Email me for the lastest condemming report from leading psychiatrist Jonathan Phillips. This covers the chilling cover up of the Qantas medical files and the danger you were put in..
This document is to show Qantas ignored two psychiatrists and the CASA regulations and spent another 2 months searching for someone to clear me to fly.
In December 1999 I was only made aware of my medical file when CASA kindly sent me a copy of it. This was requested by me after Qantas sent the NSW police (event No. E 7891736) to my house to have me charged with extortion for asking them to review my staff travel entitlement.
In January 2009 after being directed by the Workers Compensation Commission arbitrator, Qantas supplied correspondence that previously had not been sent to CASA. This has clearly shown cover-ups by Qantas.
I would like to point out the facts that without a full understanding of all the documents and how they connect, one might not get a clear picture of the failure of the duty of care given to me by Qantas.
At no stage did Qantas give me any details of my illness apart from "You will not do it. I have a letter from the Qantas doctor referring to when I was under his care. At no stage to he give me a clue of the psychiatrist reports.
In 2000 it was after help from a psychiatric nurse reading the original CASA file that the whole story revealed and the failure of duty of care was made apparent. I had previously no idea on the reason behind my debilitating mental illness.
My illness began on the 29th August 1979 when I had the compulsion to shut down all the engines on a Qantas 747. On the 31st August on my return to Sydney I reported the illness to the Qantas doctor.
I have asked Qantas several times for the reports of Dr. Thompson but they refuse to give them to me. ( They have now been delivered)
If any doctor was going to fill out a workcover certificate it should have been him, but he broke the law by ignoring my illness.
Some of the psychiatrists thought that a knock on my head on 15th November 1973 while building my swimming pool was the cause of my illness. Except from Dr. Degotardi, Qantas withheld the reports by Dr. Alsop of The Royal Prince Alfred Hospital from the psychiatrists. Dr. Allsop's conclusion was that my scans were normal and therefore psychiatrists should not have put so much emphasis on this injury, especially those that saw me at the end of my employment, and especially after I had been asked to leave Qantas. No one thought to ask for a medical opinion from the time of the accident.
The psychiatrists made reference to the fact that I panicked during the head scan. This was due to the fact that the machine was lowered too far and squashed my head. What was I meant to do?
Although most psychiatrists blame this knock on my head for my illness mainly because they were not told of the scan results, they never knew that I had a serious head injury on the 14th March 1974 on a 707 aircraft while operating as the first officer.
On getting up from the navigators seat I hit my head on the locker above causing damage to my forehead and neck. This incident which in itself could have caused an injury similar to the one earlier accident ( which I was cleared from ) should be taken into account as it happened on duty and if it was so important to show that my illness was due to a head injury then this reported on should be considered.
After responsibly reporting the incidents of wanting to shut down the engines on two flights to Qantas, they sent me to see psychiatrist Dr. Colin Degotardi in Sydney.
In the report by Dr. Degotardi (Letter No. 1 in my file) the key factors are in the last two paragraphs.
This man has now a neurotic phobic anxiety reaction, which has been present in an acute form for 5 years and has become markedly worse for the last 4 or 5 days. It is likely that this disorder will continue without treatment and that he will experience further panic attacks similar to the one Last Friday. Those symptoms could be relieved by anxiety controlling drugs but these may affect his ability to fly and therefore would be no answer while on duty. He may be responsive to psycho-therapy, but this would be prolonged and of un-certain outcome. There is even a possibility of spontaneous recovery.
Behavior therapy with
appropriately aligned deconditioning may be effective but this is also
uncertain with strong probabilities of re-emergence of symptoms eve when
originally successful.
From this report (which doesn't blame the head injury) Dr. Thompson, Qantas Medical Officer should have had me grounded according to the Air Navigation Orders (below) as set out in a letter by Dr. J.C.Lane, 3rd September 1982 (my letter No. 11) Director of Aviation Medicine. Dr. Thompson should have been fully aware of the orders, as he was an approved Pilot Medical Examiner.
The A.N.O's for a Commercial Pilot and Airline Transport licence were.
