Failure - Interactions

Credit:       Staff Reporter of The Wall Street Journal  


Author           McGinley, Laurie
Title:      Fighting Blame for Near Crash of a Boeing 727, 
​  Pilot Raises Questions About Safety of the Plane


Copyright           Dow Jones & Company Inc,    May 3, 1991.

The above excerpts  are from  

The Wall Street Journal,    

  May 3, 1991,  pg A12.

ALPA says  it has uncovered eight other similar incidents  that have occurred over the past decade or so that involve major control problems with Boeing 727s.   In December 1989, according to one report, a TWA flight cruising over Ohio suddenly started banking to the left.   The crew disconnected the autopilot but had trouble controlling the plane and made an unscheduled landing in Dayton, Ohio. 

In June 1981, a United Airlines flight turning right while approaching the Seattle airport began "peeling off to the left," says Harold Marthinsen, director of ALPA's accident-investigation department.   The captain disconnected the autopilot but the airplane continued to feel as though it were going to roll over.   The crew considered ditching in Puget Sound, but finally landed the jetliner safely and were later told by a mechanic that the problem had been caused by the failure of the plane's autopilot to disconnect properly. 

"Believe me," one of the pilots wrote ALPA, "we had a tiger by the tail.”
But Charles O. Miller, a retired head of accident investigations for the safety board, says he believes
the board "couldn't find anything wrong with the plane, so they decided
the flight crew must have made a mistake."  


Mr. Gibson describes listening to the board debate as "an out-of-body experience."   He adds:
"It was like I was dead or something --
​ the board and staff members argued over things that they hadn't even asked me."  

 He's angry that there was never a public hearing at which the crew could respond to the investigators' findings. 

After the accident,  Mr. Gibson continued to fly with TWA,  which called the safety board report a "gross injustice" to the crew and almost immediately promoted him.   But the issue became a personal obsession; he was plagued by ulcers, hypertension -- he took medical leave between 1983 and 1986 -- and an abiding bitterness toward the safety board.   "It was devastating," says Washington attorney Landon Dowdey, a close friend and longtime adviser of Mr. Gibson’s.

Now,  ALPA  and Mr. Gibson,  rejecting the premise of the NTSB report,  say the accident wasn't caused by the No.7 slat getting stuck at all.   "The missing slat became a red herring," says  … a former Boeing engineer who … spent years sifting through the Flight 841 evidence …   "It really distracted the investigators."  ALPA and Mr. Gibson say the mishap probably occurred  because of a  problem with the rudder system and the autopilot. 

A major element in their case is an affidavit submitted by P.T. Williams, a TWA pilot who in May 1977 was flying a Boeing 727 as part of a proficiency check. After disconnecting the autopilot, as instructed, he says, "the flight controls became extremely difficult to manipulate." ALPA recently discovered that the plane was the same one used for Flight 841 in 1979 -- a fact that Mr. Gibson alleges was known by some TWA officials.   TWA declines to comment.   The plane was later sold and now is owned by a Dallas cargo company. 

Selective bias,  using  

        data  from  BOEING's TESTS --


Voodoo Correlations:   Boeing led NTSB toward that  mistaken-correlation.   Boeing's test-data  had captured an unrelated cruise condition:

       EXTENDED  Slats,    at 39,000-feet:


Implicit in Yorke's proof,  was  that  Boeing and NTSB  had   mistakenly succeeded in  claiming   correlation between   UNRELATED  cruise conditions,   unrelated  to the conditions of the mishap-aircraft at FL390  with the clean wing:

On N840TW, all Slats remained nested in the RETRACTED  position  until  AFTER  failure of the "A" Hydraulic-System -- when the RHS-MLG over-Extended  late in the dive.

The crew insisted the plane had malfunctioned.  But it was clear the investigators, who weren't finding any mechanical problems,   didn't believe them.   In the Oct. 15, 1979, issue of Aviation Consumer magazine,  Leslie Kampschror,  the chief investigator on the accident,  was quoted as saying, 
  "I assume that they are hiding something, but I can't prove it."  
Mr. Kampschror, who is still at the safety board, declines to comment. 

Mr. Gibson's life style also made him vulnerable to suggestions of risk-taking.  In 1966, he was hospitalized for a year after getting into an accident while driving well over 100 miles an hour,  and he liked stunt flying.    But on the job, he says, he went by the book.   "He was a good pilot,   there's no question about that," says John Ferguson,  a former TWA pilot  and a retired NTSB staff investigator who worked on the Flight 841 case. 

Mr. Ferguson and others at the safety board concluded,  however,  that the aerodynamic evidence, developed from flight,  wind-tunnel and simulator tests,  proved that nothing was wrong with the control mechanisms or other parts of the plane,  and that wrongful use of the controls was the only explanation -- even though there wasn't direct evidence.    In June 1981, the board voted to adopt the report.
"I'm confident that the board arrived at the right decision, based on the information at the time,"
says Elwood Driver, who was a board member then.   Nevertheless,   he "anguished" over the decision. 
The view was further bolstered by   a Boeing report   filed to the board in September 1979   that said it was likely that   "a positive system command"   was initiated to extend  and  retract the slats.

And investigators found that the No. 7 slat was torn off during the descent, suggesting it had been extended. 

All three  pilots denied fooling with controls   and insisted Mr. Banks hadn't been out of the cockpit.   J. Scott Kennedy, who was Flight 841's first officer ... says:   
"You can  discard the cock-and-bull theory
  about Hoot's fooling around with the cockpit controls.
   I was there,   and   it didn't happen."
 

