Examination of Witnesses (Questions 20-39)
Dr Nigel Dowdall, Dr Mark Popplestone and Mr Roger
Wiltshire
26 JUNE 2007
Q20 Lord Haskel: There is a minimum
and that is where duty of care lies.
Dr Dowdall: Yes, there is a minimum stipulated
by the CAA and of course that responsibility is being taken over
by the European aviation safety organisation at the moment. That
process has started already but we will have to see what that
European organisation, EASA, decides to do about seat pitch regulations
and whether it wishes to apply that as a pan-European regulation.
Q21 Chairman: Does that include airlines
that land in Britain?
Mr Wiltshire: At the moment, no, the CAA regulation
applies to UK-registered airlines only, but as far as I know the
industry operates to very similar seat pitch standards. Otherwise,
as Nigel said, there would be a competitive reaction from passengers
immediately if they felt that they were getting a better deal
on comfort versus price with one airline versus another, so airlines
operate to a very similar standard worldwide.
Q22 Lord Colwyn: We had a brief discussion
about alcohol during the first question. Can you tell me, have
the airlines' systems for ensuring that passengers are fit to
fly changed in any way since 2000? I fly fairly regularly and
I am not aware of any change that I have noticed and I wondered
whether officially there is any change?
Dr Dowdall: I can only speak for British Airways
and prior to the inquiry we already had in place systems. We have
a passenger medical clearance unit which provides advice to passengers
and their medical advisers on fitness to fly and that contact
information is on our website. We also have a service through
MedLink, which is a ground-to-air medical advisory service, and
they also provide what we call "gate clearance"; if
any of our ground staff or cabin crew when passengers are boarding
are concerned about a passenger's fitness to fly, then they can
contact MedLink for advice. We do therefore have systems for either
providing advice to passengers who have concerns about their fitness
to fly or for identifying and asking questions about passengers
who appear as if they may not be fit to fly.
Q23 Lord Colwyn: Are passengers observed
by anyone other than the check-in desks?
Dr Dowdall: No, they are not and it is important
to remember that we fly over 30 million passengers a year and
have very few in-flight medical problems, so the systems that
we have in place actually work quite well. It is not in our interests
to allow people to board who patently are not fit to fly because
that is going to create us problems, either with diversions or
managing the situation in-flight, so we are as keen as anyone
else to avoid in-flight problems and the system works as effectively
as it reasonably can.
Dr Popplestone: From the Virgin Atlantic perspective
I would echo everything that Dr Dowdall has said. There is a lot
more information available on the BA website, the Virgin Atlantic
website, and many other airlines' websites, on fitness to fly.
As far as our staff are concerned, we put all our ground staff
through a training programme to give them a basic idea of the
sort of thing they are looking for in terms of identifying sick
passengers, either at check-in or at the gates when they go to
board the aircraft, and then there is a system in place that if
they have any cause for concern they can talk to the passenger
and they can get expert advice from the MedLink service, which
will make an assessment on the spot with the information available,
do they think they are fit to fly, and if they are not they will
say that you should refuse carriage to the passenger until more
information is available.
Q24 Lord Colwyn: Is this information
also available pre-booking as well as post-booking?
Dr Popplestone: Yes, and if you, for example,
go to book a ticket through the Virgin Atlantic website, as you
get onto the second page (or it might be on the first page as
you go through the process) there is a link that says if you have
any concerns over either additional needs or disabilities, or
if you have any medical problems, there is more information here
and you can contact the special assistance unit of Virgin Atlantic
where you will talk to trained staff, they will get information
from you, they will arrange to get information from your doctor
and either the staff there will make an assessment on fitness
to fly or they will pass it on to a medical expert who will.
Q25 Lord Colwyn: Has there been any
change in the check-in facilities at the gate and are the staff
there given special training and time to identify people who are
not well enough
Dr Popplestone: For Virgin Atlantic they are,
that is something that has happened over the last few years. We
look at the information that we get from in-flight medical emergencies,
and one of the things we are conscious of is that if you have
an illness before you get on board an aircraft you are perhaps
more likely to have a problem once you are on board, and so what
we have done is we have given some awareness training to the ground
staff, we have given them a manual, things to look out for, in
order to try and identify people before they board.
