FAA Must Strike Balance Between Safety, Cost Issues : Aviation: Agency has to justify rules that may burden airlines. Critics say economics carry too much weight.


When the Federal Aviation Administration decides whether to toughen airline safety regulations, the agency faces a dilemma: It must weigh the cost of proposed reforms against the value of human lives lost if nothing is done.

A life, the government calculates, is worth $2.6 million.

For example, records show, the FAA passed a regulation in 1992 requiring low-altitude warning systems in commuter airplanes, but only after agency officials determined that failing to act would cost $95.1 million in lives and property--far more than the $29 million for the devices.

When the rule finally took effect in April, 126 people had died in accidents that the FAA acknowledged may have been prevented by the safety equipment.


“The system kind of stinks,” said Vinnie Mendolia of Medford, Ore., whose brother, Richard, died in one such crash in 1989. “Too bad something has to go wrong and people have to die” before regulations are changed.

A four-month Times review of government documents and scores of interviews with air safety officials sheds light on a question hundreds of relatives of airplane crash victims and frustrated air safety investigators have asked:

Why does it sometimes take disaster or the passage of years to get federal air regulators to take meaningful action?

Like the causes of airplane crashes themselves, the answer is complex.

It is rooted partly in the conflicted nature of the FAA. Serving two masters, the agency is charged with nurturing the aviation industry while ensuring the safety of the flying public.

The FAA must balance safety against the cost to airlines, manufacturers and others whenever it considers changes in safety and equipment regulations. The result, according to records and interviews, can be delays in addressing safety problems--and more accidents related to them.

“There were several fixes on the shelf that did not come off the shelf until the second accident, or sometimes the third,” said Ira J. Furman, a New York attorney who has worked for the National Transportation Safety Board and testified before Congress on aviation safety issues.


“I always wondered why it wasn’t available beforehand. And the answer . . . is there are cost-benefit analyses being done all the time.”

The FAA’s harshest critics don’t for a minute believe that the agency knowingly waits for an accident to happen. But because the FAA must justify changes that require expenditures by the aviation industry, the agency sometimes must use past accidents to help make its case.

And once the agency decides to make safety-related changes, it can take years before new rules take effect, in part because the agency must consider the ramifications on the airline industry.

FAA Administrator David Hinson said every government agency is required by law to justify rules changes that cause financial burdens to government or private industry.

To suggest that the practice almost requires accidents is “a bit of an exaggeration,” Hinson said in an interview.

“It’s just a way for Congress to ensure” that industry isn’t “unfairly . . . burdened. . . . But we don’t compromise safety at any cost that I’m aware of.”


“I think there’s this impression that the FAA stands around, waits for accidents to happen and then acts,” Hinson said. “Nothing could be further from the truth.”

The NTSB’s Barry M. Sweedler, director of safety recommendations, said the FAA has an easier time pushing through safety regulations, particularly those that are costly to the industry, when it can justify the expense.

“For them to go forward to change rules that they can’t show a cost-benefit for, it’s very tough,” he said.

The point is illustrated by the FAA’s handling of a critical safety issue on commuter planes.

The FAA had recognized the benefits of installing “ground proximity warning systems” since the mid-1970s when it required their installation on commercial jets. The devices verbally warn a pilot if the plane is too close to mountainsides or other terrain.

After studying a series of crashes in the early and mid-1980s, the NTSB on Oct. 9, 1986, released a study, saying it was convinced that three recent commuter plane accidents that killed 25 people likely would not have happened if the aircraft had been equipped with ground proximity warning systems.


The study noted that commercial airline crashes involving “controlled flight into terrain” dropped 75% once the FAA required the altitude devices. The NTSB recommended that all turbine-powered airplanes that carry 10 or more passengers be required to have one on board.

But, records show, the FAA and some in the commuter airline industry, while acknowledging the life-saving merits of the devices, opposed them, questioning whether the cost, at roughly $14,000 apiece, was justified.

Accidents continued. On Jan. 19, 1988, a Fairchild Metro Twin commuter plane crashed into a ridge in Durango, Colo. Nine of the 17 people aboard died. A month later, a Fairchild Metro III crashed in Raleigh-Durham, N.C., killing 12.

An internal FAA memorandum dated September, 1988, said 60 of 280 commuter airline crashes between 1972 and 1985 may have been avoided with ground proximity warning systems.

“When averaged out over 14 years,” the memo said, “this amounts to approximately four accidents per year. These 60 accidents accounted for 141 fatalities.”

In 1989, at the FAA’s request, the Department of Transportation studied 41 accidents that occurred between 1970 and 1988, concluding that two-thirds of them could have been prevented if the planes had had ground proximity warning systems.


