Re' BEA's _investigation_ of AF447, AF 447 Thread No. 8 , slot #1471
"... Where is the independence of the BEA ?..."
Then, again skepticism about the INVESTIGATORs expressed in slot #1473, about the earlier BEA rpt on Tarom:
"the conclusions ... of the Tarom thesis ... by the bea ... Tarom report
BEA will release its "final" report on the night CRZ upset A330 /1Jun09: Press Release, 18 June 2012
"The BEA will publish the Final Report ... on Thursday 5 July 2012...."
The USA first established an "independent" investigating authority in 1939, the Air Safety Board -- it lasted only 14-months as an "independent" agency.
Now the USA's "independent" NTSB suffers the consequences of "unreviewable discretion": no obligation to acknowledge past investigative mistakes, nor "retract" mistakes in any Aircraft Accident Report.
*The U.S. Ninth Circuit Court of Appeals sided with the NTSB re' their erroneous findings, and lack of any oversight nor review of investigative-misconduct by the Board's staff:
"... 49 C.F.R. § 845.41 does not provide a right to reconsideration of the report ... nor ... any other provision in the statutes or regulations under which the NTSB would ever be required to reconsider a report.... the NTSB's complete discretion to conduct its investigations as it sees fit.... that unreviewable discretion." [H.G. GIBSON, Petitioner, v. NATIONAL TRANSPORTATION SAFETY BOARD, Respondent. Docket No. 95-70525. United States Court of Appeals, Ninth Circuit. Argued and Submitted Nov. 5, 1996. Decided July 7, 1997. http://ftp.resource.org/courts.gov/c...2.95-70525.htm
Re' investigator-err, scientific-retractions of investigator-err, investigator-bias, investigator-misconduct:
Prior discussion of err- or bias- detection during report writing, draft, correction & revision, slot #s 2692-2701 Turkish airliner crashes at Schiphol
In light of the current JTSB investigation of an ANA B737 / 6Sep2011 "discrepant-rudder" upset at CRZ FL410, and the BEA's investigation of AF447 A330 / 1Jun2009, perhaps now is a good time to reflect upon the USA's NTSB investigation of the "mysterious" CRZ FL390 upset of B727 N840TW /4Apr1979:
-- During primary-work (eg, the investigation "field phase") perhaps the docket might later include errors in evidence collection, measurement, &ct.
-- During secondary-work (eg, analysis), an investigator's behavior, his collegial interactions with the manufacturer's engineers, his bias, might affect his choices about his arrangement and retention of mishap-evidence, and his choice of a working hypothesis.
A continuum between unconscious error and deliberate fraud: Self-deception, bias, "unconscious manipulation of data", confirmation-bias, deliberate misconduct, fraud.
"... Science does not depend on unbiased investigators but on methods which limit the ability of the investigator's bias to influence the results....
Yet the method is so robust that even such an extreme bias cannot, short of fraud, influence the results...." [DeGusta, D. and Lewis, J.E. "...Is bias inevitable in science?" _New Scientist_ 2822 (25 July 2011), 24-5. Gould's skulls: Is bias inevitable in science? - life - 25 July 2011 - New Scientist
"... the problems caused by scientific fraud are far more limited in scope than those caused by the unconscious biases that can affect even the most honest researchers.... For those convinced that science is self-correcting ... we offer only discouragement...." Why Are Scientific Retractions Increasing? | Wired Science | Wired.com
Last edited by IGh; 16th Aug 2012 at 16:43.
Reason: added link to a prior thread
In three days, the BEA will invite the media to the high mass of misinformation. As usual, the journalists will resume its conclusions uncritically. So, to do the job for them, this lie and many omissions from the BEA in its final report:
The lie: The BEA will dare say that this is the analysis of events involving the blockage of pitot probes conducted after the accident showed that the tests for validation of this equipment did not seem suited to high-altitude flights. BEA seeks to make us believe that the certification standards of the Pitot probes are "appeared" out of date after the accident on June 1, 2009. It is a lie because the BEA can not ignore that this determination was made by Airbus in 1995, by the BFU in 1999 and by EASA in 2007.
This lie is necessary because we must not show that one has voluntarily left the situation fester.
Omissions:
In its final report, the BEA will obstruct the truth by failing to tell
Thales Pitot probes that AA had a fault, they did not work in a part of the flight envelope of the A 330
Airbus and EASA had an obligation to correct this defect
That instead of eliminating this defect, Airbus had decided to ask the pilots to ensure accountability through the application of a procedure.
That blocking the pitot probe is an "unsafe condition" which can cause victims generally with the destruction of the aircraft
That the "unsafe condition" can lead pilots to excessive workload that does not allow them to perform their tasks accurately or complete them.
