Narrative:

The flight was an MD80 from den. Scheduled gate departure time was AB20Z. Shortly after scheduled departure, den station operations called the equipment planning manager in system operations control to inform him the flight was going to be placed on a maintenance delay with an estimated departure time of AC30Z because of 2 mechanical problems. (This is SOP, so that down-line maintenance can be arranged.) first, the water pipes to both galleys were frozen, which is a no-go item because the galley water pipes run directly over the east&east bay and a ruptured pipe would mean disaster. Second, 3 oxygen masks had dropped in the coach cabin overnight. (It has been rumored that as many as 44 masks were found inoperative after the flight arrived and was inspected by maintenance personnel.) the equipment manager then came over and briefed the dispatcher as to the above situation verbally. At AB37Z, den personnel input the delay into the computer system which informed everyone company-wide of the delay and of the extent of the delay. Only the oxygen masks were noted in the message -- no reference was made to the frozen pipes. Because no company mechanics were on duty for the early morning flight, den personnel contacted all available mechanics at the other airlines and were informed it would be at least an hour until anyone would be able to inspect the aircraft. This information was relayed to the flight crew and dispatch. At this point, the plane was already loaded with no empty seats (144 passenger). The captain elected to leave the flight loaded, and proceeded to the coach cabin to repair the dropped masks himself, which is a legal alteration of the aircraft that can be performed by trained company personnel. However, according to the agent on the jetway, the captain also solicited the aid of the fueler in repacking the 3 masks (because the use of an allen wrench was required). At AB42Z, the captain requested pushback and was pushed out by station ground personnel. No entry had been made in the logbook as to the alterations performed on the oxygen masks or in regards to the status of the frozen galley pipes. Approximately 1/2 hour later, a mechanic arrived to perform the needed inspections/logbook entries and found, much to his surprise, that the aircraft was gone! The maintenance coordination department was notified and immediately contacted the equipment planner and dispatcher to notify them of the situation. This was the first time that anyone on the ground was made aware of the fact that the flight had pushed back without receiving the required repairs and logbook entries. The dispatcher sent an ACARS message to the flight asking what the situation was. After 10 mins had passed with no response from the flight over any of the 4 methods available to contact the dispatcher (or any company personnel for that matter), the dispatcher sent a second message. This message informed the captain that his release was invalid and he was operating under his emergency authority/authorized per far 121.627(a) and 121.557(a) and (C) for violation of far 121.709(a). The captain made 1 attempt to contact dispatch shortly thereafter, but the radio frequency broke up. At this point, the flight was en route just west of salina, ks. The flight proceeded solely under the captain's use of emergency authority/authorized under far 121.627(a) and no further contact with dispatch was made by the flight crew until arrival. Human performance considerations: it was my perception, as the dispatcher holding joint responsibility over operation of this flight, that the aircraft was not airworthy, as required by far 121.153 and that initiation and continuation of this flight was a violation of far 121.709(a), 91.403(C) and 91.13 by the captain. In my judgement, giving the captain 10 mins to respond to my initial query about the situation was too lenient. I was in error to not declare an emergency myself, under far 121.627(a), for the sake of the safety of the passenger involved and persons and property over which the aircraft operated. Additionally, under far 121.557(C), the captain is responsible to keep both ATC and dispatch fully informed as to the progress of the flight operating under the captain's emergency authority/authorized. This did not occur and once I had invalidated the release, I did not follow up on this fact, primarily due to thefact that I was busy researching the situation with maintenance. Supplemental information from acn 458400: late in the boarding process of flight, one of the flight attendants advised me via cabin interphone that the oxygen masks had dropped above seats 24DEF and further stated that she could not get water to the coffee makers in the rear galley and feared we had frozen water supply lines to that area. A request to the station agent was made by me via company radio asking to have contract maintenance respond at once to correct these alleged problems. As the boarding process neared completion, I made a follow-up call to the station agent to determine the ETA of the responding maintenance representatives. I was informed the ETA was 1 hour 30 mins. Considering the fact that the boarding was now complete, with all passenger seated, and the prospect of a lengthy delay, I proceeded to the rear cabin to investigate the situation myself. I found that the passenger service unit access door was open above seats 24DEF, however, the oxygen masks had not deployed and were in their original packed position. This access door was not open during my cabin preflight prior to boarding the passenger and response to my questions to the occupants of this row, led me to believe that this door was opened by a passenger. I closed the door and proceeded to the rear galley to investigate the reported water supply to the coffee makers. During my cabin and exterior preflight, I noted that cargo doors were closed and cabin temperature was comfortable with water available in all lavatories. I found that air in the water lines was the problem with the coffee makers and after some line bleeding of the galley spigots the system was normal. A call to the station agent was placed to advise that maintenance intervention would not be necessary since there were currently no problems and no logbook write-up. It was my assumption the station agent would cancel our request for maintenance and update our present situation as necessary. However, this was not done and the maintenance coordinator as well as the flight dispatcher assumed that the flight had departed with open maintenance issues in the aircraft logbook. A classic case of a breakdown in communications, resulting in incorrect assumptions and additional work for all involved. All of which could have been averted by a call, directly tome, to the maintenance coordinator prior to departure.