Finally, on April 24, 1990, the FAA announced its intent to pursue a rule change that would require the installation of altitude warning systems in commuter planes.

The next year the agency did a cost-benefit analysis.

The devices would save 56 lives a year at $1.5 million each--the estimated value of a human life at that time--and would prevent seven injuries at $4.5 million a year and salvage 16 airplanes worth $6.6 million, according to an FAA memo dated March 4, 1991.

Total benefit: $95.1 million, nearly $70 million more than the cost of requiring the devices on the more than 800 airplanes that would be covered by the rule.

Some airlines requested that the FAA require a cheaper version of the device, but the FAA refused.

The FAA did, however, give the industry two years to comply; in the meantime, more accidents happened.

Within the FAA, officials recognized the deadly cost of more delays.

“For every six months we delay GPWS, we can expect an accident,” said one official in a 1992 memo.



Four months before the deadline, Northwest Airlink Flight 5719 crashed in Hibbing, Minn, killing 18 people. The NTSB concluded: “This accident, like many others, could have been prevented.”

“To lose a son is a terrible thing,” said Leonard Falitz, whose son, Marvin, died in the Minnesota crash. “There were times when I woke up in the middle of the night and went through the flight recorder, every word, every detail.”

Another parent, Dolores Shue, still remembers a day in September, 1985, when the phone rang and the official-sounding voice on the other end of the line said he was sorry, but he had some terrible news: The plane carrying her son, Larry, and 13 others had gone down and, in all likelihood, Larry was dead.

Later, she would learn something nearly as tragic: A ground proximity warning device could have prevented the accident.

“There is no good way to learn that” your child has died in a plane crash, Dolores Shue said. “I just couldn’t believe it. I wasn’t crying. I just stood in the middle of my living room.

“He seemed like one of those eternal people to us.”

In their last conversation, Dolores Shue spoke to her son, a writer, about the upcoming Chicago opening of his successful play, “The Foreigner,” and about the sitcom pilot he was writing for CBS.


The first indication that something was wrong came at 6 p.m. when a Henson Airlines official telephoned. “She asked me if there was someone there with me. . . . I said: ‘Don’t tell me there was an accident.’ ”

The commuter plane had smashed into the side of a mountain in Virginia’s Shenandoah Valley.

Larry Shue’s wake took place the same day his play was scheduled to open in Chicago.


Critics say that the FAA, in seeking changes in regulations, depends too heavily on accidents that have already occurred. The reason, they say, is that in a climate of public outrage over a serious accident, it is easier to push reforms through Congress.

Rep. James L. Oberstar (D-Minn.) said a heavy reliance on past accidents is built into the system.

The FAA “are people who are very high-minded, very committed to safety, but then they are told: ‘You’ve got to spend the time doing these analyses,’ ” said Oberstar, the outgoing chairman of the House Committee on Public Works and Transportation’s subcommittee on aviation.

“By the time you get through this, it can be months and years.”

Before the FAA can act, records show, the agency calculates how a proposed safety rule will affect the aviation industry--everything from the public perceptions of a specific company or industry to the economic impact. Critics feel that sometimes safety takes a second seat to economic concerns.


Earlier this year, when the agency pondered whether to adopt measures to prevent accidents caused by potentially deadly wake turbulence from Boeing 757 jetliners, FAA officials were concerned about economic health of the Boeing Co., internal documents show.

In internal memos, they expressed concern about what effect any new safety measures would have on sales of the popular jetliner. They analyzed the pros and cons of taking action on the turbulence issue. “Boeing’s perception” among the public was one of the cons listed.

Two accidents linked to B-757 wake turbulence had already happened, killing 13 people.

“Ultimately, you can’t make safety recommendations in a vacuum,” said former NTSB Chairman James E. Burnett Jr. “But weighed against human life, (a company’s) image ought not to have much weight.”

A more recent, if subtler example: The FAA earlier this month called a news conference to say that ATR regional aircraft are safe. It followed the Oct. 31 crash of an American Eagle ATR-72 that killed 68 people in Roselawn, Ind. The FAA specifically declared that the planes were safe--an assurance that some observers believed went too far.

Friday--a week after the FAA held the news conference to reassure the public that ATR commuter planes were safe--the agency ordered regional airlines not to fly the planes in icy weather. Ice has been a prime suspect in the crash.

“What they ought to be saying is: ‘This airplane is complying with the full extent of regulations,’ ” said one aviation safety source who spoke on condition of anonymity. “They declared the aircraft safe. That’s not what a government regulatory agency should say. In effect, they’re a booster for the airlines.”


A close relationship between the FAA and the industry is a natural one, given the agency’s mandate to foster air travel. But critics say that it sometimes impedes safety decision-making.

