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What was behind the #PelAir accident

What was behind the #PelAir accident??

Karen Casey and David Helm are the human faces behind the PelAir ditching, where all six occupants of the Westwind jet on that dark 2009 November evening, ended up in the 2.5metres seas surrounding Norfolk Island. All the occupants, were “lucky” to be found by the observant Norfolk Island rescue group, finding the small group by only a flashing torch held by pilot Dominic James. [Pel Air – Behind the action]

Karen Casey during the time she was in the ocean, supported the patient, who only had a part inflated lifejacket. This is where Karen’s injuries largely occurred.

Unfortunately, in the well known Lockhart River tragedy, we never met the people in real-life.

Karen Casey and David Helm were suvivors, wheras Sally Urqhart – the face of Lockhart River – was not.

In Karen and David’s case it has taken over five years to get the matter into Court for resolution.

Sally’s family took 7 1/2 years.

This is an area that needs serious attention by our politicians and rule-makers of how aviation compensation for what should in many cases be a simple procedure. The role of the insurance companies in slowing the process should be included as well.

Safety management and PelAir:

The small group, who were now in the sea, had some inoperative life jackets and not been trained correctly by the operator [PelAir] and undertaken what is known as 20.11 training. The 20.11 training includes in-water escape and life jacket training and aircraft escape techniques.

This is required under the normal safety management systems.

The question of who undertook the provision of that plan and the relationship to the organisation, whether it was being correctly implemented or if the plan was sufficient to prevent likely occurrences, such as the “ditching” and fuel management, is still to be revealed.

The Consequences:

The ditching took both the flight nurse and the attendant doctor, from being fully functional and able individuals to individuals with serious long-term injuries and restrictions to their healh.

The Supreme Court evidence [largely un-challenged by the defence counsel of the insurer] showed that:

Karen Casey – Had a series of serious injuries and complaints detailed by her legal team:

All of which indicate that she will be unable to work for the rest of what would be a normal working life. This evidence details serious injury to herself and to the extent that she will have continuing medical treatment.

David Helm – Also had injuries that have taken him from an active rugby payer and sportsperson, to:

That of reduced working life and long lasting personal injuries.

The combined legal team described this as a significant alteration of the life of a young man/ woman. They went on to detail where statements of significance, such as specialist reports, went un-challenged by the insurers legal team.

The Warsaw and later Montreal treaties were argued at length as to relevance. If these treaties are applicable, the amount of compensation available, could be seriously limited to 100, 000 units [around $100 to $200,000], if these are applicable.

In this, the importance of the recent case, in the same NSW Supreme Court is instructive and worth a look.

Why did the ditching occur?

There has been an enormous amount of information, an ATSB inquiry, a CASA inquiry, a Senate inquiry, then subsequent investigations into the entire aviation industry [CASA, ATSB] to rectify, what are industry acknowledged problems.

The answer to this is complex, but of course with the benefit of 20/20 hindsight, CASA could have prevented this accident with proper and correct oversight. ATSB could have come up with a robust report if it had all the information and an interference campaign was not mounted against the final report.

The cynical of us would ask:

Why were CASA unable to or why did they not properly surveil PelAir in the 2008 [pre-accident] CASA audit?

Maybe this is similar to the views of those affected by the Lockhart River tragedy; where there was both actual and adduced evidence that there was interference with the ATSB investigation, poor CASA surveillance and probable interference with the Coronial process.

And why did the ATSB fail to report on these structural problems with PelAir?

The Senate did get to the bottom of the poor ATSB report, with an e-mail between an internal ATSB investigator and the ‘system’, being pivotal in demonstrating that the final report [by ATSB] had in fact been compromised. The Senate found 37 ‘issues’ with ATSB [and CASA], that compromised the report, to the extent that the Canadian TSB was briefed to look at the report and the process.

The ATSB then had the task of giving the TOR’s [Terms of Reference], which narrowed the area which the CTSB could investigate, to the level of a paper-work review. The CTSB was up to the task and found, similar to the Senate, serious issues in the report.

The report is to be re-done, but by someone in the ATSB, who is not independent.

One, on reading the original ATSB ‘Preliminary Report’ and comparing the ‘Final ATSB Report’, finds there are inconsistencies between both reports. For example the person flying and the positions of all on board is not reported, nor whom and whether the aircraft became visual is canvassed.

The other issue of course is the CVR [Cockpit Voice Recorder] and why ATSB never raised it from the ocean floor and what it contains. Along the way, CASA has acted to blame the pilot, then, in the words of Dominic James – “……….continue to pursue and blame me and interfere with my ability to get aviation jobs at the same level as in 2009….”

It appears, both on the surface and with investigation, that CASA and ATSB that CASA did not do it’s job properly and withheld information from ATSB.

The pivotal CASA report [by Roger Chambers] was withheld, and it on it’s own prevents ATSB from reaching an unbiased view and report. Of course, that the ATSB publishes a view, that is published as the final report, involving ‘…direction to the author…’ is lamentable and a distinct travesty, if not a ‘conflict of interest’ of the series of individuals involved.

In any event, the likely and proven interference by the regulator [CASA] on the investigator [ATSB] in the final report on the ditching is unconscionable. When the Senate investigation occurred, with the assistance of the flying crew [Captain] and the flight nurse, it, together with the 37 recommendations, is quite the reverse of where CASA and ATSB wished the users of aviation services to be and should be carefully considered.

These things, taken together show clearly, an incompetent regulator and a compromised investigator.

This is not a situation, where an aware public should be placed as this does not lead to confidence in either of these two organisations.

In fact, why did ATSB:

  • Allow itself to be compromised;
  • And Martin Dolan misquote and misuse ICAO Annex 13 and;
  • Commissioner Dolan, use a later version of Annex 13 in answering the Senate, when the earlier version applied
  • Who has most to gain from Dolan’s view??
  • Who what is the relationship of the Departmental head – Mike Mrdak  [Read – Senators and aviation]
  • What is the relationship of the CASA Board Chair, Alan Hawkes – previous head of Department and prior to head of the Department, Mike MrDak.


Together with the insurer, who were trying to avoid any liability: ATSB and CASA should have been answering the questions raised by Nurse Karen Casey, Doctor David Helm and their employer CareFlight in the NSW Supreme Court.

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