Medical Privacy Rules Let Germanwings Co-Pilot Conceal Illness

Alone in the cockpit in control of Germanwings Flight 9525, Andreas Lubitz was harboring a potentially lethal secret.

Ignoring instructions from his doctor, who certified him unfit to fly on the day the plane crashed into the French Alps, the 27-year-old appears to have single-mindedly set in motion the chain of events that resulted in the worst air disaster for the low-cost airline and its parent Deutsche Lufthansa AG, killing all 150 people on board.

Strict medical privacy laws mean the companies were oblivious to the potential dangers lurking in Lubitz’s mind as the first officer took the plane into a steep descent over the region that members of his local gliding club, where he developed his passion for flying, had toured in the past. Confidentiality regulations, designed to protect medical data and encourage people to consult doctors without fear of repercussion, put the onus on patients to disclose potentially hazardous diagnoses to authorities and their employers.

“The medical secrecy rules are centuries old and touch the core of the medical profession,” said René Steinhaeuser, an attorney at Wigge lawyers in Hamburg who specializes in medical law. “Without that, the relationship between physician and patient, and thus the medical system as a whole, wouldn’t work.”

Sparking Debate

The case is sparking debate over how practices may be changed as a result of the tragedy and whether medical records should be shared with employers in certain cases. It also raises questions about Lubitz’s period of absence from flying school that delayed his qualification, reasons of which weren’t disclosed to Lufthansa.

“The political discussion about making private data like medical files more easily accessible to employers is a double-edged sword,” said Bryan Ware, Chief Technology Officer at Haystax Technology Inc. in Los Angeles, which develops solutions that help employers rank employees by the likelihood that they may pose a threat to the organization.

If an employee “knows or believes his medical record will be reviewed, potentially to determine if he or she should get a promotion, that person is less likely to seek professional help,” he said.

Psychosomatic Condition

Lubitz, who started his pilot training in 2008, took leave for “several months” at one point, Lufthansa Chief Executive Officer Carsten Spohr said on March 26, declining to give additional information, citing medical confidentiality.

The co-pilot suffered from a psychosomatic condition and was being treated by several neurologists and psychiatrists, according to a person familiar with the investigation who declined to be identified because the information isn’t public.

Prosecutors retrieved unfilled prescriptions for tranquilizers to fight manic depression as well as large amounts of sleeping pills and unopened bottles of anti-depressants from his home, according to a report on Sunday in Bild Zeitung, which didn’t say how it obtained the information. Lubitz was also suffering from a detached retina, blurring his vision, which may have been triggered by his mental illness, the newspaper said.

Police in the city of Dusseldorf, who searched Lubitz’s home, declined to comment on the investigations, while prosecutors couldn’t be reached by Bloomberg for comment on the Bild report.

Sick Note

Psychosomatic disorders are physical diseases that are thought to have mental reasons such as stress and anxiety.

Prosecutors in Dusseldorf found a sick note at Lubitz’s home suggesting he was unfit to fly on the day of the crash, and said he may have concealed his illness intentionally.

There are two main exceptions under which a doctor may break the oath of confidentiality, said Steinhaeuser.

One is when a patient demonstrates symptoms of epidemic diseases, like cholera or typhus, and the other is when there is a suspicion the patient may be planning to commit a serious crime. There are no special rules that compel a doctor to alert authorities if a pilot is diagnosed with depression, he said.

“If he decides to hide it, it’s likely that he will successfully hide it,” said Andreas Adrian, a spokesman for Germany’s Association of Aeromedical Examiners.

Drug Tests

Certified aeromedical examiners are obliged to inform the Federal Aviation Authority if they detect a medical condition that could compromise a pilot’s ability to fly, said Adrian.

Since such examiners are generally not permitted to conduct drug tests, and are not trained or required to diagnose psychological illnesses, they “may only find out about such a condition if the pilot reveals it or demonstrates severe characteristics of these specific diseases,” he said.

Commercial pilots in Germany must undergo medical exams annually to maintain their licenses. If those checks by specially trained examiners reveal conditions that may impair a pilot’s ability to fly, that expert is not permitted to pass the patient and must inform the aviation authority. The authority then makes the call about what additional exams or treatments may have to be administered to assess if the pilot is fit to fly.

If a pilot chooses to consult a general practitioner to obtain a sick note excusing him or her from work, that physician is not obliged or in most cases not permitted to notify the airline or the aviation authority even if the illness potentially interferes with the pilot’s ability to fly, Adrian said. All the airline receives is notification of the duration of absence.

Some restrictions apply. If medical leave exceeds 21 days, or a pilot has to spend more than 24 hours in the hospital, or has undergone a general anesthetic, he or she must take the legally required medical exam anew with a certified aeromedical specialist, Adrian said.