On Mandatory Screens and the People Doing the Screening

Art Caplan 2The entirely predictable media obsession with the tragedy of the Germanwings jetliner that crashed into the French Alps on March 25 is moving forward full force. The media, especially cable television, love airline disasters. Once German prosecutors revealed that Andreas Lubitz, the pilot at the controls of the Germanwings jetliner when it crashed, had a mental illness but had kept the diagnosis hidden from his employer, all media hell broke loose.

One of the key questions raised by the spectre of mental illness was whether the pilot’s doctors tried to establish Lubitz’s mental fitness to fly and if they were concerned should they have revealed their worries to his employer. Despite a whole lot of talking heads jawing on these points few had anything useful to say since almost none of the experts consulted seemed familiar with the accuracy of mental health screening, or with the nature of German requirements for health screenings for crews or mechanics, or with German privacy law. When the discussion shifted to what about America, things still stayed fuzzy.

Pilots being interviewed noted that the Federal Aviation Administration requires they receive a physical exam from a flight surgeon annually or every six months as they get older. What mechanics or flight attendants undergo was never mentioned. Mental health is supposed to be a part of the exam for pilots but it almost never is. Pilots and the doctors examining them know that any indication of mental illness including addiction or suicidal thinking would get reported right to the FAA and that would be the end of that pilot’s job so little probing gets done. Plus those doing the screening rarely have any training in mental health.Put aside the question of whether one crash, as horrible as it was, might have been prevented by tougher mental health screening of every commercial pilot in the world by trained medical experts. The fact is asking doctors and nurses about mandatory mental health screening and the duty to disclose results to third parties is rather ironic since doctors and nurses who hold lives in their hands every day do not undergo mandatory, regular mental health or drug testing. Thus they are even less likely than pilots to get the help they need to prevent suicide, burnout and depression. Patients are left at risk because their anesthesiologist may be addicted to pain killers, their nurse may have an alcohol problem, their surgeon may suffer from cocaine abuse or their radiologist from early memory loss due to a small stroke or early Alzheimer’s.

Asking a parade of medical experts about how extensive the testing is of pilots and whether they would report any concerns about mental health misses a bigger issue with more importance then a single plane crash. Safety is a huge issue in health care in America. Too many patients die in our hospitals and nursing homes or are harmed due to errors. What is at the root of those errors is hard to say since we don’t require regular mental health and drug testing, much less mandatory reporting to any third party of those involved in providing clinical care.

When you hold the lives of others in your hands safety has to be of primary concern. When a pilot crashes his own plane into a mountain we wonder whether that could have been prevented with better medical testing. But, better medical testing and reporting is something that medicine needs as well.

It is time to take a long, hard, broad look at which occupations need mandatory testing, for what, how often and with what consequences.

Art Caplan is a contributor to NBC News and periodic columnist for THCB.

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2 replies »

  1. What about:

    – Engineers driving passenger trains? A suicidal train engineer could kill a lot of people

    – Captains of ships?

    – Drivers of large rigs/semis or buses? Cross the highway into the other lane and ….

    – Drivers of SUVs? Crush a Toyota or Mini Cooper or plow into a bus stop.
    – Etc.

    Do all of the above need mandatory psychological screening? And how effective is mandatory screening if the person being screened knows that their license and/or ability to work is on the line?

    And while we are at it, what about Judges and Members of Congress?

  2. It is interesting that the focus has been on the mental health issue instead of asking the simple question: “Why was a pilot allowed to be alone in the cockpit behind a unopenable door?”

    Implementing a “2 people always in the cockpit” rule would have provided a greater margin of safety. Australia has already mandated it: http://www.reuters.com/article/2015/03/30/us-france-crash-australia-idUSKBN0MQ07N20150330

    In dealing with safety issues, the first rule is to “eliminate the hazard.” Which is easier and quicker to do: screening all the pilots for mental health disorders on a regular basis, or just making sure there are 2 people in the cockpit at all times? I think Australia has already answered that question.

    For healthcare, we still have lessons to learn.