Is There Doctor on the Plane?

Is there a doctor on the plane?
Giving thanks. MD wants new tickets after pleasure trip turned to business

SUSAN SCHWARTZ
The Gazette

Monday, May 28, 2007

Montreal family doctor Henry Coopersmith cared for two ailing passengers on a flight to Paris. He asked Air Canada for business-class tickets to Europe, to replace the ones he wasn't able to properly enjoy, but his request hasn't been fulfilled.
CREDIT: MARIE-FRANCE COALLIER, THE GAZETTE
Montreal family doctor Henry Coopersmith cared for two ailing passengers on a flight to Paris. He asked Air Canada for business-class tickets to Europe, to replace the ones he wasn't able to properly enjoy, but his request hasn't been fulfilled.

His seat was back and Henry Coopersmith, a Montreal family physician en route to Paris with his wife, Ellen, had just fallen asleep. He'd used 160,000 Aeroplan miles, and paid more than $600 in taxes and fees, to buy two Air Canada business-class tickets and he was looking forward to a relaxing flight, the start of a five-day autumn vacation in the City of Light, and a break from his busy medical practice, when he was roused by a voice on the public-address system: It was the captain, asking if there was a doctor on board.

In stepping forward to help, Coopersmith was doing as he had done several times before - as most doctors would do. There is a consensus in the global physician community that doctors have an ethical and moral obligation to provide care in a time of crisis, as observed by Dr. Jeff Blackmer, executive director of the ethics office at the Canadian Medical Association.

In Quebec, where the code of ethics governing doctors is enshrined in law, the obligation to intervene is legal.

Coopersmith, 55, spent a portion of the nighttime flight treating two anxious passengers: One looked to be on the verge of fainting and turned out to have mixed wine and sleeping medication; the other, who was initially tended to by another doctor, was crying and hyperventilating.

After his interventions had helped and the two women were calmed, Coopersmith spent the rest of the flight filling out a pile of incident reports and other forms given to him - until it was time for breakfast. He barely slept.

On his return to Montreal, Coopersmith wrote to Air Canada, requesting a pair of business-class tickets to Europe to replace the two he hadn't had the chance to enjoy. The airline responded with a letter thanking him - and an offer to credit his Aeroplan account with 15,000 miles, the equivalent of a single short-haul flight, "to offset some of the inconvenience that you may have experienced."

Coopersmith was offended - and furious. "I paid for something I didn't get, which was a quiet and enjoyable flight," he said.

He wrote to Dr. Edward Bekeris of the airline's occupational health services department, who had replied to his first letter, and asked that the airline reconsider. Bekeris replied with a letter explaining that what was being offered was a token of appreciation intended to acknowledge volunteer medical assistance - and not compensation.

As was explained in a subsequent letter to Coopersmith from Air Canada's law branch, to offer compensation would be to change the nature of the doctor's role "from that of a Good Samaritan to that of a vendor providing a professonal service."

Airlines are notoriously sticky about compensating doctors who are travelling as passengers. Although some doctors have objected publicly, even tried to sue for fees, public opinion and, indeed, the prevailing opinion of their colleagues tends to go against them.

Coopersmith, who is a lawyer as well as a doctor, wrote back to Air Canada that he was not asking for compensation but that, rather, he was asking for what he had given up - and for the token of appreciation to be in the form of the 160,000 Aeroplan miles he had used.

Besides, he explained in an interview, while he volunteered his services initially, they were subsequently solicited when he was roused from sleep a second time - this time by the flight's service director. "She said she needed me right away," he said.

She was uncomfortable with the behaviour of the doctor who was tending to the other unwell patient - and who was preparing an injection to give to the passenger. On seeing Coopersmith approach, the other doctor, apparently angry, tossed the syringe into the cart and returned to his seat.

Coopersmith spoke to the woman. It turned out she was travelling to Paris for a funeral of someone close to her. "She was very anxious and she was having a panic attack." He checked her vital signs, covered her with blankets and warmed her with hot water bottles. He explained that he could give her medication to calm her, but that he would rather spend some time with her and see how she was doing. He spent 45 minutes or so with her, until she was quiet and felt better. He returned to his seat - and the forms.

Frustrated by what he perceives as the airline's "take it or leave it" attitude and the absence of an avenue to appeal its decision, he is considering taking his case to small claims court. "Somehow, I expected to be treated better by Air Canada," he said.

Bekeris declined to be interviewed about the case or Air Canada's policy. Peter Fitzpatrick, of the public relations department, said the airline makes decisions case by case and sometimes sends a small token of gratitude, which varies and "might include some Aeroplan miles."

In the absence of industry guidelines, airlines make individual decisions, looking at each incident on its merits. For instance, at Air Transat, said airline spokesperson Pierre Tessier, a thank-you letter is sent out and if the doctor has worked several hours, "sometimes we give them a ticket to go to a destination, or an upgrade to club class."

In 2001 the Medical Post, a publication read by the medical community, asked doctors to tell how they were treated by airlines after responding to a call for help. Of the 15 accounts published, a few involved upgrades to business or vouchers toward future flights, but several respondents had received no acknowledgement of their help.

Dr. Claude Thibeault, now medical adviser to the International Air Transport Association, was Air Canada's medical director for 13 years, until 2004, and he wrote "thousands" of letters of appreciation to doctors who had assisted during flights. He would talk to the doctor himself to be satisfied he had the proper account, he said, and in cases of significant involvement, Aeroplan miles were awarded. If a doctor was involved for much of the duration of a long flight, the token of appreciation "might have been a ticket: I say that with all due reserve."

When a doctor works for a considerable period during a flight, "I don't think it's unreasonable to expect that an airline come up with a non-monetary compensation," said Blackmer of the Canadian Medical Association.

"It doesn't seem unreasonable for him to get his air miles returned or be bumped up to business the next time he travels. ... It is just a societal acceptance that when one person does a good turn, if the other party is in a position to return it, that they would do it."

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High-flying emergencies are rarely red alerts

Among the most common inflight emergencies are fainting, stomach upsets and respiratory problems, according to aviation officials. Serious inflight medical emergencies are relatively rare, considering that close to 2 billion people worldwide fly every year; they are mainly cardiac, neurological or respiratory.

In 2006, the United States Federal Aviation Administration cited a figure of one emergency for every 1,000 to 1,400 commercial airline departures, with one in 5,000 leading to an unscheduled landing for medical reasons.

When there is no doctor on board, airlines deal with companies that have connections to doctors on the ground who can advise crew or passengers on how to respond to emergencies.

The Gazette (Montreal)