NTSB: Common organizational problems found in all five Metro-North accidents

Several common safety management problems were present in all five MTA Metro-North Railroad accidents that together caused six fatalities and 126 injuries, the National Transportation Safety Board (NTSB) announced yesterday while releasing a special investigative report on the accidents.

NTSB members discussed the accidents, which occurred between May 2013 and March 2014, and the board's investigative findings at a special meeting yesterday in Washington, D.C. The report examines several common safety management issues present in all the accidents. Last month the NTSB released briefs identifying the probable causes of the accidents, which included the December 2013 derailment near the Bronx, New York, that killed four passengers. The NTSB found that the incident occurred after the train engineer, who later was diagnosed with sleep apnea, fell asleep and failed to slow the train as it sped through a curve.

"Metro-North and the Metropolitan Transportation Authority have much work yet to do," said NTSB Acting Chairman Christopher Hart in a press release. "The [Federal Railroad Administration] has much work to do as well. Railroad safety across the country depends on the FRA turning decisively to the task."

The investigations revealed that the railroad's safety programs were not effectively used to manage the safety of operations and employees. Additionally, Metro-North failed to effectively investigate accidents and incidents to identify and fix safety deficiencies, and known deficiencies weren't corrected, NTSB officials said.

The report analyzes not only safety gaps at Metro-North and MTA, but also problems with the FRA's regulations, inspection and oversight that allowed the safety gaps to exist, they said. Had previous NTSB recommendations been implemented by the FRA, many of the safety issues encountered in these accidents could have been prevented, the report noted.

Examination of the FRA's national inspection program found that its system for prioritizing enforcement efforts was ineffective and that current methodology may not be effective in identifying systemic safety issues, NTSB members determined. This resulted in a lower FRA presence at Metro-North while track conditions were deteriorating, which increased the risk of a catastrophic accident, they said.

The NTSB issued recommendations to the FRA, Metro-North and the MTA, as well as several other entities. The recommendations address Metro-North safety policies, programs and protocols, rules on screening for obstructive sleep apnea and other sleep disorders, and track inspection plans.