Appendix B
Australian Air Navigation
Orders
3.3
Mental Fitness
(a) The applicant shall have no
established medical history or clinical diagnosis of either the following
( I ) a psychosis
(ii ) any personality order severe enough to have
repeatedly resulted in overt acts
(b) The applicant
shall have no established medical history or clinical diagnosis of a mental abnormality, personality
disorder, neurosis, alcoholism or drug dependence which makes it likely that
within two years of the examination he will be unable to safely exercise the
privileges of the licence or the rating applied for or held.
Dr.
Thompson was now aware that I should have been grounded but in all fairness he
sent me to a second psychiatrist, Dr. Warren White in Melbourne.
In the
report by Dr. White (Letter number 2 in my file) his key points were.
In summary there is no doubt that he presents a case of phobic anxiety
state, a fairly common neurosis, as also described by Dr. Colin Degotardi after
his interview on 4th September,1979.
Medication can relieve the strength of the symptoms but does not attempt
to deal with the cause. Psychotherapy which could be of some length being an
hour or two a week for some years may or not help to alleviate the condition.
Behaviour conditioning could well be tried and this would involve the
teaching of muscle relaxation, a state which inhibits feelings of panic and
anxiety.
Once again
Dr. Thompson was made aware that I should have been grounded, according to the
A.N.O's
Another
paragraphs that should be noted is,
He was
completely reconciled to the fact that he could lose his licence but he would
hope that Qantas would use his experience by giving him a job in the simulator.
By this report, Qantas were made aware that I would have accepted the fact that I shouldn't fly again and would have been happy as a simulator instructor. This position in a non-threatening environment (The simulator could have been stopped at any time) could have helped in therapy if Dr. Thompson had followed the advice he had been given.
A simulator position could have also been offered instead of the forced instruction to resign after the compulsion became too strong in 1982.
In the new 2009 documents received Qantas, sent me to Dr. Warwick Williams of the Northside clinic.
He gave me two thought stopping sessions, which entailed having a rubber band on your wrist and twanging it when you had the thought to change the subject. I was given very little time to practice this when Qantas sent me to Dr. John Ellard (Letter No. 3 in my file) in Sydney. He has some comparisons to demonstrate that my illness was not serious.
I think that first officer
Griffin comes into this category. It is quite common for those who are phobic
about heights to have the fear of voluntarily jumping off the edge of a cliff
(When they are standing on one) and many people standing on a railway station
have a sudden urge to jump in front of a train as it comes in. First Officer
Griffin's obsessional thoughts are in this category and not very far removed
from normality. One might mention in passing that quite a number of women who have
babies have obsessional thoughts about throwing their babies out of the window.
It is extremely unlikely that he would ever perform any of the acts which preoccupy him and I would have no hesitation in certifying him for all flying duties.
He was wrong, wrong, wrong.
Statistics show that hundreds of people have jumped in front of a train. When they are dead how can you determine why they did it?
Parents affected by a
mental illness http://www.kids.nsw.gov.au/kids/resources/publications/childdeathreview.cfm
The deaths of six (15.0%) children were precipitated by a
parent's or carer's mental illness. All six
children were female. The child's biological mother was the
perpetrator in four cases and the
mother's de facto was the perpetrator in two cases. All six
perpetrators had been diagnosed with
mental health problems, including psychotic disorders (3),
depressive disorder (2), and postnatal
depression (1). The children were either killed in the context
of depressive symptoms and
psychosocial stress or due to the perpetrator's delusional
beliefs that involved the child.
People that Dr. Ellard describes don't normally carry out
the act because they CAN WALK AWAY from the situation and thus defuses it. This
fact is mentioned in the report from Ashburn Hall where I had the compulsion to
step in front of a train in London. No, it didn't happen because I could walk
away.
That
is not the case when you are a pilot on a 10 hour flight with NOWHERE to go to
get out of the situation.
It is quite obvious that Dr. Ellard did not think any further than the fact that all the people he was talking about had an escape. I didn't.
The Qantas First officer's pilot's licence entitles them to act as Pilot in Command in cruise flight when the captain is off the flight deck.
Why have a pilot in charge of a 747 with his body in turmoil. It has been proven that the reasoning given by Dr. Ellard is not foolproof and that I was one case that could not control the compulsion similar to the now deceased would be train passengers.
