The National
Transportation
Safety Board determines that the probable cause of this accident was
the
in-flight separation of the vertical stabilizer as a result of the
loads beyond
ultimate design that were created by the first officer's
unnecessary and
excessive rudder pedal inputs. Contributing to these rudder pedal
inputs
were characteristics of the A300-600 rudder system design and elements
of the
American Airlines Advanced Aircraft Maneuvering Program.
For those who were present at the Meeting, what the NTSB was really
saying came
through loud and clear. AA 587 encountered mild wake
turbulence.
Investigators who participated in simulations of the flight felt the
second
alleged wake encounter was "barely perceptible". The Pilot
"inappropriately handled" the aircraft and set off a chain of events
that led to the separation of the tail. There was no reason for
the Pilot
to react the way he did. His overreaction was worsened by an
overly
sensitive rudder control system and by some negative wake turbulence
training he had received from American Airlines. But had he not overreacted and applied unnecessary
control inputs . . . AA 587
would not have crashed.
The NTSB used the words "excessive", "unnecessary", and
"inappropriate" close to a dozen times in describing the actions of
First Officer Sten Molin. Mr. Stan Molin, the father of the
Pilot,
himself a retired airline Captain, was sitting near the front of the
NTSB's
conference center in Washington, D.C. He had expected that his
son was
going to take a large part of the blame––this had been leaked
to the media by the NTSB or Airbus almost a month before the
meeting. Mr. Molin, who taught Sten
to fly,
had a sense, just days after the crash, that the NSTB would lay the
blame on his son. Even
though they knew this was coming it was still
very
unpleasant for the Molins to hear the NTSB says the words ––
"excessive", "unnecessary", "inappropriate"
–– again and again and again –– in reference to their
son's piloting.
The Molins did find some consolation in hearing some of the NTSB
investigators (later in the day) state that their son had gotten caught
up
in a piloting phenomenon called adverse Aircraft Pilot Coupling (APC), although this wording is not found
in the probable cause statement. To explain this in lay terms ––
it basically means that due to a very sensitive rudder pedal system
(never mentioned in the AA training program because Airbus never
disclosed its unique nature to the airline), the Pilot quickly got
caught up in a situation where, the NTSB believes, he didn't know that
the side-to-side (lateral) forces he was sensing were mostly caused by
his own rudder movements. As
he repeatedly tried to compensate with the rudder, he made
matters worse–– to the point where, in just seven and a half seconds,
the tail broke off. Adverse APC implies that there is a
design/systems flaw that confused the Pilot and the two “systems” are
equally responsible in the subsequent failure. But the way in
which the NTSB presented their findings, and the way in which they
critiqued the Pilot's actions over and over again, left no doubt in the
minds of the major media: "Pilot Error" was the cause, and that is how
most reported it.
Airbus walked out of the final report meeting with a big "whew" written
across their heads. It could have been much worse for them.
As one Airbus lawyer was leaving the conference center he stated to a
Pilot's Union representative, "better luck next time". The Airbus
lawyer was referring to intense lobbying by both American Airlines and
the Union (even up to the night before the meeting) to get the NTSB to
highlight Airbus' 1997 failure to communicate known defects with the
A300-600 rudder system and the role that rudder reversals played in the
American Airlines Flight 903 (AA 903) accident. In that 1997
accident, the aircraft's tail experienced higher loads than the loads
placed on AA 587's tail. American Airlines and the Union firmly
believed there was a link between AA 903 and AA 587–– they were pushing
and hoping to get the NTSB to see it that way. The fact the NTSB
did not is the most obvious proof that the NTSB's investigation was
compromised –– probably by the powerful lobbying by Airbus. This
lobbying (by both sides) was even acknowledged by the NTSB Chairman at
a breakfast meeting with reporters on January 5th 2005, and described
by her as "inappropriate", "intense", and having led to a delay of the
final report's release. The Chairman conceded that in the
presence of such lobbying the "potential for contaminating the
investigation exists". Is it possible that one party
(Airbus) "contaminated" the NTSB?
The family of the Pilot, American Airlines, and the Union, were not the
only interested parties considerably displeased by the NTSB's
conclusions. Many of the victims' families were dismayed at the
findings. They couldn't believe that they had waited almost three
years for a probable cause statement which placed the majority of the
blame literally at the feet of a dead man. In the minds of these
disappointed people –– the NTSB had failed.
Credibility Lost
On March 26th, 2004, U.S.Read released an exclusive article
titled,
"Coverups, Foulups, and
Credibility Lost". This article was not about an NTSB
cover-up. It was about a five year old Airbus cover-up of very
relevant safety information dating back to 1997. And it was a
cover-up –– U.S.Read's analysis of the AA 587 docket material uncovered
Airbus' cover-up of the rudder travel limiting system failures on AA903
in 1997. We also discussed the failures of the NTSB –– from 1997
through the present –– to identify and disclose very troubling behavior
on the part of Airbus. Most importantly, we showed that even if
the NTSB was correct that AA 587's tail separation was the cause of the
crash, the NTSB had lost credibility in determining why or how the tail
had separated.
