Aeromedical Forum: June 2015

In a seminar a few years ago, an FAA psychiatrist was describing the “typical” profile of a pilot.

“He is independent, wears a big watch and used to be an Eagle Scout.” Over the years, I’ve found that this description holds true, especially for Part 121/135 pilots who fly for a living. They usually are a bunch of admirably straight arrows. They can be depended upon to keep their ducks in a line.

However, as the ill-fated Germanwings Flight 9525 of March 24th demonstrated, there are occasional dark exceptions to this rule. This incident is not an isolated one. EgyptAir Flight 990 of October 1999, Mozambique Airlines Flight 470 of November 2013 and the mysterious Malaysian Airlines Flight of March 2014 are crashes known or suspected to have been caused by intentional pilot actions.

Closer to home, Jet Blue Flight 191 of March 2012 was diverted from Las Vegas to Amarillo by the First Officer after the Captain sustained what was described as a “psychotic break.” General Aviation pilots are a more heterogeneous population. They more often have medical issues. They frequently have a lower degree of training and experience and less stringent medical monitoring. Thus it’s anyone’s guess as to how much of this sort of thing has happened in GA over the years.

It does make you strongly question the wisdom of excluding large segments of this vulnerable population from the oversight of a Third Class Medical Examination, however. Speaking of that, if you consider 45 minutes of your time and $125 of your money every five years “expensive and time consuming” you haven’t bought a tank of avgas lately!

As you might imagine the issue of psychiatric illness in the cockpit has been a subject of intense discussion among the pilots I serve as well as the AMEs and the FAA over the last couple of months. The ultimate outcome of all of this remains to be seen. However, a few things have come out. Although we should never assume that “it can’t happen here,” German privacy laws seem to have inhibited reporting the significant psychiatric problems that the Germanwings pilot was experiencing. How much more stringent they are than ours in the U.S. I can’t say. We’ve got some pretty strong ones in place especially for mental illness. However, when the actions of a patient might clearly endanger others, reporting generally is permissible. A second and more daunting point is that an Aviation Medical Examiner is often hard pressed to detect significant psychiatric problems if the pilot wishes to conceal them. Now mind you if a pilot walks into my office saying that men for Mars are listening to his thoughts, he’s not going to walk out with a medical certificate. Likewise I will “shoot the breeze” with a pilot when he’s in for an exam. If anything seems amiss in his tone or affect I’ll ask some questions. However, if a guy has significant depression or anxiety and really tries hard to “put on a happy face”, odds are good he’ll slip by. Like so much of compliance with FAA regulations, medical certification depends to a large degree on the honor system.

So what fallback is there to identify pilots at risk of suicide? In the commercial environment there are several resources. The check pilot has an opportunity to assess the mental status of his examinees every six months although he/she is usually more concerned with the pilot’s ability to fly to minimums. Probably the most effective way to detect dangerous mental status in a commercial pilot is the assessment of his /her colleagues. If you think the guy you’re flying with just isn’t quite right, talk about it with your Chief Pilot or follow whatever alternate procedures are outlined in your Operations Specifications. You are not betraying your colleague! You’re doing both him and you a favor. If you think the issue is being swept under the rug and aviation safety is being compromised the FAA has established the Whistleblower Protection Program. The WBPP “protects covered employees of air carriers and their contractors and subcontractors”. Most investigations are directed to situations in which an airline employee declined to participate in or circumstances in which the employee was compelled to commit a violation. Failure to act on suspicion of pilot incapacitation by virtue of mental dysfunction is a clear violation. The website is http://www.faa.gov/about/initiatives/whistleblower.

General aviation issues can be reported through the Aviation Safety Hotline (ASH). The ASH was established to “provide an outlet for anyone to express concerns about unsafe aviation situations without fear of reprisal”. So if you’re good buddy at the FBO starts talking to the wall and doing sloppy Cuban Rolls over the field in his Ercoupe, call (800) 255-1111 or punch up http://www.faa.gov/contact/safety-hotline.

Fly wisely. See you next month!

As always, comments, questions and suggestions are welcome: jdlakin@mnallergyclinic.com.