Q26 Lord Colwyn: I dealt with an
emergency two or three years ago where someone was in a hypoglycaemic
coma. I do not understand how that could happen, but the plane
had been delayed, and I imagine that the passenger had missed
a meal.
Dr Popplestone: It happens in normal life, these
things do happen, and as airlines we want to carry passengers.
Passengers who either have long term illnesses such as diabetes
or short term illnesses still want to fly, so what we do is we
do our best to enable people who are fit enough to fly to fly,
but sometimes if a meal is delayed, if they have been hurrying
through the airport, if they have had a drink of alcohol or something,
it may tip them over the balance into something like hypoglycaemia,
but there are then facilities on board—there are medications
for the staff, for the crew to use and also for travelling medical
professionals to use to actually get the passenger through that
emergency.
Q27 Lord Colwyn: Do you have any
instances where passengers refuse to answer questions relating
to their relevant health when questioned at check-in or at the
gate, or even if they look unwell?
Dr Popplestone: I do not have any specific data,
but I am sure it does happen. If the staff have doubt about somebody's
fitness to fly then they can refuse to carry them.
Q28 Lord Colwyn: For someone checking-in
it could well be a couple of hours before they board the plane
and so lots of things could happen.
Dr Popplestone: But as you get to the boarding
gate there are then more staff who again look at you, they take
your boarding card and they check you in as you go through to
the flight and then you have the crew on board the aircraft as
well as the final sort of backstop as it were, but once the person
has got there and they have been through the airport environment,
sometimes the long distance through the airport will be enough
in some individuals to exacerbate a medical problem. People do
get through that process unnoticed.
Q29 Lord Colwyn: It is not really
a problem as far as you are concerned.
Dr Dowdall: I do not think it is an issue we
could realistically do much more about; we have as many checks
and balances in as we reasonably can.
Q30 Chairman: Your evidence from
British Airways said that you had something like 1,700 medical
incidents in the air; it should be possible to analyse those and
see which cases might have been avoided with better filtering.
Dr Dowdall: That is 1,700 where the crew sought
the advice of the MedLink ground-to-air medical advisory service.
There are a range of conditions, most of them trivial, and there
will be a small number of serious illnesses, some of which will
lead to diversions, but in the context of 30 million plus passengers
and a number of quite long flights, it is inevitable that actually
some people will become unwell, some people with pre-existing
medical conditions.
Q31 Chairman: I am trying to sense
whether this is a problem or not; you are indicating that it probably
is not a problem.
Dr Dowdall: We want that number to be as small
as possible; we have probably gone as far as we realistically
can in terms of stopping people flying who should not.
Dr Popplestone: If I could just add to that,
I previously worked for British Airways and analysed two years'
worth of medical diversions, because that was a manageable number
of cases to look at, and it was something over 100 cases, 88 of
which we had fairly detailed medical information on. Of those
I recall off the top of my head that something like 11 of them
had, as it transpired, what one might call significant medical
problems before they got on the aircraft and that the airline
was not aware of, so that was 11 out of 88. The only other factor
that one could identify before they got on board that might give
an indication that somebody was more likely to cause a medical
diversion was actually age, so there was a peak in the over 50s
but beyond that there was nothing else that you could identify
as possibly being a likely factor in medical diversion. Clearly,
identifying those 11 would be ideal, but it is very difficult
to do if the passenger is not going to disclose it.
Q32 Earl of Selborne: Do the airlines
ever run into problems when they determine not to carry a passenger
because of reasons of ill-health or infection? Do you have sufficient
powers simply to say you are not prepared to take them?
Dr Popplestone: I have looked at British Airways
terms and conditions of carriage and it actually says "Our
right to refuse to carry you if your mental or physical state
or health is a danger or risk to you, the aircraft or any person
in it." So under their terms and conditions of carriage one
can refuse to carry them and ultimately it is the captain of the
aircraft who can make a decision on that.
