Showing posts with label design fault. Show all posts
Showing posts with label design fault. Show all posts

Friday, 14 May 2010

The combined effects of the Gaul’s stability shortfalls and duff and offal chute design faults

The principal finding of the 2004 Re-opened Formal Investigation (RFI) into the loss of the Gaul was that flooding of the factory space had occurred through two hull openings in the side of the vessel and that it was probable that this ingress of water led to the capsize and sinking of the Gaul.

Up until December of last year this blog focussed on a number of obvious design faults and flaws in the construction of the duff and offal chutes on the Gaul, and criticised the conduct and outcome of the 2004 RFI which, ignoring these facts had concluded that the flooding and loss of the vessel had been caused by the crew’s failure to close the inner covers of the duff and offal chute hull openings. Recently, however, we have added a summary of the results of a separate investigation, which has revealed significant stability shortfalls (on IMCO’s minimum stability standards [*]) that would have affected the Gaul in a number of her normal operating conditions.

As far the capsize and loss of the vessel is concerned, it should be noted that, while the stability shortfalls and flooding of the factory space through the duff and offal hull openings (facilitated by defective closing arrangements) are two different matters, they do not suggest differing causes for the loss of the Gaul; in fact, the impact of each is complementary to the chain of events which led to the loss of the vessel.
The stability reserves of a trawler may be regarded as a finite but variable quantity, dependent upon the vessel’s condition of loading, disposition of fuel, water etc. If seawater is allowed to flood into the hull, the stability of that trawler is reduced and the possibility of capsizes rises.

The 2004 RFI concluded that an ingress of about 100 tonnes of seawater (entering through her duff and offal chute openings) would have been necessary before the Gaul’s stability reserves would have been depleted to a level where capsize was probable in the weather the vessel encountered.
Our investigation has shown that, because the Gaul’s actual stability reserves were initially much lower than those assumed by the RFI, capsize would have been probable after only a modest ingress of seawater.

However, regardless of the design faults in the chutes’ closing arrangements, the Gaul’s stability problems and their combined effect on the safety of the vessel, the 2004 RFI was still content to attribute her loss to a failure on the part of the crew to close and secure the duff and offal lids during the storm they encountered on 8 February 1974.
Their conclusion, however, appears now extremely far-fetched.

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[*] One of the most important safety standards for a sea-going trawler is that it should meet the IMCO minimum stability criteria, however:
- Compliance with the IMCO minimum stability standard does not guarantee that a trawler will be safe from capsize in severe weather
- A trawler having stability reserves that significantly exceed the IMCO minimum standard is unlikely to capsize in severe weather
- Non-compliance with the IMCO minimum stability standard does not automatically mean that a trawler is likely to capsize in severe weather
- A trawler having stability reserves that fall significantly below the IMCO minimum standard is likely to capsize in severe weather.

Thursday, 18 December 2008

Legal advice

On the 20th of May I had a most interesting conversation with Mr Max Gold, the solicitor who represented the families of the Gaul crew in the 2004 RFI.
Mr Gold admitted that it did come out during the formal inquiry that the duff and offal chutes on the Gaul had a design defect, which meant that, in certain sea conditions, the vessel could take water on into the factory deck, loose stability and sink.
So, the families’ solicitor admitted that he knew all along that the loss of the Gaul had not been due to crew error, but due to a design defect.
As regards the compensation for the families of the deceased, Mr Gold made some extraordinary assertions:
  1. That, during the inquiry, the bereaved families had in fact been informed that the most probable cause of the tragedy was a design defect. (?!) (Obs. However, it appears to me that not all of them were informed.)
  2. That only a few of the families were "interested" in suing for compensation. (?!)
  3. That those who were interested in suing for compensation were advised by their barrister (Mr Tim Saloman, QC) that they stood no chance of getting any because of the limitation rules that exist on such claims. (?!) According to Mr Gold’s recollection, Mr Saloman’s expert opinion was that no action for compensation could be brought after the expiration of 15 years from the date of the victims’ death, no matter if the cause of the tragedy was only ‘discovered’ in 2004.
    (Obs. This opinion, as far as I have learned from independent advice, does not appear to be correct, the law being pretty straightforward in this respect.
    And, in any case, this could not have given any justification to the RFI panel to manipulate the results of a public inquiry
    .)
  4. That Mr Saloman’s written advice is confidential and I am therefore not entitled to receive a copy of his counsel. (?!)
I had more questions for Mr Gold, but he was in a hurry and promised to call me back towards the end of the week (i.e. last week.). Unfortunately, he never managed to.
(To be continued…)