My compulsion was not one of just killing myself which
could have been accepted, but Qantas knew that I wanted to take 450
passengers with me.
It was noted in a letter 7th December from Qantas Dr. Goldfinch to Dr. Tym that "I have been told that some captains will not leave the flight-deck for their normal 'crew rest' when operating by him"
Dr. Thompson of Qantas wrote to the Director of Aviation
Medicine on the 25th October 1979 stating, (my letter No. 4)
As mentioned to Dr. Lane on 25.10.79, Griffin has seen Dr. John Ellard, and a copy of his report 22.10.79 is attached. Dr. Ellard also phoned to emphasise his conviction that no contraindication exist to an early return to duty. At the licence examination today therefore I gave a pass assessment, after discussions with Dr. Lane
This is where Dr. Thompson failed in his duty of care to
me. He had two reports that I needed treatment and he knew the CASA regulations
but relied on flimsy examples by Dr. Ellard of why I should fly.
In all fairness to the travelling public I should have been
made aware of the diagnosis of my illness. I was the one with the compulsion.
To sit with a compulsion to shut down the engines for 10 hours was a sentence
of torture. I wonder of any of the example referred to by Dr. Ellard would have
lasted the 10 hours, not once but several times a week?
Apart from that, it was dangerous to have a first officer
thinking of other thoughts and twanging a rubber band. Scenario on take off.
"First officer Gear Up please" Oh just a second captain, I have one more twang
to do.
When Dr. Thompson sent his report to CASA 25th
October 1979 (my
letter No.4) he did not sent the reports by Dr.'s White, Degotardi and
Dr. Williams. If he had done his job correctly, as there should have been doubt
in his mind about my mental state, then these reports would have been closely
examined by CASA and I'm sure that I would not have been thrown back in the
cockpit so quickly. CASA who will not make comment now on my case have said
that today I would not be cleared.
The proof that Qantas did not send the reports to CASA is
in the letter from Dr. White to Dr. J.C. Lane, Director of Aviation Medicine on
10th May 1982. (My
letter No. 9)
Dr. Lane (assuming that I had never seen him) had written
to Dr. White to see if he would see me. Dr. White has this to say.
This was after I had been asked to leave Qantas and there could be no way of knowing how I would cope in a 747 flight deck.
I wonder whether it might be advisable for you to get from Dr. Goldfinch (Qantas) the previous reports from Drs White (me) and Degotardi, which he refers to in his letter as being held by you but obviously not in your possession.
(I could, of course, give you a copy of my report but I believe it would be more appropriate if you obtained it from Qantas)
Dr. White also had this to say about Dr. Tym. Dr. Tym was
rumoured to be banned from practicing in NSW, and now practices in Canberra. I
will cover Dr. Tym and his weird and dangerous treatment later.
Viewing the whole matter of Mr.
Griffin's illness and management over the years I could not be as confident as
Dr. Tym about the cause, management and prognosis.
Only Dr. Thompson knew the full extent of the
psychiatrist's reports on me and he should have considered them after an
incident on a flight that I was on in his letter to The Director of Aviation
Medicine on 17th September 1980. (My letter No.5)
He has flown with senior captains and has been most carefully scrutinised by them in view of his medical history. (There was understandable reluctance on their part to re-admit him to the flight deck - but as the months have passed they accept him less unwillingly.
The incident we discussed on September 16, concerned a hostile reaction from a captain on the flight deck (Sin/Bah 19th July) when Griffin unwisely chose to discus his medical history. Griffin was removed from duty precipitously and in my opinion quite unreasonably. After a long phone talk with the captain (in Bahrain) tied in myself and 2 senior pilots in Sydney, the crew re-united and completed the trip to Europe and back to Sydney with Griffin performing normal co-pilot duties.
This letter shows contempt for the law by Dr. Thompson and
the safety of the passengers. Although Dr. Ellard said the He would fly with
me, Dr. Thompson should have considered the reports of Drs White and Degotardi
to decide if I should continue on the flight as first officer.
If I was mentioning my problem to the crews, he should have
got the warning signals that I was still having problems. If I had no problem
then there would be no point in telling the other crew about them. See Dr.
