Objective consideration of the results of the investigation

That Andreas Lubitz caused the crash of the Germanwings plane on 24 March 2015 in the French Alps on the flight from Barcelona to Düsseldorf is found in many news reports and is based upon the following allegations by the investigating bodies:

  • He had locked the cockpit door after the captain left the cockpit.
  • He would have been depressed and on sick leave on 24 March 2015.
  • He had searched an iPad for ways to commit suicide and researched cockpit access codes.
  • He had deliberately initiated the final descent of the Germanwings plane.

The attempt to verify these allegations are based on the more than 21,000 pages of investigation files of the Düsseldorf public prosecutor and the Marseille public prosecutor’s office as well as the BEA (Bureau d’Enquêtes et d’Analyses pour la sécurité de l’aviation civile) final report of the accident investigation.

 

The cockpit door that cannot be opened

In various reports on the Germanwings crash, it was said that the co-pilot had locked the cockpit door to lock out his colleague. In the BEA final report, German version, it is noted on page 38(1) that at the time of the pilot’s return the buzzer signal and another noise were recorded on the CVR (Cockpit Voice Recorder). However, the BEA final report clearly states that this other noise is not compatible with pilot manipulation of the cockpit door locking system. The BEA thus disproved that the pilot in the cockpit could have intentionally locked the door. The BEA goes on to make the statement in its final report that the pilot “did not open the cockpit door and thus prevented other persons from accessing the cockpit”(2).

The question arises, why did the pilot not open the cockpit door? In this context, page HA 04310 of the investigation file of the Germanwings crash documents demonstrates what the result of the CVR recording revealed with regard to the condition of the co-pilot present in the cockpit(3).

“Listening to the various recording channels revealed that breathing could be heard through the mouth microphones, which meant that he was alive, although it was not possible to prove whether he was also conscious.”

In his expert report on the Germanwings crash the author, journalist and aviation expert Tim van Beveren comes to the conclusion that the pilot was incapable of acting or was unconscious in the cockpit(4). In this case, however, the cockpit door can be opened by entering on the keypad a three-digit emergency code which every crew member knows. There were indications from Germanwings employees that the keypad of the aircraft involved in the accident had a defect that made it impossible to successfully enter the emergency code, and thus the cockpit door could not be opened despite any attempt to enter the code(5).

It should be noted that four microphones are recorded on the four tracks of the CVR. Each pilot has his own microphone attached to the headset. There is an area microphone, which picks up sounds and noises from the entire cockpit. And on the jumpseat (seat for an additional crew member) is another headset with microphone.
According to investigation file HA 05266, the allocation of tracks of the co-pilot and captain by officers of the Air Traffic Gendarmerie SRTA Paris Charles De Gaulle was as follows:

• “Track 1 corresponds to a high-quality recording of the last 30 minutes of the co-pilot’s headset.
• Track 2 corresponds to a high-quality recording of the last 30 minutes of the flight captain’s headset.”(6)

Accordingly, the investigation assigned track 1 to the co-pilot and track 2 to the captain. However, this clearly contradicts the Airbus manual, the Flight Crew Operating Manual and the Airbus wiring diagrams of the crashed Germanwings aircraft D-AIPX. This original Airbus wiring diagram clearly shows that

• the CVR track 1 is assigned to the captain and not to the co-pilot, and
• the CVR track 2 is assigned to the co-pilot and not to the captain.

This raises the question of who actually remained in the cockpit, the co-pilot or the captain? Voice identification with the captain’s wife and the co-pilot’s parents to clarify this discrepancy was never carried out.

The conclusion is that the co-pilot or captain did not manually activate the “lock function” for the cockpit door. He was incapacitated or unconscious in the cockpit. However, the captain or co-pilot was also unable to open the cockpit door by entering the emergency code because the keypad had a defect.

 

Was Andreas Lubitz depressed and on sick leave on March 24, 2015?