Wilful ignorance

When they’ve finished filling in their various questionnaires, the Fraud Squad detectives set about catching criminals.
But, how do they perform this task? Do they go out into the street, copping people at random? No, of course not! They employ logic.
The unfortunate thing, however, is that their logic can sometimes take the shape of the politicised Heads of the Met.

In our previous posts we reported on the progress made by the Fraud Squad in response to our fraud complaint. Today, we are able to provide you with an exciting update:
After 11 months of rumination, the Met detectives were finally able to shout Eureka, as they found an answer to our concerns, and a simple one at that.

In a letter signed by a Detective Chief Inspector of the Fraud Squad, we were informed that the design fault on the Gaul - which, we contended, could have competed as a more likely cause for the loss of the vessel than crew negligence, had evidence of this fault not been withheld – was, in fact, recognised by the 2004 RFI and duly mentioned in the final report, at paras 2.44 –2.49.

How extraordinary! The naval architect, who has been carping about the final report to the RFI and its findings for more than two years now, never realised that the Investigation Panel had in fact agreed with him.
How could he have missed the meaning of those six vital paragraphs, which the Met detectives’ perspicacity identified as proof that the RFI panel didn’t keep shtum about the design fault in question?
Well, the truth of the matter is that the above-mentioned paragraphs[1] refer, in fact, only to:
  1. a calculation error in the design of the chutes, the unfortunate significance of which being, nevertheless, overlooked (see DESIGN ERROR 2 document);
  2. a mention of the fact that the vessel owners had annotated the drawing of the chute with the statement “the design of the watertight hopper hatch cover was “too fiddly” " – statement endorsed by the final report despite being factually incorrect;
  3. the unrealistic notion that the one inch square section of the steel hinge spindles would have become rounded with normal use (while, in the same paragraph, the experts advise that they had visited the Gaul’s 29 year old sister vessel on which, the same type of spindle had not, even by that time, become rounded);
  4. a suggestion that the design of the hinges would have “inevitably resulted in corrosion within the brass gland” - in fact the ‘brass gland’ referred to therein was a sintered bronze, self lubricating, bearing, and
  5. a statement that the flaps could not be maintained without destroying them, which, as we explained HERE as well as in this POST and on page 22 of the TECHNICAL REPORT, was pure misconception.
Nowhere in the report is it mentioned that the non-return flaps opened the wrong way round (a major DESIGN FAULT) and, therefore, would have failed to act as the principal strength barrier against seawater flooding, as they were supposed to. And that is the crux of the matter. Plain as daylight.
To claim otherwise is brazenly insincere, similar to saying that white is black and black is white.

When questioned about these inadvertences, the DCI professed ignorance of the details of the case, passing the buck to the lowest rank: i.e. a constable in his squad.

(To be continued)
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[1] A copy of paras 2.44 –2.49 is provided at THIS LINK

The puzzle tour

We have often asked ourselves why such an obvious fault in the design of the Gaul had escaped the attention of scores of technical experts and assessors during years of legal battles and official scrutiny.
Why was this fault not noticed when the drawings were examined, immediately after the loss of the vessel?

Is it really possible that the design fault was, in fact, noticed?
Is it possible that the 2002 discovery of the design fault in the duff and offal chutes was, in fact, a re-discovery?