After investigating a 1988 non-fatal accident in Dallas involving a DC-10, air safety investigators determined that the brakes on DC-10s were inadequate to stop the airplanes during an aborted takeoff.

But, Burnett said, “the FAA was slow to admit there was a problem. That’s because the people at the FAA had been involved in the certification of this aircraft years ago. Admitting there was something wrong now meant they had made a mistake the first time.”

Another example: In 1985, an Eastern Airlines L1011 had to make an emergency landing in Miami shortly after takeoff. An investigation showed that the airline had a problem with missing O-rings on engines in its L1011s that caused seven forced landings.

At a hearing, the FAA said it had been aware of the problem prior to the incident. Officials acknowledged that they relied on a phone call to Eastern’s vice president to remedy the problem and had not checked his maintenance records.

“Vice presidents don’t put on O-rings,” Burnett said curtly.

In an interview, Burnett later said: “The FAA says it has an arm’s length relationship with industry, but the question is whether it should be just an arm’s length.”


FAA officials say their relationship with the airlines and manufacturers is proper and healthy, and both are working together to make flying even safer.

Chris Chiames, spokesman for the Air Transport Assn., said: “They are our regulators. We have a working relationship with them. Sometimes it’s a good relationship; sometimes we are at odds.

“To suggest anything other than that it is a working relationship is incorrect. There are plenty of times we feel the FAA oversteps its regulatory authority in imposing requirements on us.”

Chiames defended the FAA’s record on safety issues. “What is the (safety) record of the industry the FAA regulates? It’s the best in the world. Can it be better? We want it to.”

In other instances, safety issues at the FAA--a bureaucracy with 50,000 employees and a budget nearly equivalent to the state of Alabama’s--have simply fallen through the cracks.

One recent fatal accident involved one of the FAA’s own planes--a Beechcraft Super King Air 300 that crashed into a mountain in October, 1993, in Virginia, killing three people.


The NTSB determined that pilot error was the chief reason for the crash, but the safety board, in a wider investigation, also found some disturbing lapses in the way the FAA runs its fleet of 50 planes.

Many planes were missing critical safety equipment, such as cockpit voice recorders and ground proximity warning systems, the safety board said. The agency had no approved manuals for maintenance procedures and flight operations, the board said.

Similar problems were identified by the FAA itself after a 1988 accident that destroyed a Rockwell Jet Commander operated by the FAA.

The NTSB cited failure of the FAA hierarchy “to properly recognize and resolve problems within the flight inspection program” of their own agency.

Those problems, the NTSB said, were not corrected because “management action was ineffective, and oversight by senior executives was insufficient.”

“This business of their own flying operations--they made promises, they said they would clean it up and they didn’t,” one air safety investigator said. “Their own audits had pointed it out.”


Hinson said the agency doesn’t always agree with the accident findings of the NTSB, which is responsible for making safety recommendations following crashes. FAA has vowed, however, to scrutinize the procedures it uses for its own fleet to prevent future accidents.

Next: How the FAA is addressing problems.

Times researcher Sheila A. Kern and special correspondent Shelby Grad contributed to this report.

How the Study Was Conducted

To complete this report, The Times reviewed about 20,000 pages of internal documents obtained from the Federal Aviation Administration through the Freedom of Information Act. The newspaper also reviewed a computer analysis of the causes of airplane crashes between 1983 and last July by the National Transportation Safety Board. The Times also studied dozens of reports by government oversight agencies and interviewed scores of present and past FAA officials, airline industry sources, aviation safety experts, members of Congress, crash survivors and the families of crash victims.


Slow Response to Low-Altitude Crashes

Federal Aviation Administration officials say at least 60 crashes killing more than 150 people might have been prevented if commuter aircraft were equipped with ground proximity warning systems. However, it took numerous reports and several years for the FAA to require such alarms.

* 1975: FAA requires low-altitude warning devices on commercial jets after two crashes; 167 dead.

* 1981: Study of 1976-80 near-crashes involving commercial jetliners finds ground proximity warning system prevented several potential disastrous crashes.


* Aug. 25, 1985: BE-99 crashes in Lewiston, Me.; 8 dead.

* Sept. 23, 1985: BE-99 crashes into mountain in Shenandoah Valley, Va.; 14 dead.

* March 13, 1986: Simmons Airlines Flight 1746 crashes in Alpena, Mich.; 3 dead.

* Aug. 28, 1986: Cessna 441 Conquest crashes in Lander, Wyo.; 7 dead.

* Oct. 9, 1986: National Transportation Safety Board says three commuter plane crashes “could have been prevented if the flight crew had been alerted to their proximity to the ground”; 25 dead.

