In May 2016, Lewis Christman was flying from Chicago to Rome when he suffered a bout of acute pancreatitis. He curled into a fetal position on the floor. He spent the next seven hours in agony while the plane flew on. The next three months, he spent in hospitals.

This month, Christman sued, accusing United Continental Holdings Inc. of ignoring a recommendation from a doctor on board to divert the flight and failing to contact medical consultants on the ground. It was another round of bad publicity for United and one that draws scrutiny to how U.S. air carriers treat passengers in distress and the pressure to keep flights in the air.

“Obviously, there is a significant cost to landing the plane,” said David Axelrod, Christman’s lawyer. “We’re looking for all the information about this incident, where my poor client is doubled over in pain and he’s vomiting and they’re not landing this plane."

A medical emergency sets in motion a high-altitude calculation with human lives in the balance. While pilots are the ultimate decision-makers, airlines have earth-bound medical consultants that help bypass on-board volunteers -- reducing expensive emergency landings, but with the potential of providing expert decisions in real time.

Washing Hands

Christman’s suit seeks information about the incident from Phoenix-based MedAire Inc., which provides in-flight medical advice to more than 100 airlines. Company spokeswoman Mandy Eddington declined to comment on the lawsuit or any relationship with United.

Paulo Alves, MedAire’s global medical director of aviation health, said in an interview before the suit was filed that his company provides help from doctors with extensive experience. Just 1.6 percent of flights in which MedAire is called are diverted. He said airlines see the value in bypassing medicos who happen to be aboard.

“If the model was not financially interesting for them, then they wouldn’t hire us,” Alves said. “Doctors, they tend to recommend diversions more than we do, because of course they don’t want to assume the long-term responsibility.”

A medical emergency occurs once every 604 flights and 7.3 percent led to diversions, according to a 2013 New England Journal of Medicine study. It also found that 0.3 percent of emergencies on planes end in deaths.

Accounting Aloft

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