The labyrinthine trail of the Gaul’s history has eventually lead us back to the autumn of 1977 when, probably for the first time, the possibility of a problem with the chutes on the Gaul, as a likely cause for the loss of the vessel, was recorded. In a memo dated 14 September 1977, the Surveyor General in the Department of Trade (DOT) wrote:
“ It would indeed be a bonus if we not only located the GAUL but also established the cause of the loss. However, most evidence points to the GAUL being an intact ship, so we can give little guidance as to damage and I would expect small openings[1] which may have allowed the entry of water to the factory deck to be indetectable. The soundings also indicate the wreck which we suspect is the GAUL, is lying on its side…”
(Source RFI formal report paragraph 8.25)

On 22 December 1977, the NMI released to members of the DOT the report of their DOT-sponsored research into the sea-keeping and stability characteristics of the Gaul. These findings refuted the conclusions of the 1974 Formal Investigation by establishing that flooding of the factory deck would have been a precondition for the vessel’s capsize.

In a strange twist of logic, the results of the NMI research were subsequently interpreted as clearing the vessel’s builders and designers of any responsibility and, thus, the case[2] against them was dropped. In the whole maze of tangle and misdirection, this was probably a significant point. A supreme example of slothful induction, the decision implied that a design fault on the vessel could have only been contemplated if the capsize and sinking had been caused by water accumulated on the trawl deck - that is water accumulated on the factory deck could not have been put down to a design fault or construction error, but only to crew action or inaction. (?!)

During the 30 years of floundering and confusion that followed, no one managed to reach the centre of this circular labyrinth – the place where, as the legend has it, you will probably find a monster.

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[1] There were only two “small openings” capable of admitting water to the factory deck that would be undetectable if the vessel was lying on its starboard side: the duff and offal chute openings.
[2] In February 1997, a writ alleging negligence had been issued against the Gaul’s owners and its designers/ builders, Brooke Marine shipyard, by the families of the crew.

More about the main design fault on the Gaul

In an earlier posting we gave details of the main design fault that was present in the closing arrangements for the duff and offal chute openings on the Gaul (i.e. that that non-return flap plates opened the wrong way). In that posting we suggested that, if for any reason the flap valve was not fully closed, it could be opened by the action of the sea.
In fact, those comments did not reveal the full extent of the problem; the design of the flap valve was such that even if the valve had been in the fully closed position, the forces of the sea could have opened it.
Furthermore, this is not a just a hypothetical scenario, the partial print from one of the Gaul’s drawings (below), shows that there was a lip or ‘free edge’ at the end of the flap for the sea to act on.


And the VIDEO CLIP in our previous post shows in graphic detail just how easy it would have been for this “non-return” flap valve to open and for the seawater to flood into the factory deck of the vessel.
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If the above link does not work, please try HERE

Parliamentary Questions and Answers (IV)

8 January 2007

In December last year the Lib Dem MP for Romsey, Sandra Gidley, tabled another set of questions to Parliament. These were meant to shed some light on the vexed issues of the Gaul, which, after previous parliamentary enquiries, still remained unclear.

Sandra Gidley’s requests for information, received by the tabling office on 19 December 2006, subsequently morphed into a slightly different set of questions and were answered by the minister for transport on the 8th of January. (The document published HERE shows both versions as well as the ministerial answers.)

If we compare the last question on the Gaul, submitted to the tabling office in December, with its published version [113499], we cannot help noticing that the formerly closed, narrowly drawn question, meant to elicit an unambiguous 'yes or no' reply, turned into an open-ended inquiry, which allowed the minister enough “wriggle room” to answer as he pleased and keep control of the flow of information. The change of wording from “whether any evidence of design inadequacies, in the construction and arrangements of the duff and offal chutes on the Gaul, relating to: a. The non-return flaps and their possibility of malfunction (i.e. to open under the action of the sea) b. The strength of the inner covers when subjected to direct sea loading, was made available to the Wreck Commissioner...” to “what evidence of design inadequacies in the construction and arrangements of the duff and offal chutes on the Gaul was made available to the wreck commissioner” enabled the minister to get easily off the hook.

