodic medical exams for fitness, but they are limited; they rely heavily on self reporting, and not all medical conditions are going to be obvious to a doctor who is seeing a patient for the first time, especially in the case of mental illness. And not all of these AMEs are as thorough as they should be. The 2006 FAA survey, the Medical Service Airman Customer Satisfaction Survey--they have got these wonderful long words and usually they come down to an acronym--found that 15 percent of airmen reported their medical history had not been reviewed by their medical examiner. Seventy-nine percent had no medical history review done at all of that small 15 percent sample. But if you extrapolate that survey result to the entire pilot population, it could be in 1986 that 89,000 pilots did not have an AME review their medical histories, and nearly 24,000 pilots did not have a physical exam done by an AME. Now, the reason we have this AME process is so you have persons who are designated by the FAA who know what they are looking for, know what questions to ask, know what kind of exam to give, and they should not be subverted or averted. Inspector General Scovel, in 2005, your office found egregious cases of airmen lying to the FAA about medical conditions in order to pass their medical exams. In the 40,000 pilot sample, the IG's Office found 3,200 airmen with current medical certificates simultaneously receiving Social Security disability pay. Forty of those cases ultimately were prosecuted, but hundreds more could have been prosecuted if they had had enough personnel in the U.S. Attorney's Office to do it. Over a 10 year period, FAA's own researchers found 400 fatal accidents where pilots had potentially disqualifying medical conditions. I note with interest in Mr. Sabatini's testimony, his more detailed testimony, that FAA has gone through these and reduced it down to a very small number, small fraction; that if those exams had been done and if corrective actions had taken, and if a number of other things had happened, you would have had a fraction of a percent of irregular medical conditions. But that is not good enough and I think, Mr. Sabatini, you recognize that, and you have agreed to coordinate with the Social Security Administration. In Social Security determination, if you are disabled, you are 100 percent disabled. Not so with the VA, which has gradations of disability. Some VA disability conditions may permit a person to continue to fly, but that is going to take very careful review. It is going to take very careful consideration of all those varying medical conditions. I appreciate the seriousness with which Mr. Sabatini, Mr. Chairman, undertakes his responsibilities. He is a premier safety professional. But bringing together the National Driver Register, notifying airmen that they are subject to review through the National Driver Register I think is an important point. I am the author of the National Driver Register, over 26 years ago. Well, not quite the author; it was John Rhodes who preceded me by six years. But I did upgrade the National Driver Register and brought it to what it is today, and I think it is an exceptionally valuable tool in getting the full picture of airmen's conditions. So I think, while this process has been uncomfortable, maybe even painful for the FAA, thanks to the Inspector General's Office, thanks to the NTSB, thanks to our investigative staff, the issues have been raised, they have surfaced, they have been examined, they have been evaluated, and FAA is on track to taking some vigorous steps toward resolution of the problem and creating an even safer airspace. I will have some questions later. Thank you, Mr. Chairman. Mr. Costello. Thank you. The Chair now recognizes the Ranking Member, Mr. Petri. Mr. Petri. Thank you very much. Thank you all for your testimony. This is an important subject, as the Chairman of the Full Committee has pointed out, and it is good that we have oversight on it. I wonder, maybe Mr. Sabatini might be the right one, if you could just sort of walk us through how the procedure works now and whether this episode or whatever has pointed out some ways of improving the procedure because of computerization and opportunities for cooperation between agencies and the like. Mr. Sabatini. The current system today requires that in order to exercise the privileges of an Airman Certificate, one must have an appropriate medical certificate to accompany those privileges. Depending on the class of medical certificate, nonetheless, one must complete an application which has a host of questions, one of which specifically requires that you answer whether or not you have been convicted of a DUI, or driving while under the influence, and, in that instance, 100 percent of medical applications are matched or cross-checked with the National Driver Registry. If there is a positive hit, then there is a follow-up investigation that is conducted to assess that situation. The system is dependent on pilots being honest, and if someone is intent on defrauding the system, as the Inspector General has discovered, then certainly that is possible. So the current system could stand to_as we have agreed_to have some improvements included, one of which is going to be adding a question to the questionnaire that specifically requires an answer to whether or not you are receiving disability benefits from any disability provider. And we will then, on a sampling basis, compare that with, starting with the Social Security Administration, a records match; and, of course, then follow-up investigation in that regard. We are also proposing to not only do the cross-checking, but also to add the question, and we are strong advocates of educating the community in the many different ways that we can do that. So we can advise the community that this is now going to be on the medical certificate and make them aware that there is the potential for serious follow-up in terms of enforcement, whether it is from the criminal side or whether it is ours, from an administrative procedures side. We will vigorously follow up any indication that there is misrepresentation of one's medical condition. Mr. Petri. There have been stories in the press from time to time--I suppose they are accurate, though may be exaggerated--indicating that when people retire from the military or even from various civilian jobs, like being a bus driver or so on, they often discover they have some disability and that increases their retirement under some of the programs. I don't know how widespread that is in the Air Force or among pilots, but is that checked? Mr. Sabatini. We do not now, today, have a method in place to check exactly what it is that you have suggested. But I would also tell you that is--and I don't have factual information, but I can tell you anecdotally that we know that there are military retirees who have a percentage of disability that, in and of itself, would not necessarily mean being disqualified, or having a condition that would prohibit the issuance of an FAA medical certificate. So we don't have any numbers on that, Mr. Petri, and that is the current state, but we hope to change that. Mr. Petri. One question. This works both ways, with Social Security, at least, and some of these other programs; people may be perfectly