Poor maintenance linked
to hundreds of mishaps
Many mechanics inexperienced, overworked

Series - Part 3 of 6

The tail rotor sat on sawhorses for more than a year before mechanics installed it on the helicopter Lt. Col. Allen E. Oliver and Capt. Robert E. Edwards flew on March 1, 1996.

Thirty-six minutes after takeoff, the tail rotor fell off, and the AH-1W Super Cobra fell 1,000 feet into a Georgia pine forest, killing the two Marines.

NAVAL SAFETY CENTER INVESTIGATORS LOOK OVER the scene after an AH-1W Cobra fell 1,000 feet into a Georgia pine forest in 1996, killing Lt. Col. Allen E. Oliver and Capt. Robert E. Edwards. The helicopter's tail rotor fell off 36 minutes after takeoff.

"I just can't understand coming out of the factory like that and having a major mishap," said Oliver's father, Edward, who served in the Pacific as a Marine during World War II. "Whenever you're in combat, you know the risk. Accidents happen, but this one here I felt should never have happened.

"Two lives were lost."

Oliver and Edwards died because the system used to maintain military aircraft is itself broken.

An 18-month Dayton Daily News examination linked hundreds of incidents, ranging from in-flight emergencies to major crashes, to maintenance errors: work performed by unqualified mechanics, parts installed improperly, engines overhauled incorrectly, aircraft shoddily inspected.

Never-before-released computer records identified "improperly installed" parts in 632 emergencies and accidents occurring in the Air Force between 1972 to 1997. Of those cases, 83 were major accidents, killing 79 people and permanently injuring nearly 200.

And there are indications the military's aviation maintenance problems are worsening as the services struggle with the loss of thousands of experienced mechanics, aging aircraft, lack of spare parts and global conflicts.

More than 25 percent of the Marine Corps squadron assigned to support the President's aircraft fleet -- typically where the military sends its best mechanics -- consisted of Marines just out of training, says a 1996 study the administration ordered following several incidents involving the White House fleet.

A Sept. 19, 1996, report from the Air Force Audit Agency also found that 107 of the 210 maintenance personnel the Air National Guard listed as fully qualified "had not received mandatory skill-level training on over 1,400 tasks."

The newspaper's computer analysis found that in the Air Force, the only service to specifically track such cases, maintenance-related incidents more than doubled between 1992 and 1997, while the number attributed to other causes dropped by half. In a single year, from 1996-1997, maintenance-related incidents increased 58 percent.

"We're not as skilled as we want to be. There's no question," said Col. Jack Leonard, who oversees aircraft maintenance policy for the Air Force.

With the end of the Cold War, tens of thousands of the military's most skilled mechanics left the services, some victims of massive downsizing and others lured away by the expanding civilian aviation industry.

Since 1994, the Air Force lost 19 percent of its mechanics overall, among them thousands of the most experienced ones. But, at the same time, the ranks of the least experienced mechanics, those still in training, increased by 35 percent.

SKIP PETERSON/DAYTON DAILY NEWS LT. KENNETH DUKE, JR. gazes at the air strip at Calender Field in New Orleans where he used to fly F-15s for the Louisiana Air National Guard. Duke was severely injured in 1993 when he hit his head on the cockpit canopy as he ejected from an F-15. He's still unable to speak or move his limbs properly.

With these changes came an increase in maintenance-related incidents.

On June 12, 1993, just 12 minutes after takeoff, Lt. Kenneth Duke, Jr., was flying a National Guard F-15A fighter not far from the New Orleans skyline when he realized he was losing control of the airplane.

As Duke struggled with the controls, the plane went into a nose dive at 310 miles an hour, rolling left and right as it fell from the sky.

At 8,500 feet, while the plane flew out of control, Duke hit his head on the cockpit canopy as he ejected, causing a severe head injury that has left him unable to speak properly or fully control the movement of his arms and legs.

"There are some things worse than death," said Duke's father, the Rev. Kenneth Duke, pastor of a New Orleans-area church. "He has been robbed of everything.

"You see we love him so much. It's not fair for him to suffer that much."

Months before the accident, investigators found, someone forgot to install a small metal cotter pin that helps secure one of the jets's most critical flight controls. Without the pin, a device allowing the pilot to control the movement of the horizontal tail surface disconnected, leaving Duke helpless to guide the plane.

"How could it possibly be inspected and not noticed?" a mechanic was asked during the Guard's crash investigation. "Do you suppose that that would suggest that somebody just wrote their name down and said they inspected it and hadn't actually looked at it?"

The mechanic responded, "Yes, sir."

One of the mechanics who worked on those flight controls, the investigation found, "received no flight control system training other than being qualified to lubricate components."

Other mechanics, the report found, "had not even been entered into a training status for such basic aircraft maintenance functions as the operation of aerospace ground equipment."

Maj. Gen. Francis C. Gideon, Jr., commander of the Air Force Safety Center, reviewed records from the New Orleans crash at the request of the Dayton Daily News.

"The statements (in the report) are accurate," he said. "I have no comment."

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