to Whistleblower in 10 days
December 27th 1991 – January 5th 1992
On December 27th 1991 captain Stefan Rasmussen emergency landed his MD-80 in a rocky, snowy field just outside of the Swedish capital, Stockholm. This happened just four minutes after take-off from Arlanda Airport. Both engines were destroyed by ice, which had been sitting on the upper side of the wings. Stefan Rasmussen brought a 55 ton glider down from an altitude of more than 1 kilometer, through the clouds, and some Swedish tree tops, landing it without the loss of a single human life. This was to be Stefan’s last flight as a captain.
On that same morning I landed my MD-80 at London’s Heathrow Airport.
During the following two days I carried out, what turned out to be my last flights as a captain. These were to Geneva, Switzerland and Luleaa, Sweden. After these two flights I went on a vacation, which had been planned for a long time. However, as it turned out, the vacation lasted quite a bit longer than planned – at this moment it has in fact lasted for more than 13 years. Allthough I was just as shocked by Stefan’s accident as everyone else in Scandinavian Airlines System (SAS), my vacation had nothing to do with this. It had, as mentioned, been planned long before then.
The “new” safety procedure
During my flight to Geneva and Luleaa I had stop overs in Stockholm and Copenhagen. Bearing in mind that we had just lost an aircraft due to ice, I spoke to about 20 of my colleagues and my different co-pilots. I asked them, if they knew and applied SAS’ new procedure for engine run-ups, where you take the engines to app. half take-off power. Run-ups prevent ice from setting in the engines of the aircraft. This is a risk, when the engines are running at idle power.
(Click here to read the history of the engine anti-ice procedure)
The procedure however, really wasn’t all that new. As a matter of fact it had at this point in time existed for more than 14 months, but where the manuals previously said that the pilot should do engine run-ups, they now said shall, meaning that run-ups had to be performed. A significant difference to say the least and definetely an indication that the procedure is extremely important to flight safety.
But I discovered that practically none of my colleagues did, what they were supposed to. As a pilot in SAS you fly with a lot of different crews – actually with more than 100 different ones a year. This meant that considerable experience could be gathered by talking to even relatively few colleagues who flew MD-80. I asked them about their own knowledge of the procedure as well as their experiences from flying with other colleagues. Summing up these talks it was revealed that it couldn’t be more than a couple of percent of the 5-600 pilots who flew MD-80s who actually knew and performed the procedure which took 23 seconds to do and was rather noisy. Even more disturbing was the fact that only one of the chief pilots knew the procedure. As it turned out, this was the one who had decided on tightening it, the chief pilot on the MD-80, Bengt Andersson. He had, however, written the correction into the manuals in a rather incomplete way. As a matter of fact it contained several problems. Sure, it now said that the pilot shall do an engine run-up every 10 minutes and at least once before take-off. The older should had been erased, and this meant that there was no longer any doubt as to whether or not the procedure had to be performed. On the other hand Bengt Andersson hadn’t made sure to erase the section of the manuals which stated that in SAS you always perform a “rolling take-off”. An engine run-up can only be performed with blocked brakes – meaning that the aircraft is standing completely still on the runway. This of course does not comply with a rolling take-off.
Hardly anyone knew the procedure
Allthough I was officially on vacation I couldn’t help thinking that more accidents could happen, simply because my colleagues didn’t know or perform the standing wintherization procedures. So I decided to check the magnitude of the problem and spread the word that you shall do engine run-ups in order to secure ice free engines. I considered this to be my duty, and I was well aware that as a captain I could in fact be punished in accordance with the Aviation Act, if I knew of violations of safety procedures and failed to report them. I’ll get back to that in a moment.
I started out with the chief pilots.
During the first 5 days of my planned vacation I questioned the 11 chief pilots and seconds in command over the phone, including the one who was representing SAS in the accident investigation board investigating Stefan Rasmussen’s accident, Norwegian Tore Hultgren. Hultgren was also an MD-80 captain and the head of the internal SAS accident investigation team, known as SAINT. Among the two-three chief pilots who claimed to know the procedure, only one stated that he had in fact performed it.
SAS was in the middle of it’s worst crisis ever. An aircraft carrying 129 people had crashed, and SAS soon admitted that the plane had not been properly de-iced before taking off. On top of this we had a 14 months old wintherization procedure, which practically none of my colleagues seemed to know about, and even fewer of them actually performed. This could be a contributing factor in the accident, and I therefore brought it to the attention of the chief pilot on the MD-80 and of the airline’s representative in the official accident investigation. One would think that I had done enough and could rest assured. But no. Allthough I only wanted the people in charge to highlight a procedure which had long been implemented, and which was of great importance to flight safety, nothing happened. This despite the fact that my findings concluded that basically noone followed the procedure.
I then went on to present and former instructors, a group of people in which I was also included. Based on talks with approx. 50 instructors I discovered that very few of them had noticed and performed the 14 month old “new” procedure. On top of that none of the ones, who performed the procedure, had met more than one co-pilot who wasn’t puzzled, when they did it.