good pilots, but they may not actually have the disability that they are getting paid for. Was fraud discovered that way as this match was done, or was it only a check on the qualification of people to actually fly airplanes? Mr. Sabatini. The investigation_and I might defer to the Inspector General who conducted the investigation_was primarily to assess people who were claiming disability and who also had a pilot medical certificate. And Social Security Administration disability is 100 percent disability, and once you have that, you would not qualify for an FAA medical certificate, so that would be a concern to us and we would want to ferret that information out. Mr. Petri. Maybe I should ask Mr. Scovel. Mr. Scovel. Thank you, Mr. Petri. I do have some information that may help you understand the extent of that problem. We touched base last week with the Social Security Administration Office of Inspector General and we were informed that, to date, six cases of disability fraud from Operation Safe Pilot had been identified for their purposes. They report total monetary achievements--and that is their term--of $499,706 achieved from Operation Safe Pilot. The breakdown includes $425,160 in savings due to canceled benefits extrapolated over a period of five years; $66,513 in fraud identified; and $8,033 recovered by way of restitution. It is clear that, while Social Security has identified six cases to date, they have informed us that they continue to work other cases, so a limited number of subsequent court cases may well come to our attention. Comparing that against the number of cases which we identified and which the U.S. attorney chose to prosecute, it is clear that the intent on the part of most of the pilots that we identified as investigative targets was to deceive the FAA, as opposed to the Social Security Administration. Mr. Petri. Thank you. Mr. Costello. The Chair recognizes the gentleman from New York, Mr. Hall. Mr. Hall. Thank you, Mr. Chairman, Mr. Ranking Member, and our esteemed witnesses. Inspector General, what do you estimate that it costs per prosecution to carry out Operation Safe Pilot, and would the FAA likely incur similar costs if they were to pursue administrative sanctions? If not, what would account for the difference? Mr. Scovel. Thank you, Mr. Hall. We had an opportunity to evaluate the cost to my office of pursuing Operation Safe Pilot. They amounted to a total of $401,192. The majority of that had to be charged to the direct labor hours of the investigation, but we also incurred administrative overhead costs, some travel costs, and other direct costs. That cost figure did not include FAA or U.S. Attorney Office costs, I should note. The cost per case prosecuted--and I will note that there were 45 cases prosecuted--was $8,915 per case. My testimony mentioned the figure of 48 cases. Those were the number of individuals that we referred to the U.S. attorney for consideration for prosecution. Three of those cases could not be pursued, as I mentioned in my testimony, two because the individuals died before the U.S. attorney could bring charges and one because the individual was deemed to lack sufficient capacity to participate in his defense at trial. Mr. Hall. Thank you. On another topic, during Operation Safe Pilot, did you find that the falsifications were more prevalent in the general aviation community or were cases where cargo or air transportation pilots were not being truthful? And do these categories pose a higher safety risk than GA pilots? Mr. Scovel. Thanks. I will note that among the cases that we identified and referred to the U.S. attorney, there were 4 airline transport-rated pilots, 6 commercial pilots, 28 private pilots, and 7 student pilots. The figure of 28 private pilots, presumably all GA pilots, amounted to 62 percent of the number of cases we referred to the U.S. attorney. I don't think, and I won't say today on the record, that that indicates that general aviation pilots pose a greater threat. The reason, as I see it, that, in fact, 62 percent of our investigative targets happen to be private and presumably GA pilots was simply because of the investigative parameters that we and the U.S. Attorney's Office set. In other words, we were looking at the type of disability claimed, the nature and duration of the falsification that had been submitted to FAA as part of the medical certificate application, and also the U.S. attorney's prosecutive requirements; they basically were looking for open and shut cases. Applying all of those factors to the number of cases that we had under consideration, more private pilots--in fact, 62 percent--rose to the surface, and air transport pilots and commercial pilots represented smaller numbers. Mr. Hall. Thank you, sir. This one is both to Dr. Garber and to Mr. Sabatini. The Inspector General's testimony notes that the FAA and SSA are trying to work in compliance under the Privacy Act to create a list to cross-check applicants who may not have disclosed this potentially disqualifying type of condition. In your estimation, can the system be set up within the current structure of the Privacy Act or, at some point, does Congress need to consider amending the statute to allow the process to move forward? Dr. Garber. I think that that question probably would be better handled by Mr. Sabatini, as it goes to the sharing of information between those two agencies, so I will defer to him on that question. Mr. Sabatini. What we are proposing is a notice in the Federal Register to inform the public about routine use of information that would be available through the Social Security Administration database and our database. As to the Privacy Act, I would have to defer to our attorneys to answer that question, since that is more of a legal issue, but certainly we would respect whatever the requirements are of the Privacy Act. Mr. Hall. Are there technological or proprietary barriers to moving forward in terms of this coordination with SSA and FAA? Mr. Sabatini. We are in discussions with the Social Security Administration, the Social Security Administration Office of the Inspector General, and, of course, our people, working out a memorandum of understanding on how best to implement this. Mr. Hall. Thank you very much. Thank you, Mr. Chairman. I yield back. Mr. Costello. The Chair thanks the gentleman and now recognizes the gentleman from New York, Mr. Kuhl. You pass? Very good. The Chair now recognizes the gentleman from North Carolina, Mr. Hayes. Mr. Hayes. Thank you, Mr. Chairman, and thank you very much for having a very worthwhile and thoughtful hearing on an important safety issue. I thank Mr. Oberstar, as well, for his interest and concern in this vital matter. Thank you all for very extensive and informative testimony. As a pilot--I was just looking--the form that we fill out is quite comprehensive in nature and it can lead in a number of different directions. Safety is the issue which everyone in this room holds above_by considerable margins_anything else we are talking about. So, with that as a backdrop, would you all care to speculate out loud about the dangers we face? We have talked about medical issues, we have talked about falsification, all of which are very serious. We have talked about jointly looking at double-dipping. All these are