Source: http://olsonbrooksby.com/blog/2017/01/pilot-mental-fitness-context-international-mental-health-crisis/
Timestamp: 2019-04-21 12:15:20+00:00

Document:
On March 24, 2015, the A320 aircraft was on a scheduled flight en route from Barcelona to Dusseldorf, with 144 passengers and a crew of six.
The 27 year-old co-pilot, Andreas Lubitz, had been flying for Germanwings since June, 2014.
Lubitz’s First Class Medical Certificate was issued in April 2008, and had been renewed yearly.
Since July, 2009, the medical certificate had contained a waiver due to a prior major depressive episode without psychotic symptoms that lasted from 8/08-7/09.
The waiver in the medical certificate provided that the certificate would be revoked if there was a relapse into depression.
In December, 2014, Lubitz experienced symptoms consistent with the onset of a psychotic depressive episode.
Lubitz then consulted with several doctors, including a psychiatrist, who prescribed an anti-depressant.
None of the doctors notified the authorities or Germanwings.
Lubitz waited until he was alone in cockpit at cruise altitude, and then he changed the selected altitude from 38,000 feet to 100 feet, leading to a steady descent into terrain.
He also increased and decreased the airspeed inputs multiple times.
Lubitz ignored the PIC pounding on the cockpit door, and calls from civilian and military air traffic controllers and from other aircraft and kept cockpit door locked.
Lubitz had practiced similar inputs on a flight earlier that day.
The official BEA investigation concluded that the crash was intentional.
The crash in the French Alps was investigated by French Authorities, with assistance from their German counterpart, the Federal Bureau of Aircraft Accident Investigation (“BFU”), with assistance from the F.B.I. The Bureau d’Enquêtes et d’ Analyses (“BEA”) released its preliminary report on May 6, 2015 and its final report on March 13, 2016.
On March 27, 2015, just three days after the crash, the European Aviation Safety Agency (“EASA”) issued a temporary recommendation that air carriers insure that at least two flight crew members, including one pilot, occupy the flight deck at all times during a flight.
Despite an apparent recognition among their own ranks that pilot mental fitness is an important issue, the pilot unions in most of the commercial crashes of the last three decades reacted skeptically, or even disputed, at least initially, claims by investigators that the crashes were intentional.
A 2014 study examined aircraft-assisted suicides in the United States, United Kingdom, German and Finland between 1956 and 2012. The study concluded that in the United States, for the 20 year period 1993-2012, the aircraft assisted suicide rate was 0.33%.
According to the Guide for Aviation Medical Examiners, “The FAA does not expect the Examiner to perform a formal psychiatric examination. However, the Examiner should form a general impression of the emotional stability and mental state of the applicant.” FAA Guide for Aviation Medical Examiners, 137 (2015).
The Guide also explains how the Examiner may become informed about possible mental health concerns based on questions and answers an applicant provides about background, occupation, and reasons for seeking a certificate. Id. at 138-39. If the AME believes there may be mental health concerns, the Examiner is instructed to either deny the certificate or defer issuing the medical certificate and note the mental health issues on the examination report. If the medical certificate application is deferred, the Examiner is to report the findings to the FAA, which will then request further evaluation and information from the applicant. Id. at 139.
In the United States, there are three types of medical certificates. 14 C.F.R. Part 61. A first-class medical certificate, which is required for airline pilots, expires twelve months after the date of the medical examination for pilots under age 40, or six months after the date of the examination for pilots over age 40 at the time of the most recent medical examination.
The same standard applies to second-class and third-class airman medical certificates in 14 C.F.R. § 67.207 and 14 C.F.R. § 67.307, respectively.
Applicants shall have no established medical history or clinical diagnosis of any psychiatric disease or disability, condition or disorder, acute or chronic, congenital or acquired, which is likely to interfere with the safe exercise of the privileges of the applicable licence(s).
Interestingly, the EASA regulations contain a specific provision addressing self-harm, and provide that “[a]pplicants with a history of a single or repeated acts of deliberate self-harm shall be assessed as unfit.” MED.B.055.
The European regulations related to alcohol and drug use are also much more abbreviated than those applicable in the United States, and provide that “[a]pplicants with a mental or behavioral disorder due to alcohol or other use or abuse of psychotropic substances shall be assessed as unfit pending recovery and freedom from substance use and subject to satisfactory psychiatric evaluation after successful treatment. Id.
Enhance AME Training. The FAA should ensure all Aviation Medical Examiners demonstrate knowledge in assessing basic mental health concerns, and enhance AME training on this topic.
Psychological Testing. The ARC does not recommend mandating formal psychological testing during the pilot hiring process nor as part of routine FAA aviation medical examination beyond those which already exist.