The WHAT questions, as any sales professional will be able to confirm, notoriously invite digression.
We must, however, admit that, although open-ended, the question was a lot better than the answer we got. In his reply, Dr Stephen Ladyman kept to the official line and offered nothing extra to what he had stated before. (see the Parliamentary Questions and Answers of 25 October 2006 and 1 November 2006)

The main design defect


For a pictorial explanation of the design defect on the Gaul, please follow this link:
http://webzoom.freewebs.com/inconvenientcitizen/Gaul%20design%20fault.pdf
OR

Letter from the Department for Transport

We have recently received an emailed reply from the Department for Transport (DfT):

http://www.freewebs.com/inconvenientcitizen/dftletter7nov.htm

The reply was of unattributed authorship and did not bear the usual DfT logo and header. Anyway, we assume that its contents would have been given some form of ministerial approval prior to dispatch.
The response was entirely as expected, apart from the disappointment of having taken nearly eight weeks to arrive.
The reply fails to address the design fault issue that was put forward in our paper, but merely reiterates the conclusions of the RFI. The DfT also carefully avoids to comment on whether this fault in the duff and offal chutes has been examined (either prior, during or subsequent to the 2004 investigation).

Now, we would like, in our turn, to comment on some of the points that are made by the Department:
“The investigation was conducted with unprecedented thoroughness………. The evidence……… was scrutinised by leading experts in the fields of oceanography, naval architecture and engineering.”
Yes, the investigation was thorough, but not consistently so. The critical areas – i.e. the duff and offal chutes - were not examined in depth.
“…….the FV Gaul and her sister ships were built under Lloyd’s approval, with the same duff and offal chutes design. On the sister ships these chutes survived under similar conditions and were retained until the end of their service.”
Ipse dixit. However, we don’t quite accept that the validity of a claim automatically follows from the authority of its source.

As to the sister vessels, the Department’s argument, which suggests that the design was satisfactory, is not sound. Our posting of 8 November (below) explains why.
“18.17 … it is important to note that although both chutes were found to be open both in way of the non-return flap and the internal top cover, there is no known mechanical reason why this was so. Both could have been closed or, if jammed, could have been freed. In any event the top lids exhibited nothing during the 2002 survey to prevent them from being closed and secured using the butterfly clips.
The design and operation of the chutes was therefore considered by the RFI.”
The information given to the DfT shows that there are credible alternative reasons, for the covers and flaps to be open.
Yes, the design and operation of the chutes was considered, but only in passing and not along the lines suggested in our paper.
“Whilst acknowledging the criticism that has been expressed towards the findings of the RFI, there is no reason to doubt the outcome of the thorough and expert analysis that led to the report’s conclusions and consequently there is no reason to reopen the investigation.”
We disagree. Reasons for re-examining the outcome of the formal investigation are presented in our paper, which is published online at:
The paper is detailed and includes pictorial explanations and evidence of shortfalls in the RFI.
Here is an extract from the 1995 Merchant Shipping Act, which will remind the Minister that the possibility of getting it wrong, the first or even second time around, has been anticipated and provided for in law:
Re-hearing of and appeal from investigations

269.—(1) Where a formal investigation has been held under section 268 the Secretary of State may order the whole or part of the case to be re-heard, and shall do so—
(a) if new and important evidence which could not be produced at the investigation has been discovered; or
(b) if there appear to the Secretary of State to be other grounds for suspecting that a miscarriage of justice may have occurred.
“In closing, I would like to echo the sentiments expressed in the RFI’s overview, that the crew of the Gaul should now be left to rest in peace undisturbed by the speculation created by their dramatic disappearance.”
The government’s argumentum ad misericordiam to defend the outcome of the RFI is inappropriate and, considering that this put the blame squarely upon the victims, rather cynical.

Wednesday, 17 December 2008

Not so sure...

The other day I asked another retained expert the same question: did he identify or see any reference to a design fault, in terms of inadequate strength of the inner covers and possible malfunction of the non-return flaps on the Gaul, within the documentation that had been made available to him during the formal investigation?

He seemed hesitant and unsure about that...