Anecdote: One of the instructors told me that when he was flying as a captain on an MD-80 on the same day that Stefan Rasmussen became world famous, a passenger in Luleaa had changed her mind at the last moment, and didn’t want to board the plane. She had discovered that it was the same type of plane that she had been watching on TV all day, lying in three pieces in a field outside of Stockholm. Then the purser told her: “Captain Jensen will be sorry to hear that.” The woman then replied: “He is Danish? In that case I’d like to come anyway.
The correction to the procedure 14 months earlier also meant that for the first time ever we got a clear definition of when the weather required engine run-ups. That was, when the temperature was +2 degrees celsius and below and humidity was high. Until November of 1990, when the new procedure was introduced, this had always been left to the captain to determine.
Almost 700 planes a day violated safety procedures
During those 10 days that I fought intensely to break through to the SAS management in order to tighten safety and spread the word about engine run-ups, the weather conditions did in fact require engine run-ups. Based on this I could conclude, that SAS’ app. 110 DC-9s and MD-80s were in danger of experiencing vibrations, damages or destroyed engines approx. 700 times a day – or 7000 times during those 10 days, either during the start or as the wheels were pulled up. The risk of the ice breaking loose and getting sucked into the engines is worst within the first 60 seconds after brakes off. This is when you release the brakes and commence the take-off run.
In the days following Stefan Rasmussen’s accident the SAS management were very busy explaining to the world press and the accident investigation board, why SAS procedures would neither have prevented the setting of 30 milimeters of clear ice on the wings, nor have meant that the ice would have been discovered, once it had set. The management didn’t want to admit to yet another serious flaw: The fact that there might have been ice in the engines as well due to the lack of clarity surrounding the procedures for engine run-ups. This might be one explanation for why my cries to the management about the lack of knowledge of the procedures were seemingly ignored.
Management and authorities to blame for accident
The final report concerning Stefan Rasmussen’s accident came out in November of 1993. The report placed full responsibility for the accident on SAS and the authorities. Poor management and poor public supervision – simple as that, and on top of that the very unqualified recruitement to management within SAS. Captain Stefan Rasmussen was aquitted of any responsibility.
The SAS chief desk pilots, for instance the accountable manager, chief pilots, chief instructors, and their seconds in commands all had offices in Stockholm, and they all spend between one and three weeks in the office each month. The jobs were usually occupied by Norwegians and Danes, because we have got hotel stay and tax free daily allowance (per diem), whereas a Swedish pilot would loose more daily allowance than the chief’s bonus was worth with the tax rates back then. In spite of this from 1990-1994 both the accountable manager and chief pilot on MD-80 were Swedish for the first time – unfortunately. Unfortunately because: Man to man the experienced pilots would argue that we preferred the type of chiefs who had to be persuaded to take on the power and responsibility of such a job, and who could also convince their families that they would be well paid as a compensation for the extra time and effort required in these positions. We had trouble placing trust in someone who would take on as much extra work, as these positions required, and at the same time get quite a bit less out of it economically. Nevertheless that was excactly what these two Swedes had done by taking the jobs.
Five days after the accident – on January 1st 1992 – I borrowed the aircraft manufacturer’s original winterization procedures from a captain in Sterling Airways. Unlike SAS, who has both permission and the financial ability to write their own standarized procedures, which makes pilot’s re-schooling to other aircraft types a lot quicker, Sterling could only afford to use the manual that came free from the manufacturer (click here to see the Sterling procedures)
Hot air can turn into ice
I discovered that the original procedure was also vague. Here as well it didn’t say that the pilot shall do engine run-ups. But there was a warning: ”The higher the temperature, the higher the cloud liquid water content and the more severe will be the icing conditions.” This is due to the fact that moist air contains twice the amount of water at +10 degrees celsius compared to when it’s 0 degrees celsius. And bearing in mind that all air is cooled down by 10 degrees celsius, as it sucked through a jet engine, then the metal in the front of the engine – ie. the big fan compressor blades – will be cooled down accordingly. That means that the humid air can now set as ice, and therefore it is obviously dangerous to have upper temperature limits such as 8, 6, 3, or 2 degrees celsius. Air at any of these temperatures will drop below freezing temperature on it’s way into a jet engine. Subsequently the moisture which is contained in the air will also freeze and turn into ice. And the warmer the air before it’s sucked into the engine, the more moisture it contains. Thus, the warmer the air, the more ice will set in the engine. In spite of this fact the temperature limits mentioned above still excist in the manuals of airlines throughout the world. One example is the correction that MD-80 chief pilot Bengt Andersson added to the SAS’ manuals in 1990 concerning engine run-ups. This correction is described above. Andersson set an upper limit of +2 degrees celsius, and his correction was even tighter than what was recommended by both the engine- and the aircraft manufacturers. This explains how the entire airline industry were – and still are – in a state of comprehensive professional ignorance. The manuals, which contain these procedures are considered bibles to the pilot – they even override scientifically proven facts. This obvious, but unfortunately wide spread, denial of reality is the most important reason, why I continue to be a very active whistleblower. Much to the regret of a lot of people.
One of the arguments for not recognizing the scientific facts and doing the engine run-ups, just in case, is to be found in the fact that airlines are under great pressure from the airports. The procedure takes app. 23 seconds to perform, and in the rush hour of an international airport, traffic would simply break down, should every crew of every airline choose to meet this minimal requirement for flight safety. That, in itself, should make one wonder quite seriously.