crucial. Having said that, again, do you have any concern that we might get beyond where we need to go and make this complicated form even more complicated, which, at the end of the day, puts a damper on the vital commerce provided by commercial_and that is an issue, because some of the things we do here concern commercial pilots_that the process may be slowed down for them. By the same token, general aviation and that group of pilots is important to business and commerce as well. Could you just speculate for me about some of the precautionary measures that we, on both sides of the bench, should be aware of as we move forward in this very important process? Dr. Tilton, we have left you alone. May I start with you? Dr. Tilton. Thank you, sir, for the question. I am certainly, obviously, very concerned. As you said, safety is paramount. I work for Mr. Sabatini in the Office of the Associate Administrator for Aviation Safety, so whenever I give a talk, the first thing I say is the safety of the airspace is number one; and then number two is to make sure, once we make that as the ground assumption, that every airman that we can possibly get back in the air, we do so. And we have a good record. Obviously, we are very concerned about the small minority of people who might take advantage of the system and give us incorrect information. And I am concerned somewhat about making the process more complicated, but I think what we proposed are the correct level of response to the IG's investigation. I don't think that we are asking for any more ominous requirements on the part of the airman; we are just making the questions a little more explicit so there is absolutely no question in his or her mind that, when they answer the question, they are doing it correctly. And it give us one more opportunity to make sure the airspace is safe. Certainly, I am not interested in making the system more egregious and difficult to participate in, but I think safety, again, is paramount in this situation. Mr. Hayes. Thank you very much. At the risk of sounding like doing a promotion for AOPA, which is not my intention, I held up the AOPA turbo medical, which is an online service that pilots who are for the first time or going to renew their certificate, can go online and look at some of the very complicated but relevant chemical and other issues there are. I am working with constituents right now. If you check off a block that says ``have you ever been unconscious,'' then a whole host of things happens to you. In this particular case, there was an automobile accident and the law enforcement officer said the person was unconscious and he says he never was. Well, if he was never unconscious, his life is much easier. Again, neurological issues are important. I simply make the point, going forward, that I would encourage the continuation of this process, but filtering in as heavy a dose of common and practical sense as we can moving forward. Again, this is kind of off the wall, it is not in the official questions, but is there an appropriate place to consider even a fourth class medical? It is kind of like somebody learning to drive. If you are out in the pasture and there is not a tree within 300 yards, and you are driving and learning, that is one thing. There is a lot of aviation that relates to that, as opposed to using sophisticated aircraft in congested area space. Good reason for first, second, and third class. Is there any fault, again, as a part of this effort, to improve safety and focus on the right areas that maybe even an additional to correspond with sport class license might be appropriate. Mr. Sabatini or Dr. Tilton? Anyone. My time has expired. Mr. Sabatini. Thank you, Mr. Hayes. We do not now have any thoughts about a fourth class medical certificate, but we do have different grades, the first, second, and third; and we also have, for light support aviators, other conditions under which they cannot safely operate. That was done through a very rigorous process of an NPRM and comments from the general public, and we are convinced that is a safe approach. So, in essence, there almost is something like a fourth class medical certificate. Mr. Hayes. Thank you, Mr. Chairman. I have taken it over my time, but I appreciate your thoughtful responses as we work toward better aviation safety and a practical response. Thank you very much. Mr. Costello. The Chair thanks the gentleman and now recognizes the distinguished Chairman of the Full Committee, Chairman Oberstar. Mr. Oberstar. Thank you, Mr. Chairman. Dr. Garber, in your statement you allude to the number of aviation accidents where medical conditions contributed to, or were a factor, and say that that number is underestimated. What was your basis for that? Dr. Garber. Well, we don't have the resources, sir, the NTSB does not have the resources to do a complete aeromedical investigation of every single accident. We focus on those accidents where there is evidence, either from autopsy information, toxicology information, or the circumstances of the accident itself, suggesting in fact that there may be medical or medication issues in regard to the accident itself. So those are the ones that we look at. Given that, there are probably some of those that we are not able to make a determination; there is simply insufficient information available, even with a comprehensive investigation, to come to a conclusion as to whether or not the medical condition or the medication played a role in the accident. For that reason I say that the circumstances are certainly underestimated. To that extent, it is difficult to say, but I would say that we do a thorough job investigating those where we have significant information suggesting that the individual may have been impaired. Mr. Oberstar. You had a staff review of 20,000 aviation accidents, which you reviewed, since 1995 and found 327 in which a medical condition, impairment or incapacitation, including over-the-counter medications, antihistamines and commonly known name of Benadryl. So it raises the question what makes a condition a disqualifying condition. Some of these are cardiac valve replacements; diabetes requires insulin; epilepsy. What other conditions are disqualifying? And what medications taken randomly, even over-the-counter medications, can cause incapacitation? Dr. Garber. Sir, I will speak a little bit to the medication issue in that the NTSB has recommended more comprehensive information be provided to pilots and other transportation operators with regard to the medication issue. There is no real comprehensive list of medications that are either disqualifying or permitted within the transportation industry or oversight regulatory area, so it is very difficult to determine which medications, from an operator perspective, would be allowed or would be disallowed if one was to indicate that they were using those; and we believe that that should be corrected. The NTSB has made recommendations in regard to that. With regard to the question about the medical conditions which are disqualifying and why, I think I will defer that question to the FAA. They can give you more background as to why they have chosen the particular conditions that they have as being disqualifying in that regard. Mr. Oberstar. I will pursue that in a moment. Recently, the