The NTSB could not be trusted to go after Airbus if that was where the
evidence pointed. In fact, if one believes that tail separation was the
cause of the AA 587 crash, the evidence certainly pointed against
Airbus. If the NTSB was unreliable in highlighting the fairly
obvious in relation to the tail separation and rudder limiter issues
and the Airbus' coverups dating back to 1997 –– then the NTSB's ability
to determine the actual initiating event on AA 587 was even less likely.
At the Final Report meeting the NTSB proved beyond any doubt that the
their credibility in the investigation had been lost. The NTSB
basically let Airbus slip away on the most critical issue and even
created a grossly erroneous and incomplete presentation that was
favorable to Airbus.
American Airlines Flight 903 (AA 903) in 1997
To anyone even remotely familiar with the AA 587 crash, there was no
doubt that the AA 903 accident in 1997 near West Palm Beach was very
relevant and very connected to AA587. Most experts who believe
tail separation was the cause of AA 587’s crash agree that had the NTSB
and FAA been informed by Airbus about the role that rudder reversals
and the faulty RTLU (Rudder Travel Limiting Unit) had on the extreme
loads placed on AA 903's tail, the crash of AA 587 could have been
prevented. There were such obvious similarities between the two
flights, and such an obvious failure or cover-up on the part of Airbus
to communicate very important safety information to federal
investigators, that Bernard Loeb, who headed the National
Transportation Safety Board's aviation division until January 2001,
said the following to USA Today (May 27, 2003):
"When I heard (about
what
Airbus knew), [about AA 903] it made me sick ... People are kicking
themselves."
It would seem that Mr. Loeb got worked up about nothing –– because the
NTSB went out of their way at the AA 587 final report meeting to say
there was "no connection" between the two flights –– no "eureka" piece
of information from AA 903 that could have prevented AA 587. Even
with the benefit of hindsight available to them the NTSB's statement
was very far from the truth. This is why the Airbus attorney
walked out of the meeting at the end of the day and told the pilot's
union representative, "better luck next time". Airbus' lobbying
efforts had paid off well –– the NTSB had been rendered mostly impotent
–– and the bulk of the blame had been placed on a Pilot who allegedly
used the controls "excessively" and "inappropriately".
Presenting Misinformation
How far did the NTSB go to distort the significance of the AA 903
event?
–– they produced their own misleading slide presentation (Figure 1):
Figure 1
Figure 1 was produced
by the NTSB's John Clarke, Director of the Office of Aviation Safety,
to show how the two flights weren't
connected when in fact they were
very similar . What is most striking about Mr. Clarke's slide is
the omission of two very significant similarities between the two
flights: (a) repeated rudder reversals leading to (b)
higher-than-ultimate loads being placed on the vertical
stabilizer. These are the two most important issues related
to both flights –– and it was these that John Clarke omitted from his
slide. Mr. Clarke is either incapable of connecting the dots or
he was willingly evading the facts to help Airbus escape blame.
Either way, this is an egregious failure on the part of both Mr. Clarke
and his employer, the NTSB.
Instead, Mr. Clarke's presentation had "Pilot training" as the number
one issue, and as the only similarity between the two flights.
There is no doubt that Pilot training was an issue in both cases ––
both Pilots had never received training about the dangers of rudder
reversals. But there is also no doubt that Airbus (a) never told
the NTSB and FAA that AA 903's tail experienced loads beyond the
ultimate load, that (b) the rudder reversals contributed to the very
high loads, and that (c) the RTLU failed
several times during the AA 903 event, which led to a direct
increase in the loads experienced by AA 903's tail.
Had Airbus told the NTSB in 1997 about all of these facts, when Airbus
knew them, then the NTSB would have issued its warnings to the
aviation community about rudder reversals, about the peculiar
characteristics and sensitivities of the A300-600's rudder system, and
about the failure modes of the RTLU. Had the NTSB done so in
1997, AA 587's Pilot, Sten Molin, would have known not to reverse the
rudder long before November 12,2001.
The NTSB was able to look at these same facts, these obvious
connections between the two flights, and state that nothing from AA 903 could have
prevented AA 587. This NTSB distortion and whitewash of the AA
903 affair solidifies the conclusion that the NTSB had lost credibility
in the AA 587 investigation. If they were incapable of connecting
the obvious dots, they couldn't be expected to identify the actual,
elusive, initiating event on board AA 587.
Perhaps one clue as to why the NTSB reached this illogical conclusion
about the AA 903 connection is found in Mr. Loeb's statement to USA
Today: "People [in the NTSB] are kicking themselves." Perhaps the NTSB
was encouraged to downplay the significance of AA 903 in an effort to
veil the significance of their own failures in the AA 903
investigation. Why else would Mr. Loeb say "kicking themselves"?
