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Can airlines refuse to fly a dying passenger?

Can an airline refuse to transport a dying passenger? That wasn’t just an academic question for Allegiant Air, which recently had to make a decision for a customer who wanted to fly from Bangor, Maine, to Orlando.
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Can an airline refuse to transport a dying passenger? That wasn’t just an academic question for Allegiant Air, which recently had to make a decision for a customer who wanted to fly from Bangor, Maine, to Orlando.

Terminal cancer patient Dennis Hill had been in Maine last month to say his final farewells to his family. While there, his health deteriorated, and doctors in Bangor recommended he fly back to Florida instead of driving.

Allegiant refused.

Can it do that? Yes, and here’s why.

If you have a disability, you should understand your rights about airlines refusing you transportation or requiring a personal care attendant before letting you board. There are legitimate cases when airlines can do so, as much as they may pull at our heartstrings.

Refusal of transportation and personal care attendants are two of the subjects outlined in the Air Carrier Access Act, and its implementing regulation, Part 382. Whether or not you think denying Hill was the right thing to do, these provisions exist to protect the rights of the customer with the disability, his or her safety, fellow customers, the crew and the airline.

We will never know what the basis was for the expert recommendations to Allegiant — Hill’s privacy is protected by HIPAA — but we have to assume it was valid.

I suspect many of you don’t know what MedLink is or what they do. MedLink is one of the most reputable medical advising services in the industry, and it is used by a large number of domestic and foreign airlines, including Allegiant.

From my former role in the airline industry, I have years of personal experience working directly with MedLink; in addition to working with airlines on issues such as Hill’s, MedLink physicians help guide airline personnel during in-flight medical situations to stabilize ill passengers and prevent emergency landings.

MedLink doctors typically know their stuff, and if they felt Mr. Hill was unable to travel, my experience tells me they probably made the right call.

Back to the subject at hand, there are five essentials outlined by the regulation pertaining to refusing transportation to an airline customer:

1. An airline cannot refuse transportation just because a person’s disability results in appearance or involuntary behavior that might offend, annoy or inconvenience other passengers or crewmembers.

2. The airline cannot place limits on the number of disabled customers on a particular flight, although they can ask for advance notice for large groups traveling together.

3. Airline personnel can refuse to provide transportation on the basis of safety, or in a situation that would violate a Federal Aviation Administration regulation.

4. If a customer is refused transportation, the airline must follow-up with a written explanation within ten calendar days of the event.

5. Just because airline personnel are concerned that a customer with a disability will be unable to use inaccessible lavatories, or that he or she will need extensive personal assistance while in flight, that doesn’t give the airline the right to deny them transportation.

And let me be clear, airline personnel are not required to help anyone within the confines of the lavatory. That’s not what I mean by “extensive personal assistance.” There is surprising amount of text in the regulation devoted to the subject of using the bathroom.

“The basis of safety” in item No. 3 above is broad. Really broad. There is so much wiggle room there for interpretation; one has to wonder if that vague wording was intentional.

I used to be in charge of these sorts of decisions during my airline career, and putting myself back into that role, I can see Allegiant’s point of view. That’s probably not going to make me popular with some readers, but from the airline’s perspective, they can’t accept a customer if there is a medically-supported concern that the flight will not be able to reach its destination without needing to divert to an en route airport for a medical emergency.

Some airlines specify in their contracts of carriage that they will refuse boarding to customers if their medical personnel feel this is the case. I checked, though, and it doesn’t appear Allegiant has such a provision.

On a slightly different, but closely related subject, there are also cases when airlines can require that a customer with a disability travel with a personal care attendant. This provision is in place to ensure that, in the event of an emergency, someone is there to assist the customer, because in an aircraft accident, a flight attendant may not always be able to do so.

An attendant may be required as a condition of travel if:

1. A person has a mental disability so severe that he or she is unable to comprehend or respond to safety instructions, including the pre-flight safety briefing.

2. A person has a mobility impairment that prohibits him or her from being able to assist in evacuating the aircraft in the event of an emergency.

3. A person has both hearing and vision impairments and cannot establish some means of communication that is adequate to convey the safety briefing.

Finally, if the airline feels the customer needs an attendant because of one of the above conditions, but the passenger’s self-assessment is that he or she can travel independently, then the airline must allow the attendant to travel at no charge. The attendant must travel on the exact same itinerary as the customer.

You might have a fleeting thought about using this as a loophole to bring someone along for free, but given the specific nature of the above three provisions, I have experienced very few cases of people trying to take advantage of this in an unscrupulous way, and none have been successful.

I read a good number of the comments left on the Bangor Daily News site related to this article, and they were fairly critical (make that downright harsh) of Allegiant’s decision to deny Hill transportation. I guess in this instance, I’m coming to the defense of the airline, in spite of how I feel. I can’t change your (or my) humanitarian reaction to Hill’s sad story, but I hope my explanation has helped you see the airline industry’s point of view — and how the applicable regulation works — a little more clearly.