Traveling With a Pump: TSA Regulations

Insulin pump manufacturers have been put in a difficult position by the new rules. Customers turn to them for advice, but without more specific guidance from the TSA, it's difficult for them to give specifics.

| Dec 23, 2010

Most holiday stories are comforting and familiar, wrapped up with the happiest of endings. But the tales that swept the nation this Thanksgiving were sometimes distressing and strange, and the one told by Laura Seay has no resolution or simple solution. Seay was one of the travelers caught in the center of the debate over the Transportation Security Administration's forceful new screening methods.

For the 18-year diabetic and insulin pump user, the debate has yielded questions aplenty, but few concrete answers. "It's extremely frustrating because you can't get anyone to say, in writing, what the deal is," Seay said. "It's frustrating because I have this medical device that's critical for my life, and because of that I'm being singled out."

Seay, an assistant professor of political science at Morehouse University in Atlanta, recognized that something was amiss in September, when she caught a flight out of Reagan National Airport in Washington, D.C. Her screening checkpoint featured a new kind of scanner -- not the simple X-ray machine of old, but a high-tech, full-body imaging system. Unfamiliar with the device or any new rules, Seay told the screeners that she had a medical device (an OmniPod insulin pump). She was then subjected to a new kind of patdown, and not a gentle one. "It's extremely invasive, extremely uncomfortable," she said.

A couple of weeks later, Seay flew out of her home city of Atlanta, Georgia. After a routine screening, she talked with security personnel and asked them about the new security procedures. Once the new machines were in place everywhere, she asked, would she have to be patted down every time she flew? Yes, they told her.

And so began Seay's struggle -- to voice her concerns about the new procedures' effect on diabetics and to find out exactly what the new screening procedures require. Three months later, despite national controversy, those goals remain elusive.

The Official Response

The TSA has been reluctant to talk about the new screening procedures in detail. To do so, it says, would give clues to terrorists and others who wish Americans harm. But that's scant comfort for travelers like Seay, who must contend with uncertainty when they fly.

When asked for comment, the agency offered some basic recommendations for diabetics. They should tell screeners that they have the disease and if they're wearing a pump. They should also have insulin with a "professionally printed label identifying the medication or manufacturer's name or pharmacy label" accompanying their supplies.

The TSA also has a curious piece of advice for pumpers: "If necessary, advise the screener that (the pump) cannot be removed since it is surgically implanted." While such pumps exist, they're not commonly available. What's missing is any sort of advice about a pump like the OmniPod, which attaches directly to the skin and cannot be removed without being deactivated.

The agency won't say, however, if such notifications from diabetics trigger enhanced security measures. And that's the key point. Does being a diabetic with a pump mean a patdown every single time you fly? (The TSA promises, for what it's worth, that diabetic travelers can have a private screening if necessary.)

In an interview with The Atlantic, TSA Administrator James Pistole made one thing very clear: The agency believes it has a right and responsibility to conduct stringent searches, and it doesn't believe they're an invasion of privacy. "If people take an affirmative act of engaging in, in this case, aviation -- they want to get on a plane -- they're taking an affirmative act to do that," Pistole said. "Then, yes, there is authority to do the administrative search for public safety purposes."

The agency's new measures, much debated over the Thanksgiving holiday, are two-pronged. In a column for USA Today, Pistole outlined them. First, there are the new body scans, performed by AIT ( Advanced Imaging Technology) machines. They look beneath a traveler's clothes with far more detail than X-ray machines.

While the machines have been certified as safe by the FDA and outside observers, travelers can choose to opt out of using them (some have raised concerns about radiation). But if passengers opt out (or if the machines raise an alarm), they are subjected to a thorough patdown. These comprehensive body searches are the second change introduced by the TSA and are the focal point of recent outrage. While the agency is vague about the specifics, passengers like Seay complain about the patdowns' intrusiveness.

Again talking to The Atlantic, Pistole acknowledged that the agency's approach isn't perfect. "I want to use the latest intelligence to inform our judgments and actions, and use the best technology when we don't have intelligence," he said. "So there's a huge gap there. So here are the threats, here are capabilities, here are gaps. So how do we fill those gaps? And right now we do it with a somewhat blunt approach."

Pump Companies Speak

Insulin pump manufacturers have been put in a difficult position by the new rules. Customers turn to them for advice, but without more specific guidance from the TSA, it's difficult for them to give specifics.

Different pump manufacturers have different levels of concern. Insulet, the Bedford, Massachusetts, company that manufactures the OmniPod, has perhaps the most difficult task. Because its pods  attach to the skin, they're not easily removed for examination.

The company recommends, in general, the same approach outlined by the TSA. If you're concerned at all, talk to security screeners at the airport and outline your situation. Tell them, if you're patted down, that your insulin pump is attached to your body and cannot be removed.

As an extra precaution, Insulet advises that you carry "a signed letter from your healthcare provider explaining you need to carry insulin supplies and OmniPod equipment," along with "prescriptions for all medications and supplies with original prescription labels."

Medtronic, the maker of MiniMed pumps, has simpler advice for its customers. That's made possible by the fact that its pumps are easily detachable from a cannula that remains inserted under the skin.

"We have conducted official testing on the effects of the new full body scanners at airports with Medtronic medical devices," said Amanda Sheldon, the company's director of public relations. "Since the new scanners include X-ray, remove your insulin pump, Guardian monitor, sensor, transmitter, meter, and remote before going through the scanner." If you don't want to remove the equipment, Medtronic recommends that you ask for a patdown instead.

A third major U.S. manufacturer of insulin pumps, Animas, could not be reached for comment.

It's worth noting that none of the measure recommended by the TSA or by insulin pump manufacturers is actually required. Travelers' experiences (including this writer's) have varied greatly. I went through one of the new full-body scan machines at Boston's Logan International Airport in August without telling anyone about my diabetes or OmniPod and had no problems whatsoever. I did, however, have OmniPod literature packed on my carry-on to show a security officer if he or she was curious about the device stuck to my abdomen.

Still Searching for Answers

Over the past three months, Laura Seay has tried to find out more. She filed a complaint with the TSA after talking with the security screeners in Atlanta. She still hasn't received a response.

She talked to the American Diabetes Association, which told her it had been unsuccessful in getting any sort of written policy from the TSA.

She contacted her U.S. representative -- John Lewis -- and her senators, Johnny Isakson and Saxby Chambliss. Isakson's office has been working to find her answers, Seay said. Lewis's staff offered her sympathy; they had seen a demonstration of the new security measures. "They had all watched a patdown and were really grossed out by it," Seay said.

Finally, she contacted FlyersRights.org's Kate Hanni. The group had successfully lobbied to limit the amount of time that airlines can keep passengers on a plane without taking off. Seay figured that the group might be able to help her find some clarity.

It ended up helping her find some fame. She was put in touch with a reporter from The New York Times, and the newspaper of record featured her in a November 18 article that helped make the furor about the new screening regulations a national story.

"I would just hope that some reasonable and sane policy prevails," Seay said. "There needs to be a balance between security and just basic common sense."

This holiday story remains unfinished and confused. The government and pump companies offer advice, but few facts. Yet Seay's simple message -- repeated over and over to government and advocates alike -- should count for something.

"If I'm a terrorist and I have a bomb strapped to my body, I'm not going to say to the TSA, ‘I'm wearing something on my body.'" she said. "If you tell them up front you have an insulin pump, and it looks like an insulin pump when you go through -- I just feel like we should have the same choices everybody else has."

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Categories: Diabetes, Diabetes, Government & Policy, Insulin, Insulin Pumps, Personal Stories, Type 1 Issues


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