Six months after the Federal Aviation Administration changed its rules to make air travel easier for people with emphysema and other respiratory illnesses, the two breathing aids approved for travelers' use on commercial flights are proving too expensive for most patients.
And it gets worse.
Airlines have established a hodgepodge of conflicting policies, and some airport security screeners seem unaware of the new rules.
The result: "It's made no difference," said Dr. Richard Pomerantz, a Palm Beach Gardens pulmonary specialist who has been an outspoken advocate for people with respiratory diseases.
"The airlines accommodate other people, but they don't accommodate people who require oxygen, and I find that just incredibly unfair," he said.
Until Aug. 11, travelers who needed supplemental oxygen when flying often spent more time and money in planning their flights than they did in the air. Compressed oxygen had to be bought from individual airlines, which charged $100 or more for each leg of a trip. Flying round-trip from West Palm Beach to New York City with a stopover in Atlanta, for example, could add $400 to the cost.
In addition, a 48-hour notice was required to reserve the oxygen, and a doctor's letter was needed each time a patient traveled.
If the flight had, say, a two-hour layover in Atlanta, more oxygen had to be ordered from a local company so the passenger could breathe before boarding a plane for the second leg of the journey, when the airline again would provide oxygen.
Last summer, after more than a year of discussion, the FAA approved two breathing aids, called "portable oxygen concentrators," for use on all commercial flights. Unlike compressed oxygen, which is classified as a hazardous material, both the AirSep and Inogen One brand concentrators separate the oxygen from nitrogen and other gases in the regular cabin air and filter it to the patient at a purity rate of about 90 percent.
Passengers simply could buy a concentrator, which weighs about 10 pounds, and use it whenever they flew. And a one-time doctor's note would be sufficient.
But the well-intentioned rules change is encountering some turbulence.
The AirSep has a list price of about $4,000, and the Inogen One costs about $5,000.
"So it's meaningless to the average person, unless you're a very wealthy individual," said Harold Sagalow, 76, a Boynton Beach retiree who has used compressed oxygen since being diagnosed with emphysema in 1990. "It amounts to a toy, and you've got to be a very, very wealthy person to afford this toy."
Both units plug in and also can run on rechargeable batteries, which cost about $150 to $200 each. But the batteries last only about two hours before needing to be recharged, so a traveler on a six-hour flight might need to bring at least two along if the airline cannot or will not provide an electric power source.
"Most people can't afford it," agreed Greg Esposito of Cardiosom of Palm Beach, a respiratory and medical equipment company. "We're getting a lot of questions because people have heard about them and think, 'I've got Medicare.' "
But Medicare allows only about $200 a month to supply oxygen, and at $4,000 or more each, it wouldn't be feasible for his company to rent them.
"Medicare won't buy them," Esposito said, "or everybody would have one."
For those who can afford their own oxygen concentrators, the next hassle arises from the airlines' conflicting policies.
In dropping its objection to portable concentrators on board flights, the FAA nevertheless left it up to individual airlines. Some allow the AirSep but not the Inogen One. Some allow both. And some, such as American Airlines, forbid both and still require passengers to buy oxygen from them.
Most frustrating, though, is what can happen after you've paid $4,000, bought an extra battery, found an airline that accepts your model and arrived at the airport.
"They won't let me on," said Carl Malachowski, 75, of Naples. "They don't know what it is."
"They" are the security screeners who inspect carry-on luggage for the Transportation Security Administration.
Malachowski has had chronic obstructive pulmonary disease for nearly a decade. He bought an AirSep concentrator about two years ago, but security screeners won't let him take it on a plane, even though he carries a medical certificate, he said.
"I'm pretty sure they think the concentrator has oxygen in it, and it doesn't," he said. "They're misinformed. They don't know what's going on."
When Malachowski and his wife, Jeannette, flew to New York for Christmas, they sent the AirSep ahead and trusted in an on-time arrival for the 2 1/2-hour flight. He can breathe on his own for that long, he said.
The Malachowskis plan a trip to London in September for their 54th wedding anniversary, and Jeannette said she has been trying frantically to find reassurance that they can take the concentrator through security.
"We'd be happy just to bring it as a carry-on," she said. "We'll buy their oxygen, but we don't want to store it in baggage because if they lose the baggage, we'd arrive in London with no concentrator."
When asked about Carl Malachowski's problem, Lauren Stover, public affairs manager for the security administration's South Atlantic region, said she was unfamiliar with the device.
"The term 'oxygen concentrator' is not a popular medical device that we see with frequency," Stover said. "I don't know if we were even advised of this rule change, so there may be a disconnect."
Bill Mosley, a spokesman for the U.S. Department of Transportation, of which the FAA is a part, said the agency had informed the security administration of the rules change.
"It seems to be a question of how they communicate those procedures to their people at the airport," Mosley said.
But Stover and the security administration have a point. As many as 24 million Americans have emphysema or chronic bronchitis, according to the federal Centers for Disease Control, but only a fraction of them are likely to own an oxygen concentrator. An individual screener is unlikely to encounter them.
After investigating, Stover sent a statement by e-mail: "The oxygen concentrators are permitted beyond the TSA passenger screening checkpoints once the Transportation Security Officers conduct appropriate screening on the device," she wrote. "The device should be disconnected. If the passenger is unable to disconnect the device, we do have protocols in place to clear them. If passengers do experience a problem whereby they are not permitted beyond the checkpoint, they should request a TSA supervisor to resolve any confusion."
Some relief may be on the way for passengers with portable concentrators, once they get past the security gate. The FAA is reviewing still another rules change that would require all airlines to test proposed breathing devices and, once they're found to be safe, allow passengers to bring them on board or provide oxygen free of charge.
"It could be another year, but I hope not," said Paul Billings, a lobbyist for the American Lung Association, who expects the rules to be approved because they came from Transportation Secretary Norman Mineta's office. "This is something he's championed."
Airline policies differ
In August, the Federal Aviation Administration dropped its objection to portable oxygen concentrators on board flights but gave individual airlines the option of allowing one, both or neither of the approved models. How some airlines have responded:
American Airlines: Permits neither the AirSep nor Inogen One on its flights. Passengers who need supplemental oxygen must buy it from the airline for $100 per leg of the flight, with 72 hours' advance notice required.
Continental Airlines: The approved concentrators may be carried on the plane but cannot be used in flight.
Delta Air Lines: Allows the Inogen One concentrator to be used on flights. Charges a fee to provide medical pre-approvals and requires 48 hours of advance notice.
JetBlue Airways: Does not allow concentrators on board but will accept them as checked baggage.
Northwest Airlines: Allows the Inogen One to be used during flights but does not provide electrical power.
Southwest Airlines: Allows both the AirSep and Inogen One concentrators on board with a medical certificate at no extra charge.
US Airways: Allows both the AirSep and Inogen One concentrators on board with a medical certificate. Does not provide electrical power.
Sources: Airline representatives and Web sites
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