Has it been only three years since the Cosco Busan, the leakiest 2001 Hyundai ever, spilled 58,000 gallons of bunker fuel* into the bay? Seems longer.
Anyway, turns out that a dude who supposed to be up front looking out for stuff in the pea soup fog was downstairs in the galley eating breakfast. I did not know that, no sir. Of course, the idea to depart on sked despite the fog came from the bar pilot, so that’s the person who’s primarily responsible. But there still plenty of blame to go around. Deets below.
Click to expand
All right, it’s Blame Time:
The National Transportation Safety Board determined the following probable causes of the accident:
- the pilot’s degraded cognitive performance from his use of prescription medications, despite his completely clean post accident drug test,
- the absence of a comprehensive pre-departure master/pilot exchange and a lack of effective communication between Pilot John Cota and Master Mao Cai Sun during the accident voyage, and
- (COSCO Busan Master) Sun’s ineffective oversight of Cota’s piloting performance and the vessel’s progress.
Other contributing factors included:
- the failure of Fleet Management Ltd. to train the COSCO Busan crewmembers (which led to such acts of gross negligence as the bow lookout eating breakfast in the galley instead of being on watch) and Fleet Management’s failure to ensure that the crew understood and complied with the company’s safety management system;
- the failure of Caltrans to maintain foghorns on the bridge which were silent despite the heavy fog;
- the failure of Vessel Traffic Safety (VTS) to alert Cota and Sun that they were headed for the tower. VTS is legally required to alert a vessel if an accident appears imminent, yet they remained silent;
- the malfunctioning radar on the COSCO Busan, which led Captains Cota and Sun to use an electronic chart for the rest of the voyage. Although Coast Guard investigators found the radar to be in working order, they did not examine it until days after the accident (allowing time for faulty equipment to be fixed, which is not uncommon after a marine accident)
- Captain Sun’s incorrect identification of symbols on the electronic chart;
- the U.S. Coast Guard’s failure to provide adequate medical oversight of Cota, in view of the medical and medication information he had reported to the Coast Guard
Happy Anniversary, Cosco Busan, or should I say MSC Venezia? Don’t ever come back.
*Yeah, Wiki is still wrong on that gallonage figure, partly due to the U.S. Coast Guard sitting on information for months and months ’cause they didn’t want to earn themselves any more bad press.