case study airlines

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USA AIRLINES *

Debbie loved her job. Because of her, thousands of people are able to travel around the United States every day with ease. Some commute between coastal cities like Los Angeles and San Francisco or Washington, DC, and New York—others travel from coast to coast or stop somewhere in between. Even more people cross the Atlantic or Pacific oceans for foreign destinations. All of these people share one thing in common: they are our passengers. They choose to fly USA Airlines, when they are many other domestic and international carriers from which to choose. And that they choose USA Airlines is exactly what they company wants, as embodied in its corporate mission statement: “To be recognized worldwide as the airline of choice.”

Debbie considers herself important to the choice passengers make to fly USA Airlines, for, as Director of System Operation Control and Pilot Resources, it is she who is in charge of the pilots who fly the planes that carry these passengers safely to their destinations. An airline is only as good as its pilots, so she makes sure USA Airlines has only the best.

This is why she is particularly troubled today. As she sits slow down at her desk, there is a particular pilot—Jeffrey Campbell—about whom she is thinking. Jeffrey is one of the company’s top pilots. He began flying as an air force pilot after he graduated from college, but then left the military and switched to commercial planes in his early 30s. He has been flying for USA Airlines for just over 10 years now, and during all that time Jeffrey has proved an excellent pilot and mentor for junior pilots. It is Jeffrey’s intent to keep on flying for at least another 10 years—more if he is able to do so. When he and Debbie met to review his annual evaluations, this is exactly what they discussed. At that time, there was no reason to think otherwise. His performance was nothing less than superior, and he passed all medical tests with flying colors.

But Debbie now has concerns, and she is not sure what to do. Jeffrey’s father recently passed away from an apparent overdose of sleeping pills. While it could have been accidental, the speculation at the funeral she attended yesterday was that it was suicide: Mr. Campbell had been diagnosed with Huntington’s Disease and had recently become symptomatic. As much compassion as she felt for Mr. Campbell, and for Jeffrey and his loss, her concern now was with her passengers. If Mr. Campbell really did have Huntington’s Disease, there is a 50% chance that Jeffrey will have the disease as well. And the disease is often not diagnosed until after neurological anomalies become present—the sort of anomalies that could very well interfere with flying. Can Debbie really wait to address this until Jeffrey becomes symptomatic? What if he is flying at that time? But how can she address this now? Jeffrey passed all of his medical exams. And USA Airlines does not currently administer any sort of genetic testing. What a quandary.

* This case is based on a fictitious situation based very loosely on some of the facts in Danville Airlines (UVA-E-0265).

This case is an updated version of Danville Airlines, with significant modifications that turn it into a very different case; in particular, certain facts have been changed to integrate changing legislation. This case was prepared as the basis for class discussion rather than to illustrate either effective or ineffective handling of a situation. Copyright © 2012 by Neu Academic Press. To order copies or request permission to reproduce materials please go to http://www.study.net. No part of this publication may be reproduced, stored in a retrieval system, used in a spreadsheet or transmitted in any form or by any means—electronic, mechanical, photocopying, recording or otherwise—without the permission of Neu Academic Press.

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HUNTINGTON’S DISEASE

Huntington’s Disease is a rare neurodegenerative genetic disorder that, according to National Institute of Neurological Disorders and Stroke, causes uncontrolled movements, loss of intellectual faculties, and emotional disturbance. It is a hereditary disease, passed along from parent to child. Every child with a parent who has Huntington’s Disease has a 50-50 chance of inheriting the gene for the disease. At this time, there is no cure for Huntington’s disease—there is no way even to slow the progression of the disease. The medications that are prescribed simply mitigate some of the symptoms, such as by helping to control some of the emotional and movement problems associated with the disease.

The disease is most prevalent among people of European descent (as opposed to African Americans and Japanese, for example). It is not a common disease, however, in that if affects only about 1 in 10,000 people. In the United States, with a population in 2010 of approximately 300,000,000 people, only about 30,000 people have Huntington’s Disease.

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Although the symptoms can occur at any age, people with the Huntington’s Disease gene typically do not become symptomatic until they are middle-aged—i.e., 50 or older, though a small number do suffer from juvenile onset (less than 10%) and a handful of others become symptomatic in their early 40s (less than 5%). Once diagnosed, the disease tends to progress relatively slowly in that people tend to live an additional 10 to 15 years or more.

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Symptoms of Huntington’s Disease vary markedly and can appear vague and nonspecific in early stages of the onset of the disease. Early symptoms include mood swings, behavioral difficulties, twitching, memory loss, a decrease in coordination and uncontrollable movements. It is not until the later stages that the neurological anomalies become disabling. In most cases, people with Huntington’s Disease become symptomatic gradually; in only a very small number of situations (less than 3%) do people find themselves suddenly without control over their movements.

Huntington’s Disease is considered emotionally and physically painful. There is considerable concern expressed by medical professional of identifying people with Huntington’s Disease because of the trauma typically associated with the diagnosis. Studies show that the suicide rate among people with Huntington’s Disease is significantly greater than for people without the disease. Particularly in the absence of effective treatment protocols, there is often considered little benefit in diagnosing patients before they are symptomatic.

1 medTV, http://nervous-system.emedtv.com/huntington%27s-disease/huntington%27s-disease-statistics.html.

2 The HD lighthouse, http://hdlighthouse.org/see/index.html?/see/facts/stats/ondur.htm.

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HEALTH INFORMATION PRIVACY

The Health Insurance Portability and Accountability Act, better known by its initials HIPAA, was an act passed by Congress in 1996. It emerged in the wake of the AIDS epidemic and the rise of the Internet, and promises privacy protection health insurance coverage for employees and their families. The impact of HIPPA is broad in that it prevents anyone from acquiring access to a patient’s private medical information without his or her explicit prior consent. Covered entities must not disclose the patient’s personal information, and they must put in place safeguards preventing others from obtaining access on their own.

