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 #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.
{ 15 comments… read them below or add one }
There’s a difference between doing what the rules allow and what is right. What Allegiant Air did just isn’t right. The reason stated by the airline was that he didn’t have medical assistance? His wife was flying with him, shouldn’t that be enough?
In a customer service oriented industry (Which the airlines once were), you find a way to work within the rules to help the customer. With an airline, they find a way to use the rules to the customer’s detriment.
In the words of John Mellencamp,
“Hey calling it your job ol’ hoss, sure dont make it right
But if you want me to I’ll say a prayer for your soul tonight”
Ron
I had an interesting situation come up last year. I had an Iraq War Vet who was a bilateral (legs) amputee who wished to fly to Cancun for his honeymoon. He has prosthesis but they are very uncomfortable and so while he was planning to take them along, he wished to board the airplane by wheelchair. UA’s rules were that he could only fly without “legs” if you will, if he had a urinary catheter installed prior to boarding – now let me remind you with trip was for a honeymoon. UA’s explanation was that the FAs would not be able to assist (carry him) to the lav – rmember, he didn’t want to have his prosthesis with him. In the end, he boarded on crutches with both prosthetics on and checked his wheelchair. I worked out with UA that they block the seat between him and his wife, and he took the less comfortable leg off and strapped it into the empty seat. Then he went one legged with crutches to the lav. Interestingly he had flow UA from BWI to SFO non-stop with no problems (or legs) – the issue was the length of flight and the likelihood that he would need to use the lav. He actually agreed with UA’s rule once explained to him saying he could see how the FA’s could not be expected to carry him. The point here is that “legless” they would have denied him boarding, but they were willing to work out a compromise.
And I can’t resist – none of this would have worked out had he not used a Travel Agent – he would simply have booked his flight and been denied boarding at the gate. In this case he had a Travel Agent who saw a reason to question to the airline about accomodating this gentleman.
Hi. It’s David, the author of the article. I figure I’d write back here in response to Ron’s comment “What Allegiant Air did just isn’t right.” I also wrote him back individually.
What we have here are opinions from people who are presumably not medically educated: the pilot (they’re famous for making a mess of things with off-the-cuff comments like the one made in this case), Bangor International Airport director Rebecca Hupp, Mr. Hill’s brother Richard Brackett and an unidentified Allegiant Air spokeswoman.
What we don’t have is access to federally-protected information that doctor used to make his or her decision to keep Mr. Hill off of the flight. Keep in mind that MedLink likely talked to healthcare workers in Bangor and Orlando, determined Mr. Hill’s condition, what medication he had taken to sedate him, and made a final determination on whether he could fly safely.
We’ll never know what the basis was for MedLink’s decision. And, keep in mind, the airline follows MedLink’s advice to the letter. If the doctor says “no,” the airline isn’t about to override that advice and let the customer fly.
I agree this doesn’t “feel” like the right thing to do. Keep in mind, though, that we don’t know the complete story from reading the article in the Bangor Daily News.
David
I actually think what Allegiant did is right. The pilot had a question (however ineptly put) and referred the matter to the company’s expert consultants, who investigated the matter and recommended against boarding the passenger.
Had Mr.Hill been permitted to board, he may well have passed away in flight. Having witnessed several deaths from natural causes, I didn’t find the experience particularly distressing, but I wouldn’t necessarily want to sit near a recently deceased passenger for the balance of a 3h25m flight.
In any event, it is extremely foolhardy having sought medical advice, to go against that medical advice.
David,
Keep up the good work. There are many of us at Tripso that only see things from the passenger or agent side of things, you are one of the few that try and balance things….
You are right, we don’t have access to what factors actually were used to make the determination on whether Mr. Hill got to fly. I am sure the Medlink folks got all kinds of data from doctors, family and the staff at Allegiant.
But I still stand by my assertion that if the airline really wanted to get this man on the plane, they would have found a way. The pilot didn’t want him on board, so he didn’t go (Mr. Hill’s brother said that was the first reason he was given why his brother could not fly home). No doctor in his right mind in this litigious society we live in would go against the onsite observations of the airline staff. If something did happen to Mr. Hill on board, the Medlink doc would be left holding the ‘responsibility’ bag. We have all asked leading questions to get the kind of answer we wanted. We do it with our kids, we do it with our spouses.
