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Tue, Jun 19, 2012

NTSB Chair Hersman Criticizes Gulfstream For G650 Accident Reporting

Letter To President Larry Flynn Details Concerns About The Planemaker's Role In The Investigation

Among the documents contained in the NTSB's public docket of information which will be used to determine the probable cause of the April 2nd, 2011 accident involving a flight-test version of the G650 are letters exchanged between NTSB Chair Deborah A.P. Hersman and Gulfstream president Larry Flynn about the company's role in the accident investigation.

The airplane went down during a flight test in Roswell, NM, after the test pilots simulated an engine-out scenario on takeoff. Four Gulfstream employees were fatally injured in the accident.

Hersman asked Flynn to meet with her in her office in Washington, D.C. on March 22, 2012. In that meeting, Hersman expressed concerns about how Gulfstream was cooperating with the agency in the accident investigation. Her letter, dated April 4th, 2012, states "During the course of this investigation, NTSB investigators and management officials encountered a variety of situations that are not typical when dealing with parties to investigations, including:

  • Gulfstream's noncompliance with instructions from the NTSB investigator-in charge relating to quarantine of accident-related telemetry data, informing Gulfstream employees about the nature and use of NTSB interviews, and the prohibition on legal counsel becoming involved in the accident investigation.
  • Unexplained missing evidence, including a computer hard drive containing accident-related telemetry data and flight test notebooks, both of which Gulfstream had been asked to safeguard because they were of significant interest and value to the investigation.
  • Gulfstream's withholding of relevant information relating to the existence and results of its internal safety audit.
  • Gulfstream's delay in providing requested factual information relating to the accident and in making staff available for participation in group activities, such as interviews and wreckage review.
  • General conduct and dilatory tactics prejudicial to the investigation, including multiple and excessive redaction requests, delays in providing comments on
  • draft factual reports, combative and argumentative behavior on the part of Gulfstream's legal counsel during witness interviews, excessive objections to disclosure of factual information based on claims of protection for proprietary data, excessive requests for repeat reviews of draft factual reports, and a last-minute request for photograph copyright privileges.

"In sum, we expect all party participants to follow our rules and procedures, and to act in good faith with a spirit of cooperation, rather than obstruction," Hersman (pictured) said. "NTSB accident investigations are non-adversarial proceedings aimed at determining probable cause and preventing future accidents. Litigious behavior frustrates the party process and degrades working relationships. We expect all parties to work with us toward our mutual goals of fully understanding the circumstances of the accident and improving safety.

"I encourage you to counsel Gulfstream employees associated with this accident investigation to follow NTSB instructions and to cooperate fully with NTSB investigators. In addition, it may be useful for Gulfstream employees, especially those who might be called on to participate in future NTSB investigations, to attend industry training that we offer at our Training Center. We offer courses that are aimed at familiarizing industry representatives, including senior managers, with NTSB investigative processes and the roles and responsibilities of parties to our investigations."

Flynn must have known the letter was coming. While he is unable to comment on the ongoing NTSB investigation, a letter from him to Chairman Hersman dated March 30, 2012 ... a few day after the meeting but before Chairman Hersman wrote to the Gulfstream president appears to try to address at least some of those concerns pre-emptively.

"I believe it would be useful to provide you with some of the facts and circumstances surrounding the other matters you raised at our meeting, in order to give you a fuller understanding of Gulfstream's role supporting the NTSB investigation," Flynn wrote. He addressed the following points in his letter:

  • The flight data recorder, the cockpit voice recorder and all other on-board recording devices, including the lADS hard drives located at the flight test engineer workstations, remained on board the aircraft until removed by the NTSB.
  • Telemetry data had been captured on a hard drive in a trailer at the airport as part of the ordinary course of flight test activities.

Promptly upon the arrival of the IIC at the accident site, Gulfstream:

  • Advised the IIC of the existence of the telemetry data.
  • Provided the IIC with an electronic copy of the data.·
  • Advised the IIC of the existence and whereabouts of each other copy of the data, including a copy that had been returned to Savannah.

Flynn said that at the IIC's request, Gulfstream dispatched a team of experts from Savannah to Roswell to instruct NTSB staff in how to access and utilize the telemetry data. As soon as it became clear that Gulfstream would not be able to convince the NTSB to allow us to keep or continue using the copy of the telemetry data in our possession, Gulfstream, at the direction of the NTSB ordered all employees who had been given access to the data to immediately cease using it, and either sequestered or destroyed all paper and electronic copies of the data or any analysis derived from the data.

Flynn says the NTSB then provided Gulfstream with another copy of the telemetry data (without the audio) for Gulfstream's use.

Flynn also said in the letter that "Gulfstream has responded to each and every request for information from the NTSB as promptly as possible. In addition, Gulfstream has proactively provided to the NTSB a substantial amount of additional information that might assist the NTSB in understanding any and all aspects of the precursor and accident events. Indeed, NTSB staff has previously called our level of technical cooperation 'unprecedented'."

He stated that the company had requested that some information be redacted from the reports to protect "trade secrets" that would not be a concern when investigating an accident involving a production airplane.

A probable cause report is not expected until later this year. (Accident images provided by the NTSB. Hersman photo from file)

FMI: www.ntsb.gov, www.gulfstream.com


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