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Judge calls for review of `sliding' air safety
http://www.thestar.com/NASApp/cs/Con...=1149242524490 Judge calls for review of `sliding' air safety Wrote '92 report that led to safer skies Fears plan to let industry self-regulate Jun. 17, 2006. 09:49 PM ROBERT CRIBB, FRED VALLANCE-JONES AND TAMSIN MCMAHON TORSTAR NEWS SERVICE Canadians need another public inquiry into aviation safety, says the judge who oversaw the last sweeping probe of the industry nearly two decades ago. Retired Alberta justice Virgil Moshansky is worried about a Transport Canada strategy to transfer much of the responsibility for safety oversight to airlines and make Transport a "partner" with the industry. Moshansky, whose massive report on the 1989 Air Ontario crash in Dryden that killed 24 people led to many improvements in air safety, fears the system is "backsliding" and says it should be reviewed once a decade. Experts agree many recurring safety problems have only been addressed after they killed people, leading to so-called "tombstone improvements." "I believe the government is moving away from more vigorous inspection and enforcement strictly as a cost-cutting measure, much as was done in the mid- and late-1980s preceding the Dryden crash," said Moshansky, made a member of the Order of Canada in 2004 for his "singular dedication to enhancing aviation safety." Moshansky proposes a review "at least equal to a judicial inquiry," adding: "I think you would have to make provision for the calling of witnesses under oath and so forth, to have a credible inquiry." He is not alone in his concern about the direction of air safety in Canada. Senior people across the industry, including former Transport Canada inspectors, pilots and mechanics, say they're witnessing a drift in safety standards. Capt. Raymond Hall, a 33-year veteran Air Canada pilot, says the current climate in Canadian aviation reminds him of periods prior to the Dryden crash, in which an Air Ontario jet crashed after takeoff, and the 1997 Fredericton accident in which an Air Canada airliner crashed while trying to land in heavy fog. "I think a serious incident is looming. It's just a matter of who, where and what form it will take," says the 56-year-old Hall. "There is going to be something that causes the public to take concern with the laissez-faire attitude of both the regulatory authority and airline management that mandates or tolerates the squeezing of resources and necessarily impinges on flight safety." In the past two weeks, an investigation by the Toronto Star, the Hamilton Spectator and The Record of Waterloo Region has revealed growing cracks in Canada's aviation industry, with close calls in the sky, growing numbers of mechanical defects, lax oversight of airlines and regulations allowing dangerous bad weather landings and overwork of flight crews. Transport Canada's answer to future air safety is "safety management systems" or SMS, which is a form of industry self-regulation in which airlines will develop and maintain their own safety protocols. Under the current system, federal inspectors conduct detailed audits and on-site monitoring of airline operations, which include boarding planes, riding along on flights and studying maintenance logbooks. Under SMS, the responsibility for such hands-on monitoring largely shifts to the airlines themselves. Visits from Transport Canada inspectors will largely focus on auditing the performance of airlines' safety systems. Transport Canada is phasing in SMS regulations gradually across the industry. The new regulatory scheme will be in force by 2008. The SMS concept is not uniquely Canadian, and has the support of air carriers and the Air Line Pilots Association. But there are those with doubts about whether Transport Canada's version of SMS - with the regulator also backing away from being safety cop to becoming an industry partner - will work in a competitive industry with razor-thin profit margins and cost-cutting pressures. Some fear the regulator is repeating tragic mistakes, backing away from a pro-active role in aviation safety. "The first place (the government reduces costs) is safety because that's where you can make the easiest cuts and hope that all is going to be well," Moshansky said. Marc Gregoire, Transport Canada's assistant deputy minister of safety and security, calls it a "shifting relationship between the operator and the regulator" that will make federal inspectors partners with the commercial airlines they inspect. "There must (be) a willingness on the part of the regulator to step back from involvement in the day-to-day activities of the company in favour of allowing organizations to manage their activities and related hazards and risks themselves," Gregoire told 400 aviation industry representatives at a recent conference in Halifax. "Companies will have the freedom to use the most cost-effective method of improving safety performance." But Moshansky bristles at the idea of a partnership. "I am skeptical whether `partner relationships' between the inspector and the inspected are in the best interests of aviation safety," he said. "It is possible if they get too cozy, they'll maybe let things slip by." Ted Price also believes Transport Canada is moving in the wrong direction. Price's son, Wayne, was at the controls of the Georgian Express plane that crashed just after takeoff from Pelee Island on Jan. 17, 2004, killing all 10 aboard. Wayne gave up a career as a police officer to return to aviation, a career he loved. He had started on the Pelee run, flying an eight-passenger Cessna Caravan, the month before the crash. A Transport Safety Board investigation found the crash happened because the plane took off overweight and with ice on the wings. But it also pointed a finger at Transport Canada, saying lax oversight was a factor in the tragedy. "(Transport) is suggesting operators will effectively and efficiently police themselves," Price said in an interview. Given the history of these many tragedies, how can (Transport) go ahead and try to implement something like this? "You can have all of the regulations in the world, but regulations without good policing - by that I mean audits and inspections - it will fail." That message has been delivered time after time: In 1981, a federal inquiry into aviation safety led by Mr. Justice Charles Dubin said "enforcement should play a very significant role in an aviation safety program. ... It is presently not doing so." Resources were beefed up. In 1992, Moshansky's final report on the Dryden crash found Transport Canada had once again failed and he called on the department to "focus adequate resources on surveillance and monitoring of the air carrier industry, with emphasis on in-flight