Taking refuge in ambiguity


In a recent message, the Treasury Solicitor writes: 
“You have indicated that in your view the chutes were a design fault. This is your view but appears not to have been accepted as such by any of the retained experts.”

Having contacted one of the retained experts, I learned that the design fault they had considered was in fact related to the difficulty of maintenance of the non-return flaps (2) (3), and that they had not identified or even seen, within the documentation that had been made available to them, any reference to a design fault in terms of inadequate strength of the inner covers and possible malfunction of the non-return flaps.
There is definitely a difference in perception here. Could some occlusion of the communication lines between those involved in the 2004 investigation be the explanation for that?

Anyway, that the vessel had a design fault in the construction and arrangement of the duff and offal chutes is an engineering fact (see the technical report on our website).
Why this has not also become a legal fact, is something that should be explained – plainly and without procrastination.
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(2)
Concluding remarks from Mr Meeson (Investigation transcript) suggesting answers to the formal questions:
“………Although the design of the non-return flap was deficient, in that it was liable to seize over time and had no real means whereby it could be maintained, proper use……..”

(3) This was also questioned in the technical report published on our website:
http://www.freewebs.com/inconvenientcitizen/fulltechnicalreportpdf.htm.

Initial comments

Critical comments on the findings of the Re-Opened Formal Investigation (RFI) into the loss of the trawler Gaul


Following a careful study of the report into the loss of the trawler Gaul published in December 2004, at the end of the RFI, (http://www.fv-gaul.org.uk/), a number of questions and objections as to its content and conclusions arise.


In essence, the inquiry concluded that human error on the part of the crew, shore maintenance staff and the vessel's owners was the cause of the vessel's loss.
In this post, it is suggested that what actually led to loss of the vessel was a design fault in the construction and arrangements of the duff and offal chute openings and their means of closure.

The RFI conclusions in brief
  1. That the Gaul capsized and sank in severe weather following undetected seawater ingress into the factory space. The water entered this space through two hull side chute openings[1].
  2. That each of these two hull side chute openings had two means of closure: an outer non-return flap valve and a hinged inner cover; and that both of these closures were open prior to, and during the loss of the vessel. 
  3.  That, as a result of inadequate shore-side maintenance, both outer flap valves had become seized in the open position due to corrosion in their hinges, and that they had been in this condition since the time of the vessel’s departure from Hull, 16 days prior to the accident;
  4. That the hinged inner covers had been left open and unsecured by the crew; and 
  5. That, had the crew closed the inner covers, this would have been sufficient to prevent the loss of the vessel.
  6. ....................................................................................................
    [1] These chutes facilitated the overboard discharge of duff and offal waste resulting from fish processing operations within the factory space.
    .....................................................................................................

The design fault

The duff and offal chute openings in the hull of the vessel were provided with a two-barrier closure system: an outer non-return flap (the strength barrier) and an inner cover (the leakage barrier), and these were both required to be closed in order to maintain the hull’s full watertight integrity.
Unfortunately, it can be demonstrated that the outer non-return flap arrangement, which was present onboard the Gaul was such that, in certain circumstances, the sea could act directly on the exposed free edge of this outer flap and push it open. In such circumstancess, if the inner covers had also been open or had subsequently failed[2] , the seawater would have been able to enter the vessel unhindered. 

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[2] It should be mentioned here that the inner covers were neither designed nor intended to withstand, on their own, the forces of the sea
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For a pictorial explanation of the design defect on the Gaul, please follow this link:
http://webzoom.freewebs.com/inconvenientcitizen/Gaul%20design%20fault.pdf

This shows that a slightly different design arrangement of the outer non-return flaps would have prevented the rapid flooding of the Gaul, even with the inner covers left fully open.


Possible causes for the loss of the Gaul

The Re-opened Formal Investigation came to the conclusion that the outer non-return flaps in the duff and offal chutes on the Gaul had been seized in the open position since the time of the vessel’s departure from port - this conclusion having been drawn from the fact that the flaps were found to be in the open position during the 2002 underwater survey.
The fact that the inner covers were also found to be open during this survey was ascribed to the crew’s failure to close them.

