MD11 CREW HAD A PAX THAT HAD A HEART ATTACK INFLT ON AN INTL FLT. THE PAX HAD ANOTHER HEART ATTACK 12 HRS PREVIOUSLY.

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USURPATION OF CAPT'S AUTH. AFTER 4 HRS OF FLT; 300 MI OVER THE PACIFIC OCEAN FROM GUAYAQUIL; EQUADOR; PAX HAD HEART ATTACK. A PAGE RESULTED IN 2 DOCTORS WHO USED THE AED AND THE NITRO TABLETS FROM THE EMER KIT TO MONITOR AND STABILIZE THE PAX. INVESTIGATION OF THIS PAX PRODUCED THE INFO THAT SHE HAD A HEART ATTACK THE PREVIOUS NIGHT AT ABOUT XA15 IN A PAX BOARDING LOUNGE AFTER DEPLANING FOLLOWING AN ABORTED TKOF DUE TO ACFT MECHANICAL MALFUNCTION. PAX SVC REBOARDED HER 12 HRS LATER AFTER A NIGHT IN THE EMER ROOM. THE MGR WAS INVOLVED IN CONVINCING THE PURSER TO TAKE THIS PAX. REF WAS MADE TO A SIGNED NOTE FROM A DOCTOR THAT SHE COULD FLY. AT NO TIME DID THE MGR CONSULT WITH THE CAPT TO INFORM HIM OF THIS PAX AND HER CONDITION. THIS IS A VIOLATION OF FAR 121.533D. THE WRITTEN DOCTOR'S PERMISSION TURNED OUT TO BE 2 PAGES OF GENERIC EMER ROOM CARE FOLLOW-UP ADVICE WITH A PRESCRIPTION FOR NITRO TABLETS THAT THE PATIENT HADN'T HAD TIME TO FILL BEFORE BOARDING AGAIN. AT NO TIME WAS AN ACR PHYSICIAN ON CALL CONTACTED. I WAS INFORMED BY THE DOCTORS ON BOARD THAT THEY THOUGHT SHE MIGHT HAVE DIED WITHOUT THEIR CARE; THE AED; AND THE NITRO TABLETS. 300 MI OUT OVER THE PACIFIC OCEAN MIDWAY BTWN PANAMA; EQUADOR; AND PERU IS NOT THE TIME FOR THE CAPT TO FIND OUT THAT THE MGR HAS ACTED AS CTLING MEDICAL AND LEGAL AUTH TO CLR A GRAVELY ILL PAX FOR TRANSPORT.