In December 2014, Andreas Lubitz noticed problems with his eyes and consulted various doctors. In keeping with his character, he not only sought the help of a doctor but always sought at least a second medical opinion.
His family doctor, who could not initially determine a cause, referred him to various eye specialists, but no eye disease could be found. The family doctor, therefore, developed the theory that it could be a psychosomatic illness and referred Andreas Lubitz to appropriate specialists, such as psychiatrists and psychologists. The psychiatrist who treated Andreas Lubitz for his depressive episode in 2008 and 2009 issued a specialist medical certificate on 29 January 2015, see page HA 10309(7) of the investigation file. It explicitly states:

“The patient named above appears to be completely healthy from a psychiatric point of view. There is no indication of a psychiatric disease. Regarding illness, Mr. Lubitz does not have a higher risk than the average population.”

However, the family doctor maintained her suspected diagnosis of a psychosomatic cause and wrote Andreas Lubitz off sick from 22.2.2015 to 24.2.2015 due to sleep and visual disturbances and finally initiated an appropriate examination and treatment in the direction of psychosis on 10.3.2015. For the periods of taking medication, Andreas Lubitz had a corresponding certificate of incapacity to work, which he also presented to his employer.

The family doctor issued a certificate of incapacity for work from 12.3.2015 to 30.3.2015 on 12.3.2015. By 18.3.2015, however, the situation had not improved. The family doctor was on vacation and so Andreas Lubitz went to the practice of the substitute doctor. This substitute doctor ended the erroneous treatment in the direction of psychosomatic illness, phased out the medication and wrote Andreas Lubitz off sick for this phasing-out period from 18.3.2015 to 22.3.2015. The amended certificate of incapacity for work was dutifully handed over to the employer, Germanwings, on 18 March 2015, see HA 10594(8), certificate of incapacity for work for submission to the employer. The certificate of incapacity for work also bears the receipt stamp of Germanwings. A copy of the old certificate of incapacity to work until 30 March 2015, issued by the family doctor, was found torn up in Andreas Lubitz’s flat, see HA 09570(9), as it was now obsolete and was only intended to be presented to the health insurance company and not to the employer.

However, in the press conference of the Düsseldorf public prosecutor’s office on 27 March 2015, public prosecutor Dr. Kumpa presented these investigation results as if Andreas Lubitz had not presented the certificate of incapacity for work to his employer but had destroyed it in order to conceal his illness. According to public prosecutor Dr. Kumpa, the torn certificate of incapacity for work found during the house search of the Düsseldorf flat was proof of this.

The bottom line, however, is that Andreas Lubitz did not hide his illness from his employer. This is clear from the documentation of the certificates of incapacity for work that had been duly submitted. Andreas Lubitz was last thoroughly examined by a general practitioner as late as 18.03.2015 and was given written sick leave up to and including 22.03.2015. Previously issued certificates for a longer period of time were thus obsolete. In addition, as a psychiatrist testified, Andreas Lubitz was neither suicidal nor suffering from any form of psychiatric illness.

 

The iPad search

In the press conferences held by the prosecutor of Düsseldorf, Dr. Kumpa, he mentioned that an iPad had been found with which Andreas Lubitz had searched for ways to commit suicide, medication information and also cockpit code access. However, the investigation file with its more than 21,000 pages refutes this statement by Dr. Kumpa.

According to the search and seizure protocol, see HA 09578(10), an iPad was seized during the search of Andreas Lubitz’s flat in Düsseldorf on 26 March 2015. In a file note, supplement to the police search on 26.03.2015, see HA 09581(11), it is stated that by mistake in the seizure report the number of iPads found and seized was listed as one (1). It is confirmed that the actual number of iPads was two (2). However, the criminal investigation department, which examined both iPads, found nothing “relevant to the proceedings” (HA 08916(12), HA 08910(13)), so both iPads were inconspicuous. One of the iPads belonged to Andreas Lubitz and the other to his partner.

