Dangerous Skies

I used to never be afraid of flying but with all the recent airline disasters in the past year (most recently the recent deliberate crash of Germanwings 9525 into the French Alps), I can't help feel a bit anxious every time I set foot on a plane now. The latest reports suggest that the co-pilot of the Germanwings flight had a medical condition (depression?) that deemed him unfit to fly, yet his employers knew nothing about it. If his condition was really that serious, did his physician have a duty to report this if working meant putting other people's lives at risk?

I had a similar case approximately 2 years ago when I admitted an airline pilot to the hospital after he had a seizure during a marathon. His CT head was negative and he later got an MRI, but he left AMA before the results came back. He'd believed that dehydration was the cause of his seizure (he did have AKI but felt better after getting fluids) and saw no need to stay in the hospital. Usually when people leave AMA we don't follow up on their results, but the following day I looked up his MRI report and saw that he had a brain mass. I asked my partners what to do, and they said to call him and his PCP so that he could self-report to his employers that he could not work.

I called the patient at home and gave him his MRI results, telling him that he needed to schedule an appointment with his PCP so that he could arrange followup with a neurosurgeon. I further told him that he could not fly anymore and needed to tell his employers so. Then I faxed a letter to his PCP explaining what had happened, then called the PCP the next day to confirm that he'd gotten the letter.I was somewhat amused when the CMO of our hospital called me about a day after I spoke with the patient's PCP telling me I needed to notify his employers immediately of his diagnosis so that he can't fly. "Already done," I told him, and couldn't help but feel satisfied that I was one step ahead of him.

Within a month of diagnosis, the pt had his brain mass resected and was diagnosed with stage IV GBM. What happened afterwards I don't know, only that the craniotomy left him debilitated and he required extensive PT and OT before he could undergo XRT. I doubt he will ever pilot a plane again, but at least we were able to stop him before he potentially had a seizure mid-flight, and no lives had to be put at risk. Who can say what was going on in Andreas Lubitz's mind when he chose to fly the plane into the Alps. Committing suicide is selfish enough, but why take 149 other lives with you? Nothing about this case makes sense to me. I shouldn't have to wonder if my pilot is of sound mind and body before I board a flight; that should be a given.