inspections and unannounced spot checks." Moshansky, recipient of Transport Canada's aviation safety award in 1995, warned of the consequences of a hands-off regulatory approach, concluding that a "degree of laxness" led to the (Dryden) accident and said in a statement at the time that the accident "did not just happen by chance - it was allowed to happen." It all led to, yet again, beefed-up inspections and resources. In 1998, a report on the air taxi industry in B.C. recommended more hands-on checks. A policy to implement it was drafted, but insiders say it was never implemented. Transport insiders talk of a repeating pattern: crash, inquiry, improvements, then a slide backward. "Those of us that have been around a while kind of wonder when is the next crash and public inquiry," said Greg Holbrook, national chairman of the Canadian Federal Pilots Association. It represents pilots working as inspectors at Transport Canada and investigators at the Transportation Safety Board. -------------------------------------------------------------------------------- `How safety emerges out of (SMS) to me is magic, it's mysticism. I have no idea' Dr. Sidney Dekker, professor of human factors and aviation safety at Sweden's Lund University -------------------------------------------------------------------------------- Pilots, mechanics and Transport Canada insiders interviewed for this series agree safety has slipped and the SMS plan could weaken it further. "This is the worst thing they could do," says a senior mechanic with a major Canadian airline who spoke on the condition of anonymity. The bottom line is Transport Canada needs to show their presence. The public deserves it. Transport Canada is sitting in the bush." SMS is being driven by Transport Canada's need to reduce costs, say many industry insiders. The budget for aviation safety regulation is actually expected to drop from $265 million in 2003-2004 to $243 million by 2007-2008. "The departments are under increasing financial pressures to find ways to keep doing the job, and do it for less money" Holbrook said. Transport Canada's director of civil aviation, Merlin Preuss, acknowledges that resources are a factor in the adoption of SMS as 46 per cent of the department's workforce will be retired or eligible for retirement by 2013. "Replacing these employees, let alone adding to the current workforce, to continue the current oversight regime given the current and predicted workforce demographics, is not feasible," he said in a speech at the Halifax conference. Moshansky believes regular, unannounced spot checks are key to keeping airlines on their toes. "I have grave doubts that Transport Canada can properly fulfill its function of providing a safe aviation environment for the travelling public with fewer aviation inspectors." Dr. Sidney Dekker, professor of human factors and aviation safety at Sweden's Lund University, calls SMS the "McDonaldization" of aviation safety. "It's about making the customer do the work because (regulators) don't have the cash," says Dekker, who was invited to speak at Transport Canada's recent industry conference. "How safety emerges out of that to me is magic, it's mysticism. I have no idea. I don't think we have the models that explain to us how safety can emerge from a well-applied SMS. If it does, we're just lucky." Air Canada, the country's largest carrier, welcomes the SMS approach, saying it builds upon safety systems the airline already has internally. "When we find something that isn't operating the way it should, we have the expertise within the airline, and in many cases far greater expertise than a regulator would have," said John Bradshaw, the airline's manager of safety management systems. Former Transport Canada test pilot Shawn Coyle says while the strategy will probably work at larger carriers with strong safety cultures, it's a different story at financially struggling airlines where corners are more likely to be cut. "It is like saying, `We expect you as a driver to report when you are not driving well, and to tell us when you exceed the speed limit, so we can send you a fine,'" Coyle said. Rick Bray, a retired Transport Canada safety investigator, agreed there are serious shortcomings in his former employer's inspection regime. A policy requiring inspectors to warn companies when they would be doing inspections was one of several problems with an safety oversight system that is understaffed, overburdened with paperwork and allows airlines a broad interpretation of the rules, he said. Bray said he has seen a host of maintenance abuses, including airlines that skip internal aircraft inspections or delay them by not recording flying hours in a plane's logbook. But such violations rarely resulted in tough punitive action, he added. "It is too easy for operators that are on the slippery slope to continue in operation by some way, shape or form (by) manipulating the regulations," said Bray. "To shut down somebody is really hard. You don't like to see people shut down. There are jobs involved. There's politics involved." Even when Transport Canada inspectors do assess penalties, they are generally small - a few hundred dollars or brief licence suspensions. That level of enforcement is set to shift further. Under the safety management system, Transport Canada will allow airlines to make their own "corrective plans" when unintentional violations occur. If an inspector believes a company has an adequate system in place to deal with a problem, even the plan won't be required. As Transport Canada's Gregoire says: "Better safety means more trust." Australia's experimentation with trusting its aviation industry in the 1990s holds little comfort for Canadian travellers. The strategy was introduced under the mantra of "affordable safety" and was an effort by Australia's Civil Aviation Safety Authority (CASA) - the equivalent to Transport Canada - to cut costs, said John Wood, former chairman of the Pilot Council of CASA and an inspector who retired in 1999. He said inspectors were given less time training on aircraft and conducted far fewer inspections. Active enforcement was replaced by airlines running their own quality management programs. "Over a period of time, I suggest that the CASA inspectorate became less skilled and less cognizant of what was going on out there, particularly if you only go in once every six or 12 months and audit their system, especially if they know you're coming," said Wood. "On the basis of my own experience, I would not recommend (Canada) go this way. I can understand why they want to because it's probably going to save them costs. But if you deskill your inspectorate then you're flying in the dark, aren't you? You're flying blind." |
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