Board made a recommendation that FAA should require airmen reporting conditions involving driving while impaired by alcohol or drugs to provide a complete copy of the relevant arrest report, including, maybe, court records. Why do you believe that is necessary? Dr. Garber. In the same way that the FAA requires records to be submitted on any disqualifying condition. If you were to mention to the FAA, as an example, that you had been in an emergency room for chest pain, they would request information as to the outcome of that evaluation and the specific information that was developed during that evaluation. In the same way, we think it is very important for circumstances like a DUI, which are significant indicators of a potential problem with substance abuse or dependence, should be evaluated more completely. An individual who may have had one or two drinks may not have an issue with abuse of the substance or dependence, but an individual who is driving on a very high level of alcohol may certainly be exhibiting evidence of tolerance, which, by the FAA's own definition, is an indication of substance dependence. Mr. Oberstar. Well, I think it is an important recommendation and an important action to take because that arrest report gives a complete picture, not just a little slice, not just a little subtitle or headline; but it gives the medical examiner an opportunity for a complete review of the circumstances. As Mr. Hayes referenced a moment ago, the question of ``were you ever unconscious.'' Well, under what circumstances? The arrest report would provide that kind of information. In the course of NTSB review of all--you looked at 20,000 records, you at NTSB and your staff followed these issues very thoroughly, very carefully. Are you persuaded that the airman medical evaluation is rigorous enough? Should the whole process be reconsidered, re-evaluated? I want to get Mr. Scovel's reaction to that as well. Dr. Garber. The NTSB has made specific recommendations in a variety of areas; for instance, medications and substance dependence, as we have discussed here. Also, we have commented that we believe that there should be a reporting requirement to the system itself. The system itself, however, is fairly robust, like many other areas of aviation, and provides a significant review of those conditions under fairly strict guidelines, and in that regard probably is something of a model for other agencies, other organizations that share the same sort of regulatory oversight. There are areas for improvement, and the NTSB has certainly specified the areas where we believe improvement is both possible and should be made in the interest of safety. At the same time, we do recognize that this is a significant oversight function which is generally performed in a fairly substantial manner by the FAA. Mr. Oberstar. Mr. Scovel, have you evaluated the airman medical review and do you think it is adequate as it stands, or should it be overhauled? Mr. Scovel. Good morning, Mr. Chairman. I would begin by noting that my testimony this morning, of course, is based on Operation Safe Pilot, which was a criminal investigation project undertaken in one corner of the Country, really. We have not audited a full-blown audit of the Airman Medical Certification Program, so I am not able to say with authority that the program itself is systemically deficient. I think we can say, however, based on both the results of Operation Safe Pilot and on the results of an FAA survey from 2006, which was referred to by the Committee earlier, that improvement in oversight certainly is to be desired. Operation Safe Pilot identified some limited systemic problems and we have suggested improvements to FAA and to the Committee to remedy those. The 2006 survey, which, to its credit, FAA itself undertook--it was not an IG project--identified problems, however, with the airman medical examination itself. Some of those examinations, as reported by airmen, had been conducted not by physicians, but by non-physicians. In a significant number of instances there was no detailed inquiry during the examination of the airman's reported medical history. That too is required by FAA regulations. We would encourage the Committee and, of course, FAA to tighten up its oversight and the procedures involved in the actual examination that airmen undergo by Airman Medical Examiners, too. Mr. Oberstar. Thank you, Mr. Scovel. Dr. Tilton, are you satisfied that FAA's AME is as good as it should be, needs to be? Dr. Tilton. Sir, I am satisfied that the process---- Mr. Oberstar. And enough oversight of the process and enforcement? Dr. Tilton. I am certainly satisfied that the standards we have and the process we have set up is correct. I am obviously not satisfied by results of the survey that the IG just told you about and that you have referred to because we always have concerns any time we find out someone is not complying or following the correct process. So, in the case of this particular survey, it was an anonymous survey, so how do we then proceed upon reviewing the results and making a determination? What we do is, we talk to our AMEs. And the purpose of the bulletin, where you noted that particular survey, is education to the AMEs on how they should be educating their airmen. The other thing that we do is, we go to air shows. For instance, in a week or so I will be at Oshkosh; we go to Sun 'n Fun and we talk to airmen directly. In every seminar we have with airmen, we talk to them about the importance of the system, and we also tell them if they find an AME like the ones that are reported in this anonymous survey, they should let us know. And when we know that information, we take positive action against that AME to make sure that he or she is appropriately disciplined, including de-designation. So although I think we need to do more, we always can do more, I think we have a good system. We need to keep looking at it and making sure that every time we find information like this, we take positive action to correct it. Mr. Oberstar. Well, taking the positive action is critically important, and strong enforcement action. Mr. Sabatini, an FAA researcher last winter found, during a 10 year period, 10 percent of pilots involved in fatal accidents tested positive for medications used to treat potentially disqualifying medical conditions, but only 20 percent of them reported their medical condition on their airman application. Is that acceptable? Mr. Sabatini. Absolutely not, sir. As I said in my opening comments and my closing comment, safety is paramount for us, and every system can stand improvement, and I can assure you, Mr. Chairman, that we will vigorously pursue anyone who falsifies information provided as required to be provided. I would also like to point out that while this report, this survey that is being discussed here was exactly that, it was anonymous to solicit information, again, it is an indication of how the FAA is being vigilant to assess what is going on in a system that is highly dependent on voluntary compliance. I would also add that the recommendation that was made by the NTSB has been taken very seriously by us, and, in discussions as recent as this past week, I can assure you that we will be taking the kind of action that is going to require an airman to provide us