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Original NASA ASRS Text

Title: AN AIRLINE DISPATCHER RPT ON A FLT DEP WHEREIN THE CAPT WAS INVOLVED IN SOME ALLEGED ILLEGAL MAINT PRACTICES TO AID IN THE DEP OF THE FLT FROM DEN, CO.

Narrative: THE FLT WAS AN MD80 FROM DEN. SCHEDULED GATE DEP TIME WAS AB20Z. SHORTLY AFTER SCHEDULED DEP, DEN STATION OPS CALLED THE EQUIP PLANNING MGR IN SYS OPS CTL TO INFORM HIM THE FLT WAS GOING TO BE PLACED ON A MAINT DELAY WITH AN ESTIMATED DEP TIME OF AC30Z BECAUSE OF 2 MECHANICAL PROBS. (THIS IS SOP, SO THAT DOWN-LINE MAINT CAN BE ARRANGED.) FIRST, THE WATER PIPES TO BOTH GALLEYS WERE FROZEN, WHICH IS A NO-GO ITEM BECAUSE THE GALLEY WATER PIPES RUN DIRECTLY OVER THE E&E BAY AND A RUPTURED PIPE WOULD MEAN DISASTER. SECOND, 3 OXYGEN MASKS HAD DROPPED IN THE COACH CABIN OVERNIGHT. (IT HAS BEEN RUMORED THAT AS MANY AS 44 MASKS WERE FOUND INOP AFTER THE FLT ARRIVED AND WAS INSPECTED BY MAINT PERSONNEL.) THE EQUIP MGR THEN CAME OVER AND BRIEFED THE DISPATCHER AS TO THE ABOVE SIT VERBALLY. AT AB37Z, DEN PERSONNEL INPUT THE DELAY INTO THE COMPUTER SYS WHICH INFORMED EVERYONE COMPANY-WIDE OF THE DELAY AND OF THE EXTENT OF THE DELAY. ONLY THE OXYGEN MASKS WERE NOTED IN THE MESSAGE -- NO REF WAS MADE TO THE FROZEN PIPES. BECAUSE NO COMPANY MECHS WERE ON DUTY FOR THE EARLY MORNING FLT, DEN PERSONNEL CONTACTED ALL AVAILABLE MECHS AT THE OTHER AIRLINES AND WERE INFORMED IT WOULD BE AT LEAST AN HR UNTIL ANYONE WOULD BE ABLE TO INSPECT THE ACFT. THIS INFO WAS RELAYED TO THE FLC AND DISPATCH. AT THIS POINT, THE PLANE WAS ALREADY LOADED WITH NO EMPTY SEATS (144 PAX). THE CAPT ELECTED TO LEAVE THE FLT LOADED, AND PROCEEDED TO THE COACH CABIN TO REPAIR THE DROPPED MASKS HIMSELF, WHICH IS A LEGAL ALTERATION OF THE ACFT THAT CAN BE PERFORMED BY TRAINED COMPANY PERSONNEL. HOWEVER, ACCORDING TO THE AGENT ON THE JETWAY, THE CAPT ALSO SOLICITED THE AID OF THE FUELER IN REPACKING THE 3 MASKS (BECAUSE THE USE OF AN ALLEN WRENCH WAS REQUIRED). AT AB42Z, THE CAPT REQUESTED PUSHBACK AND WAS PUSHED OUT BY STATION GND PERSONNEL. NO ENTRY HAD BEEN MADE IN THE LOGBOOK AS TO THE ALTERATIONS PERFORMED ON THE OXYGEN MASKS OR IN REGARDS TO THE STATUS OF THE FROZEN GALLEY PIPES. APPROX 1/2 HR LATER, A MECH ARRIVED