Pilot Assistance Programs. Air carriers should develop effective pilot assistance programs.
Air Carrier Education. Air carrier operators should be encouraged to implement mental health education programs…improve awareness and recognition of mental health issues, reduce stigmas, and promote available resources to assist with resolving mental health problems.
Informational Material on Pilot Support Programs. The FAA should assemble and disseminate information on benchmark pilot support programs…to serve as a resource for air carriers to develop new or improve existing programs.
Medical Professional Reporting. Encourage advocacy for a uniform national policy on mandatory reporting of medical issues that affect public safety.
Two Persons on Flightdeck and Flightdeck Access. The ARC recommends no changes to the guidance found in applicable FAA orders.
Aircraft Design Standards. The ARC believes existing aircraft and flightdeck door design standards are adequate and no changes are required by the FAA.
Many of the recommendations contained in the report tracked issues that the Aerospace Medical Association (“AsMA”) had been addressing just prior to the Germanwings crash. In fact, the AsMA Coordinating Chair had just discussed the issues at the 2014 European Society of Aerospace Medicine conference in Bucharest, Romania in September, 2014, a few months before the crash of Germanwings 9505.
IATA and ICAO have both expressed concern about the importance in stepped up coordinated approaches to monitoring pilot mental health.
The BEA investigation into Germanwings 9525 and the ARC report both conclude that pilot perceptions about the potentially career-ending consequences of self-reporting a mental fitness problem and the financial repercussions are serious impediments to effective self-reporting. The BEA report noted that in December, 2014, emails created by Lubitz reflect a financial anxiety associated with his inability to obtain additional loss-of-license insurance because of the waiver in his medical certificate.
The BEA’s preliminary report on Germanwings 9505 noted that there were only six instances of commercial flight crews intentionally crashing planes since 1980 were found in a search of ICAO and BEA databases. It is worth noting than in two of the instances, JAL 350 and Egypt Air 990, the pilot or co-pilot were not alone in the cockpits, but other flight crew members were not able to regain control of the plane.
February 9, 1982. Japan Air Lines Flight 350. 35-yer-old captain, who had just returned to work a few months earlier after a year-long medical leave for psychiatric reasons. Despite history of psychosomatic disorder, doctors deemed him fit to fly. McDonnel Douglas DC-8 from Fukuoka to Tokyo Haneda. Either engaged thrust reverser or cancelled auto-pilot and threw throttles forward. First officer and flight engineer tried to restrain him but could not. Among 166 passengers and eight crew, 24 died.
August 21, 1994. Royal Air Maroc Flight 630. Scheduled flight from Agadir, Morocco to Casablanca. About ten minutes after takeoff, while climbing through 16,000 feet, plane (ATR-42) entered steep dive and crashed into Atlas Mountains, killing all 40 passengers and four crew members. Investigation revealed the 32 year-old pilot intentionally turned off autopilot. The Moroccan pilots’ union disputed any conclusion that the crash was intentional.
December 19, 1997. Silk Air Flight 185. The 41 year-old captain was flying a ten month-old Boeing 737-300 with a crew of 97 passengers and a crew of seven from Jakarta to Singapore. The captain was also a pilot in the Singaporean air force and a member of the Black Knights air force flight demonstration team. He had 7,173 flight hours. In July, 1997, the captain had been demoted as a line-instructor pilot after he pulled a CVR circuit-breaker for non-technical reasons to preserve a conversation. The plane dove from an altitude of 35,000 feet in one minute, diving almost vertically into the Musi River. The crash was independently investigated by the NTSB and the Indonesian National Transportation Committee (“NTSC”). The NTSB concluded that the pilot deliberately caused the crash. The NTSC could not determine the cause of the crash.
October 11, 1999. Air Botswana. A Botswanan pilot commandeered an ATR 42-320 and circled the airport at Gaborone, Botswana for two hours. The pilot repeatedly threatened to crash into the Air Botswana Terminal and kill himself. After the plane ran out of fuel, it crashed into two other ATR 42s on the tarmac, destroying all three planes and killing the pilot. The pilot had been grounded after failing a medical exam.
October 31, 1999. Egypt Air Flight 990. The scheduled passenger flight to Cairo, Egypt originated in Los Angeles and had a scheduled stopover at JFK. The Boeing 767-300 crashed into the Atlantic Ocean about 60 miles south of Nantucket, killing all 203 passengers and 17 crew members. At the request of the Egyptian government, the NTSB investigated the accident and concluded that the 59 year-old relief co-pilot, who had more than 12,500 flight hours, intentionally crashed the plane. As the evidence of an intentional crash grew, the Egyptian government launched its own investigation, and attempted to revoke the request made to the NTSB to lead the investigation. The co-pilot, a married father of five, was under stress because his youngest daughter, age 10, was undergoing medical treatment in Los Angeles. Egypt Air had attempted to defray medical expenses on both a company and employee level.