Thompson's hand notes below.
The captain, according to the A.N.O's was perfectly correct
in removing me from the flight deck. If you were the captain of a 747 and the
first officer said, Captain, I have this feeling I want to shut down the
engines, could you sit back and ignore it as though it was a common occurrence.
I now have the report from the captain concerned and he
stated "It is not overly desirable to place the burden upon captains of having
a crew member under their command with such a medical condition as might give
rise to doubt their reliability.
My whole case should have been reviewed again, but rumours
were that Qantas thought that my so called illness was a scam to get my loss of
licence insurance, and for that reason they could not see the wood for the
trees.
In the new medical documents provided this is proven in Dr.
Thompson's hand notes where he states,
'Is he talking too much on his want'
Is he genuinely
having a recurrence'
'Is he still angling for a loss of licence on medical
grounds'
'he doesn't seem the best material for continuing flying'
At the same time the chief pilot received a memo from The
Safety Manager saying that he found Captain Gillies report 'both disturbing and
perplexing'.
Even after all the concerns Dr. Thompson still cleared me
to fly.
I he didn't fail me at the onset he should have done now
and let me claim my two loss of licence insurances.
As he said in his notes 'Is he talking too much' must have
surely rung alarm bells as it did with the captains. Dr Thompson put too much
faith in the report from Dr. Ellard.
When I felt that I was loosing control on my compulsive
thoughts, I took myself off duty in Honolulu and passengered back to Sydney.
Thoughts about the repercussions on my career went out the door, as passenger
safety was my main concern.
Qantas's Dr. Goldfinch referred me to Dr. Tym on 7th
December 1981.
He said in his letter to Dr. Tym that some captains will
not leave the flight deck for their normal "crew rest" when operating with him.
( this is against the CASA regulation of duty time)
He continued, " My view is contrary to those expressed by
the doctors two years ago. Obviously the persistence of the symptoms, and
'Going sick" in Honolulu, have helped me reach this decision.
A re-reading of the relevant ANO reinforces any view, and I
enclose a copy for your information. I feel that Bryan no longer meets the
mental fitness standard."
On the 3rd March 1982 Dr. Howell wrote to Dr.
Tym and said. "I had indicated that under no circumstances was Griffin to be
returned to duty without prior consultation with me." I could not, and would
not allow Griffin in his present state to resume flying company aircraft"
This when Qantas should have given me a medical retirement.
Dr. Tym said ( letter number 6 ) 11th December
1981
The illness is totally and permanently curable by an adequate dose of tricyclic drug given over an adequate time and he can now be returned to his normal, pre 1973 mental state within a month from now.
In two months time he will be 100% fit physically and mentally and off all medication. (impossible)
The high doses of Triptonal and Parnate that Dr. Tym gave
me can cause cardiac arrest and should never be given together. Also I have
been advised that a person cannot get onto these drugs; get to the normal dose
and the weaned off them in a period of 3 months. Please correct me if I am
wrong (with the proof).
Doctor Phillips says on page 10 of his report that I was
NOT cured as Dr. Tym had said and other doctors in their reports are not
convinced by his diagnosis.
Based on the reports from Dr. Tym, the operations section
asked me to resign. In their smooth talking about me being able to get a job
overseas, they reduced my normal staff trave allowance to a reduced level as
they said that I would get it with me new employer.
They well new the feeling of the Qantas doctors. However,
after I had signed the resignation from Qantas on the basis that I would be
able to keep flying they put on my certificate of employment that I left
because of ill health. If they had not renewed my licence I could have claimed
'Loss of licence insurance' but that was now impossible as I had a current
licence although I was not flying.
After months of turmoil and becoming very ill I contacted
Dr. Tym to see if he would put me back on medication. He declined but said that
he had a new technique, which he gave me several sessions of at the Sydney
Clinic. Very strange as he was the person that said I was permanently cured.
Dr. Tym's new procedure was to mimic the sun. The patient had to lie on a bed for three hours (yes three) staring into a bright light, which was to have the same effect as drugs on the brain. It did not work however and I continued to have physiological problems as described in other documents.
