NTSB To Investigate Overseas Reymar Contact

 Accident, Accident Investigation, allision, collision, contact  Comments Off on NTSB To Investigate Overseas Reymar Contact
Jan 082013
 

ntsbThe US National Transportation Safety Board today announced it is investigating a contact incident on Monday between the oil tanker Overseas Reymar and one of the supports of the San Francisco-Oakland Bay Bridge while under pilotage.

The NTSB named Barry Strauch as the investigator-in-charge. Strauch will coordinate with the US Coast Guard, which classified the accident today as a “major marine casualty,” because the incident exceeded the threshold of more than $500,000 in property damage.

The NTSB investigated a similar accident in 2007, when the container ship Cosco Busan hit the Bay Bridge and spilled thousands of gallons of fuel oil into the San Francisco Bay. In the Cosco Busan accident, the NTSB determined that a medically unfit pilot, an ineffective master, and poor communications between the two were the cause of the accident. Investigators will be reviewing the circumstances of yesterday’s accident in light of the safety recommendations made following the Cosco Busan accident.

Share
Jul 242009
 

John Clandillon-Baker, who edits the UK Pilots Magazine sent us this:

Ref your “Foggy Pilot” article your readers  may be interested in the editorial ( which deals with some of the issue raised) and the feature on piloting in fog that I did for the April issue of the Pilot which can be read at the following links:

www.pilotmag.co.uk/2009/06/25/921/

www.pilotmag.co.uk/2009/06/25/fog-pilotage/
The unprecedented jail sentence of John Cota has set an alarming precedent of criminalising a pilot and this is the topic of my editorial and feature for the July issue which I have just finalised. I usually upload content onto the website a few weeks after the print edition has been received by members so will advise you when I post it.

Share

A Little Fed Finaigling For Cosco Busan

 maritime accidents  Comments Off on A Little Fed Finaigling For Cosco Busan
Jun 192009
 

There’s nothing quite as impressive to watch as a lawyer on the make. Take this federal attorney prosecuting Fleet Management in a San Francisco court.

John Upton of the San Francisco Examiner tells an interesting tale of legal eagle skulduggery: “Attorneys filed court documents May 11 on behalf of ship operator Fleet Management Ltd. offering to plead guilty to environmental misdemeanors… Those violations would ordinarily carry a maximum fine of hundreds of thousands of dollars.”

But the Fed want to hit Fleet Management for $40m, so planned to “ use the Alternative Fines Act to enhance one of the penalties, but, by May 11, it still had not filed the necessary court documents.” says Upton. That plan would fall through if the judge accepted Fleet Management’s guilty plea before a new indictment was filed, so the plan looked doomed.

Up steps Washington, D.C.-based prosecutor Richard Udell who tells the judge that he won’t be available for a court hearing on 26 May because “that would necessitate my traveling on Memorial Day (May 25), which I would like to avoid if possible.” He wanted to spend that day with his wife and children in Washington DC. So the hearing was moved to 27 May.

Says Upton: “But Udell did not spend Memorial Day with his kids. Instead, according to his court filings, he changed his plans and flew on Memorial Day to San Francisco, where he secured the needed indictment before the hearing.”

Hmm.

You can read John Upton’s report here.

Share

NTSB On Cosco Busan: Unfit, Ineffective, Incompetent

 allision  Comments Off on NTSB On Cosco Busan: Unfit, Ineffective, Incompetent
Feb 192009
 

Investigators for the US National Transportation Safety Board claim that the pilot conducting the Cosco Busan was unit, the master “ineffective” and the crew poorly trained.

The NTSB has issued the following statement:

“The National Transportation Safety Board says that a medically unfit pilot, an ineffective master, and poor communications between the two were the cause of an accident in which the Cosco Busan
container ship spilled thousands of gallons of fuel oil into the San Francisco Bay after striking a bridge support tower.