November 29, 2013. LAM Mozambique Airlines Flight 470. Embraer 190, which had just been delivered in November, 2012. Scheduled passenger flight from Maputo, Mozambique, to Luanda, Angola. Halfway through the route, plane crashed in Namibia. The Republic of Namibia, Ministry of Works and Transport, Directorate of Aircraft Accident Investigation (“DAAI”) investigated. They determined (as did the Mozambican Civil Aviation Institute) that the 49 year-old captain intentionally crashed the plane by repeatedly changing the intended altitude settings from 38,000 feet to 592 feet, deploying speed brakes and repeatedly slowing the manual speed settings. 27 passengers and six crew members were killed. The investigation revealed that the captain’s son had been killed in a car accident, which was a suspected suicide one year earlier. The captain was also in the process of a contentious divorce after ten years of separation, and his youngest daughter had gone through heart surgery in South Africa recently.
In addition to the six passenger flights, one incident in 1976 involved a single pilot crashing an empty plane into homes on the ground, killing 11 on the ground.
September 26, 1976. Aeroflot, Antonov 2. The pilot directed the plane into the block of flats in Novosibirsk, Western Siberia where his ex-wife lived, killing himself and 11 occupants.
Federal courts have generally given the airlines wide discretion to address safety. In Johnson v American Airlines, Inc., 745 F.2d 988 (5th Cir. 1984), the court addressed American’s overhaul of the cockpit crew training, certification and promotional system following a large number of crashes in the early 1960s. Part of the overhaul involved an “up or out” certification system requiring flight crew to train for the next highest cockpit position. Plaintiffs sued, alleging violation of the Age Discrimination in Employment Act. The Fifth Circuit affirmed, holding that “the airline industry must be accorded great leeway and discretion in determining the manner in which it may be operated most safely”. Id. at 993, quoting Murnane v. American Airlines, Inc., 667 F.2d 98, 101 (D.C. Cir. 1981).
However, preemption is not without limits, even in the context of flight crew employment, and airlines are still subject to the laws of general applicability. In the context of pilot mental health, this may include the implications of the Americans With Disabilities Act (“ADA” 42 U.S.C. § 12112). Under the ADA, a person is considered disabled if he or she: (1) suffers from a mental or physical impairment that substantially limits one or more major life activities; (2) has a record of such impairment; or (3) is regarded as having such an impairment. 42 U.S.C. § 12102(2).
In Witter v Delta Airlines, 966 F. Supp. 1193, 1195-1197 (N.D. Ga. 1997), the court addressed pilot mental health in the context of an ADA claim. Plaintiff had been employed by Delta as a pilot since 1967. In February, 1992 plaintiff was involved in a domestic dispute with his wife, and threatened to commit suicide. As a result, plaintiff was incarcerated, and sent for a psychiatric evaluation, after which he was transferred to another psychiatric facility at Delta’s request. Plaintiff alleged that Delta told him that if he did not consent to psychiatric evaluation, he would be fired. Plaintiff then voluntarily grounded himself because he believed that he was not medically fit to fly.
Plaintiff’s FAA Class I Medical Certification was set to expire in June, 1992. Plaintiff found an AME who agreed to “help Plaintiff with this situation”. Relying on the report of a psychiatrist to which the AME had referred plaintiff, the AME diagnosed plaintiff as suffering from bi-polar disorder, and found him unfit to fly. Subsequently, plaintiff examined by an FAA psychiatrist who concluded that plaintiff had a “characterological problem that might be considered a personality disorder”. The FAA psychiatrist also concluded that plaintiff should be issued a Class I Medical Certificate on the condition that he submit to semi-annual psychiatric reports.
In returning Capt. Witter to the cockpit, the major concern is the possibility of a recurrence of this type of behavior reaction, especially while flying…. If it did occur again, even in the cockpit, I do not believe that it would be incapacitating from a safety point of view. Capt. Witter’s basic personality may make him a difficult person with whom to work. However, he does not have a psychiatric disorder at the present time. If any future unusual behavior indicates the occurrence of another adjustment disorder, Capt. Witter should be grounded permanently. Until then, he is qualified to fly.
Based on the report, Witter returned to line flying status in August, 2003. In November, 1993, plaintiff flew a European rotation, during which he had a conflict with two other crew members which resulted in the crew refusing to follow his instructions. After further evaluation, the Senior AME diagnosed plaintiff with Narcissistic Personality Disorder and possible Cyclothymia, and memorialized the findings in an April, 1994 report. In response, Delta grounded plaintiff. The FAA then convened a panel of six psychiatrists, who reviewed the case and concluded that plaintiff should not be returned to flight status. The NTSB then overturned the FAA and restored plaintiff’s Class I Medical Certification. Delta refused to reinstate plaintiff to flight status without further medical evaluation.