Several doctors have clearly stated that I never recovered and that the treatment given to me by Dr. Tym was dangerous.
His reports can't be taken seriously if you look at his weird treatments.
It is clear that if he even thought I had such an illness, then I shouldn't have been flying, so the reports from Dr. Thompson on my mental state were a figment of his imagination and his lack of knowledge of mental illnesses. In his position as a medical examiner of airmen he should have more concerns for the public's safety than his own theories, which in hindsight were very wrong
Because of the illegal actions of Qantas in ignoring the
reports of Drs White and Degotardi, my career as an airline pilot was thrown
out the door. If the treatment recommended had been followed and or a new
position in the company had been made available to me, I might not be in the
mess I am in today. That also applies to the treatment given to me by Dr. Tym.
Report by Doctor Jonathan Phillips
Mr. B Griffin is a 61 year old ex QANTAS pilot who developed an obsessive
compulsive disorder at around 29 August 1979 whilst flying as a co-pilot on a
747 aircraft. He became obsessionally pre-occupied with a particular emergency
procedure at that time and had a compulsion to carry out actions likely to
cause major problems for the aircraft which was then in normal operating mode.
He had a not dissimilar experience on 30 August 1979. He suffered generalised
anxiety symptoms additionally.
It should be noted that Mr. Griffin was "forced to resign" during
1982 after a turbulent period when fellow pilots were reluctant to fly with
him. He appears not to have managed to establish a continuing and satisfactory
career from that time. He remains obsessionally preoccupied with matters linked to his
treatment by Qantas and additionally in relation to his psychiatric assessment
and treatment.
It is always difficult to make comment on the management of a patient more that
20 years after the index event. Additionally there has been considerable
development in the classification of psychiatric illness since that time and in
the assessment and treatment of a person suffering from psychiatric illness.
In retrospect I believe the psychiatrists who examined Mr. Griffin in 1979
should have given more weight to his general anxiety symptoms leading up to and
including 1979, in addition to the obvious and acute obsessive-compulsive
components of his disorder. There may have been evidence additionally to
suggest that the client had underlying personality problems, particularly a
rather driven quality in the way he went about his life.
Taking all maters together, I believe Mr. Griffin should have been medically
retired at the time of his acute problems, particularly noting the difficulties
to be experienced in the management of any person with obsessive compulsive
disorder ( a point highlighted by Professor Ball) and matters of public safety.
It seems more likely than not that Mr. Griffin was given false hope during
1979, particularly that he would overcome his then problems and be able to keep
flying with QANTAS. As it happened the client was identified by other pilots as
having various problems and he appears to have been rejected by them.
Simply, If Mr. Griffin had been assisted in making an orderly medical
retirement at/around 1979, he would have been better able to address issues of
rehabilitation, particularly organising a further career in which he could use
the more generalised higher level skills gained during his period with Qantas.
If the above had applied, Mr. Griffin would have not experienced much of the
chaos and uncertainly which followed his exit from QANTAS. He would have been
in a position to find clearer direction in life and I doubt would have suffered
as severely from ongoing anxiety depression symptoms and depression spectrum
symptoms.
On my evaluation Mr. Griffin experienced a worsening of his symptoms generally
as a consequence of QANTAS expecting him to continue flying and failing to
organise appropriate medical retirement.
Amongst other matters I accept that Mr. Griffin experienced difficulties in
relation to his wife and his partner and these matters may have led to some
degree of ongoing psychiatric disturbance. However on the balance of
probabilities his psychiatric pathology would have been of lower order.
At this
relatively late stage, Mr. Griffin is likely to remain obsessionally
preoccupied by what he understandably considers to be inappropriate treatment
by QANTAS. He
is unlikely to benefit from intensive psychiatric treatment at this point in
time and will remain as he is indefinitely. It is more likely that not that he
will continue to experience dysphoric symptoms and the quality of his life will
remain impaired.
Jonathan Phillips
MB BS FRANZCP
Consultant Psychiatrist
19th March 2009
Opinion
It seems to me, in the
current circumstances, that my principal task is to reconsider your
psychopathology as it was during the period when you were employed as a pilot
with Qantas Airways Limited, and more particularly to determine, on the basis of
your medical history and a scientific understanding of your illness, whether
your position as a first officer with Qantas has caused or contributed to your
psychiatric problems.