with the full record of that person's arrest or conviction, or whatever the case may be, as well as exploring whether we can, in fact, get that record from the law enforcement organization. So it is a new area for us, but we take very seriously what has been recommended. It makes good sense. There is a possibility of tolerance. That is unacceptable in our community, and we are working vigorously to address these areas of, as has been said, in the area of oversight. I would also tell you, as Dr. Tilton has said, the standards that we have are global standards. We are sought after and asked to share with the global community how we go about the business of certifying from, a medical perspective, our airmen. So I believe the standard is more than adequate and I would tell you that the FAA is vigilant and will continue to be vigorous in its pursuit of anyone who misrepresents information. Mr. Oberstar. We are counting on you to be vigilant. We are counting on FAA to be the gold standard for the whole world in all of aviation safety, and that means pursuing these matters vigorously. In that analysis of the research, 40 percent of those pilots were rated for air transport or cargo operations. It didn't say whether they actually were operating as Part 121 pilots, but it is troubling that apparently these more stringent medical exams were not applied in those cases. You are going to correct that? Mr. Sabatini. Oh, absolutely, sir. Yes, sir. Mr. Oberstar. All right, thank you. Thank you, Mr. Chairman. Mr. Costello. Thank you. The Chair now recognizes Mr. Reichert. Mr. Reichert. Thank you, Mr. Chairman. I would like to follow up on a couple of comments and a couple of lines of questioning by Mr. Oberstar and Mr. Petri that has to do with process. I am not a pilot, but I fly a lot as a passenger, and have over the last number of years. But what I have done in my past career is investigate; 33 years with the sheriff's office in Seattle. My last eight years was as the sheriff. We have an air support unit there, so I have been responsible for, of course, making sure that our pilots are trained well and meet the medical requirements. And as you know, safety, of course, is our number one priority in the sheriff's office, too. And here, today, we are talking about safety and keeping our airlines safe and the pilots safe and the passengers safe. Again, the process is_it seems like there are a lot of moving pieces here, for me. The medical evaluation and the medical application is completed; there is an employment application. Does that marry up? Do those two documents marry up when the pilots apply--in the case of a commercial pilot--to the airlines for a job? How does that work? Or do they have their own separate medical document that they need to complete? Mr. Sabatini. First of all, let me say that we have a lot in common. I am a retired New York City police officer, spent 20 years in the NYPD, 11 of those years flying in the air unit. So I am very familiar with that kind of support. Mr. Reichert. Thank you for your service. Mr. Sabatini. I would say that the medical certificate is required to be provided as evidence to a potential employer as to the qualifications that are required for that particular position. You will then be subjected to, say, an air carrier's own medical examination as well. So, in that sense they come together. Whether the air carrier in fact researches the medical certificate, I can't answer that with certainty at this point in time. Mr. Reichert. You know, in the NYPD and in the King County Sheriff's Office, as you go through this process of hiring someone, a medical application is completed, there is a release that is signed for medical records. Does that occur in the pilot field? Mr. Sabatini. Before someone can be hired in the air carrier world, I know the acronym, I can't think of the actual description, but it's the pilot record, PRIA, that has to be complied with in terms of_the air carrier has access to the previous history of the pilot, and I believe that will include the medical certificate as well. Mr. Reichert. So as these applications are completed, is there--we have background investigators that go out to the sites and visit with neighbors and friends of people applying for a job. Is there a polygraph given to prospective employees of airline companies? Mr. Sabatini. I don't know of any air carrier, so I can't speak with authority on it, but I doubt that there would be a polygraph. There are many examinations that are required, written exams or questions that need to be answered. But I will tell you this, that the system is a robust system. Before someone actually ends up at the controls of an aircraft--and let's use the air carrier world as an example--one must go through required training, basic indoctrination to that air carrier's system. And that is not an option, it is required by Federal regulation. Once the training is complete, then that person must demonstrate through a flight check with their own instructors that the person is competent and proficient in that particular pilot station that person may be sitting in; then followed by an FAA proficiency check to ensure that that person can in fact execute the responsibilities of that position. Mr. Reichert. Thank you. My time is really going by here fast. In the law enforcement world, you fill out this application, you know, ``have you used drugs in the past;'' and, of course, there are time limits on some of the more major drugs. Marijuana is also listed on there; how long ago did you use it, those sorts of things. And when those questions are asked on the medical application, the polygraph test is given and they say on the application ``we have never taken this drug, we have never taken this drug,'' and it has been 10 years since but it has been 5 years in reality. A polygraph test catches that sort of thing. The other thing is, we have a fit-for-duty, as you know, in law enforcement. When you recognize something with a pilot, is there a fit-for-duty examination? And the last comment I want to make here, before you respond, is the connection between SSA and the FAA and medical records--and you say if they are on Social Security, there is 100 percent disability. There is no need, then, to really know what the personal medical history is if the Social Security system has already reviewed that, given the 100 percent disability. All you need to know is if he or she is on Social Security, and they are gone. I am over time, but could they answer, Mr. Chair? Thank you. Mr. Sabatini. That is true. We would, at that point in time, if it was an SSA disability, that person would automatically be disqualified. But there is a due process that we must follow and revoke that medical certificate. Mr. Costello. The Chair thanks the gentleman. Mr. Sabatini and Dr. Tilton, you have heard from the Chairman of the Full Committee, Chairman Oberstar, and I think other Members of this Subcommittee were pleased that the FAA is moving in the right direction to correct some of these problems, one, by looking at the database and working with the Social Security Administration; two, by revising the form to specifically ask the question if the applicant is receiving any disability. So we are pleased that you are moving in that direction. You heard Mr. Scovel testify