Plaintiff filed suit, alleging violation of the ADA. In McDonnell Douglas Corp. v. Green, 411 U.S. 792 (1973) the Court ruled that for claims of discriminatory treatment in employment, a plaintiff must establish a prima facie case of discrimination by showing: (1) that he or she has a disability; (2) that he or she is a qualified individual; and (3) that he or she was subjected to unlawful discrimination because of the disability. The burden then shifts to the employer to articulate a legitimate nondiscriminatory reason for the employment action.
The court found that since plaintiff’s psychological condition did not appear to be exceptionally severe, and only manifested itself while plaintiff was under stress, it did not substantially impair the life activity of working. The court also noted that the impact of the emotional disturbance was not long-term, since the NTSB had concluded that the First Class Medical Certification should be returned. The court also noted that plaintiff was a resident of the Atlanta area, a large metropolitan area with substantial job opportunities. The court also reasoned that there were many other pilots in management, training and administration, and while plaintiff may not be able to fly commercially, he did not even argue that he was impaired from holding any other job. Witter, 966 F. Supp. 1199.
As discussed above, McDonnell Douglas requires the establishment of three conditions to move forward with a case of discrimination. If the plaintiff in Witter had established that his mental condition was a disability for purposes of the first element, he still would have had to establish that he was a qualified individual, and that he was subject to unlawful discrimination for purposes of establishing a prima facie case of discrimination under the ADA. Although he was subjected to testing after the domestic incident and European rotation, it is unlike that those actions constitute unlawful discrimination. Under the ADA, an employer is prohibited from conducting a medical examination after the commencement of employment unless such an examination is job-related and consistent with business necessity. 42 U.S.C. § 12112(d)(4)(A).
Moreover, pursuant to 14 C.F.R. 67.113(c)(1), the FAA requires that in order to receive a first-class airman medical certificate, a person must not have any medical condition which renders that person “unable to safely perform the duties or exercise the privileges of the airman certificate applied for or held”.
In Martin v Lennox Intern. Inc., a pilot suffered a heart attack and was grounded during the six-month recovery period, after which he sought re-certification from the FAA. 342 Fed. Appx. 15 (5th Cir. 2009). After informing his employer that there would be a delay in the re-certification process while he awaited his medical certificate he was fired. He then brought several claims, including discrimination under the ADA. The court granted the defendant employer’s motion for summary judgment on the basis that plaintiff could not hold a medical certificate. Therefore, it is highly unlikely that a pilot with a mental illness that would not allow him or her to hold a medical certificate would not be able to satisfy the qualification element of a prima facie case of discrimination under the ADA.
Courts have generally ruled that an employer’s request for a medical examination when the request is grounded in good faith, and where the specific facts show that an employee may not be able to perform the essential functions of his or her job. Sullivan v. River Valley Sch. Dist., 197 F.3d 804, 808 (6th Cir. 1999).
Plaintiff in Witter also brought state tort claims for intentional infliction of emotional distress and negligent hiring and retention, which were dismissed. Plaintiff’s defamation claims against both the Sr. AME and Delta were also dismissed. Plaintiff’s libel claims against Delta, and his claim against the Sr. AME for tortious interference with Witter’s contractual relationship with Delta were also dismissed.
The BEA and ARC reports both recommend the development and implementation of a unified, coordinated system of national mental health reporting. However, the confidentiality of medical records arises through a complicated morass of federal and state statute and common law.
Although the ADA contains confidentiality provisions, the ADA generally insulates air carriers from liability in cases where pilots have a mental disability.
Family Medical Leave Act of 1993 (FMLA). Unique eligibility requirements apply to pilots, flight attendants and other crewmembers under the Airline Flight Crew Technical corrections Act of 2009. Eligible if (1) worked at least 60% of the minimum number of hours scheduled to work in any given month during prior 12 month period and (2) at least 60% of the minimum number of hours that the employee was scheduled to work in any given month.
Aviation and Transportation Security Act (ATSA). Provides immunity for air carrier or any employee of an air carrier who makes a voluntary disclosure related to a threat to aircraft of passenger safety. 49 U.S.C.A. § 44941(b). See, Air Wisconsin Airlines Corp. v. Hoeper, 134 S. Ct. 852 (2014).
Health Insurance and Portability Accountability Act (HIPAA). Contains an exception for “uses and disclosure to avert a serious threat to health or safety. 45 C.F.R. § 164.512.

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