Amidst the media reports accompanying the worldwide grounding of the 737 MAX, concluding with the reluctant Federal Aviation Administration (FAA) grounding, were mentions that the investigative team on the ground in Ethiopia had found “airplane configuration evidence” similar to the Lion Air Flight 610 accident. This evidence, along with the Automatic Dependent Surveillance Broadcast (ADSB) altitude data, were strong enough evidence to indicate the likelihood that the 737 MAX’s new Maneuvering Characteristics Augmentation System (MCAS) had, as in the Lion Air Flight 610 accident, failed in the nose-down direction most likely due to another failed single angle of attack (AOA) input.
Faced with 346 deaths in less than five months due to similar circumstances, Boeing and the FAA succumbed to the worldwide pressure to ground the fleet of 737 MAX airplanes until Boeing’s planned software and pilot education and training “fixes” are in place – the ones Boeing appears to have deliberately chosen not to implement during design and certification in order to save money and sell more airplanes.
The “airplane configuration evidence” mentioned in these news reports likely includes the wing flap positions in the retracted position, as Boeing statements to date indicate this problem only occurs in the flaps up configuration with the autopilot off. This configuration is typical of the latter stages of takeoff and initial climb phase as the airplane is accelerating through the flaps up speed with the pilots often still flying manually. The other likely configuration evidence they found is the horizontal stabilizer position in or near the full nose-down position, consistent with the position the MCAS is trying to drive it to in its logic-driven, fruitless pursuit of lowering the single, failed AOA value.
The engineering and safety managers at Boeing can’t be sleeping much lately. They know they have failed badly in every aspect of their corporate mission to be both profitable and safe at the same time. They did not learn their lesson from the 2009 Turkish Airlines Flight 1951 accident debacle and subsequent lawsuits. Boeing repeated those mistakes and then some. How is that possible with a company as filled with capable talent and resources as Boeing?
One easy observation is that their engineers and managers clearly don’t practice what they preach for airline pilots – adherence to training and checklists. System redundancy and considering and testing every failure mode are surely in their design training and checklists – they are listed on the company website – but Boeing didn’t adhere to them. Is Boeing merely there for lip service and liability reasons?
Robert A. Clifford, founder and senior partner at Clifford Law Offices who has represented many victims and their families involved in Boeing crashes around the world, explains:
“Another easy observation is that it doesn’t have a mechanism by which to assure past mistakes aren’t repeated. How else can one explain the Turkish Airlines Flight 1951 mistakes related to lack of system redundancy and voting for validity of sensor inputs being repeated to a “T” in Lion Air Flight 610 and now likely Ethiopian Flight 302? To the aeronautical engineering, technical pilot and safety professional community, it’s unfathomable, inexcusable and shameful. To Boeing, its shareholders and its insurers, it will likely be financially painful in the short and long runs.”
News reports now say the flight data and cockpit voice recorders (FDR and CVR) are being taken to the French Bureau d’Enquetes et d’Analyses (BEA), the French version of the U.S. National Transportation Safety Board (NTSB), where its recorder lab specialists will attempt to download the data from the memory chips. After download, they will then convert the recorded binary data (0s and 1s) to engineering units, print them out in spreadsheet and graphical formats, then analyze the data to begin reconstruction of the accident and actions of the flight crew. At that time, the Ethiopians then will decide what new information to release to the public, and Boeing and the various airworthiness authorities like the FAA will decide their next moves with respect to the airworthiness and flight authorization of the 737 MAX fleets. The legal actions will also begin to play out amongst those representing the victims and their families once the initial results of the recorder readouts are released.
It’s important to note that the Ethiopians chose to take the recorders to France despite the strong push from Boeing, the FAA and the NTSB to take them to the NTSB recorder labs in Washington, D.C. “France has no horse in this race other than their country’s Airbus A320 which is the primary competitor to the 737, so the Ethiopians probably felt that France was closer to them and had less conflict of interest than the U.S. NTSB,” Clifford said of this move. “The BEA recorder labs are known to be among the top labs in the world and they surely licked their chops at the opportunity to show the world their talents and make sure they fully analyzed the Ethiopian recorder data to help the Ethiopians expose every flaw and weakness of the 737 MAX that may have caused or contributed to this crash.”
Clifford continued, “Overall, the decision to take the recorders to the BEA was a wise strategic move for the Ethiopians – it assures they maintain control over the investigation and data to a larger extent than the NTSB choice, and they save a lot of time travelling for the readout and analysis portions of the effort.” Boeing and the NTSB, on the other hand, will have a good number of their staff in Ethiopia and France for some time until the field investigation and recorder work is done.
Now comes the tedious wait for the public release of the FDR and CVR download and analysis results, as well as the wreckage field investigation results. “Fortunately, the grounding of the 737 MAX fleet will likely result in a much faster process and public release versus a typical non-grounded fleet investigation. Boeing and the airlines will want results and a fix in place as soon as possible to slow and eventually stop the financial bleeding that started a couple days ago and reached maximum rate with the U.S. grounding,” Clifford said.
Did Boeing really think they were going to save that much money when they decided to design the MCAS with only one AOA input? Did they weigh that savings against the potential loss situation they have now put themselves in? What role did the Boeing safety engineers and managers play in the design and certification of the 737 MAX, and in particular, the MCAS with its single AOA input and total lack of pilot education and training? Clifford said, “Somewhere, somehow, something is very wrong in the Boeing Company and needs to be fixed permanently, now.”
To speak with Robert A. Clifford or one of the aviation partners at the firm, contact Clifford Law Offices Communications Partner, Pamela Sakowicz Menaker at 847-721-0909 (cell).