Q33 Earl of Selborne: Do you ever
find yourself in court or challenged on this?
Mr Wiltshire: I have seen some cases of passengers
who have been offloaded because of a medical problem, demanding
that they should not have been offloaded, that they have recovered
ten minutes later and should have been allowed to travel. I have
seen examples of complaint cases asking for compensation.
Q34 Earl of Selborne: Do you keep
records of the number of passengers that you are not prepared
to carry?
Dr Popplestone: We have some figures and I suppose
they fall into two categories, those who identify themselves with
medical problems well before the flight, and when you have been
through the medical information on that out of the thousands who
come forward for what I would call medical screening, it really
is a handful that are declined. I know the British Airways figures
when I was there, it was something in the region of 7,500 cases
who were assessed by the passenger clearance unit, or who were
assessed by them, and only about 40 were refused travel in the
course of a year and they fell into three main categories: those
who were terminally ill who we felt were unlikely to make the
flight, those who were so seriously ill, intensive care-type patients,
that again it was impractical for travel, and the third were people
with acute psychiatric illnesses who, again, it would be inappropriate
to carry on board. The figures for Virgin Atlantic show that we
decline a handful a year. When you get to the gate screening where
people are identified just prior to travel, the percentage of
people that you turn down—again, I was looking for some
industry figures yesterday provided by MedLink and something like
between 15 and 20% of passengers who are identified at the gate
are refused to travel at that point, but that does not mean to
say they do not travel subsequently when more information is available.
The reason for the higher percentage, I firmly believe, is simply
because of lack of information.
Q35 Lord Colwyn: If you have a family
who have had a holiday booked for six months and on the morning
of flight the youngest goes down with a chicken pox rash, or measles,
you are unlikely to be told about it, surely.
Dr Dowdall: Funnily enough, chicken pox is one
of those ones that is easiest to spot because the spots come out
on the face. It is very unfortunate if you have planned your holiday
and your child—
Q36 Lord Colwyn: You are unlikely
to be told because they want to go on their holiday.
Dr Dowdall: If you went on the website and looked
then the information would be there, but I accept that that is
a situation where people are quite likely not to think it is going
to be a problem, will arrive at the airport and will be refused
travel at that point and, regrettably, we would refuse travel
if one of the children had chicken pox and was contagious or potentially
contagious.
Q37 Lord Colwyn: With some airlines
you would not get a refund, would you?
Dr Popplestone: One would hope that the family
would have travel insurance and it would be covered by that. In
general airlines are fairly sympathetic to medical issues but
I could not give policy across the board on it. Certainly that
is one of the many benefits of taking out medical insurance before
you travel.
Q38 Baroness Perry of Southwark:
I do have a rather colourful memory of sitting in the lounge close
to a passenger who was being told that the airline was refusing
to fly him because he had had rather too much to drink, and he
was quite vocal about his afflictions. My question, however, is
do you think there is a case for standardised guidelines for carrying
ill passengers across all the airlines? Should there be a standard
rule rather than people saying one airline is softer than another,
and if you do think it would be a good idea who would do it, what
agency would be responsible for that?
Dr Dowdall: We all have a common interest in
avoiding carrying people who should not be carried, and again
it is one of the benefits of the much greater interest in air
travel and health that we are seeing at an international level.
There are guidelines being agreed and so, for instance, the Aerospace
Medical Association, which is probably the largest aviation medicine
organisation, publishes on its website guidelines both for passengers
and for doctors, guidelines on air travel and health.
Q39 Baroness Perry of Southwark:
Do the airlines follow that, is that accepted by all airlines?
Dr Dowdall: I would not say accepted by all
airlines, but those common sources of information are what we
are drawing people to refer to. For instance, IATA (International
Air Transport Association) in its advice links in with the work
that is going on in the Aerospace Medical Association. Fortunately,
the speciality is fairly small so those of us who are involved
in it tend to know each other so there is good communication and
we share information, leading to increasing consistency in information
generally. The information is about what effect does air travel
have on your health and what effect does your health have on your
fitness to travel by air.
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