As new details continue to surface about Andreas Lubitz, the co-pilot whom investigators believe intentionally took down Germanwings Flight 9525, many are questioning whether he had been sufficiently screened and monitored for health conditions that could potentially put passengers at risk.
Reports emerged in the German press that the 27-year-old pilot had a medically documented history of depression from when he was in training. Additionally, German prosecutors said Friday they had found evidence that Lubitz may have been hiding a recently-documented health problem from his employer, Lufthansa, where he had worked since September 2013.
Were these issues his employer, a physician or the European Aviation Safety Agency -- the European equivalent of the FAA -- should somehow have caught before this tragedy?
In the U.S., the Federal Aviation Administration oversees initial and follow-up medical and psychological evaluations of pilots who wish to maintain their license to fly either private or commercial aircraft. Dr. James Vanderploeg, a professor of aerospace medicine at the University of Texas Medical Branch in Galveston, who conducts medical and psychological screening for the FAA, says similar requirements are mandatory for pilots outside the U.S.
"Each country has its own aviation authority, and part of that is the medical requirements, and they're quite similar across most of Western Europe and the U.S. and Canada," Vanderploeg told CBS News. "The pilot examinations for airline pilots include a review of the medical history of the pilot, which includes any psychiatric history or psychological treatments or psychiatric treatments, along with the other medical history and the physical examination, review of any medications that the pilot may be taking, the impact those medications may or may not have on suitability to fly."
There are some mental illness diagnoses that are "specifically disqualifying," said Vanderploeg. Patients diagnosed with bipolar disorder, psychosis, a history of substance abuse or substance dependence, or personality disorders with a history of "outward acts of abnormal behavior" can be blocked from obtaining -- or maintaining -- their license. However, the FAA states that in some cases, if the condition is "adequately controlled" and monitored, medical certification may be allowed.
Vanderploeg added that up until about three years ago, the FAA included clinical depression on the list of disqualifying conditions. Now in the U.S. there is a certain process and criteria by which a pilot with a history of depression can still maintain a license. They must undergo more frequent evaluations, and the the pilot must also provide documentation that he or she is on a regular, therapeutic dose of one of four SSRI antidepressant drugs for at least six months. Prozac, Lexapro, Zoloft or Selexa are the only drugs approved by the FAA's medical authorities as effective and safe for pilots, according to Vanderploeg.
"The U.S. was certainly not the first country to initiate a process like this to enable pilots with depression to potentially get back into flying," said Vanderploeg. "If a pilot is diagnosed with depression and is taking one of these medications, there's a very extensive initial evaluation that is required even before being granted the medical certificate, and then the follow ups with neuropsychological testing. It's a very intensive monitoring program to make sure that the person is well controlled, not having adverse side effects from the medication and is doing well."
The follow-up reporting must include documentation from the treating psychiatrist that the pilot is taking their medication. Additionally, Vanderploeg says the pilot's employer is required to send reports every three months to the FAA on the pilot's behavior and job performance.
Investigations into Lubitz's medical history have not yet revealed whether he was taking any medications at the time he crashed the Airbus A320 into the French Alps en route from Barcelona to Dusseldorf. Though SSRIs have in the past been known to put a patient at an increased risk for suicide, Vanderploeg says the FAA has approved these drugs after a careful review of their safety profile, including their risk for physical side effects such as drowsiness. "You can't assume that an increased risk of suicide applies to all SSRIs," he said.
Vanderploeg says during the initial screening process with an FAA physician, the pilot is required to offer their full medical history during a conversation. This means that at first the FAA is relying on patient-reported information to build a comprehensive medical history; this can, no doubt, leave room for oversight or omission. When Vanderploeg conducts a screening, he will also ask questions about the pilot's family medical history and chronic health conditions such as heart disease, high blood pressure, diabetes. He pays specific attention to identifying problems like depression or anxiety.
Then Vanderploeg conducts a full physical examination of the patient "from head to toe, and specially looking for those kinds of things that could adversely impact performance as a pilot."
The FAA doesn't require a patient's physicians to release medical records to the agency as part of their evaluation, unless it's determined that there is a history of some type of medical treatment that could impact the pilot's physical and psychological qualifications.
"If that were to occur, then that becomes part of the review of whatever that condition was at the time of their next pilot medical exam to determine whether or not that condition has been resolved," he said.
Lubitz himself would have undergone an FAA medical evaluation just like the one Vanderploeg described. Earlier this week, it was confirmed that in 2012 Lubitz obtained an FAA license to fly private aircraft in the U.S.
He would have had to stay up-to-date on his medical evaluations in order to hold on to that license. Vanderploeg said the frequency of follow-up evaluations depends on a pilot's age and type of flying he or she plans to do. The FAA requires annual follow-up evaluations for pilots up to the age of 40; pilots 40 and older are required to get evaluated every six months because "as we get older things start happening to us," he explained.