NTSB: Am­trak’s lax safety cul­ture led to crash that killed 2

The Times Herald (Norristown, PA) - - NEWS - By Michael R. Sisak

PHILADEL­PHIA » Am­trak’s safety cul­ture suf­fered ma­jor lapses, in­clud­ing more than two dozen un­safe con­di­tions at a work zone where a train slammed into a main­te­nance back­hoe last year, killing two work­ers, fed­eral in­ves­ti­ga­tors said Tues­day.

Chief among them, in­ves­ti­ga­tors said, were a fore­man’s fail­ure to make sure dis­patch­ers were still rerout­ing trains from the area un­der re­pair near Philadel­phia and the crew’s fail­ure to use a de­vice that would have au­to­mat­i­cally blocked ac­cess to those tracks.

“Had any of these is­sues been ad­dressed, the ac­ci­dent may have been pre­vented or the sever­ity mit­i­gated,” Na­tional Trans­porta­tion Safety Board in­ves­ti­ga­tor Joe Gor­don said at a public meet­ing on the crash at the agency’s Wash­ing­ton head­quar­ters.

The April 2016 crash killed back­hoe op­er­a­tor Joseph Carter Jr. and su­per­vi­sor Peter Adamovich. About 40 pas­sen­gers on the New York to Sa­van­nah, Ge­or­gia, train were in­jured.

NTSB chair­man Robert Sumwalt said Am­trak’s ap­proach to safety — with ev­i­dence show­ing it pri­or­i­tized on-time per­for­mance while threat­en­ing to fire work­ers who broke rules — had cre­ated a cul­ture of fear where bend­ing the rules was ac­cept­able to “get the job done.”

“Am­trak’s lack of a strong safety cul­ture is at the heart of this ac­ci­dent,” in­ves­ti­ga­tor Mike Hoepf said.

Am­trak said it would re­spond to the NTSB’s find­ings later on Tues­day.

Tox­i­col­ogy re­ports showed that Carter, 61, had co­caine in his sys­tem and Adamovich, 59, tested pos­i­tive for mor­phine, codeine and oxy­codone. The train’s en­gi­neer, 47-year-old Alexan­der Hunter, tested pos­i­tive for mar­i­juana, ac­cord­ing to the re­ports.

Only Hunter, as a train crew mem­ber, would have been sub­ject to ran­dom drug test­ing at the time of the crash. In June, fed­eral reg­u­la­tors ex­panded the test­ing pro­gram to in­clude track main­te­nance work­ers. On Mon­day, the Fed­eral Rail­road Ad­min­is­tra­tion is­sued a rule man­dat­ing test­ing for opi­oids be­gin­ning Jan. 1.

Hunter is no longer em­ployed by Am­trak. No amount of mar­i­juana use by an en­gi­neer is ac­cept­able, the rail­road has said.

He told in­ves­ti­ga­tors that he knew of main­te­nance work be­ing done in the area but was not given any warn­ings about equip­ment be­ing on the same track as his train.

Hunter blew the train’s horn and hit the brakes once he saw equip­ment on an ad­ja­cent track and then on his own track. In­ves­ti­ga­tors say that was about 12 sec­onds be­fore im­pact.

The train slowed from 106 mph to 100 mph at im­pact and only came to a com­plete stop about a mile down the track. The lead en­gine of the train derailed.

Fol­low Mike Sisak at twit­ter.com/mike­sisak

MICHAEL BRYANT/THE PHILADEL­PHIA INQUIRER VIA AP, FILE

In this April 3, 2016, file photo, Am­trak in­ves­ti­ga­tors in­spect the deadly train crash in Ch­ester. The Am­trak train struck a piece of con­struc­tion equip­ment just south of Philadel­phia caus­ing a de­rail­ment.

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