Back to the chronology:
I now tried to explain to the SAS’ Executive Officer in Denmark, Peter Højland, whom I knew personally that I would go to the press and tell them about the company’s problems with flight safety, unless “Latest News” (a web page that all pilots are required to read prior to every single flight) was updated. Peter Højland’s secretary, who by the way was a close friend of my wife’s, promised to have him call me, but forgot to mention that he was skiing in Lapland in the north of Norway. This was before cell phones became standard issue, and Peter Højland never called back. The secretary however got so nervous that she called the chief of flight operations in Copenhagen, Erik Thrane without telling me. This was on January 3rd.
Warnings against the management
On that same evening I then contacted the head af my union, Eigil Kragh, who was also a SAS MD-80 captain, who by the way never did an engine run-up. I told him as well that I would go to the press, unless the responsible management of SAS took use of the “Latest News” web page immediately in order to emphazise the current, but vaguely written, procedure. Eigil Kragh warned me against the management. According to him they were just about fed up with this stubborn pilot (yours truly) who kept on yelling about safety procedures not being followed. I promised to come to Eigil again, before actually going to the media. While I was at his house, I called the last one of the chiefs. He had had a stop over abroad, and as it turned out he actually knew of the new procedure. However, he had never remembered to actually perform it.
Eigil Kragh’s warning against management would soon be alarmingly real. As a matter of fact it did only two days later.
Meeting with the chiefs
In the meantime SAS held it’s annual chief and intructors meeting from January 4th to January 5th. This year the meeting was held at The Globetrotter Hotel in Copenhagen. For the occation I had been asked by chief instructor Per Ytting-Knudsen to give a brief lecture on another poorly described procedure, auto-landings. The lecture was a succes, and I received an ovation from the 50 attending instructors after my 15 minutes on the podium. This was at 4.45 pm.
A few hours prior to that something more interesting had occured. Since all chiefs and instructors were already set to gather in one place, which didn’t happen very often, I saw the chance to ask for a meeting with those of them who were most in need of understanding my message of the alarmingly poor knowledge and attitude amongst our colleagues towards the official safety procedures concerning engine run-ups.
At 10 a.m. – 2 hours prior to the official part of the meeting – I met with my superior on the MD-80, Bengt Andersson, The chief of Scanair (Scanair was SAS’ sister- and charter company), Arne Olsson, technical pilot, Klas Johnsson, and my Danish MD-80 chief pilots, Bo Seebach at the hotel. I knew that the situation was tense, and within a few days I would pose a serious problem to the SAS management. Simply because I insisted on bringing forward the truth about the procedures. A truth, which, if it came out, would place a lot of colleagues and chiefs in a very embarrasing position as incompetent and not paying sufficient attetion to flight safety. For that reason I had brought three assessors to the meeting: A representative from the Pilots Union (they had appointed one who by the way was on a sick leave with a bad liver) and two of my former Airforce colleagues who were now captains colleagues in SAS/Scanair, Hans Fenneberg and Ari Vaala.
My clear intention with this meeting was to explain to the different chiefs that we were in bad shape as far as the knowledge and attitude concerning wintherization procedures went – especially engine run-ups.After about two hours of going over the problems nearly everyone – and especially the technical pilot – could see that I was right. Bengt Andersson who had inherited the introduction of the above mentioned procedure from the former accountable manager, Norwegian Viggo Løfsgaard, after tough negotiations with both the engine manufacturer Pratt & Whitney and the aircraft manufacturer McDonnell Douglas, wouldn’t risk promising an update of SAS’ own Latest News web page to contain a tightening of the procedures. Two days later I discovered what the “tough negotiations” had meant, but by then SAS had allready had my pilot’s license revoked! Before then though, the following transspired:
On January 5th a letter landed in the mailbox of every Danish pilot in the SAS sister company Scanair. The sender was anonymous, but I know now that the author was one of the two colleagues whom I had brought to the meeting with the chiefs at the Globetrotter Hotel, Ari Vaala. The letter was a harshly written warning to all Scanair pilots with excact reference to the contents of the two hour long meeting the day before. It was both a rundown of the scientific facts, which I had presented at the meeting, and an encouragement to all colleagues to seriously consider if they were actually familiar with the risk of engine ice, and whether they performed their engine run-ups, as they should. Furthermore the letter was a frontal attack on the current procedures in both SAS and Scanair. In other words total support of me and my fight for getting through to the management and dealing with these problems with flight safety. (Click here to see the letter from Ari Vaala)
The anonymous letter however, would not be the only interesting event to take place on this January 5th 1992.
On the same day I called chief of flight operations in Copenhagen, Erik Thrane. He was in his summer residence in Rørvig. I told him about Peter Højland, who had never called me back, and I explained to Thrane that it would then have to be up to him to update “Latest News”. His reaction was a dramatic one.
Captain without a license
A few hours later he called back to tell me that he had decided to revoke my pilots license.
“That’s a bad idea. You’ll ruin your own retirement. I’ve still got two weeks left of my vacation,” was my prompt response with reference to the fact that it was completely unfounded to revoke my license for the reasons mentioned, during a period of time when I wasn’t even scheduled to fly.
“Well, I’m doing it anyway,” the chief of flight operations replied.
“In that case you’ll have to send a copy to all three pilot’s unions,” I said, well aware that things were now starting to get out of control.