that there are improvements that need to come about in oversight. Also, the fact that there were some examinations apparently given by non-medical doctors. I want to give both of you the opportunity to comment on both of those issues, on improving oversight and the fact that apparently some examinations have been given by non-medical doctors. I wish you would comment on both, please. Mr. Sabatini. Sir, let me give you my first response in terms of non-medical. Again, it is the FAA aggressively pursuing information that can help us be good at the work that we are responsible for, and that is the oversight of the system. I would suspect that--first, let me say that no one has ever been issued a medical certificate that was not signed off by a doctor. So perhaps in the office--and this is speculation on my part, and that is the issue that we have in terms of surveys that are anonymous_we can't pursue that person and find out exactly what they are referring to. But it is possible that there are physician assistants who performs a preliminary medical examination and then present the information to the doctor in the office, and that doctor is then required to, of course, be the person who signs off on the medical authorization and the issuance of the certificate. But I will turn to Dr. Tilton and ask him to expand on that. Dr. Tilton. I agree with what Mr. Sabatini said. It certainly is possible that occurred. It is not in line with our process. We do use ancillary personnel to do things such as EKGs or draw blood or check the blood pressure, but the AME, he or she, is duly responsible to do that examination; they are required to lay hands on the patient, to do the various tests that the physician should be doing to ensure to him or herself that that is done correctly. Whenever we find out that there is a case where that hasn't been done, we take aggressive action against that AME. It is difficult sometimes to get that information, and we have heard anecdotes about some people traveling a long way to get their physical because they know if they pay such an amount of money, they will get it without a whole lot of difficulty involving the AME himself. When we find out about that case, we take action against those; and we rarely find those. In fact, we have a process now that we look at all our AMEs; we look at how many examinations they do, we look at where they are located, we look at how far people travel to get to that AME to compare distances. For instance, if someone has traveled 3,000 miles to get their physical_why? We have a good example of that in Prescott, Arizona. Although Prescott, Arizona has the school Embry-Riddle, so there is good reason why people coming from some other State might have their physicals there. We haven't found any meat in that data, although we have reviewed it very carefully. I am very concerned about this information where we hear that an AME has not done the physical correctly or they haven't seen the doctor, and when we find that out, we will take aggressive action to make sure that doesn't happen again. Mr. Costello. Dr. Garber mentions in his statement the fact that he talks about anonymous reporting, and I am just curious how many anonymous reports on a pilot's medical condition does the FAA receive? Is it a large number or is it rare that someone anonymously reports a medical condition to the FAA of a pilot? Dr. Tilton. Sir, I wouldn't say it is--it is not every day, but it is not rare, either. We get several anonymous reports yearly, and what we do with those reports is we immediately go out to that airman and we acknowledge that we have information that may affect that airman's privileges, and we ask them for more information. Of course, with an anonymous report, sometimes we find out it was somebody who had some kind of reason, an ex-wife or something, and that does occur occasionally. But we do take action; we ask for more information. Sometimes we get family members saying, you know, my husband is 86 years old and I am really concerned and I don't want to do anything about it myself, but I would really like you to do something. We will pursue that; we will ask for more medical information to see if there is substance. If there is substance, we take action. Mr. Costello. Last question. I think we all recognize that some pilots have intentionally failed to disclose information on their applications and others inadvertently leave off, omit, or fail to report either medication or other debilitating illnesses. Both the IG and AOPA have suggested that there should be an amnesty period before we begin to do the match-up, the matching program, and I just want your comments, Mr. Sabatini and Dr. Tilton. Do you believe that we, in fact, should proceed with an amnesty program? Please. Mr. Sabatini. I believe a grace period would be an appropriate action to take, but I would caution so that we all understand. In those circumstances where someone were to reveal a medical condition that would be disqualifying, we would still take the appropriate revocation action of that medical certificate, even though they came forward voluntarily and revealed that condition. In other circumstances we would not pursue any punitive action. Mr. Costello. The Chair thanks you, Mr. Sabatini, Dr. Tilton, Dr. Garber, and Mr. Scovel, for your testimony today, and we look forward to following up on this important issue with the FAA as they move forward to implement this program. We thank you, and the first panel is dismissed. We would ask the second panel, consisting of one witness, to come forward, please. Let me recognize and introduce our sole witness on the second panel and let Members know, and the first panel know, of course, as always, that there are questions that we will submit both for the first panel and Mr. Boyer, as well, in writing for the record. So we want both Members and witnesses to know that. We recognize now Mr. Phil Boyer, the President of the Aircraft Owners and Pilots Association, for his testimony. And let me say, before you present your testimony, Mr. Boyer, we greatly appreciate both you and your organization taking this issue very seriously and coming up with a four-point plan to address the issue, and we look forward to hearing your testimony and hearing you explain what that plan is about. TESTIMONY OF PHIL BOYER, PRESIDENT, AIRCRAFT OWNERS AND PILOTS ASSOCIATION, FREDERICK, MD Mr. Boyer. Well, thank you, Mr. Chairman. Just before starting, not exactly the appropriate place, but I would like to thank you, your leadership, the Committee, Ranking Member Petri for a really sane approach to financing the entire FAA, not just the section we are talking about here. You have our undivided support of all of our membership for H.R. 2881. You know about us, 412,000 members. That is two-thirds of all of those certificates that were reported earlier. And, in the main, many of these are the private pilots that we were talking about. The organization has always taken medical services very, very seriously. As a matter of fact, there are about 30,000 member contacts a year, 13,000 of those by phone that we answer. So it is a good example of industry and the industry self-policing itself. We even cover non-members. We talk about medical action in magazines and in our electronic publications, including