Emergency Medical Transport Insurance

[FL420]

I really can't address the insurance aspects of medical transportation by air but based on extensive experience as a fixed-wing air ambulance pilot I can offer a few recommendations. I was based in San Diego flying twin-engined turboprops which are slower and shorter ranged than jets but faster and longer ranged than piston powered propeller airplanes. They are also pressurized and air conditioned which is essential for almost all medical flights.


Most of our business involved bringing Americans back from Baja California and the interior as far south as Guadalajara. The majority of patients were injured in traffic accidents but some patients ventured down there with pre-existing medical conditions which deteriorated and adequate treatment wasn't available.


Much of our business involved bringing patients injured in boating accidents on the Colorado River and others from the Imperial Valley injured in ORV collisions near Glamis back to San Diego. Most of the rest of our business involved transferring patients who were relatively stable from one facility to another either to receive better treatment or to be closer to family.


The only patient who ever expired on one of my flights was an older lady who had rented a moped in Guaymas, BC to go shopping while her husband went out on a chartered fishing boat. She turned a corner on the moped and ran head on into a Club Med bus. The bus won.


I got the call late that afternoon to go down to Guaymas to get her but was told to leave early the next morning as the airport would be closed before I could get there. My crew consisting of a co-pilot and two flight nurses and I left as soon as the Customs office opened at the Tijuana Airport to clear us into Mexico. When we got to Guaymas Airport the flight nurses hitched a ride into town to get the patient. When they came back the nurses were riding in the bed of a pickup with the patient. The bumpy ride had caused the patient's condition to deteriorate. The nurses said the medical facility in Guaymas was barely equipped any better than a high school's nurses office and the ride back in the pickup would likely kill her. They made the decision we should try to get back to the closest medical facility in the states ASAP.


I decided that Tucson was closer than San Diego and we would try to sort out the issues of changing our flight plan in the air and try to work out the problems of getting permission to leave Mexico and enter the US without clearing customs in both countries. Somehow, it all worked out in the short amount of time we had available.


My co-pilot, a former All American linebacker and San Diego Charger, had been doing a fine job on the radios making everybody on the ground happy with what we were doing. He had ATC in the US call the hospital to have an ambulance meet us at the Tucson Airport as soon as we came to a stop.


Unfortunately, when we were a little past Hermosillo, the lead flight nurse parted the curtain and told us we could slow down as the patient had hemorrhaged uncontrollably and expired. I pulled the power back a bit to lower the engine temps while my co-pilot picked up the microphone and told ATC to inform the hospital and "cancel the ambulance, send the coroner." I physically slapped the mic out of his hand as fast as I could. It surprised both of us.

After telling him to tell ATC to disregard his last transmission and to still send the ambulance, which he did, I explained why I did what I did. I had a lot more experience flying in Mexico and dealing with their rules, regulations and customs than he had. We are used to our legal system based primarily on English common law with laws like habeus corpus whereas Mexican law is based more on Roman law and the Napoleonic Code. Specifically, in our situation, Mexican law requires any person present when a person passes away must be available to participate in a coroner's inquest of the circumstances surrounding that death.


The Mexicans have learned through experience that many Americans who have been present at a death, most of whom were young, drunk and acting stupid, have fled back to the US before the coroner's inquest could be held. I had been told that instead of sending people back to their hotel to await the inquest they could and would ensure their attendance at the inquest by putting them in jail until the inquest.


In our case they would probably impound our airplane which would perhaps jeopardize our company's financial viability. His natural response was to doubt they could do anything to us seeing as how they couldn't prevent us from leaving. I reminded him we flew into Mexico 2 or 3 times a week and I doubt the Mexicans would forget about us if they became aware of what we did. That made sense to him.


The sad thing in this case was the lady's death could possibly have been prevented if we had gone down to get her the previous day. Many smaller airports with control towers in Mexico close at night. If someone wants to operate at one of these airports at night it can often be arranged if the user will pay for the personnel required to operate the tower and runway lights. I didn't learn that until talking with an airport employee while waiting for the patient at Guaymas. I never learned whether anyone involved in arranging the flight knew about the ability to pay for an airport to stay open at night or someone knew but made a decision to save some money by waiting until the next day.

Finally, in case anyone is still reading, I would recommend anyone travelling outside the US(and perhaps Canada) purchase insurance covering medical air transportation. It might be a good idea for those who do a lot of boondocking at great distances(well, out in the boonies of course) from large cities with well-equipped medical facilities. If you like to rock climb, bungee jump, paraglide, ride dirt bikes, go off-roading, etc. it might be a good idea to have the insurance.


If you have a good employer or are a member of a good union you may get or already have that type of coverage. I once buzzed the bridge of a super tanker anchored near a very small island off the west coast of Baja California and when I saw them put my "acute appendicitis" patient in a boat for shore I landed on the oil soaked dirt runway at the small military airport on the island. A pickup pulled up to the plane and my "patient", a tall lanky man dressed in blue jeans, a western shirt and wearing cowboy boots, climbed out and sauntered up to me. I asked if he was the guy with appendicitis and he told me he wasn't ill but the captain of the ship got mad at him and wanted him off the ship immediately. They got his union to pay for his transportation from the ship to the US by telling them he had a severe medical condition. So they made one up.


Because his condition was so severe(I was told) I took advantage of the good rapport I had established over time with customs officials in Mexico and the US to get permission to clear Mexican customs both inbound and outbound without landing in Tijuana both times and to overfly US Customs at Brown Field to land and clear customs at San Diego's Lindbergh Field so we could get his sorry ass into an ambulance ASAP to hopefully save his life.


He had the audacity to ask me to take him to Torrance after we cleared customs. I told him not only NO but hell NO. I told him when the customs officials came on the plane he better lay on the stretcher and moan as convincingly as possible because I pulled a lot of favors to get him back. I wasn't about to jeopardize my FAA pilot's license, my company's FAA Operating Certificate and incur a 5 figure fine anymore than I already had to enable his scam any further.


I doubt much has changed in the medical air transportation industry since I was involved in it. There are a lot of small operators in the business operating on very thin margins in a very competitive market leading them to cut corners on pilot qualifications, training and aircraft maintenance.


Many flights are put together by brokers masquerading as large operators when actually they operated no aircraft of their own but contacted different small operators and booked whoever had the right equipment, availability and lowest cost. There was no oversight of the operations of the contracted operators. There are quite a few operators who operate safe, reliable aircraft, employ well-qualified pilots and medical personnel and ensure they receive quality initial and recurrent training. Their overhead is high and their prices commensurately so. When it comes to medical air transportation you get what you pay for.

[mrboyer]

FMCAssist is world wide coverage. Return of RV is only for Canada, Mexico and USA with a limit of $5,000.