Whilst I will keep within
my area of expertise, it will be necessary to reference your clinical status
circa 1979/1980 against the wording within s26 of the Workers Compensation Act 1926,
particularly s26(a) and s26(b), and also to reference your condition against
the wording in s74 of the Workers Injury
Management and Workers Compensation Act 1998.
There should be little
doubt that you have suffered anxiety spectrum symptoms intermittently over many
years and symptoms predated your period of employment with Qantas. The symptoms at the earlier time were probably
mainly of phobic type. I note
particularly the history obtained by Dr White who identified you to have
developed a fear of blood which began following the accidental shooting, and the
presence of anxiety linked with a fear of entrapment which followed the
immobilisation of your head at the time when you underwent a brain scan. Additionally, Dr Williams advised that you had
a number of phobias over a number of years which did not relate to flying.
I believe it might
reasonably be stated that you had a predisposition to develop anxiety spectrum
symptoms before 1979, but your symptoms were more of a phobic type than
reflecting an obsessive compulsive disorder.
You accidentally struck
yourself in the region of the left eyebrow with a hammer on 15 November
1973. You have been described as
suffering from a concussion at the time, which in essence is a low/middle grade
closed head injury generally of relatively short duration. You suffered headache following that
incident. Headache is a core symptom of
concussion. Dr Allsop assessed you within
two months of the injury and did not find any physical abnormality. He ordered a brain scan (type unstated) and
the radiologist did not find you to have any abnormality.
On the basis of the
above, it is highly unlikely that you would have suffered any continuing organic
damage to your brain which would have led to longer-term physical and/or
psychological problems. I believe it is
fanciful to consider that your accident on 15 November 1973 had any relationship
with the obsessive compulsive disorder which became problematic in 1979. Simply, a brain injury needs to be severe if
it is to be associated with any substantive psychiatric disorder including
obsessive compulsive disorder.
Perhaps the best
description of the onset of your obsessive compulsive disorder has been given by
Dr White. My colleague identified your
symptoms as having commenced suddenly on 29 August 1979 whilst you were flying
between Perth and Singapore. A check
captain was in the cockpit, and you were aware that he might ask you questions
about safety procedures involving the aircraft.
You developed, totally unexpectedly, a preoccupation with a situation of
loss of all generators with the onset of a compulsion to switch to cut-off. This was sensed by you as being both
irrational and dangerous and set in process substantive anxiety. You immobilised your left arm in order not to
act on the compulsion. The experience
occurred again on 30 August 1979 whilst you were flying between Singapore and
Sydney. You were so overborne by the
experience on the second occasion, as to cause you to experience a powerful need
to leave your seat. I understand that you
experienced similar excessive compulsive incidents with co-existing anxiety
symptoms on later flights.
I do not think that there
should be dispute about your obsessive compulsive symptoms which began on 29
August 1979 at a time of relative stress, and in the course of your routine
employment with Qantas as a first officer.
The obsessive compulsive incidents then took a life of their own, causing
you increasing distress and leading ultimately to the end of your career.
Additionally, it should
be emphasised that your early phobic anxiety symptoms and your obsessive
compulsive disorder represent different psychiatric conditions and must not be
confused. I accept, however, that you
developed, in keeping with your early phobic anxiety symptoms, a more general
state of anxiety. This state would have
reduced your psychological resilience and predisposed you to other psychiatric
symptoms at times of stress, including the beginning of your obsessive
compulsive disorder on 29 August 1979.
The fact that your
obsessive compulsive disorder began in the course of your employment with Qantas
is obvious. But for your position as
first officer, and concerns regarding possible questioning by the check captain,
you probably would have not developed obsessive compulsive symptoms associated
with loss of all generators. However, I
do not rule out the possibility (even probability) that you may later have
developed an obsessive compulsive disorder in some unrelated stressful
situation.