On November 7, 2007, at about 8:00 a.m. PST, in heavy fog with visibility of less than a quarter mile, the Hong Kong-registered, 901-foot-long container ship M/V Cosco Busan left its berth in the Port of Oakland destined for South Korea. The San Francisco Bay pilot, who was attempting to navigate the ship between the Delta and Echo support towers of the San Francisco-Oakland Bay Bridge, issued directions that resulted in the ship heading directly toward the Delta support tower. While avoiding a direct hit, the side of the
ship struck the fendering system at the base of the Delta tower, which created a 212-foot-long gash in the ship’s forward port side and breached two fuel tanks and a ballast tank.

As a result of striking the bridge, over 53,000 gallons of fuel oil were released into the Bay, contaminating about 26 miles of shoreline and killing more than 2,500 birds of about 50 species. Total monetary damages were estimated at $2 million for the ship, $1.5 million for the bridge, and
more than $70 million for environmental cleanup.

“How a man who was taking a half-dozen impairing prescription medications got to stand on the bridge of a 68,000-ton ship and give directions to guide the vessel through a foggy bay and under a busy highway bridge, is very troubling, and raises a great many questions about the adequacy of the medical oversight system for mariners,” said Acting Chairman Mark V. Rosenker.

In its determination of probable cause, the Safety Board cited three factors: 1) the pilot’s degraded cognitive performance due to his use of impairing prescription medications; 2) the lack of a comprehensive pre-departure master/pilot exchange and a lack of effective communication
between the pilot and the master during the short voyage; and 3) the master’s ineffective oversight of the pilot’s performance and the vessel’s progress.

Contributing to the cause of the accident, the Board cited 1) the ship’s operator, Fleet Management, Ltd., for failing to properly train and prepare crew members prior to the accident voyage, and for failing to adequately ensure that the crew understood and complied with the company’s safety
management system; and 2) the U.S. Coast Guard for failing to provide adequate medical oversight of the pilot.

“Given the pilot’s medical condition, the Coast Guard should have revoked his license, but they didn’t; the pilot should have made the effort to provide a meaningful pre-departure
briefing to the master, but he didn’t; and the master should have taken a more active role in ensuring the safety of his ship, but he didn’t,” said Rosenker. “There was a lack of
competence in so many areas that this accident seemed almost inevitable.”

As a result of its investigation, the Safety Board made a total of eight safety recommendations. In its five to the U.S. Coast Guard, the Board recommended that it 1) ask the
International Maritime Organization to address cultural and language differences in its bridge resource management curricula; 2) revise policies to ensure that, in its radio
communications, the Vessel Traffic Service, VTS, identifies the vessel, not only the pilot; 3) provide guidance to VTS personnel that defines expectations for when their authority
to direct or control vessel movement should be exercised; 4) require mariners to report any substantive changes in their health or medication use that occur between required
medical evaluations; and 5) ensure that pilot oversight organizations share relevant performance and safety data with each other, including best practices.

The Board recommended that Fleet Management Limited 1) ensure that all new crewmembers are thoroughly familiar with vessel operations and company safety procedures; and 2)
provide safety management system manuals in the working language of the crew.

The Safety Board also recommended that the American Pilots’ Association remind its members of the value and importance of a verbal master/pilot exchange, and encourage its pilots
to include the master in all discussions involving the navigation through pilotage waters.

Two safety recommendations on medical oversight previously made to the U.S. Coast Guard as a result of an accident in 2005 were closed due to improvements the Coast Guard had
made in its reporting procedures.

A synopsis of the Board’s report, including the probable cause, conclusions, and recommendations, will be available on February 19 on the NTSB’s website, www.ntsb.gov, under
“Board Meetings.” The Board’s full report will be available on the website in several weeks.

Share

Not Being John Cota

 allision  Comments Off on Not Being John Cota
Apr 112008
 

“Capt. Cota acknowledges the lack of situational awareness and does not expect it to happen again.”
Board of Pilot Commissioners for the Bays: Investigation into the grounding of the M/V Pioneer…on 20 February 2006.

Bay pilot John Cota’s week it wasn’t, starting April 8, 2008. Since the US Department of Justice has already charged him on two criminal counts, an act likely to hinder a helpful investigation, his lawyers advised him to claim the protection under the Fifth Amendment of the US constitution against self-incrimination and declined to give testimony at the public hearings of the US National Transportation Safety Board, a protection ironically, which the US government does not want extended to non-US seafarers.

The ship’s crew, currently detained as ‘material witnesses’ for Cota’s trial did not give testimony, either.

Much of the second day of the hearing was occupied by evidence on Cota’s medical condition and previous history of alcohol abuse – he was tested for alcohol immediately after the incident and found clear. After the incident, the US Coast Guard asked Cota to surrender his mariner’s license because “the listed potential side effects of those medications and how they may or may not have some impact upon his judgment, his ability to function, cognitive ability,” said Chief of the Regional Exam Center, George Buffleben.

A medical witness, Dr. Robert Bourgeois, told the hearing “I wouldn’t want anyone taking those medicines and having to make decisions in a safety-sensitive position”. When asked if he would let his children board a bus with a driver using such medication, he said “my kids would not be on that bus”.

John Cota, call sign Romeo, was evaluated for renewal of his license in January 2007 under a system that is currently undergoing changes. However, this does call into question the effectiveness of the medical examination process.

This does not necessarily mean that Cota was suffering impairment. If he was, the hearing was told, it would be difficult for the master or officers to tell whether or not he was so impaired as to present a hazard. Under US legislation ship’s officers are required to obey the orders of the pilot unless he is clearly incompetent or incapacitated.

There has been much comment about alleged problems with the radar, AIS and ECIDS, with Cota saying that the latter was confusing. It is clear for the VDR transcript that he was struggling with both. The pilot who had conducted the Cosco Busan inbound, Captain Nyborg, had no problems with radar or AIS, and these were found to be working after the incident.

He also had little problem communicating with the Captain, Mao Cai Sun, nor with the helmsman.

Captain Nyborg did notice a problem with the ECDIS, with the track being offset to the west. Nyborg disembarked the Cosco Busan and later went to the pilot conference centre for a monthly meeting. From there he saw the ship coming away from anchorage 7 and moving towards anchorage 9, “I was surprised because I recognized her as a ship I put in Oakland, and it would be very unusual for that ship to be coming to the wrong direction unless something had happened or something was wrong, like if they had a breakdown or something” said Nyborg. Other pilots present told Nyborg about the allision.

“I tried to remember where, you know, what issues I might have had with it, and what my, you know, if I had any difficulties or, you know, bad helmsman or anything like that. Nothing stuck out in my mind except that I, I remembered that, gee, I think that ECDIS display was showing a poor course as far as — a poor planned route through Delta Echo span, and I wondered if they had tracked the same deal coming outbound,” he told investigators.

Cota arrived at the meeting looking shaken: “(He) actually sat down within 3 or 4 feet of me, and I scooted my chair over and out of concern asked him, John, how you doing? He described how he was doing. Oh, my God, John, what happened? And, and he was visibly shaken. And I said you know what you should look into that – you should look into this ECDIS display because I believe it was, it was running West of where it should have been on my inbound. And of course I didn’t need it, but if you relied on it at all maybe it ought to be something that is investigated.”

Surprisingly, or prehaps not considering the possible emotional impact of the event, Cota forgot about the meeting: “John called me last night, and he had actually — didn’t recall me telling him that. He’s like there’s rumor around that you saw this or saw that, and I’m like, John, I talked to you at the meeting. Didn’t you remember that meeting? He said, no. I was really rattled, and I probably talked to people I didn’t, I don’t remember talking to. And that’s very understandable, you know,” said Nyborg.

To be continued

This entry was posted o

Share