According to HA 09803(14), Andreas Lubitz’s partner handed over another tablet or iPad to the Düsseldorf criminal investigation department after being questioned as a witness on 26 March 2015. Thus, there were now three iPads among the evidence at the Düsseldorf criminal investigation department. On this third iPad the Düsseldorf criminal investigation department found search terms such as “suicide”, “buy cyanide”, “chloroquine suicide” after reviewing the internet history on 18/19.03.2015, and that on 20.03.2015, among others, the keywords “code cockpit door” were searched for, see HA 08923(15).

According to the interrogation protocol, however, the criminal police did not question the partner about why the iPad was not found during the search of the joint flat; where it was at that time; where it was during the entire time in question when the search and seizures were carried out; and who had used it. The fact that the third iPad was not found during the search of the flat and was only handed over later by his partner makes it clear that the device was apparently not under the control of Andreas Lubitz nor had it been in his flat. Why was it not determined where the device was during the period in question? Who had the device from when to when? According to the investigation file, there is no evidence of an investigation.

Could it be that the search for the cockpit door access code was carried out by another person, inspired by a TV report on the current use of cockpit access codes (as also noted by the Criminal Investigation Department in the printout of the web searches on page HA 08930(16): “Report shows code for cockpit door on TV”)? Why should Andreas Lubitz look for cockpit door access code information on the internet, as he was certainly informed of it by his airline and therefore knew it anyway? Even if the two iPads directly seized during the home search did not have any contents relevant to the proceedings, the history of the use of these devices would be of crucial importance. If, for example, the iPad had been used by Andres Lubitz at the times when the third iPad, which was handed over later, was also used, then it would be ultimately clear that the third iPad was not used by Andreas Lubitz and that the online searches apparently incriminating him could not have been credited.

However, all these open questions were not comprehensively investigated and must therefore be considered unresolved. How can it be that the criminal investigation department as well as the public prosecutor’s office did not question the partner either on 26.3.2015 or later on the use and the user of the third iPad? Why was it not precisely clarified whether this iPad had been accessible to Andreas Lubitz at all? Why doesn’t the investigation file explicitly state where it was actually located between 3/16/2015 and 3/26/2015 and who was using it? Why does the investigation file not explicitly state when the other two iPads were used?

So how could the investigation simply arbitrarily assign this web history to Andreas Lubitz without having explored and verified the context of these searches? The criminal police and the public prosecutor’s office seem to have jumped to the conclusion, without any factual basis, that Andreas Lubitz would have operated the iPad during that time and carried out these searches without even remotely considering, checking and ruling out other possibilities.

The bottom line is that the conclusions of the Düsseldorf public prosecutor’s office are devoid of any factual basis, i.e. they are pure conjecture and therefore completely worthless for evidentiary proceedings.

 

Who initiated the last descent of the D-AIPX?

In the BEA final report, German version of 13 March 2016, it is documented on page 13: “At 09:30:53 (point 4), the set altitude on the FCU (Flight Control Unit) changed from 38,000 ft to 100 ft within one second. This is the minimum value that can be set on the A320.”(17) It is assumed that the co-pilot caused the change in altitude by interfering with the FCU. To verify this, the transcript of the cockpit voice recorder protocol will be used. On the transcript of the cockpit voice recorder log, page HA 05280(18), at 09:30:53, there is no documented noise indicating an adjustment of the flight level at the aircraft controls. Thus, it is not documented that the co-pilot set the altitude at 100 feet. The reduction in altitude within one second from 38,000 ft to 100 ft at 09:30:53 must therefore have been implemented by the Flight Management System without manual intervention by a pilot. This phenomenon has already occurred several times before and after the Germanwings crash.

Extensively documented is an incident at the Australian airline Quantas, flight 72, on 7 October 2008. An Airbus A330, whose control interfaces are identical to the crashed Germanwings Airbus, was on a flight over the Indian Ocean to Perth, Western Australia. Suddenly and without warning it descended twice. In this incident 119 of the 315 passengers and crew on board were injured, 12 of them seriously, see Australian Transport Safety Bureau report “In-flight upset 154 km west of Learmonth, WA 7 October 2008 VH-QPAAirbus A330-303″(19)

As the Australian Transport Safety Bureau stated in its investigation, it is highly likely that defective data packets were sent via the data bus to the fly-by-wire electronic aircraft control system. This triggered the stall protection and the Airbus was sent without warning into descent by the Flight Management System. The three pilots on board were able to intervene and the aircraft continued the flight.