​Mr. Banks . . . says,   "The NTSB was cold wrong." 
 --  that Mr. Gibson had pulled a circuit breaker to manipulate improperly 
​ the wing flaps and slats   in an effort to improve the plane's performance.
  
-- They believed that Gary Banks, the flight engineer, had stepped away from the cockpit,
and upon returning pushed the circuit breaker back in,
causing the slats to extend;

-- then, when Mr. Gibson retracted the flaps and slats,   the No. 7 slat stuck,
   triggering the airplane's roll and plunge.    

  Once Chairman,    James King,   accepted  

The Boeing  Scenario

--------->     as if  Boeing  had  NOT  a  bias

to   protect   their best selling airliner.    

The NTSB refused to  comply with their own procedures for acknowledging the Petitions,  see NTSB's MIM 4.15.

  Years later,  NTSB  replied that   their records show

      NO PETITIONS  included in the Public Docket:

an open disclosure of their violation of  rules-of-practice 845.50.

But some outside analysts say  the new claims deserve a hearing.    "There's a distinct possibility that there was something wrong with  (Mr. Gibson's)  plane,"  says John Galipault,  president of the Aviation Safety Institute,  a private group in Worthington, Ohio.    James King,   who was the safety board's chairman at the time of the TWA investigation,  notes that  

 "ALPA is a bargaining unit, and they are  there to protect their members."  

But, he adds, "If he  (Mr.Gibson)  found something on the performance of the aircraft,  I would hope the board would look at it."     The safety board won't say whether the case will be reopened,  or comment further. 









For Mr. Gibson  . . .   the turning point of his life occurred on what should have been a routine flight from New York to Minneapolis.   He says the airplane began turning to the right on its own.  He disconnected the autopilot  and grabbed the controls,  but couldn't stop the plane from rolling over and plunging toward earth.  The jet's descent slowed after the landing gear was lowered.  Eight passengers suffered minor injuries.  


Safety board investigators immediately became suspicious about the erasure of the cockpit voice-recorder tape.      Mr. Gibson says he  doesn't think he erased the tape,

   but if  he did  it was by habit . . . .


​Early on,    safety board staff members began  pursuing a damning scenario:

On 2May1991 -- after months with no acknowledgement from NTSB  [the MIM's detailed procedure for acknowledging a Petition],  Gibson's attorney  filed  another 845.41a-Petition.


 This second Petition, set-up a  legal basis for future court intervention of Jan'95,  into the NTSB's refusal to comply with its own procedures for processing those various 845.41- Petitions,  against the errs  in AAR-81-8.

Nearly 10 years later,   the 56-year-old Mr. Gibson,   who was never disciplined by the Federal Aviation Administration   and  continued flying for Trans World Airlines until he retired in 1989,  is still fighting with the safety board  in a crusade to clear his name.   Yesterday, he filed a petition with the board  asking that the case be reopened,  citing new evidence about a possible safety defect with the autopilot of the Boeing 727  and  sharply criticizing the original probe.


 "The stupidest pilot in the world wouldn't have done what they accused me of doing,"  he says. 


Mr. Gibson and  the Air Line Pilots Association,   which represents more than 40,000 commercial pilots and  which filed its own petition with the NTSB last fall, say they have received nine complaints from pilots saying they had control problems similar to those Mr. Gibson described -- one of them involving the very same plane that Mr. Gibson flew on that day over Flint.

 

The Federal Aviation Administration   and  Boeing Co.  are reviewing the ALPA information.   But, "Our initial examination doesn't give rise to concern that there is an inherent problem," says Craig Martin, director of public relations for the Boeing Commercial Airplane Group.   William Hendricks, the FAA's top investigator and   chief of the NTSB's aviation-accident inquiries during the Flight 841 probe,   says  the 727    "is a very safe plane." 

TWA Flight 841 was cruising at 39,000 feet  above Flint, Mich.,  when Capt. H.G. "Hoot" Gibson  felt the plane  vibrate and roll suddenly to the right.   Engines roaring,  the Boeing 727, with 89 people aboard, keeled over into a terrifying spiral,   plummeting almost seven miles in a minute.  Passengers screamed, cried   and   sobbed   goodbye. 


At the last moment, Mr. Gibson pulled the plane out of the dive, just 5,000 feet above the ground, and landed in Detroit.   It was April 4, 1979,  and  Mr. Gibson was hailed as a hero.   A cartoon in a Detroit newspaper   featured a movie marquee   that read: 

        "Thirty Seconds Over Flint -- Best Performance in a Double-Barrel Roll Starring Hoot Gibson."

 

But Mr. Gibson's  glory  didn't last long.   Investigators could find nothing wrong with the plane   and quickly turned their attention to the crew.   And the  cockpit voice recorder  was found  mysteriously erased.    On June 9, 1981,  the National Transportation Safety Board ruled,  3-0, that    he caused the accident   by monkeying with the controls     in a foolhardy effort  to improve the plane's performance. 

Abstract (summary) H. G. "Hoot" Gibson was first labeled a hero as pilot of TWA Flight 841, which almost crashed over Flint, MI in 1979,  but was later said to be responsible for the near-crash,  and was accused of monkeying with the controls.  Gibson is still fighting with the NTSB to have his name cleared.  

In    May    1991,  

five months  after  NTSB   had   received  the  Petition

 detailing  Yorke's  refutation  of   The Boeing Scenario,

the Wall Street Journal   printed  a review  of

NTSB's     lack-of-progress   

toward  correcting    AAR-81-8.

Fighting   Blame

for  Near Crash  of a Boeing 727,

Pilot Raises Questions About Safety of the Plane

Excerpts  from   Wall Street Journal

Author           McGinley, Laurie
WSJ,  Eastern edition
May 3, 1991, pg A12