TO PERFORM THE NEEDED INSPECTIONS/LOGBOOK ENTRIES AND FOUND, MUCH TO HIS SURPRISE, THAT THE ACFT WAS GONE! THE MAINT COORD DEPT WAS NOTIFIED AND IMMEDIATELY CONTACTED THE EQUIP PLANNER AND DISPATCHER TO NOTIFY THEM OF THE SIT. THIS WAS THE FIRST TIME THAT ANYONE ON THE GND WAS MADE AWARE OF THE FACT THAT THE FLT HAD PUSHED BACK WITHOUT RECEIVING THE REQUIRED REPAIRS AND LOGBOOK ENTRIES. THE DISPATCHER SENT AN ACARS MESSAGE TO THE FLT ASKING WHAT THE SIT WAS. AFTER 10 MINS HAD PASSED WITH NO RESPONSE FROM THE FLT OVER ANY OF THE 4 METHODS AVAILABLE TO CONTACT THE DISPATCHER (OR ANY COMPANY PERSONNEL FOR THAT MATTER), THE DISPATCHER SENT A SECOND MESSAGE. THIS MESSAGE INFORMED THE CAPT THAT HIS RELEASE WAS INVALID AND HE WAS OPERATING UNDER HIS EMER AUTH PER FAR 121.627(A) AND 121.557(A) AND (C) FOR VIOLATION OF FAR 121.709(A). THE CAPT MADE 1 ATTEMPT TO CONTACT DISPATCH SHORTLY THEREAFTER, BUT THE RADIO FREQ BROKE UP. AT THIS POINT, THE FLT WAS ENRTE JUST W OF SALINA, KS. THE FLT PROCEEDED SOLELY UNDER THE CAPT'S USE OF EMER AUTH UNDER FAR 121.627(A) AND NO FURTHER CONTACT WITH DISPATCH WAS MADE BY THE FLC UNTIL ARR. HUMAN PERFORMANCE CONSIDERATIONS: IT WAS MY PERCEPTION, AS THE DISPATCHER HOLDING JOINT RESPONSIBILITY OVER OP OF THIS FLT, THAT THE ACFT WAS NOT AIRWORTHY, AS REQUIRED BY FAR 121.153 AND THAT INITIATION AND CONTINUATION OF THIS FLT WAS A VIOLATION OF FAR 121.709(A), 91.403(C) AND 91.13 BY THE CAPT. IN MY JUDGEMENT, GIVING THE CAPT 10 MINS TO RESPOND TO MY INITIAL QUERY ABOUT THE SIT WAS TOO LENIENT. I WAS IN ERROR TO NOT DECLARE AN EMER MYSELF, UNDER FAR 121.627(A), FOR THE SAKE OF THE SAFETY OF THE PAX INVOLVED AND PERSONS AND PROPERTY OVER WHICH THE ACFT OPERATED. ADDITIONALLY, UNDER FAR 121.557(C), THE CAPT IS RESPONSIBLE TO KEEP BOTH ATC AND DISPATCH FULLY INFORMED AS TO THE PROGRESS OF THE FLT OPERATING UNDER THE CAPT'S EMER AUTH. THIS DID NOT OCCUR AND ONCE I HAD INVALIDATED THE RELEASE, I DID NOT FOLLOW UP ON THIS FACT, PRIMARILY DUE TO THEFACT THAT I WAS BUSY RESEARCHING THE SIT WITH MAINT. SUPPLEMENTAL INFO FROM ACN 458400: LATE IN THE BOARDING PROCESS OF FLT, ONE OF THE FLT ATTENDANTS ADVISED ME VIA CABIN INTERPHONE THAT THE OXYGEN MASKS HAD DROPPED ABOVE SEATS 24DEF AND FURTHER STATED THAT SHE