the website. Let me tell you--and pardon me, Mr. Graves, for talking about something you know about--a medical certificate is a pilot's most prized possession. It is sacred. I mean, getting a license is one thing, but let's not forget, you must be medically certified to be in one of these categories that we are talking about. Therefore, when ramp checked or anything else, a pilot has to have not only the original license of issue, but also that medical certificate, and since 9/11, through the actions of our group, a photo ID. Once again, pardon me, Sam, but just to clarify, there are three levels of medical certification. The third class, that is somebody who flies not for hire, generally taking a family, a business associate, somebody who knows them up; not, as was mentioned, somebody who is flying or taking up in law enforcement. That is good for three years except, for most of us over 40, for two years we go to the doctor. And, actually, there is a proposal and a ruling right now on the docket that would--a notice of proposed rulemaking that would extend that period to five years. It is an example of our talking about an issue that is constantly changing. The technology, the medicines really do need to be looked at, and not stay with rules from 1940 or earlier, when we are looking at what we certify and what we don't certify; and, as we all know, that brings us a lot of longevity. The second class medical, which is the first place in which you would fly for hire or carry passengers, is used for the commercial pilot certificate. It is good for one year. And then the airline pilots that we were talking about have to go for a medical--and the corporate aircraft--every six months. And this rulemaking I talked about is being proposed to extend that to one year. One thing that wasn't brought up that I think is very, very interesting and should be considered as we talk about that is the FARs continue to emphasize that the pilot must determine that he or she is healthy to fly before every flight. And it is a violation of the rules--whether you are taking an antihistamine, a prescription drug, or whatever--if you are not self-certifying before flights. And those of us who have flown many times know bad cold, maybe an injury to the foot or something that might affect a rudder pedal is a reason we might have another pilot onboard flying our plane. Just to look at the misconception out there is_you heard a lot of statistics. In the end, we are dealing with reasonable people who don't want to go out and kill themselves and their family; a very conservative group of people who will ground themselves before flights when they are taking a medication or have some other kind of medical situation; and medical incapacitation is rare. One-quarter of one percent of all accidents are due to medical incapacitation. Now, you heard larger numbers than that, but that would be like me looking at somebody who had 50 stab wounds, was obviously killed, and then we examined that individual and found that they may have had a plaque buildup in their arteries. The real reason were those 50 stab wounds. The plane ran out of fuel or this or that. But, once again, you heard that word ``possibly.'' The actual data shows one-quarter of one percent. And if we look at medical fraud, five-one hundredths of one percent. Now, once again, we don't condone any kind of falsification of fraudulent records. And I will tell you, in preparing for this, in talking to the Committee, and in really seeing the IG's report, as a 40- year pilot, I was never aware that this complicated form that Congressman Hayes referred to_that there were these kinds of penalties if we didn't get something right; and I will tell you, it is not difficult to forget that doctor's exam that you went to. I just was thinking about, now, where would that apply to me when I go in next April. And, you know, I went to the doctor about four months ago for a sore in my heel. Turned out to be a burr caused by a shoe. I might forget that when I am going to an AME. It had nothing to do with my flying. And that would be counted as a falsification of the record. So we have got to understand that there are inadvertent errors. There is a question 17 on here: Do you take any non- prescription medicines? Somebody starts filling it in and it causes you to be kicked back if you, once in a while, take a Tylenol. Believe me, in this job, and I am sure in your jobs, you have to take one of those every once in a while. One of the things I think we want to protect is, that the FAA budget, the Civil Aviation Medical Institute is not well funded; it is a flat budget. The people that you are looking for_Sabatini and Tilton_to do all this fact checking are not given a great budget, and right now many of your members probably write you and say, ``could you help me get my medical; I've put in all the paperwork and it doesn't come through.'' That is because this area of FAA has never been given the proper money. So if we are going to do other things, let's make sure the FAA has the budget to do them. And I think the four-point plan that we have outlined--and I am not going to take a lot of time on it because, actually, you are aware of it in my testimony and it has been spoken to already, but we ought to have a warning on the form, a public disclosure that the data will be shared with public agencies. Let's face it now, security agencies are looking at this, not just the driver record. So let's add to that all agencies. And, you know what? In September of 2005, when the IG report first came out, we wrote a letter to the FAA saying let's do this; not waiting for this Committee to have a hearing or anything like that. Proactively, let's look at identifying falsifications. So let's say I had filled out that application last April and I hadn't talked about this little burr on the heel of my foot when I visited a doctor. Once again, not disqualifying, but I didn't put that I had that physician visit. Let's give this amnesty period we talked about for people to clear up things like that; not that I had heart bypass surgery and I didn't put it in. I mean, they will have to go through the rigors of getting back in. And then I think one of the most important things is a data sharing program. Let's not put the onus on the FAA. They don't have the budget to do this, and it is going to slow down, it is going to increase your e-mail and letter flow, and mine, to help pilots as our constituents. But the most important thing is we will help. With the size of our publications, the size of our organization, the many ways to reach pilots, we will get back in and talk about the changes that will occur to the medical form. For more than four years we have had, like Turbo Tax, a medical form online. It was referred to here by Congressman Hayes. It allows you to go through, and if you make a mistake or fill in a box wrong--this is before you go to the doctor--it kicks it back and says that medication is not valid under FAA rules, you may want to try this kind of beta blocker or something else. For four years we tried to get the FAA to accept this form. They spent a lot of money and now have just recently come out with their own electronic form, so now they are saying, okay, we will accept yours. We had already spent the money and could have