IN May 2016 Lewis Christman was flying from Chicago to Rome when he suffered a bout of acute pancreatitis. He curled into a fetal position on the floor. He spent the next seven hours in agony while the plane flew on. The next three months, he spent in hospitals.
This month Christman sued, accusing United Continental Holdings Inc. of ignoring a recommendation from a doctor on board to divert the flight and failing to contact medical consultants on the ground. It was another round of bad publicity for United and one that draws scrutiny to how United States air carriers treat passengers in distress and the pressure to keep flights in the air.
“Obviously, there is a significant cost to landing the plane,” said David Axelrod, Christman’s lawyer. “We’re looking for all the information about this incident, where my poor client is doubled over in pain, and he’s vomiting, and they’re not landing this plane.”
A medical emergency sets in motion a high-altitude calculation with human lives in the balance. While pilots are the ultimate decision-makers, airlines have earth-bound medical consultants that help bypass on-board volunteers—reducing expensive emergency landings, but with the potential of providing expert decisions in real time.
Christman’s suit seeks information about the incident from Phoenix-based MedAire Inc., which provides in-flight medical advice to more than 100 airlines. Company Spokesman Mandy Eddington declined to comment on the lawsuit or any relationship with United.
Paulo Alves, MedAire’s global medical director of aviation health, said in an interview before the suit was filed that his company provides help from doctors with extensive experience. Just 1.6 percent of flights in which MedAire is called are diverted. He said airlines see the value in bypassing medicos who happen to be aboard.
“If the model was not financially interesting for them, then they wouldn’t hire us,” Alves said. “Doctors tend to recommend diversions more than we do, because of course they don’t want to assume the long-term responsibility.”
A medical emergency occurs once every 604 flights, and 7.3 percent led to diversions, according to a 2013 New England Journal of Medicine study. It also found that 0.3 percent of emergencies on planes end in deaths.
“It’s fairly expensive to divert an aircraft, and so a captain has to take into account a whole host of issues,” said Jose Nable, an assistant professor of emergency medicine at MedStar Georgetown University Hospital and coauthor of a 2017 paper on in-flight emergencies. Perry Flint, a spokesman for the International Air Transport Association airline trade group, said his organization estimates that a diversion can cost anywhere from $10,000 to $200,000.
Erin Benson Scharra, a United Airlines spokesman, said the company is investigating Christman’s claims, but declined to speak further about medical diversions or consultants it employs.
Companies like MedAire, housed in the emergency unit of the Banner-University Medical Center Phoenix, play a key role in diversion decisions. STAT-MD Inc., which offers a similar service and uses doctors from the University of Pittsburgh, works with around 20 national and international air carriers. It says it reduces landings that would otherwise be recommended by nervous and out-of-their-element doctors in the sky.
“They’re going to revert to divert,” said TJ Doyle, the medical director for STAT-MD. “The medical volunteer should be a data-gatherer and a procedure-doer. They should not be a decision-maker.”
The emergencies encountered by medical professionals on flights vary in severity. Internal medicine doctor Gina Jabbour of New York revived an elderly woman who fainted after using the bathroom. The flight continued on schedule and Jabbour was rewarded by a flight attendant with “secret cookies.”
Scott Schoifet, an orthopedic surgeon, was dozing on a flight from Japan to New York in 2006 when he was awakened to help a fellow passenger with chest pain. Flight attendants asked Schoifet whether it was safe to continue flying.
“It was stressful first because they’re looking at me like, ‘What do you want to do?”’ Schoifet said. “I can’t make this decision. There are 350 people on the plane.”