COULD NOT GET WATER TO THE COFFEE MAKERS IN THE REAR GALLEY AND FEARED WE HAD FROZEN WATER SUPPLY LINES TO THAT AREA. A REQUEST TO THE STATION AGENT WAS MADE BY ME VIA COMPANY RADIO ASKING TO HAVE CONTRACT MAINT RESPOND AT ONCE TO CORRECT THESE ALLEGED PROBS. AS THE BOARDING PROCESS NEARED COMPLETION, I MADE A FOLLOW-UP CALL TO THE STATION AGENT TO DETERMINE THE ETA OF THE RESPONDING MAINT REPRESENTATIVES. I WAS INFORMED THE ETA WAS 1 HR 30 MINS. CONSIDERING THE FACT THAT THE BOARDING WAS NOW COMPLETE, WITH ALL PAX SEATED, AND THE PROSPECT OF A LENGTHY DELAY, I PROCEEDED TO THE REAR CABIN TO INVESTIGATE THE SIT MYSELF. I FOUND THAT THE PAX SVC UNIT ACCESS DOOR WAS OPEN ABOVE SEATS 24DEF, HOWEVER, THE OXYGEN MASKS HAD NOT DEPLOYED AND WERE IN THEIR ORIGINAL PACKED POS. THIS ACCESS DOOR WAS NOT OPEN DURING MY CABIN PREFLT PRIOR TO BOARDING THE PAX AND RESPONSE TO MY QUESTIONS TO THE OCCUPANTS OF THIS ROW, LED ME TO BELIEVE THAT THIS DOOR WAS OPENED BY A PAX. I CLOSED THE DOOR AND PROCEEDED TO THE REAR GALLEY TO INVESTIGATE THE RPTED WATER SUPPLY TO THE COFFEE MAKERS. DURING MY CABIN AND EXTERIOR PREFLT, I NOTED THAT CARGO DOORS WERE CLOSED AND CABIN TEMP WAS COMFORTABLE WITH WATER AVAILABLE IN ALL LAVATORIES. I FOUND THAT AIR IN THE WATER LINES WAS THE PROB WITH THE COFFEE MAKERS AND AFTER SOME LINE BLEEDING OF THE GALLEY SPIGOTS THE SYS WAS NORMAL. A CALL TO THE STATION AGENT WAS PLACED TO ADVISE THAT MAINT INTERVENTION WOULD NOT BE NECESSARY SINCE THERE WERE CURRENTLY NO PROBS AND NO LOGBOOK WRITE-UP. IT WAS MY ASSUMPTION THE STATION AGENT WOULD CANCEL OUR REQUEST FOR MAINT AND UPDATE OUR PRESENT SIT AS NECESSARY. HOWEVER, THIS WAS NOT DONE AND THE MAINT COORDINATOR AS WELL AS THE FLT DISPATCHER ASSUMED THAT THE FLT HAD DEPARTED WITH OPEN MAINT ISSUES IN THE ACFT LOGBOOK. A CLASSIC CASE OF A BREAKDOWN IN COMS, RESULTING IN INCORRECT ASSUMPTIONS AND ADDITIONAL WORK FOR ALL INVOLVED. ALL OF WHICH COULD HAVE BEEN AVERTED BY A CALL, DIRECTLY TOME, TO THE MAINT COORDINATOR PRIOR TO DEP.

Data retrieved from NASA's ASRS site as of July 2007 and automatically converted to unabbreviated mixed upper/lowercase text. This report is for informational purposes with no guarantee of accuracy. See NASA's ASRS site for official report.