* Jan. 19, 1988: Metro Twin commuter plane crashes into ridge in Durango, Colo.; 9 dead.

* Feb. 19, 1988: Fairchild Metro III crashes in Raleigh-Durham, N.C. NTSB says warning system could have prevented the crash; 12 dead.

* September, 1988: Internal FAA analysis of 280 commuter airline crashes, 1972-1985, shows ground proximity warning systems could have “helped” pilots in 60 instances.

* March, 1989: U.S. Department of Transportation study of 41 accidents, 1970-1988, concludes that 66% could have been prevented if the planes had warning systems.

* Oct. 28, 1989: DeHaviland DHC-6-300 crashes in Molokai, Hawaii; 20 dead.

* Jan. 15, 1990: Fairchild Metro III crashes in Elko, Nev. NTSB says warning device might have prevented crash; 13 injured.

* April 24, 1990: FAA indicates plans to require warning systems on turbine-powered craft with 10 or more seats.


* March, 1992: FAA passes new rule requiring warning systems in turbine-powered, fixed-wing airplanes with 10 or more seats. Industry complains about cost, FAA pushes compliance date to April 20, 1994.

* Nov. 5, 1992: Internal FAA memorandum says “for every six months we delay GPWS, we can expect an accident.”

* Feb. 25, 1993: Internal FAA memorandum says 119 people died in preventable crashes before new rule on ground proximity warning systems. Since then, memo says, there have been four crashes and seven deaths.

* Dec. 1, 1993: Northwest Airlink Flight 5719 crashes in Hibbing, Minn. Six months later, NTSB says, “The safety board concludes that this accident, like many others, could have been prevented.” 18 dead.

Source: Federal Aviation Administration and National Transportation Safety Board

Researched by JEFF BRAZIL and SHELBY GRAD / Los Angeles Times


Aviation Death Toll

After reaching its lowest point in a decade in 1993, the number of civilian fatalities on U.S.-registered aircraft has turned upward: 1994: 843* * Through October


Source: National Transportation Safety Board



Small Problem Took Years to Fix

At least seven accidents during the last 15 years have been attributed in part to a carburetor defect in Cessna aircraft. The part, known as a two-piece venturi, is supposed to moderate fuel and air mixture. Instead, it would inexplicably break, causing the engine to run roughly or quit. In the face of accidents and warnings, some coming from within its own ranks, the Federal Aviation Administration took years before requiring a simple fix of the defect.

* 1963: FAA requires a fix for the carburetor defect, but the change applies to only one carburetor model, despite the fact that similar models have the same flaw.

* July, 1984: A Cessna crashes in West Plains, Mo., killing one.

* March 8, 1985: National Transportation Safety Board, citing 26 incidents and seven crashes from 1979 to 1984, recommends that the FAA require the manufacturer to design replacement parts for flawed carburetor models and require installation.

* Dec. 3, 1987: FAA says it will not order the fix but instead will “monitor the situation.”

* 1988: Carburetor manufacturer, Precision Airmotive Corp., without FAA’s prodding, designs a fix.


* March, 1991: General Accounting Office issues report critical of FAA’s ability to spot and act upon safety problems involving specific airplane models.

* Sept. 21, 1991: A Cessna crashes in West Chicago, Ill., killing two.

* Oct. 29, 1991: Carburetor manufacturer urges FAA to issue a directive requiring replacement of two-piece venturi with one piece, saying the “old-style two-piece venturis used in earlier carburetors constitute a significant safety of flight problem and must be removed from service.”

* December, 1991: Manufacturer revises its own bulletin to say replacement of defective carburetors should be carried out immediately.

* Jan. 24, 1992: Safety board, noting that it first brought this problem to the FAA’s attention in 1985, again recommends that the agency make the fix.

* Jan. 29, 1992: Internal FAA memorandum says fix was not ordered after manufacturer’s October, 1991, request because the “small number” of incidents did not warrant it.

* February, 1992: The FAA, in light of the safety board’s latest recommendations, says it will consider requiring a fix.


* May 10, 1992: A Cessna 177 crashes in Maryland; three die.

* June, 1992: FAA acknowledges carburetor problem, vows to prepare a directive requiring fix to be made on all Cessnas within four years.

* July 3, 1992: Private Oregon engine inspector tells FAA “to allow up to 48 months for compliance is to invite the possibility of further accident and injury or loss of life.”

* March 18, 1993: FAA issues directive requiring carburetor fix with a two-year compliance period.

Sources: Federal Aviation Administration, National Transportation Safety Board

Researched by JEFF BRAZIL and SHELBY GRAD / Los Angeles Times