He wouldn’t do that, but he insisted on bringing me a copy himself, as he was heading home from the summer residence around 3 pm. As I started preparing some tea well before 3 o’clock, my wife suddenly rushed out of the house. The chief of flight operations arrived three hours late, but he was still served the tea. I called the head of the Pilot’s Union and my friend from Sterling Airways. When he arrived along with his wife, my wife was with them as well. She had spent the past five hours with them. All except the head of the Union, Eigil Kragh, had a chance to meet the chief of flight operations.
With that letter which chief of flight operations, Copenhagen, Erik Thrane delivered to me, SAS revoked my license stating the following reason:
“You are worn down, stressed out, and without the necessary balance to perform your duty.”
(Click here to read the letter from the Danish chief of flight operations and the letter of confirmation from the overall chief of flight operation
Eigil Kragh’s warning that the SAS management was very irritated and feeling pressured by a pilot, who was simply trying to make them enjoin the current safety procedures, had turned out to be well founded. I hadn’t imagined though that they would go this far to shut me up. All of a sudden I was declared incapable of performing my duties and the responsibility as a captain. However, as they would soon realize, they couldn’t succeed in stopping me. I quickly decided to keep on fighting, and meanwhile I now had to fight another unexpected battle to keep my certificate, and my source of income.
When Erik Thrane left after 40 minutes, I told my concerned, remaining guests and my wife that I was going to the airport to hand out warnings to those pilots who where scheduled for flight at approx. 10 pm. that night. This included 7-8 crews in total. The head of the pilot’s union strongly warned me against this, but I had allready lost my certificate, and I was determined to keep up the struggle.
As I was driving towards Copenhagen Airport, Kastrup, I discovered that I had brought the original McDonnell Douglas procedures, so I decided to use those with the supplement of a few enlightning details and a greeting from me to all MD-80 captains in SAS – 300 copies in total. Furthermore, I had the crews bound for Oslo and Stockholm promise that they would deliver a copy to all relevant personel at those destinations on the same evening. The crews who were bound for domestic destinations were given a copy in person along with a brief explanation. They all promised to perform the required engine run-ups.
Manufacturers in a tight spot
Finally, I had an opportunity to read the correspondence between SAS and the manufacturers, which I had kept after the meeting at the Globetrotter Hotel the day before. I did this along with a colleague who was on call at the airport. There were five pages, which turned out to reveal a disturbing lack of professionalism. The explanations were crooked to say the least, and that might not be so coincedental. The drill for the manufacturers was to explain a procedure, which basically shouldn’t be nescessary to perform. Elsewhere in the documentation from the very same manufacturers it said that “a jet engine can stay ice free – also at idle power.” So it is an obvious contradiction in terms to say that it is necessary to make an extra effort, such as engine run-ups, to make absolutely sure there’s no ice setting in the engine. It is, in other words, a difficult task to explain to the customers, the airlines, that they must perform a procedure, which it cannot be nescessary to perform. The contradictions and the unprofessional explanations from the manufacturers put the case in perspective. This wasn’t just a fight against ignorance. It was a question of a lot of high ranking gentlemen and large companies who would severely loose face, if they were to admit that the captain, who no longer had a license, was in fact right.
The next day I discovered that the head of the Pilot’s Union, whom I had called from the airport and told about my plan to hand out the original procedures, had collected all the papers that I had handed out in Copenhagen. Furthermore he had called Stockholm and stopped the hand outs there, but he had been unable to do the same in Oslo. Here, the procedures were handed out and created quite a stir.
In the meantime others besides myself and my anonymous colleagus in Scanair were beginning to fear for the flight safety.
A concerned telex
On January 6th a very concerned second in command in SAS, Niels Th. Pedersen, sent an internal telex to the MD-80 chief pilot, Bengt Andersson. In this he wrote that if SAS was to examine the Flight Data Monitoring, “FDM” – what is popularly known as the black box – one would discover that practically noone performed the required engine run-ups. The telex was sent after I had brought the problem concerning lack of engine run-ups to his attention. The reason that I can claim this with great certainty is this: In his telex Niels Th. Pedersen recommended a special procedure for engine run-ups after landing, which was current at a competing airline, Sterling Airways. I had learned about the procedure as I was given the original McDonnell Douglas procedures from a colleague at Sterling, and I had mentioned these to Niels Th. Pedersen – just a few days before he wrote his telex. (Click here to read the internal telex from Niels Th. Pedersen)
Even though unrest was spreading, and more and more people were beginning to acknowledge the fact that something was wrong concerning the procedures, I was now grounded. The chief of flight operations in Copenhagen, Erik Thrane, later told me that SAS really had considered just firing me. However this would require SAS to convince a court appointed umpire and three assessors from the Pilot’s Union, that the firing was professionally well founded. So this idea was dropped.
Postscript concerning the further fate of engine run-ups in SAS:
On March 17th 1992 SAS introduced the procedures that I had suggested (Click here to read the suggestions) and demanded, but SAS and the public supervision claimed the honors themselves for having “seen the light”. Ever since I have been working on getting all airlines to introduce the same and correct procedure, and furthermore to check that the pilots actually perform it, by using FDM, that is the black box.