done it for the FAA, but it is out there and we will promote that. The penalties_things I didn't know about_we would love to let members know that, careful now, this is an important form, and if you make a mistake on it, you could be subject to these onerous penalties that are out there. And the amnesty period. Anything that has to do this. Pilots are very law-abiding people and, believe me, they don't want to defraud the Government. They don't want to fly unsafely. And I thank you very much for allowing me this time to explain what I think would be a great program for the FAA and for AOPA to undertake. Mr. Costello. The Chair thanks you, Mr. Boyer, and recognizes the Ranking Member, Mr. Petri. Mr. Petri. Thank you. Thank you for your testimony. Obviously, much thought and work was put into it; it was a very professional job. I think it does remind us all that we are, in our Country, self-governing, and that is how the system really works and works best, and if it is driven by the people who are involved in these systems, they have the best sense of what is working and what is not working, and also incentive to make it as effective, but also as simple and user-friendly as possible. I hope you may be in Oshkosh. I don't know if you are going to be there next week or not. Not this year? Mr. Boyer. Oh, I am there for two different sessions. Mr. Petri. Oh, you are. Mr. Boyer. Four days total. Mr. Petri. Then you know the manifestation of pride in aviation, and in our Country, really, that is there, and it is a unique kind of a thing in all kinds of subtle ways. So anything we can do to help you and your association as you promote safety and, at the same time, attempt to make this an open and accessible process for Americans so that they have the freedom to engage in this aspect of science and of life, we are eager to work with you on that. Thank you very much for your testimony. Mr. Costello. Thank you, Mr. Petri. Mr. Boyer, I had just a few questions, and you answered them in your presentation, so I have no other questions. As you indicated, we had a prior discussion several weeks ago, and you put together what I think is an action plan that is workable and makes sense and is very reasonable. We look forward to working with the FAA and other agencies that will be involved in the process to follow up as the process goes forward. I do believe there should be a grace period. There are many pilots out there that, as I mentioned earlier, some may have intentionally failed to disclose, but many, many others it is just an omission on their part that they forget to put on the form. So I believe there should be a grace period, and I think a one-year grace period, as AOPA is proposing, is reasonable. So we thank you for your testimony. We thank you for your always being proactive, and that concludes this hearing. [Whereupon, at 11:35 a.m., the Subcommittee was adjourned.] [GRAPHIC] [TIFF OMITTED] T6735.146 [GRAPHIC] [TIFF OMITTED] T6735.147 [GRAPHIC] [TIFF OMITTED] T6735.148 [GRAPHIC] [TIFF OMITTED] T6735.022 [GRAPHIC] [TIFF OMITTED] T6735.023 [GRAPHIC] [TIFF OMITTED] T6735.024 [GRAPHIC] [TIFF OMITTED] T6735.025 [GRAPHIC] [TIFF OMITTED] T6735.026 [GRAPHIC] [TIFF OMITTED] T6735.027 [GRAPHIC] [TIFF OMITTED] T6735.028 [GRAPHIC] [TIFF OMITTED] T6735.029 [GRAPHIC] [TIFF OMITTED] T6735.030 [GRAPHIC] [TIFF OMITTED] T6735.031 [GRAPHIC] [TIFF OMITTED] T6735.032 [GRAPHIC] [TIFF OMITTED] T6735.033 [GRAPHIC] [TIFF OMITTED] T6735.034 [GRAPHIC] [TIFF OMITTED] T6735.035 [GRAPHIC] [TIFF OMITTED] T6735.036 [GRAPHIC] [TIFF OMITTED] T6735.037 [GRAPHIC] [TIFF OMITTED] T6735.038 [GRAPHIC] [TIFF OMITTED] T6735.039 [GRAPHIC] [TIFF OMITTED] T6735.040 [GRAPHIC] [TIFF OMITTED] T6735.041 [GRAPHIC] [TIFF OMITTED] T6735.042 [GRAPHIC] [TIFF OMITTED] T6735.043 [GRAPHIC] [TIFF OMITTED] T6735.044 [GRAPHIC] [TIFF OMITTED] T6735.045 [GRAPHIC] [TIFF OMITTED] T6735.046 [GRAPHIC] [TIFF OMITTED] T6735.047 [GRAPHIC] [TIFF OMITTED] T6735.048 [GRAPHIC] [TIFF OMITTED] T6735.049 [GRAPHIC] [TIFF OMITTED] T6735.145 [GRAPHIC] [TIFF OMITTED] T6735.050 [GRAPHIC] [TIFF OMITTED] T6735.051 [GRAPHIC] [TIFF OMITTED] T6735.052 [GRAPHIC] [TIFF OMITTED] T6735.053 [GRAPHIC] [TIFF OMITTED] T6735.054 [GRAPHIC] [TIFF OMITTED] T6735.055 [GRAPHIC] [TIFF OMITTED] T6735.056 [GRAPHIC] [TIFF OMITTED] T6735.057 [GRAPHIC] [TIFF OMITTED] T6735.058 [GRAPHIC] [TIFF OMITTED] T6735.059 [GRAPHIC] [TIFF OMITTED] T6735.060 [GRAPHIC] [TIFF OMITTED] T6735.061 [GRAPHIC] [TIFF OMITTED] T6735.062 [GRAPHIC] [TIFF OMITTED] T6735.063 [GRAPHIC] [TIFF OMITTED] T6735.064 [GRAPHIC] [TIFF OMITTED] T6735.065 [GRAPHIC] [TIFF OMITTED] T6735.066 [GRAPHIC] [TIFF OMITTED] T6735.067 [GRAPHIC] [TIFF OMITTED] T6735.068 [GRAPHIC] [TIFF OMITTED] T6735.069 [GRAPHIC] [TIFF OMITTED] T6735.070 [GRAPHIC] [TIFF OMITTED] T6735.071 [GRAPHIC] [TIFF OMITTED] T6735.072 [GRAPHIC] [TIFF OMITTED] T6735.073 [GRAPHIC] [TIFF OMITTED] T6735.074 [GRAPHIC] [TIFF OMITTED] T6735.075 [GRAPHIC] [TIFF OMITTED] T6735.076 [GRAPHIC] [TIFF OMITTED] T6735.077 [GRAPHIC] [TIFF OMITTED] T6735.078 [GRAPHIC] [TIFF OMITTED] T6735.079 [GRAPHIC] [TIFF OMITTED] T6735.080 [GRAPHIC] [TIFF OMITTED] T6735.081 [GRAPHIC] [TIFF OMITTED] T6735.082 [GRAPHIC] [TIFF OMITTED] T6735.083 [GRAPHIC] [TIFF OMITTED] T6735.084 [GRAPHIC] [TIFF OMITTED] T6735.085 [GRAPHIC] [TIFF OMITTED] T6735.086 [GRAPHIC] [TIFF OMITTED] T6735.087 [GRAPHIC] [TIFF OMITTED] T6735.088 [GRAPHIC] [TIFF OMITTED] T6735.089 [GRAPHIC] [TIFF OMITTED] T6735.090 [GRAPHIC] [TIFF OMITTED] T6735.091 [GRAPHIC] [TIFF OMITTED] T6735.092 [GRAPHIC] [TIFF OMITTED] T6735.093 [GRAPHIC] [TIFF OMITTED] T6735.094 [GRAPHIC] [TIFF OMITTED] T6735.095 [GRAPHIC] [TIFF OMITTED] T6735.096 [GRAPHIC] [TIFF OMITTED] T6735.097 [GRAPHIC] [TIFF OMITTED] T6735.098 [GRAPHIC] [TIFF OMITTED] T6735.099 [GRAPHIC] [TIFF OMITTED] T6735.100 [GRAPHIC] [TIFF OMITTED] T6735.101 [GRAPHIC] [TIFF OMITTED] T6735.102 [GRAPHIC] [TIFF OMITTED] T6735.103 [GRAPHIC] [TIFF OMITTED] T6735.104 [GRAPHIC] [TIFF OMITTED] T6735.105 [GRAPHIC] [TIFF OMITTED] T6735.106 [GRAPHIC] [TIFF OMITTED] T6735.107 [GRAPHIC] [TIFF OMITTED] T6735.108 [GRAPHIC] [TIFF OMITTED] T6735.109 [GRAPHIC] [TIFF OMITTED] T6735.110 [GRAPHIC] [TIFF OMITTED] T6735.111 [GRAPHIC] [TIFF OMITTED] T6735.112 [GRAPHIC] [TIFF OMITTED] T6735.113 [GRAPHIC] [TIFF OMITTED] T6735.114 [GRAPHIC] [TIFF OMITTED] T6735.115 [GRAPHIC] [TIFF OMITTED] T6735.116 [GRAPHIC] [TIFF OMITTED] T6735.117 [GRAPHIC] [TIFF OMITTED] T6735.118 [GRAPHIC] [TIFF OMITTED] T6735.119 [GRAPHIC] [TIFF OMITTED] T6735.120 [GRAPHIC] [TIFF OMITTED] T6735.121 [GRAPHIC] [TIFF OMITTED] T6735.122 [GRAPHIC] [TIFF OMITTED] T6735.123 [GRAPHIC] [TIFF OMITTED] T6735.124 [GRAPHIC] [TIFF OMITTED] T6735.125 [GRAPHIC] [TIFF OMITTED] T6735.126 [GRAPHIC] [TIFF OMITTED] T6735.127 [GRAPHIC] [TIFF OMITTED] T6735.128 [GRAPHIC] [TIFF OMITTED] T6735.129 [GRAPHIC] [TIFF OMITTED] T6735.130 [GRAPHIC] [TIFF OMITTED] T6735.131 [GRAPHIC] [TIFF OMITTED] T6735.132 [GRAPHIC] [TIFF OMITTED] T6735.133 [GRAPHIC] [TIFF OMITTED] T6735.134 [GRAPHIC] [TIFF OMITTED] T6735.135 [GRAPHIC] [TIFF OMITTED] T6735.136 [GRAPHIC] [TIFF OMITTED] T6735.137 [GRAPHIC] [TIFF OMITTED] T6735.138 [GRAPHIC] [TIFF OMITTED] T6735.139 [GRAPHIC] [TIFF OMITTED] T6735.140 [GRAPHIC] [TIFF OMITTED] T6735.141 [GRAPHIC] [TIFF OMITTED] T6735.142 [GRAPHIC] [TIFF OMITTED] T6735.143 [GRAPHIC] [TIFF OMITTED] T6735.144