First it is a man that is gravely ill that is refused transport. Next, it will be a man with a bad cold (Hey, it is a communicable disease, right?). After that, will they check the oversold flight to see who might be too “ill” to fly today and refuse them service, no compensation required? Where do we draw the line?
The airlines are increasingly pushing the limits on fees, rules, and limits. All of these changes are becoming increasingly one-sided. If I am 5 minutes late for boarding, I pay a change fee for another flight. If they are two hours late getting me to my destination; Oh well, be grateful you got there at all.
There is an old poem written by Pastor Martin Niemöller that ended:
“When they came for me,
there was no one left to speak out”
To me, there’s a bigger story here than simply not allowing one man to fly. If we don’t speak out and stand up say this is wrong now, they will continue to treat people poorly. This will only embolden the airlines and things will get worse. We need to have a voice that calls the airline out when they do these things. Make them think twice before they risk the bad PR.
In a normal industry, you might give the benefit of the doubt to the corporation. Hey, it’s a one-time thing, not indicative of how they do business. There are too many airline-first, customer-last stories to make me think this is anything other than a pattern.
In high school, I had my first job with a man, Charles Hunter, who was nuts over customer service. He used an analogy that still rings true today. He told me that customer good will was like a bucket of water. Each time we made the customer angry or didn’t serve them to our full ability, the customer took a ladle and scooped out some water and poured it on the floor, gone forever. If you keep emptying from the bucket, eventually it would go dry.
Sad to say, the airlines are standing in a pool of water and the bucket is long dry.
Ron
Here’s a question for everyone:
What if the Gentleman became very ill in-flight? Perhaps he falls in “extremis”? What are the repercussions to turning a plane around, or making an emergency landing to get him the appropriate care? The repercussions to the ill passenger, his family, all the other passengers and to the airline?
Just another thought.
Also, I believe that MedLink is also used as a service by several insurers who offer Travel Insurance – they use MedLink to determine whether a patient/guest/passenger who has fallen ill or been in an accident needs to be moved to a US Hospital or needs Emergency Medical Evacuation. MedLink is know to be a very reputable company with top-notch Physician Advisors.
I suspect that there is a lot more to this story that we’ll never know because of the Privacy Act – that is of course, if Mr. Hill’s estate does not sue Allegiant.
If the aircraft returns to its point of origin to deplane the ill customer, it will likely have to undergo an “overweight landing inspection” since it will not have burned off enough fuel to be under normally accepted landing weights. That’s a cost to the airline, and a delay to the other customers onboard who wish to get to their destination. The airline will also need to purchase more fuel to depart a second time.
A worse scenario is if the aircraft has to divert to an en route city, especially if it is one to which the particular airline does not fly. And that goes double for overseas flights.
If the closest suitable airport happens to be one the airline flies to, it’s a no-brainer. Once the ill customer is (hopefully) released, the airline simply rebooks the customer to his or her destination.
But if it’s a city that airline doesn’t serve, at least at my old employer, the customer is on his or her own to get to the nearest city served by “X” airline. And imagine if that were a transatlantic flight, and we put down in Iceland to get you to a hospital? Now you’re faced with getting from KEF to the U.S. to hook up to our domestic route network to get to Tampa, or wherever.
That’s at your expense, not ours. We’ve already paid a landing fee at KEF, additional fuel, crew overtime, hotels for customers who missed connections, etc.
It’s a harsh reality, but it’s the truth.
David
I also want to point out – what if there are other people onthe flight trying to get to their sick/dying relatives? What would be the impact of inconveniencing them?
There are so many angles to this situation , it isn’t funny!
What are the rules about “emotional assist animals.” I am tired of sitting next to someone on an airplane who must be accompanied by a yappy little dog that is supposedly an “emotional support animal.” Is there a way to determine if the animal is legitimate or just a way for some of these people to get their annoying, yappy dogs along for free on vacation?