On February 9th 1996 SAS was forced by the Frankfurt Airport to go back to only doing engine run-ups at temperatures of + 2 degrees celsius and below. The correct procedure, which had been in effect sine March 17th 1992, was gone again. That procedure being: Always do engine run-ups, when the engine anti-ice system is on, which is the case at temperatures of + 6 degrees celsius and below. The Frankfurt Airport presented the following argument:
“If all airlines did like SAS – that is used 23 seconds on the runway for a final engine run-up – then the total capacity of the airport would drop dramatically during rush hour.”
This revised and reduced procedure was given to me by a former instructors colleague. I used it for the purpose of protest to all relevant authorities – in vain!
On September 2nd 1998 Volvo Aero Engine Services had an advertisement on page 74 of the magazine Flight International. The ad. had been posted in cooperation with the engine manufacturer Pratt & Whitney and SAS, and it declared SAS the: “World leader in engine reliability.” According to the ad SAS was about three times better than the world average. The ad. was only posted this once! (Click here to see the original ad.)
On December 14th. 1998 SAS and four other airlines were struck by the worst series of accidents and incidents in aviation history. At least 15 flight crews failed to perform the required engine run-ups. This resulted in 5 aircraft making an emergency landing on only one engine, and at least 20 aircraft engines were either damaged or destroyed.
Postscript concerning the further fate of captain Oluf Husted
January 6th 1992: I was now facing the choice: Do you want to be fired or thrown in jail? Sure, SAS had given up on firing me for now, but since I was now on sick leave, I would automatically be fired, if I wasn’t declared fit for flight within six months. The Aviation Act §§ 28 and 42 which was in effect at the time stated that it was mandatory to report any circumstance, which influenced airworthiness to the aviation authorities.This was punishable by up to six months in prison. (Click here to read the Danish Aviation Act which was current at the time)
So: If you had the knowledge of something, which was of importance to flight safety, you were obligated to report this to the authorities. This was not only the case for owners and management of an airline, but also for every single captain.
Silence meant punishment
The fact that legislation like that wasn’t to be taken lightly became evident to captain Hugo Larsen, CEO Ole B. Hansen and claimed owner Henrik Johansen, when in 1993 they were each sentenced to six months in jail for violation of the parallel legislation for sea travel. On April 6th 1990 they had sent the ferry Scandinavian Star on that journey from Oslo, Norway to Frederikshavn, Denmark that ended up claiming the lives of 158 people. The ferry caught fire in Kattegat, and the three people mentioned had for instance failed to report to the authorities that they had not performed the nescessary fire drills which were also required by law. This cost them the maximum penalty under the law of six months in prison. And it cost the lives of 158 people.
So this was serious. Not only was it a question of a possible punishment by prison for me, if I failed to report the problems with the dangerous winterization procedures in SAS to the authorities. In the end it could become a matter of life or death to the passengers.
In 2001 the Aviation Act was revised. The duty of the owners and the management of an airline to report to the authorities any circumstance which influence airworthiness disappeared. So did the captain’s duty to report. He or she is now only obligated to report such circumstances to the next in command within the airline. (Click here to read the changes to the Aviation Act)
Back to January 1992: I did know of such a circumstance, which was of importance to airworthiness, and there was no doubt in my mind that I had to report this to the authorities. This also in the light of my attempt to maintain my loyalty by attempting to get through to the SAS management first.
The choice wasn’t difficult. Should I end up going to jail for failing to report the unsafe procedures, I would still be fired. I contacted the director of Danish Aviation Administration, Val Eggers. This first happened through my assessors from the meeting at the Globetrotter Hotel on January 4th 1992. After that the contact was maintained by phone and letters. (Click here to read both my letter and that of the director of the Aviation Administration)
Suggestions to the management
At the same time I continued to try contacting the SAS management. This wasn’t just a question of me living up to my responsibility, nor of whether or not I could be punished. More importantly it was to an issue of the safety of the passengers on hundreds of SAS flights every day and of the acclaimed airline’s reputation as a safe airline to fly. And there were fresh and very scary evidence that things could go terribly wrong, unless improvements were made. The pictures of Stefan Rasmussen’s Flight SK751, which lay in three pieces in a field outside of Stockholm were still very present in everyone’s memory. This went for the people at SAS as well as the general population in the three Scandinavian countries, which are part owners of SAS.
On January 10th 1992 I faxed my first suggestion to a professionally correct procedure in order to secure ice-free engines to the SAS MD-80 chief pilot, Bengt Andersson, who had also participated in the meeting in Copenhagen on January 4th. (Click here to read the suggestion) Together with my first suggestion I faxed the original procedure from the aircraft manufacturer McDonnell Douglas, which I had attempted to hand out to all colleagues on January 5th.
I was now “liberated” from the standard requirement of having to come to work unstressed on January 19th following my vacation. Since my license had been revoked. Thus I continued my efforts to bring the safety issues to the attention of both management and my colleagues, and I went to the airport in Kastrup on several occations to discuss this with even more pilots colleagues, engineers, meteorologists, and chief pilots, and to use their libraries.