In his closing remarks the judge stated firmly that "no other possible causes remained open".

The document published HERE shows that not only was this incorrect but that there are other more plausible explanations for the loss of the vessel:

Other aspects and questions

Linked to the above issues, there are also a number of elements within the formal report which appear incorrect: 1. When defining the scope of ship classification, the formal report failed to include the Classification Societies’ responsibility for watertight integrity. The definition within the report reads:
“Class/classification = covers the development and worldwide implementation of published rules and regulations which will provide for: 1. The structural strength and scantlings of all essential parts of the hull and its appendages; ......”
While the definition as per IACS – Quality management System requirements manual states in respect of “Classification service” point 1. that
“The structural strength (and where necessary the watertight integrity of) all essential parts of the exterior boundaries of the ship or offshore installation and its appendages.”

Why was the alteration of this international definition necessary in the formal report?

2. The definitions provided in the formal report for weathertight and watertight properties read as follows:
“Watertight – impervious to the passage of water, as applied to ship’s structure, closures and joints. A watertight opening is so constructed that when closed, it will prevent water under pressure from passing through, and normally incorporates a gasket.”


“Weathertight – capable of being sealed to exclude water in normal sea conditions. A weathertight opening is typically designed to keep out rain and spray only.”

Whereas watertight and weathertight are terms that have agreed International definitions such that items which are categorised and accepted as watertight or weathertight need to meet strict requirements for construction, strength, material thickness, gasketing, hinges and securing clips (these are generally set by National or International standard).
“Watertight means capable of preventing the passage of water through the structure in either direction with a proper margin of resistance under the pressure due to the maximum head of water, which it might have to sustain.”


“Weathertight means that in any sea conditions water will not penetrate into the ship.” (SOLAS 1974 as amended, 1966 Load Line Convention and Torremolinos Convention 1977)

Why were the definitions for watertight and weathertight used in the report incorrect?

Thus, a weathertight fitting should be designed to withstand, in any sea conditions, water pressure and prevent the passage of water from one side only. A watertight fitting, on the other hand, must, when closed, prevent the passage of water through an opening no matter which side is under pressure.


Since the adequacy and functioning of the ship’s duff and offal chute fittings was central to the investigation, has not their confusing definition been a serious failing?
Why have the inner covers of the Gaul’s duff and offal chutes been categorised throughout the report as being of a ‘watertight’ standard, whilst, in reality, the construction, strength and arrangement of these inner covers would not even meet the requirements that would be expected for ‘weathertight’ closures?

Watertight and weathertight fittings generally make use of rubber gaskets and clips (or bolts) to seal steel-to-steel joints and prevent the passage of water. Watertight fittings need many more bolts/clips than weathertight fittings. The principle shortfall in the strength of the chute’s inner covers is related to their direction of opening when considered in conjunction with external sea pressure loading (full sea loading on the covers would only be resisted by 3 butterfly nuts, instead of the overlapped gasketed steel plating arrangement that is normally associated with a weathertight joint). 3. It is also stated in the report that:
“it is not clear how the spindle could have been repaired or replaced should the need arise without burning off the balance weight from the connecting arms”
However, the construction drawings for the duff and offal chutes show quite clearly that the hinge, spindle, balance weight and connecting arms can be readily dismantled for maintenance, repairs or replacements. (?!)

4. Is it not the case that, if the inquiry had found that the Gaul had sunk due to a design defect, the victims’ families would have been entitled to compensation?

Extract from The Merchant Shipping (Convention on Limitation of Liability for Maritime Claims) (Amendment) Order 1998:
" 1. The limits of liability for claims other than those mentioned in Article 7, arising on any distinct occasion, shall be calculated as follows: (a) in respect of claims for loss of life or personal injury, (i) 2 million Units of Account for a ship with a tonnage not exceeding 2,000 tons,”
This would amount today to approx. 3m USD per life lost (1 SDR = 1.48727 USD)

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For those who wish to read the full technical argument behind the above points, please visit the following site: