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The Colgan Air Disaster in February 2009 Did Not Have To Happen
Whistleblower and Federal Aviation Administration inspector Christopher J. Monteleon, was in the cockpit when the airline got its first such plane, a Bombardier Dash 8 Q400, and put it through a series of test flights in June, 2008. But when he reported problems to his F.A.A. superiors, he was suspended from important portions of his job overseeing Colgan’s acquisition of the Dash 8 and given a desk job, he said. Mr. Monteleon has had other run-ins with his bosses, and is currently on paid leave because, he said, managers accused him of menacing an agency lawyer. We MUST STOP our government and private corporations from pursuing Whistleblower Retaliation and start saving lives, careers, and families. Betsy Combier
          
Colgan pilots fault airline's stall training
By Jerry Zremski, NEWS WASHINGTON BUREAU CHIEF
Updated: January 01, 2010, 8:53 AM /
LINK

WASHINGTON — Colgan Air pilots said Thursday that the airline's inappropriate training might have influenced Capt. Marvin Renslow's fatal decision to raise the nose of Continental Connection Flight 3407, which then spun out of control and crashed to the ground, killing 50 last February in Clarence.

Colgan's training emphasized maintaining a plane's altitude during a potential stall, four pilots for the regional airline that operated the flight for Continental told The Buffalo News. They said that contradicted what they previously had learned as pilots.

The four pilots, all speaking on condition of anonymity for fear of losing their jobs, said Colgan taught pilots to react to stall warnings by maintaining altitude, even though safety experts increasingly teach that the nose should be lowered and the altitude reduced slightly to build the aircraft's speed.

Documents filed with the National Transportation Safety Board confirm the pilots' contention. Most importantly, a Colgan training manual instructs pilots to "maintain altitude."

Several safety experts said that was the wrong approach.

"Pitch up and maintaining altitude ... is contrary to what I was taught as an aviator," said Steven Chealander, a former military and American Airlines pilot who was the safety board member dispatched to Buffalo at the time of the crash.

Chealander, who is no longer on the safety board, said he was speaking generally and did not want to discuss the Colgan crash, because the probable cause of the accident will not be revealed until the agency completes its work and releases its report in February.

"Negative training'
But another source with knowledge of the investigation said he expects that Colgan's "negative training" — essentially training pilots to do the wrong thing — will be one of the factors cited in the agency's final report on the crash.

Joe Williams, a spokesman for Colgan, said he could not respond to questions about the airline's training until Monday. A spokesman for the Federal Aviation Administration also said The News, which contacted the agency about this story at 2:11 p.m. Thursday, did not give the agency adequate time to respond.

The Colgan pilots said the training policy — which the FAA had approved — has since been reversed and that the airline's pilot training has vastly improved in recent months.

But they also said the airline's poor stall recovery training in years past might have been one of the factors that led to the crash in Clarence.

"Our training for this situation was a joke," one Colgan pilot said. "They stressed that the way to recover from this sort of thing was to try not to lose altitude. That's all they trained. ... What they told you to do is counter to what you're supposed to do."

The Colgan pilots stressed that several factors could have influenced Renslow's fatal decision to pull back on the plane's yoke in order to raise its nose.

The safety board investigation found he had spent the evening before the flight in a crew lounge at Newark Airport, meaning he could have been fatigued.

He also had been shown a training video on tail plane icing that might have led him to believe that the plane was in a tail stall. Pulling back on the yoke would have been the correct response in that situation.

Then again, the airline's emphasis on maintaining altitude to prevent a stall would have no doubt been fresh in his mind, said the pilot who called Colgan's training "a joke."

"You're trained to pull back" on the yoke, that pilot said. "So what are you going to do in that situation? You'll do what Marvin did."

The pilots interviewed stressed that their point of view was not just based on their experiences, but also on documents filed with the safety board as it completes its investigation of the Clarence crash.

The Air Line Pilots Association, in a recent submission to the safety board, said pilots were told during training that they would need to "hold or increase pitch" — that is, steady or raise the plane's nose — to pass their flight tests.

And a report filed by the safety board's operations group investigating the Clarence crash also noted that sources it interviewed confirmed that Colgan's stall training focused on maintaining altitude.

"It was stated in several interviews that during the stall recovery exercises for initial simulator training, the candidates were instructed to maintain an assigned altitude and complete the recovery procedures while not deviating more than 100 feet above or below the assigned altitude," that report said.

Standard abandoned
That goal stemmed in part from an FAA edict that emphasized keeping the altitude steady when recovering from a stall, the operations group said.

The FAA abandoned that standard in November 2008 and now emphasizes building speed as central to stall recovery, said Capt. John Cox of Safety Operating Systems, a Washington, D.C., consultancy.

The old standard "has been a problem in the industry for decades," Cox said. "There has been a lot of discussion and an effort under way to get away from the zero altitude loss philosophy."

The modern-day philosophy is that "you have to accept some altitude loss to get the plane flying," Cox said.

That's because of the very nature of an aerodynamic stall, where the plane is flying so slowly that its wings will not keep the plane aloft.

To build the speed needed to regain control, pilots not only must move the engines to full power, but also must point the nose downward temporarily to allow gravity to give the plane a boost in speed, aviation experts said.

"I can understand that the pilot does not want to lose altitude too fast, but at the same time, you have to make sure the airplane has flying airspeed," said Scott T. Glaser of Defiant Co., a California aviation consultancy that specializes in "upset recovery training," or flying when things go wrong.

A former investigator for the safety board, meanwhile, stressed that other airlines followed the FAA guidance and put too much emphasis on maintaining altitude.

"It does go against the way you are taught to recover from a stall in a small plane," he said of pilots' early training.

In a true stall, he said, adding power alone will not be enough to recover control.

"You have to reduce the angle of attack," he said.

Asked if the training requirement could have contributed to the Colgan crash, the former safety board investigator said, "You might say yes because they were not trained to positively lower the nose, but no one ever was trained to pull up the nose the way (Renslow) did."

FAA also draws blame
After the crash, Colgan's training program was revamped to emphasize the importance of airspeed in stall recovery, the airline's pilots said.

In addition, they said Colgan pilots now receive hands-on training in every element of the stall recovery system, including the "stick pusher," an automated stall recovery devise that Renslow overrode as he tried to control the plane on his own. Renslow never had such hands-on training in that device.

While lauding the changes made by Colgan, another pilot for the airline blamed the outdated training before the crash not only on the airline, but on the FAA, which must approve training manuals and other elements of every airline's pilot training program.

"I have old training procedures [that] clearly state that the pilot must maintain altitude while in a stall," that pilot said. "We objected to it several times, but it was not changed until after the crash. The FAA was fully aware of this as they sat in our training events."

Another Colgan pilot said the airline's approach to training at the time did not focus on ensuring that pilots knew how to react in case of trouble.

"It was all just about checking the box so it was done and accomplished," that pilot said.

A fourth pilot agreed, saying, "It doesn't do a good job in training you to deal with real-world situations."

Told of all this, Mike Loftus, a former Continental Airlines pilot who lost his daughter, Maddie, in the Clarence crash, said it's been clear for some time that the crew of Flight 3407 did not receive adequate training.

"I never really faulted Renslow or [First Officer Rebecca L.] Shaw for this," Loftus said. "They were never trained or given the tools to do it the right way — and maybe they were even led to do it the wrong way."

Year in Review: Flight 3407

News staff reporter Tom Precious contributed to this report.

jzremski@buffnews.com

PILOT'S FATAL 'DISTRACTION'
By CHUCK BENNETT and BILL SANDERSON, AP
Last Updated: 8:53 AM, May 12, 2009

Posted: 3:00 AM, May 12, 2009
LINK

The inexperienced captain of Flight 3407, which crashed into a Buffalo home, killing 50 people in February, flirted and discussed relationships with his much younger female co-pilot moments before the fatal plunge, sources close to the investigation said.

What transpired between Capt. Marvin Renslow, 47, and his co-pilot, Rebecca Shaw, 24, in the minutes before the disaster will be topic No. 1 at a public hearing by the National Transportation Safety Board today in Washington, DC.

The two chatted back and forth during the final approach into Buffalo Niagara International Airport despite FAA rules that forbid non-flight-related talk below 10,000 feet, sources said.

Their banter was captured on the flight recorder, one source close to the investigation told The Post. Transcripts of their conversation may be released over the three-day hearing.

Shaw may have further been too fatigued to aid Renslow, sources said.

She had just taken a red-eye flight to Newark after spending a week skiing and visiting her parents in Seattle, complained about a head cold and said she should have taken a sick day.

Renslow, 47, was never properly trained on the Dash 8-Q400 Bombardier's anti-stall stick-pusher, sources said.

The safety feature automatically points the plane's nose into a dive to allow it to gain speed to prevent a stall if the plane slows down.

Pilots should push the stick forward to gain speed if this happens, but Renslow apparently yanked back, causing the crash.

Colgan, the Manassas, Va.-based airline that contracts with Continental, never provided proper training on the stick-pusher or de-icing system, sources said.

Renslow had also failed numerous competency exams, called check rides, throughout his short career as a pilot. He graduated from pilot school in 2005 and had already failed three proficiency tests on general aviation aircraft administered by the FAA.

At Colgan, he failed two more accreditation exams on turboprop planes. He bombed in his first bid to qualify as a co-pilot on the Beech 1900 aircraft. Then he failed in his first try for Saab 340 pilot certification.

At the time of the crash, Renslow had been captaining a Q400 for just two months, logging only 109 hours -- a minuscule amount of time by industry standards.

chuck.bennett@nypost.com

June 4, 2009
Inspector Predicted Danger Before Buffalo Crash
By MATTHEW L. WALD, New York Times

WASHINGTON — More than a year before a twin-engine turboprop flown by Colgan Air crashed on approach to Buffalo, a Federal Aviation Administration inspector complained to his superiors about the rocky start the airline was having with that model.

The inspector, Christopher J. Monteleon, was in the cockpit when the airline got its first such plane, a Bombardier Dash 8 Q400, and put it through a series of test flights.

Three times, he said, the pilots flew the airplane faster than the manufacturer’s specifications allowed, but they initially refused to report this and have the plane inspected for damage. They flew with a broken radio and did not want to write that up in the maintenance log, as the rules require, he said, because it might delay the next test flight. And they tried three approaches to the airport in Charleston, W. Va., and “botched” all of them, failing to get the plane at an appropriate altitude, on the right path and at the right speed for landing.

“They got confused,” Mr. Monteleon said in a recent interview, as he recalled the test flights in January 2008.

But when he reported problems to his F.A.A. superiors, he was suspended from important portions of his job overseeing Colgan’s acquisition of the Dash 8 and given a desk job, he said. Mr. Monteleon has had other run-ins with his bosses, and is currently on paid leave because, he said, managers accused him of menacing an agency lawyer.

Mr. Monteleon’s complaints about Colgan, which he repeated three months later to the Office of Special Counsel, a federal agency established to hear whistle-blower complaints, foreshadowed some of the issues that emerged 13 months later at the National Transportation Safety Board hearings on the crash near Buffalo, on Feb. 12, 2009. Colgan crews were flying fatigued, Mr. Monteleon said, and were not fully focused on the tasks in front of them, two factors apparently in play in the Buffalo crash. All 49 people on board the flight, which took off from Newark, were killed, along with one man on the ground.

While the safety board usually takes about a year to issue a final report on crashes like the one in Buffalo, its hearings in early May made it clear that the quality of the F.A.A.’s regulation of Colgan was one of the areas under investigation.

The F.A.A. insists that it took Mr. Monteleon seriously in the months before the crash.

A spokeswoman for the F.A.A., Laura J. Brown, said that after Mr. Monteleon made his allegations, the agency called in a team made up of inspectors from around the country, who could review the issues with an impartial eye. They recommended some changes in F.A.A. procedures, she said, which were carried out, but did not find any “major regulatory issues.”

Mr. Monteleon was not punished, she said, and privacy laws limited what she could say about “personnel issues.”

A spokesman for Colgan, Joe F. Williams, said, “Mr. Monteleon’s claims against us are baseless.”

“Colgan met or exceeded every single F.A.A. requirement necessary to add the Q400 to its fleet prior to beginning operations,” he said.

The Office of Special Counsel does not settle safety issues but sends them on to the inspector general of the department in question if it finds a “substantial likelihood” that that they are at least partly accurate. The office did send Mr. Monteleon’s complaint to the inspector general of the Transportation Department, the parent agency of the F.A.A., but the inspector general’s office has not completed its investigation.

The claims by Mr. Monteleon, 64, a 40-year veteran of the aviation industry who joined the F.A.A. in 1997, rely mostly on documents he himself wrote when the events occurred, and on his memory. Thus they are difficult for outsiders to evaluate. But they echo a previous case of inspectors who were penalized by their supervisors who overruled them in favor of the airline.

In 2008, two F.A.A. inspectors assigned to Southwest Airlines testified before Congress that their managers had let Southwest fly its Boeing 737s without inspections for cracks that the safety agency required. Office managers referred to the airline as the regulatory agency’s “customer.” Top F.A.A. officials eventually conceded that the inspectors were right and the middle managers were wrong.

Mr. Monteleon said his supervisors were too “cozy” with Colgan, and eager to help it keep its schedule; the airline had a contract with Continental Airlines to begin flights in the Dash 8 plane — flying as Continental Express — in a little over a month after it acquired its first plane of that type.

In one memo retained by Mr. Monteleon, his manager indicates that he was reassigned because of his “conduct during a work-related duty” and because “the matter also required management to immediately respond to the operator’s scheduling needs.” The operator was Colgan.

Mr. Monteleon’s lawyer, Debra S. Katz, said the most recent charge against Mr. Monteleon, of menacing an F.A.A. lawyer, was trumped up as a way to get rid of him. “The F.A.A. seems bent on pushing Chris out in retaliation for his disclosures,” she said. She said she hoped the Office of Special Counsel would order his re-instatement.