For the sake of clarity,
you met DSM criteria[1] for obsessive
compulsive disorder from the time of onset of your then symptoms. DSM III was coming into use at/around that
time[2]. Circa 1979/1980, obsessive compulsive disorder
was referred to either by that name or by the older name of obsessive compulsive
neurosis. Specifically, in keeping with
DSM III R criteria, you met criterion A for the disorder (the presence of
intrusive ego-alien thoughts relating to the situation of loss of all generators
and the presence of a compulsion of a powerful and repetitive nature to begin a
shut-down procedure); criterion B (your symptoms were of such significance at
the time to interfere with your role as a pilot) and criterion C (exclusion of
Tourette's disorder, schizophrenia, major depression, organic mental disorder).
You will note that the
word neurosis was still used at the
time. A neurosis is best described as a
disorder of the mind which is repetitive, obligatory, stereotyped and due to
non-organic causes. In many ways the word
neurosis reflected a lack of
understanding of the pathophysiology of the brain. It is a term which has no usefulness at the
present time and has been generally discarded.
The word neurosis has been
dropped from DSM nosology.
Obsessive compulsive
disorder is undoubtedly caused by an organic brain dysfunction. High resolution brain scanning (particularly
MRI, fMRI) demonstrates abnormalities in three separate brain areas, the orbital
frontal cortex, the cingulate gyrus and the caudate nucleus (the latter two
areas being deeper within the structure of the brain). The initial trigger for obsessive compulsive
disorder is within the orbital frontal cortex, which in turn makes connection
with the deeper structures[3]. A person with obsessive compulsive disorder
has virtually no control over their symptoms and actions. This explains why traditional psychotherapy
and behaviour therapy will lead at best to reduction only in the intensity of
symptoms. However there are minimally two
psychotropic agents: clomipramine (tricyclic anti-depressant) and fluvoxamine
(SSRI anti-depressant) which assist in the management of the disorder.
Let me now return to s26
of the Workers Compensation Act 1926
relating to causation of personal injury.
It is my firm opinion that s26(a) and s26(b) apply in your case. Specifically under s26(a) your employment
(practising safety procedures in your head whilst in the cockpit of a 747
aircraft, and in the presence of a check pilot) was a necessary and obvious
point in the development on 29 August 1979 of your obsessive compulsive
disorder. Additionally s26(b) seems to
apply, noting that even if you had relatively unformed obsessive compulsive
symptoms at the time, or a vulnerability to the onset of obsessive compulsive
symptoms, then events on 29 August 1979 would have aggravated, accelerated or
exacerbated the problem.
Further, I believe there
is strong clinical data to challenge comments made about you in the Notice under
s74 of the Workers Injury Management and
Workers Compensation Act 1998, particularly that you did not suffer an injury linked with your employment which
caused an incapacity for work.
Additionally, I do not believe there is evidence to demonstrate that you
suffered from an obsessive compulsive disorder prior to your experiences in the
747 aircraft on 29 August 1979.
Whilst you may have been
predisposed to the onset of obsessive compulsive disorder by 1979, the nexus
between events on 29 August 1979 and the onset of your disorder is
absolute.
In keeping with comments
made in my email to you, I believe you had symptoms of obsessive compulsive
disorder of sufficient intensity from 29 August 1979 to have made you a risk to
passengers in your aircraft, a point reinforced in the report prepared by Dr
Goldfinch where he makes mention of potential operational
problems.
It is true that many
people with obsessive compulsive disorder do not act on their compulsions. However some do. A compulsion to carry out an action which
could lead to an air disaster should have been taken seriously by Qantas. Simply, there is a great difference between a
compulsion with potential to cause danger to substantial numbers of other
persons, and a personal compulsion which would not affect those around you or
the public more generally.
I have reconsidered my
2001 report. My opinion in that report
remains unaltered. The 2001 report and
this document will best be read together.
Yours
faithfully
JONATHAN
PHILLIPS
Clinical Associate
Professor
[1] The Diagnostic and
Statistical Manual of the American Psychiatric Association is the accepted
nomenclature for psychiatric disorders in many countries. I have used DSM as the reference point in this
report.
[2] There have been three
classifications of DSM since then: DSM IV, DSM IV R, DSM IV TR.
[3] The best readily assessable summary of the pathophysiology of obsessive compulsive disorder is to be found in