The NTSB whitewash was not only evident in Mr. Clarke's slide (Figure 1
above), but in the very words of the NTSB Board Members:
Board Member Rosenker said he was
"comfortable" that there was no relation between AA 587 and AA
903. Board Member Carmody: "we need to lay this thing (the AA 903
connection) to rest". She also described her feelings about the
Airbus'
1997 cover-up as "[I] am less than satisfied in a less than perfect
situation". Director John Clarke focused solely on AA903's
"vertical" loads (which were higher than AA 587's) and failed to
highlight the extremely high lateral
loads AA 903experienced (as high as 0.7g)––loads that were as much as
two times more severe than those AA 587 experienced. Mr. Clarke
referred to Airbus' deliberate withholding of the tail loads data
during the AA 903 investigation as ..."oblique". What made Mr.
Bernard Loeb "sick" was only an "oblique" offense for Mr. Clarke.
NTSB Chairman Connors provided the closest statement approaching a
rebuke when she said Airbus "did not meet moral obligations". But
that was the height of the criticism against Airbus––it quickly
descended into a love fest again with Board Member Hersman, perhaps
exposing the NTSB's bias in favor of Airbus, revealing "we don't want
to single out a single party". Unfortunately, the NTSB's final
report did just that––it
mostly singled out the Pilot.
What really
happened on board AA 587?
This central question is really what it's all about.
U.S.Read followed the investigation closely for three years because
never during that time did we see the NTSB addressing the central
issues of the crash.
In our previously released
preliminary report, we highlighted the
findings that led us to conclude that (a) there was a fire or explosion
on board at least several seconds before the tail separated (this is
suggested by physical evidence––the flight recorders evidence––and
eyewitness statements), (b) the crew lost control of the aircraft while
the tail was still attached, and (c) the tail did not detach until just
after the time of the large flash and smoke/mist trail seen on the
tollbooth video. In other words, the tail separation was a
consequence of the crash sequence and not the initiating event, and the
aircraft would have likely crashed even if the tail remained attached.
Finding all the debris
The NTSB's Robert Benzon stated at the meeting that
"pertinent portions" of Jamaica Bay were searched with sonar scan
equipment and that no debris was found on the Bay floor. This is
misleading and unbelievable in two respects. The NTSB did not
identify the area covered by these scans. Secondly, the NYPD (the
agency
which performed the sonar scans) told U.S.Read that they did not scan a
large area nor was their scan focused for "debris." Rather, it was
focused on finding the bodies of victims. The NYPD acknowledged
that their sonar scan effort may have missed aircraft debris.
The NTSB made no mention of the numerous and varied land-based debris
found away from the crash site, as extensively documented and
described previously by U.S.Read. Much of this debris shows
that the fuselage was compromised while the aircraft was flying.
"Several" Eyewitnesses?
In regards to the eyewitnesses, the NTSB concluded: "The
witnesses who reported observing the airplane on fire were most likely
observing a fire from the initial release of fuel or the effects of
engine compressor surges." Mr. Benzon added that there were
"several" witnesses who reported the plane on fire.
"Several" does not accurately represent the number of eyewitnesses who
saw the aircraft on fire. There were over 70 witnesses who saw
the aircraft on fire while it was
level–– before it had begun its nosedive. There were at
least 27 witnesses who saw the aircraft explode or on fire before the tail separated.
The NTSB conveniently ignored the most disturbing aspect of the
eyewitness accounts. Not only did witnesses describe the aircraft
on fire before the engines separated, but many saw the aircraft on fire
long before the tail separated.
The Tollbooth Videos
As we have previously
reported, the NTSB showed no interest in acquiring the original
tollbooth videos from the FBI––videos which show AA 587 in flight
during the most critical moments. Just months before the close of
the investigation, one of the parties to the investigation pushed the
issue with the FBI and the FBI finally released the original videos.
They ended up at the NTSB in late May of 2004––two and half years
after the crash.
On February 25th, 2005, the NTSB
responded to our request for a digital uncompressed copy of the
original footage––we are currently working out the details with the
NTSB as to how a copy will be made for us. In the interim, the
NTSB has offered to send us a broadcast-quality Betacam SP video
tape––a first generation copy from the originals (not digital, but the
best alternative). As soon as we have the opportunity to examine
this new footage we will report on it. Based on the NTSB's latest
official report on the tollbooth videos, there is a notable quality
improvement in the original videos along with additional footage and
even an additional camera
view (lane 13 of the toll plaza) of AA 587 in flight. We are very
much looking forward to examining the videos. The NTSB, in their latest tollbooth video
report, provided snapshots from the original video and from the
copy they received from the FBI in November 2001 which highlight the
quality difference between the two versions (see Figure 2).
Figure 2
(from NTSB Tollbooth Video Report dated October
7, 2004)