Stealth Pilot wrote:

I could be jaundiced here but surely the drugs were prescribed.
was the real failure a failure of the american medical system to
diagnose and correctly treat his blocked anterior artery?

Certainly, I'd say the drugs were prescribed.

As far as failure to diagnose the problem, check the NTSB report again:

"The pilot’s most recent application for airman medical certificate in
May 2007 noted a “precautionary” coronary angiogram in 2006 which
“showed no blockage.” ... Records obtained from the pilot’s cardiologist
regarding the angiogram (performed September 25, 2006) noted a “totally
occluded” small left anterior descending coronary artery with “good
collaterals” and otherwise normal coronary arteries."

So the diagnosis had been made. Phillips knew he had a problem; this
angiogram was performed over a year before his death. We don't know if
there had been any treatment other than drugs. I suspect not; his
cardiologist would probably have noted it on his records and it would
have been mentioned in the NTSB report.

There could have been many reasons why Phillips didn't have surgery to
alleviate the problem. Denial is common enough... "I feel fine...there
isn't a problem!"

Another factor is that surgery is hard to hide. Your friends know, your
enemies find out, and there's always that fear that one of the latter
will inform the FAA and get your medical canceled. All of us know
friends who have gone through the tremendous hoops necessary to get
their medicals back after heart surgery.

btw if you have been taking medications for some time the body adapts.
it is possible to have high levels of medications in the blood stream
that have next to no cognitive effect on the individual.

Certainly the body adapts, when exposed to large doses of drugs or
alcohol over a long period. We've heard stories of drunk drivers with
BACs above the line that would put most people unconscious. These
people can outwardly seem normal.

But this isn't just an issue of "Monkey Skills," as Phillips called
them. This is an issue of reaction time and decision making, especially
decision-making under stress with a less-than-nominal. cardiovascular
system. The NTSB didn't just note high levels of a cocktail of drugs
(vicodin, valium, paracodine, cardura, morphine derivatives, etc.)...the
term used was "acute mixed drug intoxication". This indicates to me
that the NTSB feels that the amount passed the line where normal
functioning was possible. The NTSB is likely to view the decision to
take off with a 20-knot gusting tailwind as an erosion of
decision-making skills due to the "drug intoxication."

Ron Wanttaja