A new French aviation authority report reveals that Andreas Lubitz, the co-pilot who intentionally flew Germanwings Flight 9525 into the French Alps on March 24, 2015, had been referred to a psychiatric hospital two weeks before the tragedy. The 27-year-old Lubitz had also been prescribed five drugs–antidepressants, sleeping pills, and an antipsychotic drug–after seeing five different doctors in the months before the crash.
None of this information had been communicated to Lufthansa, the parent company of Germanwings, since renamed Eurowings.
These and other details were released Sunday morning in a 110-page report by the investigative arm of France’s civil aviation authority, Le Bureau d’Enquêtes et d’Analyses (BEA). The BEA made 11 safety recommendations that include a call for re-evaluation and international harmonization of regulations governing the mental fitness of pilots and emotional and financial support for pilots fearing the loss of flying certification due to complicated mental illness diagnoses.
Cockpit voice recorder information confirms that after the senior pilot left the Airbus 320 cockpit for a bathroom break, Lubitz programmed the autopilot control to descend from 38,000 feet to 100 feet. The altitude of the crash site in Prads-Haute-Bléone was 5,085 feet (1,550 meters) above sea level. He refused keypad and cabin intercom requests to unlock the cockpit door. Violent blows to the cockpit door were recorded on five occasions prior to impact with the terrain.
Lubitz and the pilot had also flown the plane from Düsseldorf to Barcelona earlier that morning and the flight data recorder and cockpit voice recorders had information from that leg. When the pilot had left the cockpit during the early descent into Barcelona flight, Lubitz experimented with moving the altitude setting to 100 feet while the plane was in autopilot mode. Just before the pilot returned to the cockpit, Lubitz moved the setting to 17,000 feet as directed by Barcelona air traffic control.
Depression alone did not disqualify Lubitz from flying
When I first reported on the crash in the days following the tragedy, Lubitz was known to have suffered from clinically-diagnosed depression beginning in August 2008, when he interrupted his Lufthansa pilot training program due to “severe depressive disorder without psychotic symptoms.”
The report now reveals the severity of that episode. Lubitz exhibited suicidal ideation (suicidal preoccupation and planning), made several “no suicide pacts” with his treating psychiatrist and was hospitalized. Lubitz took antidepressant drugs and received psychotherapy through the following year. The psychiatrist stated in July 2009 that Lubitz had fully recovered.
Lubitz restarted his training in August 2009 and passed his written examination in October 2009. His pilot’s license carried a waiver for the episode of depression, with the condition that it would be revoked in the event of a depressive relapse. During his training and recurrent examinations, Lubitz’s professional performance level was judged “above standard.”
Uncomplicated depression does not always disqualify from ultimately gaining certification as a passenger airline pilot. Countries differ in their policies on the use of antidepressant drugs in such situations.
In the U.S., pilots are permitted to take one of four SSRI antidepressants and can gain medical certification to fly if they have been on a stable dose for six months. But close medical monitoring by aviation-certified medical doctors is required for this provisionary status. The addition of other drugs affecting the central nervous system or a diagnosis of other mental disorders can lead to permanent revocation of passenger pilot privileges.
Emergence of psychotic symptoms
The report focused on the progressive series of what investigators concluded was consistent with Lubitz experiencing a psychotic depressive episode beginning in late November and early December 2014. He had become concerned about visual disturbances that might have disqualified him from flying but doctors could find no pathophysiology in the eye that would account for Lubitz’s complaints. He also complained of sleep disturbances.
Physicians put him on sick leave six times between November 24, 2014 and six days before the crash. Three of these sick leave certificates were not submitted to Germanwings. Across his treating psychiatrist and one of four private doctors who saw him during this period, Lubitz was prescribed five different drugs acting on the central nervous system:
- Mirtazepine – the generic name for Remeron, an atypical antidepressant that affects norepinephrine and serotonin neurotransmission but is not a reuptake inhibitor for either transmitter.
- Escitalopram – the active stereoisomer of citalopram (Celexa) and generic name for Lexapro. Escitalopram is a serotonin-selective reuptake inhibitor (SSRI) that is conditionally permitted for pilot use by the U.S. FAA.
- Zolpidem – the generic name for the nonbenzodiazepine sleeping pill sold as Ambien.
- Zopiclone – the active stereoisomer of zolpidem (Ambien) and generic name for Lunesta.
- Dominal forte – the German brand name for prothipendyl hydrochloride, a mixed antipsychotic and insomnia drug not available in the U.S. Prothipendyl belongs to the phenothiazines, a class of early antipsychotic drugs that includes chlorpromazine (Thorazine).
In addition to these drugs, the the private physician who prescribed zopiclone referred Lubitz to a psychiatric hospital due to possible psychosis on March 10, 2014–two weeks before the crash.
Despite the fact that the crash left plane wreckage no larger than three or four meters, enough of Lubitz’s identifiable remains were found for forensic drug analysis. He was found to have the antidepressants mirtazepine and citalopram, as well as the insomnia drug zolpiclone. Citalopram is the generic version of the two chemical stereoisomers that includes escitalopram.
According to the report, all five physicians as well as Lubitz’s relatives exercised their right to refuse to be interviewed by the BEA and/or the BFU. But no other reports existed of unusual behavior by Lubitz’s co-workers or family that were communicated to Germanwings in the months before the deliberate crash. Lubitz’s girlfriend later told the press that she had been concerned for his mental state.
The balance between medical privacy and public safety is certainly a consideration addressed in the report. But this tragedy was clearly preventable had Lubitz’s mental state been communicated to the airline.
The report also gives some detail on the financial considerations that may have contributed to Lubitz’s reluctance to inform the airline of his most recent treatment. His portion of his pilot training fees were €60,000, for which he took a loan of €41,000. Germanwings provided an insurance policy that would provide a pilot with a one-time payment of €58,799 if they were declared unfit to fly during the first five years of employment. But the depression waiver on Lubitz’s license prevented him from obtaining additional insurance for future loss of income if he lost his certification.
For further reading, the BEA summary and full report are available in several languages.
(culled from www.forbes.com)
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