My former instructor from the NATO Pilots training in Canada, Mr. Gordon Crowe of Seattle (now a retired 747 captain from Nortwest Airlines) had called because of Stefan’s accident. During the years past we have continued to visit one another and keep a close contact. I told him of my newly discovered lack of professionalism in the business concerning anti- and de-icing procedures. Gordon promised to get me the current winterization procedures of Northwest Airlines and American Airlines. They arrived less than a week later and turned out to be very helpful.
The Surgeon General’s house call
On January 6th, late in the afternoon I went to the Clinic for Aviation Medicine at the Danish National Hospital. All pilots are required to go here every six months to get their physical and mental health checked, so I was very familiar with the place. This time I had been ordered to go there by my chief of flight operations, Erik Thrane. His revocation of my pilots license wouldn’t be valid for very long, before the authorities had to be involved in the case to approve his actions. It resulted in a one hour conversation with the head of clinic, doctor Regitze Videbaek. Apparently the matter was so important to SAS that she had been asked to stay after hours in order to make time for the conversation with me. I emphasized to her the fact that it was the professionalism of the airline business in general which was suffering rather than me as a person. I also briefed Doctor Videbæk on my written documentation for the safety problems. When she ran out of time, I paid for a cab, and dropped her off on the way. I had left my car at home that day due to fatigue.
On January 8th I witnessed the strangest action taken by SAS management sofar. An unannounced visit by Surgeon General, Knud Jessen and the Pilot’s Union’s “pilot in confidence”, Ole Krogh. They arrived at my house late in the afternoon in a military vehicle.((The Surgeon General later (2005) told me, that it was his own private VW-van)) Suddenly they were standing in the hallway, welcomed by my wife, who simplied annonuced:
“You have visitors.”
I had just seen the car, and asked them right of way:
“What do you want?”
“To see, if you’re all right,” they replied.
They then received the same one hour briefing that Regitze Videbaek had received two days prior to this. At the end the Surgeon General said:
“I’m becoming scared of flying.”
“Thank you,” I replied. “You’ve gotten the point then.”
“You get yourself a scotch and a good nights sleep,” he added.
“If that is the primary medical advice, you had better get the hell out of my house,” I said.
And off they went.
I was puzzled both by the fact that the visit was unannounced as well as the fact that they had arrived in a military vehicle. And why had they come all this way without even knowing for sure whether or not I’d be home?
In my diary, which I kept very minutely during those days I have entered “rubber cell visit?” I had a suspicion that the real purpose was to have me committed and thereby silenced as being insane / unbalanced.
A little over a year later my suspicions were confirmed. The visit from the surgeon general and the Pilot Union’s pilot in confidence was in fact an attempt to have me committed to a psychiatric ward. The evidence was delivered by none other than doctor Claus Curdt Christiansen, senior physician with the Danish Aviation Administration. On April 1st 1993 “Triple Charlie” as he was usually called wrote a letter to the Department of Transportation in response to my first of two complaints over the loss of my license. (Click here to read the letter of response from the senior physician)
To make matters worse I later discovered that the Surgeon General was also a private consultant on the SAS pay-roll. And here I thought that I had been paid a visit by a person representing the authorities...
The promise to fly again
Within the next couple of weeks certain people from the SAS management, especially chief pilot Erik Thrane, started pushing to get me my license back. Amongst other things Thrane told me: “They’re beginning to realize that you’re right in Stockholm (the location of the SAS headquarters).” And then he added: “You will get our first flight to Vilnius (the capitol of Lithuania). Afterall you’ve worked so hard to get SAS to fly to the “new” Eastern European countries instead of firing a lot of pilots.”
In other words this was the chief pilot’s reward for my efforts to save jobs within SAS during the hard times for the airline industry following the first Gulf War. I had suggested this in writing to SAS’ Danish CEO, Peter Højland on December 5th 1990 (Click here to read the letter to Peter Højland) and to accountable manager Johan Juhlin on March 19th 1991. (Click here to read the letter to Johan Juhlin) Peter Højland had called to ask me to elaborate on my ideas.
Erik Thrane whose middle name is Kasinir was actually set to fly this virgin flight himself in a DC-9, his aircraft type. He’s born in Lithuania. But the flight had sold so many tickets that a bigger aircraft was needed, an MD-80, my aircraft type.
Reporters all over Scandinavia were having a ball those days – as opposed to what they usually dared – with all of SAS’ serious incidents, which is an aviation term for when something occurs that is close to an actual accident. There was close to one incident a day. Emergency landing in Zürich, aborted take-off in Gothenburg, and so on.
The head of flight operational matters in the Swedish accident investigation board, Nils Benker, who like so many others within the Scandinavian aviation authorities is a formar SAS captain himself, stated on TV the day after Stefan Rasmussen’s accident that the mechanic was “the guilty party”, because he had failed to de-ice the aircraft properly.
But as described earlier the total responsibility for Stefan Rasmussen’s accident was placed with SAS management and the public supervision system. Both parties had failed to live up to their responsibilities, whereas the mechanic and Stefan Rasmussen were aquitted.
Nevertheless it became clearer every day that the many SAS procedure improvements to avoid ice on the wings of the aircraft did in fact reveal poor procedures as the cause of Stefan’s accident. The extraordinary attention from the media caused concern among the flying personnel within SAS. Mostly the stewardesses, especially those with small children, started calling in sick in great numbers.
