FO; NEW ON THE A320; STARTS A PREMATURE DSCNT TOWARDS THE REQUESTED ALT OF FL330. FLC HAD BEEN PREVIOUSLY DISTR BY A DOCTOR IN THE COCKPIT COORD WITH AIR MEDICAL SVCS REGARDING AN ILL PAX. AT DSCNT TIME PIC WAS GETTING ATIS INFO.

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WE WERE APPROX 1 HR FROM DEST AT FL350. NEW HIRE FO FLYING HIS FIRST IOE LEG AS PF. COMPLICATING THE SCENARIO WERE 2 FACTORS: FO'S TRAINING STATUS AND A MEDICAL PROB WITH A PAX THAT HAD BEEN VERY DISTRACTING ONLY MOMENTS BEFORE. (WE HAD ESTABLISHED A MED-LINK PATCH; CALLED FOR A PHYSICIAN ON BOARD AND THAT PHYSICIAN HAD HAD TO VISIT THE FLT DECK TO CONSULT WITH THE MED-LINK PHYSICIAN ON THE GND. THE DOCTOR LEFT JUST A FEW MOMENTS EARLIER.) ALL THIS ON THE FO'S FIRST LEG. THE FO WAS SOMEWHAT NERVOUS AND TENTATIVE BUT TRYING HARD TO KEEP UP. NOTHING UNUSUAL FOR THE FIRST TIME. BUT THINGS SOON CHANGED. BECAUSE OF THE PATIENT'S PROB -- LUNG CANCER; EMPHYSEMA; DIFFICULTY BREATHING; AND ON MEDICAL ADVICE; I HAD ALREADY DSNDED FROM FL390 TO FL350 AND HAD ASKED FOR LOWER ASAP. I ADVISED ATC OF OUR MEDICAL SIT; BUT ADDED THAT WE WERE NOT AS YET A 'LIFEGUARD.' I ASKED FOR EXPEDITIOUS HANDLING AND WAS TOLD 'CLRED DIRECT PHX;' SHORTLY FOLLOWED BY 'SORRY; WE HAVE TO LEAVE YOU ON THE STAR.' ATC THEN CALLED XING TFC (WE SAW IT) AND SAID TO 'EXPECT FL330 WHEN CLR.' ATC ISSUED A NUMBER OF INSTRUCTIONS; AMONG THEM 'REDUCE SPD TO 250 KTS.' I HAD BEEN EXPLAINING DSCNT STRATEGIES AND AUTOPLT MODES TO THE FO AMID ALL THE DISTRS AND ASSUMED HE UNDERSTOOD WHAT TO DO. I TOLD HIM I WAS 'OFF' ATC TO GET THE ATIS AND COMPANY INFO. WHEN I PUT MY HEAD UP FROM WRITING THE ATIS DATA; I NOTICED WE HAD LEFT FL350 AND WERE LEVELING AT FL330. I CAME BACK ON ATC JUST IN TIME TO BE ASKED TO 'SAY ALT.' I RESPONDED 'LEVELING FL330.' ATC SAID 'YOU WEREN'T CLRED TO FL330 BUT FOR NOW MAINTAIN FL330.' THERE WAS NO INDICATION FROM ATC OF A CONFLICT OR PROB OTHER THAN 'YOU WEREN'T CLRED.' THERE FOLLOWED IN OUR COCKPIT AN EARNEST DISCUSSION ABOUT CRM AND COORDINATING ANY CHANGE IN ALT BEFORE DOING IT. THE DISTRS; FO'S NERVOUSNESS; AND A MISUNDERSTANDING OF 'EXPECT FL330' WERE FACTORS. THE FREQ WAS ALSO VERY BUSY.