Nashua brings up a very good question. “Emotional Support Service Animals” are a very difficult subject for airlines. Sadly, some unscrupulous customers try to beat the system by claiming pets fit into this category to avoid the fees for pet-in-cabin travel.
Years ago, there was a rather notable situation at one airline involving an emotional support service pig. Yes, you read that correctly. The pig’s name was Charlotte. Its owner claimed over the telephone that the pig was of the Vietnamese Pot-Bellied variety, and that it would easily fit underneath the seat in front of her. The owner also claimed that having the pig in the cabin with her was necessary to her emotional well-being.
Based on her description of the situation, the pig was approved for travel in the cabin. Of note, at the time, the DOT’s guidance document on service animals did not exist and there was not federal guidance for emotional support service animal documentation procedures.
Of course, she was traveling XYZ to Seattle, not something short like XYZ to Pittsburgh.
Departure time comes, and the owner shows up with Charlotte. She is NOT of the Vietnamese Pot-Bellied variety. Charlotte is sow, so large, in fact, that she will not fit anywhere in the coach cabin. Only between a row in First Class.
My predecessor more or less orders XYZ staff to accept the animal based on its “emotional support service animal” so-called designation, it and its owner are upgraded to First Class (much to the chagrin of the 20 or so other paying customers), and off they go to Seattle. Most of the flight is uneventful.
Upon landing, Charlotte goes nuts, decides it’s a good time to relieve herself. All over the First Class cabin, up the jetway and into the terminal.
And then, Charlotte’s owner had the gall to ask for a refund of the return half of her nonrefundable ticket! Apparently, she was moving to Seattle and just wanted to take her pig with her. Her request was flatly declined.
After this, the DOT issued guidance to airlines on how to deal with difficult service animal situations, including multiple animals, oversized animals, emotional support animals, strange animals (spiders, snakes, etc.) and so on.
Check out my previous article on customers with disabilities.
http://www.tripso.com/columns/flying-with-a-disability-7-insider-tips-for-a-smooth-flight/
It’s got a link to the DOT’s guidance document on service animals.
David
I am Dennis Hill’s son… I was standing at the gate entrance when my father was refused entry to the plane by the pilot after an entire family had said their final words. No one can imagine the emotional rollercoaster, a last minute decision such as the one made by the Allegiant pilot, put my family on.
Whether or not the airline as an entity was within its right to deny flight to my father is not the issue I have with Allegiant. So far I have read your article and the one on the Bangor Dailey News website about my father and have decided that these written words do not fully explain why the decision to deny flight in this case is of much importance, focus and scrutiny. Because I believe many are not getting a complete picture of why this is an important issue, I have decided to write this to you in hopes that the broad gap in understanding might be narrowed. Please understand these words come from my point of perception and cover no regulations, rules, or rights as defined by law whatsoever.
If the airline personnel had reviewed the circumstances and refused my father flight before running him through an entire boarding process I believe the issue would have made family upset but would have been understood. The fact that the employees of this airline allowed my father to be checked in, dragged through a lengthy security procedure, made to wait with everyone at the gate to board the plane, then brought all the way to the plane door to be told he is not going home was outrageous and wrong!
The sheer amount of time wasted at this airport going through these procedures took valuable time from my father’s life and depleted the emotional state of every family member. Period.
Let me paint a picture for you:
Currently living in Florida my father had known for some time he was going to die soon and towards the end of his life decided to come back to Maine in order to see family for the last time. Once in Maine everyone in the family was privileged to share some time with him. Towards the end he asked to be taken back to his home in Florida. As much as we wanted him to stay the family honored his last request and made it top priority to get him back. My belief is he did not want us to see him anymore in this condition or just wanted to simply spend the last day of his life in his own home.