His complaints — and his troubles — did not begin with Colgan’s handling of the Dash 8. Earlier, he had a bigger job supervising Colgan, as the principal operations inspector. But, he said, after he observed violations and deficiencies in crew training, crew fatigue and other problems, he tried to bring a case against the airline and was blocked by his F.A.A. managers. As punishment, he said, he was demoted. He then agreed to be transferred to the Office of Runway Safety, which was in charge of collecting and analyzing data about incidents in which planes came too close to each other on the ground.

When he got there, he complained that the office was using skewed methodology to understate the severity of safety concerns. He said a top F.A.A. safety official testified before Congress in April 2008, and said that the agency was making progress on improving runway safety, but, Mr. Monteleon said, the testimony was based on inaccurate statistics.

This has not been verified, either, but a 2007 report by the Government Accountability Office does note that the F.A.A. found problems itself with its 2006 runway incursion data.

FAA aided Colgan’s scheduling after inspector's complaints
Inspector benched after critical report

By Jerry Zremski, News Washington Bureau Chief
Updated: June 06, 2009, 9:29 AM /
LINK

WASHINGTON — After federal flight inspector Christopher J. Monteleon reported that pilots at Colgan Air were not ready to safely fly the Bombardier Dash 8 Q400, his bosses transferred him, in part “to immediately respond to the operator’s scheduling needs,” a Federal Aviation Administration official said in a memo obtained Friday by The Buffalo News.

After the transfer, the FAA approved Colgan to begin flying the Q400 on schedule — and less than a year later, on Feb. 12, a Colgan Q400 crashed in Clarence, killing 50 people.

Monteleon and other whistleblowers at the FAA said that experience was similar to what by-the-book inspectors at the agency have faced for years.

“The FAA has fostered an internal culture of non-accountability that continues to endanger the public,” the whistleblowers said in a letter to key senators.

Lawyers for Monteleon provided that FAA memo and the whistleblowers’ letter to The News.

And in an interview, Monteleon detailed the troubles he saw Colgan pilots having flying the Q400 — and said he was moved to a desk job in retaliation for reporting those troubles.

The March 17, 2008, memo from Nick Scarpentino, manager of the FAA’s Washington Flight Standards District Office, to Monteleon’s union representative said he was transferred because of “an incident regarding . . . Monteleon’s conduct.”

Monteleon denied the FAA’s allegation that he threatened another employee.

Instead, he pointed to this line in the memo: “The matter also required management to immediately respond to the operator’s scheduling needs, which was an issue at the time.”

Saying Scarpentino should have been fired for connecting a safety issue to Colgan’s scheduling needs, Monteleon said: “When the FAA looks at its regulated entities as customers, then FAA has a systemic problem.”

Laura J. Brown, a spokeswoman for the FAA, said she could not comment on why Monteleon was transferred because personnel matters are proprietary.

“Our position is that none of his moves were retaliatory,” she said.

In the interview, Monteleon elaborated on the flight-safety issues he described to National Transportation Safety Board officials after the Colgan crash.

On test flights he took with a Colgan crew on a Q400 on Jan. 19, 2008, the pilot exceeded the plane’s speed limitations, failed to recognize a communications system malfunction and mishandled the plane’s landing.

Monteleon said the test pilot acknowledged to being fatigued — a problem that, according to investigators, also may have been an issue with the crew of Flight 3407 that crashed in Clarence.

He also saw Colgan test pilots violating “sterile cockpit” rules that prohibit unnecessary conversation during key parts of the flight — just as the crew of Flight 3407 did.

Saying he had witnessed a “wink and a nod” attitude toward safety rules at Colgan dating as far back as 2004, Monteleon added: “No, I didn’t predict an accident. And I don’t know what caused it. But the trends point in a certain direction.”

Monteleon filed a complaint about those test-flight violations, but he said he was ordered to cease his investigation and that evidence of its existence was erased.

After he was transferred away from Colgan, he filed whistleblower complaints with the Office of Special Counsel and the inspector general of the U. S. Department of Transportation.

Monteleon’s case is by no means unique, the FAA Whistleblowers Alliance said in a letter to Sen. John. D. Rockefeller, the West Virginia Democrat who heads the Senate Commerce Committee, and other senators that oversee aviation.

“The evidence of FAA oversight failures has been a constant and troubling concern in fatal air carrier accidents over the past several years,” the group said.

Brown, of the FAA, said the agency had always taken whistleblower complaints seriously and followed up with changes when necessary.

But Monteleon, for one, doesn’t think that’s so.

He said that after Flight 3407 crashed, “I put my feelings to paper in a rather emotive letter” to investigators who were probing his whistleblower complaint against the FAA.

“It was something like: Please, do something,” he said.

jzremski@buffnews.com

 
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