That because of the "unsafe condition", the A330 was not an acceptable level of safety.
That to put the A330 to a acceptable level of safety, Airbus and EASA have imposed the elimination of Thales AA Pitot probe by issuing a "Airworthiness Directive" after the accident
That the loss or inconsistency of measured speeds can cause an aircraft outside its flight envelope
That this observation was made in 2001 by the DGAC and FAA
In December 1995, Airbus had made the finding of a lack of certification for the pitot probe
In September 2007, EASA had made the finding of a lack of certification of the Pitot probes
In September 2007, EASA had made the finding of the absence in the cockpit of a specific alarm "blocking Pitot"
In January 1999 the German BFU had recommended the amendment of the certification standards of the Pitot probes
In September 2008 Airbus had recognized the difficulty faced by a crew of ACA for company implementation fast and efficient procedure unreliable AIRSPEED and Airbus pledged to consider a modification of checklists
That the DGAC has never published operational directive or information regarding the safety lock of the Pitot probes
That the A 741 to 447 offered a passage through the Intertropical Convergence Zone (ITCZ) reached more than 873 A
That for many years, it was known that fluctuations or losses indications of velocities associated with Pitot probes could lead to the A330 out of its flight when passing through areas affected by weather conditions such as those encountered in the ITCZ.
That consequently Air France should have given instructions to the OCC for increased surveillance flights during the passage of the ITCZ
No information which could lead to a change of flight plan by the crew, was sent to 447 by the OCC
These omissions are necessary because we must protect the manufacturer and does not undermine the system that operates the air transport.
Omissions: Airbus and EASA had an obligation to correct this defect
Which they did - that they let the airlines do it at their own pace was not their responsibility.
Quote:
That instead of eliminating this defect, Airbus had decided to ask the pilots to ensure accountability through the application of a procedure.
A procedure that worked more than 30 times before this accident happened. The crew in this case applied no known procedure at any point during the accident sequence
Quote:
That blocking the pitot probe is an "unsafe condition" which can cause victims generally with the destruction of the aircraft
That the "unsafe condition" can lead pilots to excessive workload that does not allow them to perform their tasks accurately or complete them.
It can, but by and large it does not if the crew responds appropriately.
Quote:
That to put the A330 to a acceptable level of safety, Airbus and EASA have imposed the elimination of Thales AA Pitot probe by issuing a "Airworthiness Directive" after the accident
That was a belt-and-braces procedure instituted to mollify the press and the public following an accident that should not have happened if the crew had followed procedure.
Quote:
That the loss or inconsistency of measured speeds can cause an aircraft outside its flight envelope
The aircraft exceeded the flight envelope due to the inputs of the pilot in control - the aircraft itself made no flight control input of its own volition after autoflight was disconnected.
That this observation was made in 2001 by the DGAC and FAA
Quote:
In September 2007, EASA had made the finding of the absence in the cockpit of a specific alarm "blocking Pitot"
No other aircraft has this specific alarm.
Quote:
In September 2008 Airbus had recognized the difficulty faced by a crew of ACA for company implementation fast and efficient procedure unreliable AIRSPEED and Airbus pledged to consider a modification of checklists
Which they did.
Quote:
That the DGAC has never published operational directive or information regarding the safety lock of the Pitot probes
Nor did they need to - it was handled by the manufacturer.
[quote[That the A 741 to 447 offered a passage through the Intertropical Convergence Zone (ITCZ) reached more than 873 A
That for many years, it was known that fluctuations or losses indications of velocities associated with Pitot probes could lead to the A330 out of its flight when passing through areas affected by weather conditions such as those encountered in the ITCZ.[/quote]
This was not specific to the type, and indeed why SOP involved diverting around such weather patterns in the ITCZ, which this crew did not .
Quote:
That consequently Air France should have given instructions to the OCC for increased surveillance flights during the passage of the ITCZ
Based on what regulation?
Quote:
These omissions are necessary because we must protect the manufacturer and does not undermine the system that operates the air transport.
Bullsh*t. Protect the manufacturer from what? They did everything any other manufacturer would, could or should do. The pitot tube replacement schedule was delegated to AF, for better or worse. A workaround procedure was disseminated to all crews of all operators of the type, and this crew did not follow it - that's not the manufacturer's fault.
The BEA have already obliquely censured AF, and have highlighted potential shortcomings in Airbus's response to the pitot tube problem prior to the crash. The idea that the French state is somehow protecting itself based on the material released is laughable.