After being advised by doctors a road trip was not the best course of travel, he was booked on an Allegiant Air flight to go home. Saturday morning June 28th 2008, my father was driven to Bangor International Airport, and accompanied by his wife, sister, 2 brothers, 2 sons, 2 nephews and their wives and children. All had come believing they were going to see a loved one get one final wish granted. Everyone followed my dad through the whole process until they could go no further. When the security checkpoint was reached each family member gave my father a hug and said goodbye before he entered. Watching my dad’s face while he tried to hug each one back and did his best to say thank you for coming knowing he would never see that person again was one of the hardest things anyone could watch and as I write these words the tears are as they were that day.
Armed with a pass I was lucky enough to go with him through security and assist in the trek to the flight gate. After explaining to an airline employee how to manage my father’s migration out of his electric chair, I watched as this employee escorted him and his wife down the boarding ramp. When they arrived at the airplanes doorway two employees removed my dad from his electric chair and buckled him into what they called an isle chair. During the changeover I remember the gate employee standing beside me mention he was also a military veteran as my dad was and asking me what my father did during his time in service. It took me a bit of time to answer as I tried to wipe the tears from my eyes and the emotion from my mind just to look his direction.
You must understand that at this point I had said my final good bye and resigned myself to the fact that I would never see my father again as did everyone else who came.
Staring down the boarding ramp at my dad reviewing in my mind all the final moments spent with him I heard a voice emanating from the plane’s entrance door saying “I’m sorry… I am so sorry”. It took me a few seconds to realize what was going on because in my thoughts there was no way it could be what was actually happening. These words were repeated several times and then my father was again moved from the isle chair back into his electric chair. I could not believe what I was hearing and seeing. The look on his wife’s face was devastating and showed an unimaginable amount of disappointment and frustration. They brought my dad all the way to the plane door allowing everyone to think he was going to make it home just to deny him at the last moment.
When my dad was brought back into the view of his family watching behind a glass wall it was clear that each one had been absolutely crushed by what had happened.
My father, Dennis Hill died in a hospital July 1st 2008 and never saw his home. Every family member now has to live with the knowledge that this man’s last simple request to die in his own home was never realized.
The only thing my father wanted in the end was to go to his home in Florida. No matter how anyone feels about that desire, myself and the rest of his family wanted nothing more than to give this dying man, my dad, that last wish. Part of the mechanism that was engaged to make this last request happen was a flight on Allegiant Airlines with a travel time of less than 4 hours. At check in the airline employees were aware of the circumstances and should have made a decision then.
Allowing us to watch as he was taken through the entire process of boarding a flight just to be refused entry at the plane’s entrance in my opinion was a serious fault by the employees of Allegiant Airlines.
Shawn,
Thank you for sharing your side of the story. I am so sorry for your loss.
I don’t think that I can add anything else to what I stated a week ago, nor do I see any reason to believe that the folks at Allegiant Airlines are any less heartless than I thought a week ago.
Ron
I, too, am sorry for Shawn’s loss.
Given the personal nature of this subject, I have responded directly to him via e-mail.
David
Shawn,
So sorry you and the other members of our family had to endure the shock given to us by the airlines. I’m still in process of hopefully getting some changes made in the system…..whether or not we’ll see any, that remains to be seen.
Love You and Take Care. If you would like to talk with me, you’ve got my e/m or tel#.
Love you,
Uncle
I support Shawn’s comments, and as a family member myself, ( Niece ) I so wish that the laws, regulations and protocols be a little more clear when denying someone flight. If we were made aware in more detail about the MEDLINK and the specific concerns regarding Dennis’ condition then they could have just asked for more details. Unfortunately Dennis’ wife was under stress and from a medical standpoint she did not have the clearity to provide medical details. And I really doubt that the MEDLINK contacted the Physcian in Bangor who cared for him because of a few things, they didn’t know who the physcian was or any other contact info for the MD in Florida, Nor did they ask; and the time frame it took for them to deny him flight was too quick for them to appropriately contact the parties involved let alone get legal clearance to do so, with HIPPA laws.
Our family wishes NO ill will against the airline but we generally do wish that the education of passengers be forthcoming and timely, instead of thinking you are going to your destination and then at the last minute after going through the security & boarding process, be told you are not permitted to fly. These procedures must be reviewed & altered by the company to better serve their clients.