Gregory Ostrom, a doctor in Elgin, Ill., estimates that he has seen 200 pilots a month for the past 13 years and calls them "great people." The most common mental issue he sees is obsessive-compulsive behavior — pilots are perfectionists. But he admits that his examinations aren't psychiatric in nature.
"Nobody sits down and says, 'Tell me about your home life,'" he said.
Ostrom said he relies on his experience observing patients to know whether to question a pilot's emotional state. About once every three years he is concerned enough to refer somebody to the FAA for a decision on mental fitness, and those are almost always student pilots, he said. Even if there was a formal psychiatric review, Ostrom is not sure that it would make flying any safer. People can snap months after seeming normal during an exam.
"A person who is suicidal today may not have been for the last 10 years, but his circumstances may have changed dramatically," he said.
Doctors who issue medical clearances must be approved by the FAA. Most are generalists, not psychiatrists, and that troubles New York attorney Jonathan Reiter. He sued JetBlue Airways and reached a confidential settlement on behalf of 35 passengers after a pilot had a nervous breakdown in the middle of a cross-country flight in 2012. He said the pilot got his medical clearance from an osteopath in Florida.
"They hand this off to someone who's not trained in psychiatric investigation, and there's no requirement to conduct a psychiatric interview, even a rudimentary one," Reiter said. "The whole vetting process is paying lip service to the issue of mental illness."
There are about 72,000 airline pilots in the U.S. There have been no fatal accidents on a so-called mainline U.S. airline since 2001, and none on a regional carrier since a Colgan Air plane hired by Continental Airlines crashed in 2009 near Buffalo, N.Y., killing all 49 people on the plane and one on the ground. That crash was blamed on pilot error. The largest pilots' union says the safety track record validates the screening system.
"You're sitting down with a doctor twice a year, going through a series of questions related to a lot of matters," said Lee Moak, president of the Air Line Pilots Association. "We have the safest airspace in the world. This is another indicator that our members are healthy physically and mentally."
It is rare for the public to hear about a pilot having a mental breakdown, but not unprecedented:
The JetBlue pilot who left the cockpit and ran through the cabin, ranting about Jesus and al-Qaida. Passengers tackled him, and the co-pilot made an emergency landing in Texas. The 49-year-old pilot had passed his medical exam three months earlier. He was charged with interfering with a flight crew but found not guilty due to insanity. A later psychiatric evaluation was sealed by the court.
On a cargo flight in 1994, an off-duty FedEx pilot facing a disciplinary hearing attacked the cockpit crew with a hammer and a spear gun before being subdued.
Pilot suicide is suspected in some deadly crashes in other countries:
A top aviation official in Mozambique said that a preliminary investigation into a November 2013 crash that killed 33 people pointed to a deliberate act by the pilot, who apparently locked the co-pilot out of the cockpit. The investigation is continuing.
In 1999, U.S. investigators determined that the co-pilot of an EgyptAir plane deliberately crashed into the Atlantic shortly after takeoff from New York's John F. Kennedy International Airport. All 217 people on board died.
In 1997, SilkAir Flight 185 plunged into a river in Indonesia, killing all 104 aboard. U.S. investigators said that the pilot probably crashed on purpose, but an Indonesian investigation was inconclusive.
In 1982, a Japan Airlines jet plunged into Tokyo Bay while approaching Haneda Airport. The captain, who had previously been grounded for mental illness, reversed some of the engines. Twenty-four of the 174 people on board were killed.
Joan Lowy in Washington and Jim Gomez in Manila contributed to this report. Contact David Koenig at http://www.twitter.com/airlinewriter
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