The AIDS epidemic is relevant because, particularly in the early years of the scare, there was tremendous fear about the vulnerability of people to contracting the disease. In some instances, this fear was founded. Popular television series ER depicted the story of a nurse who contracted AIDS when she was treating a patient. The patient was bleeding, the nurse had a cut on her hand and the glove she was wearing was torn. In light of fear of this sort of situation, even outside hospital situations, the desired response by many employers was to protect their healthy employees by eliminating contact with—or simply by eliminating—employees with AIDS.

HIPAA forces a new solution. Instead of allowing inflicted employees to simply be discarded, HIPAA requires employers to invest in better resources and more effective symptoms. With regard to AIDS, for example, one answer is for employee to be required to wear gloves (even outside hospital environments); where employees already wear gloves, those gloves should perhaps be reinforced. Regardless of the specific solution chosen, according to HIPAA, the answer is not to avoid the problem, but to confront it and solve it.

HIPAA is not without its critics. Some argue that the “protection” has drastically increased the cost of healthcare, and can actually interfere with patient care. If an adult is admitted to the hospital, HIPAA makes it difficult for even a family member to obtain information about his or her condition unless he or she explicitly grants that person access in advance. This can prove complicated when people become patients unexpectedly, such as from sudden onset of a disease or as a result of an accident.

GENETIC INFORMATION PRIVACY

In 2008, additional health care protection was created in the form of the Genetic Information Nondiscrimination Act, known as GINA. Like HIPAA protects people from discrimination based on medical information, GINA purports to protect Americans from discrimination based on genetic information. It specifically bars health care from providers from using genetic information as the basis for the denial of coverage, and also prohibits employers from using genetic information in making hiring, firing, job placement and promotion decisions. Of course the assumption is that genetic information is not related to the performance of job-related tasks.

An increasing number of employers are augmenting their pre-employment testing procedures and, in spite of GINA, many are considering genetic testing as part of their hiring processes. Genetic information may be collected with the consent of the individual being tested and if that information is collected uniformly from all applicants (in a nondiscriminatory fashion)

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Genetic testing remains a hotbed for controversy—whether used for employment purposes or for purely personal reasons. In fact, some people have expressed even greater concern for genetic testing in personal situations, particularly because of questions surrounding genetic manipulation. Some people fear that it heralds a world where parents are able to usurp God’s role in manipulate the genes of their children in order to “make” them what they want them to be. These critics are concerned about the exercise of God-like power by human beings in the absence of God-like omniscience.

Our knowledge about and experience with genetic testing remains incipient.

PASSENGER SAFETY

Pilot error nevertheless remains the main cause of plane crashes. 3 The concern with genetic

testing with regard to pilots has to do with passenger safety. The view is that all identifiable sources of pilot error should be removed. A common area of attack is physical health. Pilots therefore have to undergo extensive medical testing on a regular basis to remain certified to fly.

Genetic testing appears a particularly attractive option for pilots because it allows medical conditions to be identified before people become symptomatic. Many people argue that it is not the right of airlines but their responsibility to take advantage of every possibility opportunity to ensure that pilots do not have any sorts of encumbrances or impairments.

It has proved impossible to remove all sources of pilot error, no matter how hard the airlines try. A Delta pilot was reportedly removed from the cockpit in September 2010 for “apparent intoxication.”

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This occurred just a year after a pair of Northwest pilots overshot the Minneapolis airport by more than 100 miles when they were preoccupied on their laptops when they were supposed to be flying the aircraft.

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Passenger safety is important to all airlines, not just USA Airlines, and pilots are viewed as having a key role in maintaining passenger safety. Testing and training together enable airlines to increase passenger safety.

THE PILOT

The pilot who misbehaves is very much the exception, not the rule. Pilots are concerned with safety, like the airlines they serve, because their personal safety is involved as well. If their plane goes down, they go down with it.

While there are numerous other sorts of positions in airlines, most pilots have no desire other than to fly. While a handful except training positions when they are no longer fit to fly, the overwhelming majority of pilots have difficult conceiving of doing anything else other than flying. They routinely turn down desk jobs, even when packaged as promotions accompanied by better benefits and higher pay.

3 Planecrashinfo.com, http://www.planecrashinfo.com/cause.htm.

4 USA Today, http://travel.usatoday.com/flights/post/2010/09/pilot-alcohol-charge/114322/1.

5 CNN, http://articles.cnn.com/2009-10-26/us/airliner.flyby_1_pilots-delta-air-lines-northwest-flight?_s=PM:US.

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THE DECISION

Yes, Debbie finds herself in quite a troubling position. First and foremost, she is responsible for passenger safety, and that involves ensuring that pilot performance is not impaired in any foreseeable way. This is clearly foreseeable, that is, if Jeffrey actually has Huntington’s Disease. If he has the disease, even if he is not symptomatic today, he will be eventually—and that “eventually” could take place at a critical point in time when he is flying, such as during take off or landing.

In fact, this knowledge Debbie has offers both Debbie and Jeffrey and excellent opportunity to find out information before it becomes relevant. Most medical testing reveals problems only after they have become problems. Genetic testing could enable Jeffrey to find out if he is going to have Huntington’s Disease long before he is likely to be symptomatic.

Debbie sits back and realizes that she has thought long enough. She has to make a decision. If she is going to act, now is the time.

ASSIGNMENT

You are Debbie. What do you do?