In order to deal with this upcoming mutiny the chief of flight operations and accountable manager for all of SAS, Swede Johan Juhlin along with the chief of the technical division and the local chief of the cabin crew personnel planned a reassuring meeting for the personnel in all three Scandinavian capitals. The meeting was to be held in Copenhagen on February 3rd, and everything was to be video taped for those, who were unable to attend. The meeting in Stockholm alledgedly went well, but the one in Copenhagen... I’ll get back to that.
During my meeting with doctor Regitze Videbæk at the clinic for aviation medicine on January 6th I suggested that psychologist Jørgen Termøhlen be the one to examine me. The reason for this was a simple one. He had been one of those to pick me for both the Air Force and later for SAS, and so he had an in depth and written knowledge of me already. Thus he would also be capable of noticing whether or not I had actually changed. Termøhlen was furthermore a part owner of the “Scandinavian Institute of Aviation Medicine” (SIAP) and a consultant for SAS and the Danish Air Force.
On January 28th I met with Termøhlen in his private residence for a three hour examination. Subsequently he couldn’t make any promises, but he did say:
"With a dedication like yours a man can move mountains, but it wears.”
Later that same day I was declared well and fit for flight by the chief of the clinic for aviation medicine at the Danish National Hospital. (Click here to read more) I got word of this the following day along with the date and the name of my co-pilot for my next scheduled flight.
I was back in the SAS schedule – and would soon be airborne again.
The flight was to take place on February 3rd, and since it would then have been more than 35 days since my latest flight (December 29th), it was a standard authority requirement that I be accompanied by an instructor captain as a co-pilot on the flight. It turned out to be none other than Niels Th. Pedersen – the one who on January 6th had written a concerned telex for the MD-80 chief pilot, Bengt Andersson, about the lack of engine run-ups among the SAS pilots.
I shared the good news with those of my colleagues, who supported me and with my family. My wife was busy looking for a new place to live and had asked for separetion through her attorney on January 7th. I received the letter on January 9th – the day after the surgeon general’s visit.
In a letter On January 29th the director of the Danish Civil Aviation Administration, Val Eggers, expressed the wish that I would soon get my license back and requested a thorough briefing on my views. (Click here to read the letter from Val Eggers) I received that letter on January 30th. I was able to reply the following day that I was scheduled to resume flying on February 3rd.
Colleagues attacked the management
My other assessor from the meeting at the Globetrotter Hotel on January 4th, captain Hans Fenneberg, published an article in the Pilot Union’s magazine, Union Digest. It was a fierce attack on our socalled management, and the occasion was the way that I had been treated. (Click here to read the article)
Later on Hans Fenneberg along with two other captains colleagues started a petition with the purpose of getting rid of accountable manager Johan Juhlin. This was a highly unusual and drastic action for employees with SAS. The wish didn’t come true until 1994, when Juhlin’s 4-year contract was up for negotiations. Ironically, Juhlin himself experienced the SAS board´s refusal to listen, when he, now a captain again, several years later tried to let the board members in on his concerns for the level of flight safety within SAS.
Juhlin aired his concerns in a one hour special edition of the Danish National Broadcasting Corp. Program “The Report” on September 13th 2001. It makes you wonder, if Juhlin had completely forgotten that he was professionally deaf, when he himself was a chief?
How SAS handles critizism
“The Report” among other things told the story of the firing of the head of the Dnaish Accident Investigation Board, Jørn Madsen. Madsen had offended SAS thoroughly by being so rude as to demand that a SAS MD-80 engine, which had exploded in flight on April 26th 2000, be examined in a neutral shop.
Stefan Rasmussen also took part in the programme with a strong – and previously unspoken – criticism of the SAS management in Stockholm, and he was imediately and disgracefully smothered, especially in the editorial pages of Danish newspaper “Politiken”. Furthermore he was stripped of his honorary membership of the Danish Pilot’s Union. This was, as far as we know, the first time ever that this has occured.
After the broadcast SAS reported the Danish National Boadcasting corp.(DR) and the people behind “The Report” to the independent press council, but lost the case seven months later. Unfortunately, DR didn’t draw any attention to it’s victory. (Click here to read more about “The Report – SAS’ Black Box” and the firing of Jørn Madsen)
Almost simultaniously, on April 10th 2002, SAS CEO Jørgen Lindegaard lost a similar case against the magazine “The Engineer Weekly”. Nevertheless, in the SAS annual report for 2001 the CEO bragged that all critical Scandinavian reporters: “fortunately are wrong” in their critical coverage of SAS’ flight safety . The annual report was presented at the SAS general assembly on April 19th 2002, but it was not accompanied by any mention of the two cases recently lost in the Press Council. I pointed this out as being embarrasing at the general assembly in 2003, but by then everyone was preoccupied with the big firing round, which was set to cost 3600 jobs.
Back to February 3rd 1992, the day when I was scheduled to fly for SAS again and also the day, when Johan Juhlin was set to have his “reassuring meeting” for the cabin crew in Copenhagen at 10 a.m. The meeting had been announced on big posters, so I chose to attend. Not least to get an opportunity to talk to Juhlin face to face. At 10.05 a.m. only the three people who were in charge of the meeting, one co-pilot (from Skåne, Sweden), one purser (Janne), and yours truly were present. Almost uninfluenced by the small attendance Juhlin went on a 90 minute rampage against the stupid reporters, who had hung SAS out to dry through the past 5 weeks following Stefan Rasmussen’s accident and by emphazising SAS’ – especially past – accomplishments. After that we were allowed to ask questions, and the Swedish co-pilot, who was also previously a test pilot at the SAAB Viggen project, asked how come he never flew with a captain, who knew the SAS’ run-up procedure. Juhlin was agitated, probably because he assumed that I had made the co-pilot ask the question.