This doesn't even slightly relate to the incident in the OP, which involved the NTSB taking Boeing's assertions to the cause as read in a case over two decades old, and which led to a fundamental change in how (in the US), the state investigation committee should look into such an incident.
Last edited by DozyWannabe; 3rd Jul 2012 at 21:04.
Statement from Dozy', on 3July, in the last paragraph, re' NTSB's _investigation_ of a mysterious B727 upset 4Apr79 (AAR81-8):
"... This doesn't even slightly relate to the incident ... the NTSB taking Boeing's assertions [as] to the cause ... a case over two decades old, and which led to a fundamental change in how (in the US), the state investigation committee should look into such an incident."
?? Dozy -- just to clarify: Do you perceive any "fundamental change" in the NTSB's _investigative_ methods, since 1979 (TWA841/4Apr79)??
The reason I mentioned that old case, as an exemplar, is because those same investigative-biases persisted over the decades since (eg, NTSB initial AAR on UA811 stated a similar biased _investigation_ in which manufacturer's assertions went unchallenged). And, in this new century, NTSB staff's investigations have included the same sort of biases & errs, and NTSB's "staff" flat refusal to correct-errs -- even after the Board Chairman wrote-back that the specific errs would be corrected: Staff does what they want, Board Members never understand the lapses of their own NTSB-staff. In the USA, there is no IG, nor any "Court of Inquiry" which can challenge the NTSB staff's "unreviewable discretion".
? the curse of "independence" = "unreviewable discretion"
For you men who recall the intervention -- of earlier Royal Commissions, or a Court of Inquiry -- into an aircraft accident investigation:
?? Is the modern trend, toward an "independent" investigating authority, instead really a curse upon the quality of the investigator's product??
The US 9th Circuit Court decision
[July 7, 1997 http://ftp.resource.org/courts.gov/c/F3/118/118.F3d.1312.95-70525.htm ] set a legal fence against any binding review of the USA NTSB's investigation or its final P.C., citing NTSB's "unreviewable discretion" [see slot #1 above].
Intervention of earlier decades:
dH Comets inflight breakups: BOAC G-ALYP / 10Jan54 Br Air Safety Board investigated, then "Abell Committee"; then G-ALYY / 8Apr54. RAE's reconstruction efforts, then 19Oct54 Court of Inquiry P.C.
ANZ901 / 28Nov79, DC-10 CFIT, Mt. Erebus, Gordon Vette & Royal Commission (Mahon inquiry) vs NZ CAA IIC's.
Air Ontario 1363 / 10Mar89, F28 T/O Dryden; CASB vs Judge Moshansky's Inquiry
Indian AAR, then CASB finding, then Canadian Commission of Inquiry into the Investigation of the Bombing of Air India Flight 182, Honourable John C. Major, Q.C. Commissioner.
Considering the USA's transition from CAB to NTSB (as investigating authority), and contrasting the effectiveness of post-investigation "retraction" of investigator-errs, it appears the CAB (not independent) was better able, than an "independent" ntsb, to acknowledge its mistakes, eg revision of rumor-based P.C.:
TWA 260 / 19Feb55 Martin 404 No 40416; pilot off course, hits mountain. CFIT, struck Sandia Mtn at 0713 MST. Widespread crewroom- gossip regarding Capt Spong and suicide. CAB's initial P.C. vaguely worded, more or less endorsing the gossip. Later CAB revised their AAR, concluding that their initial AAR did not accurately reflect all the circumstances, insufficient evidence exists to substantiate the reason for the deviation from prescribed path [from 3rd AAR].
TWA841 / 4Apr79, B727 CRZ upset at night at FL390, USA's "independent" ntsb's AAR81-8 endorsed the conspiracy-theory, crewroom gossip, with their official P.C. alluding to vague sequence of switching (three Flap switches on OverHd Panel), circuit breakers (on the Bulkhead P-6 Panel), and Flap Handle (on pilots' Center Pedestal): "... extension of the slats was the result of the flightcrew's manipulation of the flap/slat controls." [AAR81-8, pg35, P.C.]
TWA800 / 17July96 -- NTSB staff and Board Member on scene initially felt comfortable with FBI-Kalstrom's "well 747's don't just fall out of the sky", a vague reference to the missile-sabotage rumors. Then with aggressive work by a dedicated staff engineer (one competent staff engineer can make a difference) staff & Board swung away from the rumor-based scenario, toward the ullage-deflagration hypothesis.
****==> Interested in reflections upon the effect of the prior "Royal Commission" and "Court of Inquiry" oversight-review of the investigating-authority.
Perhaps counter intuitive, one could fairly conclude that the USA's old CAB was better able to revise its errs or avoid err, than is the modern "independent" NTSB.
