Here’s Why You Don’t Want to Be Sick for a Flight

Apr 11, 2018

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Exactly how much power does an airline have to kick off sick passengers?

That’s the question some flyers asked themselves after an Alaska Airlines crew recently kicked off a passenger who’d vomited before the flight took off.

Patrick Hess, who has Down Syndrome, and his parents were ready to travel from St. Louis (STL) to Seattle (SEA) on Flight AS779 when Patrick “threw up a little,” his sister Meaghan said in a statement. Though the airline rebooked the family in first class the next day, the Hess family remained furious.

“I can’t help but think, if a non-disabled child that threw up, would the airline have kicked that family off the flight?” Meaghan Hess asked NBC News.

The answer would be yes more often than you’d think, experts said.

Though Department of Transportation regulations state that passengers with communicable diseases can only be prevented from flying if the condition is both “readily transmitted by casual contact” and could result in “severe health consequences” (such as SARS or active tuberculosis but not the common cold), pilots have broad leeway to determine what qualifies.

“The authority of the pilot in command is nearly absolute,” Jeffrey C. Price, professor of aviation and aeronautics at Metropolitan State University Denver and an expert in aviation safety, said. “They have the power to say if someone is a safety or security risk either to themselves or others, and whether someone shouldn’t be on a flight.”

Though the captain has the ultimate say, in practice, it’s not really a one-person decision. (And if the plane hasn’t yet left the terminal, a ground-based manager can also make the call to force the passenger to disembark.)

“These situations can have a lot of moving parts, and multiple departments might get involved: the cockpit crew, cabin crew, and airport customer service,” commercial pilot, author and host of AskThePilot.com Patrick Smith, said in an email. “The captain does have final authority, but in practice these tend to be joint decisions.”

So what usually happens is that the captain, flight attendants, gate agents, available medical professionals (including MedAire, the Phoenix-based medical-advice service that works with several airlines) and even other passengers, in some cases, all work together to form a consensus about what to do. And assessing whether someone’s too ill to fly isn’t that different than looking for signs whether someone’s too sick to be stuck next to hundreds of other people in any public space — except with the added knowledge that they’ll all soon be jammed together at altitude for what could be hours at a time with no outside medical assistance.

“Every year, we go through our annual training, and we look for general signs of concern and well-being, like sweating, shortness of breath,” Sara Nelson, international president of the Association of Flight Attendants, said in a phone interview. “Is the passenger putting everyone else in danger? Or, if they’re not well enough to travel on the ground, how are they going to do with the conditions of a pressurized cabin in the air?”

It’s not always obvious which passengers will make the cut, though, and a lot of it comes to a collective gut call by the crew, even if the final decision might seem questionable to people reading about it on the ground days later.

“Pilots are not doctors,” Price said. “I was just on a flight where they did an evaluation and let a gentleman board with his hospital gown on.”

On the other hand, extremely cautious crews may consider any emission of bodily fluids, like vomit, to be a sign of transmissibility, and assume the worst about the severity of the condition.

“I’ve seen them make passengers who were nauseous or who recently threw up take the next flight even when they were really just hung over,” Price said.

Being extra careful may have been the sole rationale behind the Alaska crew’s decision to ground Patrick Hess, though the exact details of what happened still aren’t clear.

“When a guest is actively ill prior to a flight, it is safer for them to be treated on the ground than in the air, where medical assistance is limited,” an Alaska spokeswoman said in an email. “In this case, our guest’s symptoms did not improve, and we were concerned for his well-being.”

By law, carriers must rebook passengers who have been kicked off a flight because they’re ill at the same price up to 90 days later, or give them a full refund — passenger’s choice. But Price suggested that the easiest course of action would simply be to not be sick on a plane.

“If I have even have a slight cough or sniffles, I’ll hope they don’t see it, because the last thing I want is for them to tell me I have to get off,” he said.

Featured photo by martin-dm/Getty Images

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