Germanwings – privacy or need to tell?

Image from GQ magazine – see story link below

The French accident report into the crash of GermanWings flight 4U9525 was released on Sunday and it makes for some grim reading.

The report confirmed that Lubitz had deliberately set the Airbus A320’s autopilot to carry out a controlled descent over the French Alps where it ploughed into a mountain, after locking the flight captain out of the cockpit.

The investigation revealed that Lubitz had begun suffering a “severe depressive episode without psychotic symptoms” in August 2008 and had made several “no suicide pacts” with his treating psychiatrist.

In February 2015, a private doctor diagnosed Lubitz with “psychosomatic and anxiety disorders” and referred him to a psychotherapist and psychiatrist.

On 9 March, another private doctor gave Lubitz a sick leave certificate. It was not forwarded to Germanwings. The following day, the first private doctor referred the pilot to a psychiatric hospital for treatment for a possible psychosis. The same doctor gave Lubitz a 19-day sick leave certificate on 12 March. It was not sent to Germanwings.

But there are strict privacy laws in Germany and Lubitz’s diagnosis could not be passed on to the airline. It was Lubitz’s responsibility to declare himself unfit to fly.

The investigators were hugely hampered in their work by the same doctors who confirmed Lubitz had “shown symptoms suggesting a psychotic depressive episode” just weeks before the crash, but who refused to speak to investigators, citing patient confidentiality.

“No action could have been taken by the authorities and/or his employer to prevent him from flying that day, because they were informed by neither the co-pilot himself, nor by anyone else, such as a physician, a colleague or family member,” it said.

Victims’ families have every right to be angry.

But angry at who – the airline; the medical profession; the lawmakers?

Lubitz had seen 41 doctors – many of them eye specialists – in five years, seven in the month before the crash.

“It is likely that breaching medical confidentiality was perceived by these doctors as presenting more risks, in particular for themselves, than not reporting the co-pilot to authorities,” the BEA stated.

The first officer had just 630 hours’ flying time. In reality this is low. The equivalent of about 8 months of a commercial pilot’s flying time (assuming 900 hours a year). My current IFR instructor has more hours.

Investigators recommended more frequent medical evaluations for all pilots showing any kind of psychological or psychiatric problems, however minor. The BEA said the medical secrecy rules must protect the patient, but should also take into account public safety, and that there should be greater support for pilots who have depression.

Markus Wahl, spokesman for the Cockpit union representing German pilots, said the BEA’s safety recommendations were a balanced package of measures and should be implemented in full.

However, Johann Reuss, of Germany’s air accident investigation agency, said it would be difficult to change the law regarding medical confidentiality. German doctors can be punished with a fine or up to a year in prison for breaching patient confidentiality.

But Lubitz was more than just ill. He was a murderer.

Flight recorder data showed that Lubitz was left alone at the controls of the Barcelona to Düsseldorf flight at 9.30am – 30 minutes after it had taken off. Half a minute later, Lubitz changed the altitude from a cruising height of 38,000ft to just 100ft and set the automatic pilot to descend. In the following seconds Lubitz changed the plane’s speed 10 times, according to the report.

He failed to respond to repeated calls from both civilian and military air traffic controllers and the crew of another aircraft.

He also ignored increasingly frantic signals at the door and cabin calls, and requests by the flight captain Patrick Sondenheimer to open the door. The final moments of the flight recorder suggest someone tried to break down the cockpit door.

Flight data from the outbound flight to Barcelona earlier that morning suggested Lubitz had reduced the altitude from 35,000ft to 100ft for three seconds before returning it to the original setting.

“Actions on the autopilot system during the first flight of the day may be interpreted as a rehearsal for suicide,” reported investigators.

The BEA report stated that Lubitz’s professional level was judged to be “above standard” by his flight instructors and examiners.

“None of the pilots or instructors interviewed during the investigation, who flew with him in the months preceding the accident, indicated any concern about his attitude or behaviour during flights.”

Those same pilots must be thanking their own gods that he did not choose their flights for his murderous act.

Lubitz had been denied a medical certificate enabling him to fly in 2009 because of his depression and the medication he was taking to combat it. He was granted permission, with conditions, in July 2014, which was valid until August 2015.

The BEA’s report said “the limited medical and personal data available to the safety investigation did not make it possible for an unambiguous psychiatric diagnosis to be made. In particular an interview with the co-pilot’s relatives and his private physicians was impossible, as they exercised their right to refuse to be interviewed.

“On the day of the accident, the pilot was still suffering from a psychiatric disorder, which was possibly a psychotic depressive episode and was taking psychotropic medication. This made him unfit to fly,” the BEA report states.

The privacy laws are a double-edged sword. In this case it would seem obvious that there should be a mechanism to alert the airline that one of their employees is undergoing psychotic evaluation. On the other hand if there is no confidentiality then no pilot or industry professional will ever visit a doctor for treatment.

What is clear is that the airline industry has to establish a reviewed and coordinated ‘best practice’ strategy to mental health that reflects relevant key stakeholder concerns in a workable way may offer a solution balancing effective and practical requirements. We can never manage risk away entirely, but a combined policy, best practice and technology-enabled approach may give us a viable route into managing the level of risk faced as a consequence of aircrew mental health issues, and a balanced approach to mitigating that risk which meets the need of all the key stakeholder groups.

This is the final report from the French investigator (In English)

This is a detailed GQ magazine investigation into the crash. The Real Story of Germanwings Flight 9525

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