Another documented incident occurred on 19 March 2017. “On Mar 19th 2017 a Germanwings A319 enroute began an uncommanded descent two times.”(20)

The Germanwings Airbus A319-100 D-AGWG, equipped with the same flight control systems as the crashed Germanwings Airbus, twice went into a descent after several unexplained mode changes not initiated by the pilots. The intervention of the crew prevented the aircraft from descending further. These incidents demonstrate that Airbus aircraft can descend uncontrollably without warning and without human intervention in the aircraft controls. Disasters could only be prevented by the skilled intervention of pilots.

The conclusion is that it is highly probable that this phenomenon of uncontrolled descent also occurred on Germanwings flight 9525. Tragically, the pilot remaining in the cockpit was unable to act and the other pilot was unable to open the cockpit door to intervene. As a result, the Germanwings Airbus crashed in the French Alps.

Conclusion

If one analyses the four so-called facts, they do not stand up to factual scrutiny. This shows how superficially and inaccurately the investigations were conducted and how clear indications in another direction were overlooked or ignored with preconceived opinion.

L. G.

 

References

(1) Excerpt from page 38, BEA Final Report, German version of 13 March 2016
https://www.bea.aero/uploads/tx_elyextendttnews/BEA2015-0125.de-LR_04.pdf
(2) Excerpt from page 122, BEA Final Report, German version of 13 March 2016
https://www.bea.aero/uploads/tx_elyextendttnews/BEA2015-0125.de-LR_04.pdf
(3) Excerpt from page HA 04310 of the investigation file of the Düsseldorf public prosecutor’s office
(4) Excerpt from page 109, expert report of the crash of Germanwings flight 4U9525, Tim van Beveren
https://andreas-lubitz.com/wp-content/uploads/2018/04/Gutachten-zum-Germanwings-Absturz-4U9525-S-61-120.pdf
(5) Excerpt from page 98, expert report of the crash of Germanwings flight 4U9525, Tim van Beveren
https://andreas-lubitz.com/wp-content/uploads/2018/04/Gutachten-zum-Germanwings-Absturz-4U9525-S-61-120.pdf
(6) Excerpt from page HA 05266 of the investigation file of the Düsseldorf public prosecutor’s office
(7) Excerpt from page HA 10309 of the investigation file of the Düsseldorf public prosecutor’s office
(8) Excerpt from page HA 10594 of the investigation file of the Düsseldorf public prosecutor’s office
(9) Excerpt from page HA 09570 of the investigation file of the Düsseldorf public prosecutor’s office
(10) Excerpt from page HA 09578 of the investigation file of the Düsseldorf public prosecutor’s office
(11) Excerpt from page HA 09581 of the investigation file of the Düsseldorf public prosecutor’s office
(12) Excerpt from page HA 08916 of the investigation file of the Düsseldorf public prosecutor’s office
(13) Excerpt from page HA 08910 of the investigation file of the Düsseldorf public prosecutor’s office
(14) Excerpt from page HA 09803 of the investigation file of the Düsseldorf public prosecutor’s office
(15) Excerpt from page HA 08923 of the investigation file of the Düsseldorf public prosecutor’s office
(16) Excerpt from page HA 08930 of the investigation file of the Düsseldorf public prosecutor’s office
(17) Excerpt from page 13, BEA Final Report, German version of 13 March 2016
https://www.bea.aero/uploads/tx_elyextendttnews/BEA2015-0125.de-LR_04.pdf
(18) Excerpt from page HA 05280 of the investigation file of the Düsseldorf public prosecutor’s office
(19) http://www.atsb.gov.au/media/3532398/ao2008070.pdf
(20) https://avherald.com/h?article=4aad6354&opt=0

 

References_Objective consideration of the results of the investigation

 

further posts:

What conclusions do the investigation results allow so far?