The Swanson Management System (SMS)

 On the evening of October 19, 1984, a Piper Chieftan aircraft, owned by Wapiti Aviation Ltd., Flight 402, crashed in the Swan Hills near High Prairie, Alberta, killing six of the nine passengers aboard (1998 BAEC Swanson v Canada). The widows and families of two of the passengers who died in that tragic crash sued the federal Crown for damages, alleging that the negligence of its employees contributed to their loss. The Federal Court of appeal found that because of "Transport Canada's failure to take any meaningful steps to correct the explosive situation which it knew existed at Wapiti amounted to a breach of the duty of care it owed to passengers."  The Federal Court of Appeal concluded that Transport Canada's negligence was a cause of the crash and apportioned the blame for the accident equally between Transport Canada, Wapiti and the pilot. Swanson v. Canada (1992) 1 F.C. 408. 80 D.L.R. (4^th) 741.

 

Davis Inlet, NFLD. March 19, 1999 A99A0036

 

Nineteen years later a Provincial Airlines Twin Otter aircraft crashed into the frozen sea off Davis Inlet, NFLD., killing 22 year-old Damien Samuel Hancock. Damien had 500 hours of flying time and was looking forward to a career as a pilot. The Captain of the aircraft survived with serious injuries to his legs. This was his fifth crash. Transport Canada's enforcement file on the pilot lists a long history of violations and crashes. The pilot's file included remarks by Regional Manager's indicating senior management knew that the pilot's history of rule-breaking and that he "was virtually certain to produce a fatal accident" (Swanson v Canada). Transport Canada did not investigate the crash. Transport Canada removed the pilot's licence three years after the crash when the Hancock Report was filed on October 29, 2002.

 

Recommendation A01-01

 

As a result of its investigation into the crash off Davis Inlet, the Transportation Safety Board (TSB) issued Recommendation A01-01 that states:

 

"The Department of Transport undertake a review of its safety oversight methodology, resources, and practices, particularly as they relate to smaller operators who fly in or out of remote areas, to ensure that air operators and crews consistently operate within the safety regulations." 

 

On October 4^th 2001 David Collenette submitted Transport Canada' response to TSB Recommendation A01-01.  Part of TC's response included hiring  "…a consulting firm in 1999 to conduct a comprehensive review of the Civil Aviation safety oversight program for commercial operation. The review was completed in July 2001."

 

The review is known as the DMR report. The DMR report had absolutely nothing to do with the recommendation. The DMR project grew from its initial estimate of $400,000 to 2.5 million and on September 10th, 2001, concluded that TC should do another study.

 

The TSB website contains a contradiction to its annual report of 2001-2002 indicating a "reassessment" , of TC's response on October 29, 2001, seven months before the annual submission to Parliament.

 

Not only did TC management not investigate the crash at Davis Inlet, they covered up their complicity in the death of Damien Hancock and lied to Parliament regarding a review of its regulatory oversight. TC's rewritten response to Recommendation A01-01 clearly is at odds with the Annual Report to Parliament and its internal response tracking system ASTRA record of 2003.