I hadn’t, but Juhlin went after me, claiming that I didn’t even have the support of the Pilot’s Union and that I had lost my certificate and was under suspicion for being insane / unballanced.
I could respond by informing him that I was set to resume flying on that same evening.
The meeting ended. Juhlin refused an offer to ride with me fra the Globetrotter Hotel to the Copenhagen Airport in Kastrup. The co-pilot accepted.
Only when Stefan Rasmussen agreed to repeat the accountable manager’s failed “reassuring meetings”, and this time with a massive attendance, the sick calls created by uncertainty, disappeared.
At the airport I said hello to my second in command chief pilot, captain Niels Th. Pedersen, whom I was set to fly with at approx. 6 p.m. He was in his office, as chiefs are. I went to a recreational room in the basement to be rested and free of stress for my first flight in 37 days.
When I came back up – fit for flight – a replacement had been called in.
According to chief of flight operation, Copenhagen, Erik Thrane, the Danish Aviation Administration (SLV) had suddenly decided that I should undergo further examinations with psychiatrists and psychologists at the Crisis Psychiatric Clinic at the Danish National Hospital, before I could be allowed to fly again. This happened one hour prior to take-off. And very few hours after my confrontation with Johan Juhlin.
Erik Thrane’s secretary later told me that Johan Juhlin had been on the phone behind closed doors for about two hours, while I had been resting downstairs.
SAS cheated on tests
The following day, on February 4th, the chief instructor on the MD-80, Per Ytting-Knudsen, sent out a warning to all pilots, (Click here to read the warning) who had not yet taken this years Periodic Flight Training (PFT). The PFT is an exam, which pilots must pass. If you flunk it, you get two weeks off to study, and during this period you cannot fly. This of course is of great inconvenience to SAS, but it had happened to the crews whose examining instructors supported me, if they had failed to perform the required engine run-up. The chief instructor warned that the weather simulated during the test flight required periodic engine run-ups according to the current SAS procedures. Those, who were due take the test, should remember to study this chapter carefully. Appearently Per Ytting-Knudsen had forgotten that this is a test required by the authorities, and therefore the contents MUST be unknown to the crew, whose members all risk flunking it. This however is the first time ever that the SAS’ management tells everyone in writing about the “unknown” procedure.
March 17th 1992 was my big day. On that day SAS invoked the procedure for engine run-ups that I had fought for for almost three months. (Click here to read my two suggestions to the new procedures)
Meanwhile, I had been fighting to get back my pilot’s license undergoing numerous examinations with psychologists and psychiatrists. The examinations resulted in being declared well and fit for flight twice. The first declaration came in April 1992, when a so-called council with the participation of the Crisis Psychiatric Clinic, and the Clinic for Aviation Medicine at the Danish National Hospital recommended to the senior physician with the Danish Aviation Administration, Triple Charlie, that I was fit for flight. But even this massive collection of expert’s statements appearently left no impression with Triple Charlie:
“I am still in doubt. And if there is doubt, there is no doubt,” as he so conveniently phrased it.
I didn’t get my pilot’s license back. Instead, on December 3rd 1992 Regitze Videbæk stated to the insurance company Scandia that I was permanently diagnosed with: Reactive Hypomaniac Condition. (Click here to read the diagnosis) This, mind you, was the same Regitze Videbæk, who had declared me fit for flight back on January 28th – 10 months prior. (Click here to read the declaration of being fit for flight)
I didn’t even get my license back, when I presented Triple Charlie with another declaration of being fit for flight the following year. This time it came from Hans Friis, the crisis psychiatrist with the Swedish Airforce and also a consultant with the Swedish civil aviation authorities. I had contacted Friis myself during the easter of 1993 in order to get an independent evaluation. But as it turned out, I had performed my final flight, despite the fact that Hans Friis’ declared me well in no uncertain terms.
On March 30th 1992 I received a response to my letter dated March 17th to the Douglas Aircraft Company’s chief pilot, Flight Operations, Customer Service, Pete Bernadin. He confirmed that an aircraft, which in every other way is checked and certified from nose to tail, is in fact not certified for ice building up on the hull or in the engines. The cause: It is the duty of the airline in question and the captain to remove it or to avoid it by performing run-ups before take-off.
On December 1st 1992 I was officially fired (with regrets and a golden pen).
Since then I have continued my efforts for flight safety.
On July 24th 1997 I received a warning from the Flight Deck Safety Committee (FDSC) of the Danish Pilot’s Union not to question their
professionalism and not to contact former colleagues, who, if they were to hand out procedures, would be in “grave trouble”, as it was expressed. (Click here to read the warning)
When I heard of SAS’ new procedures by March 17th 1992 I actually felt that it had been worth the struggle. But even that joy was relatively brief. On February 9th 1996 SAS went back to the old procedures.
April 13th 2005