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Safety Recommendation Details

Safety Recommendation M-12-004
Synopsis: The recommendations address the maintenance of bridge navigation lighting in Kentucky. This safety issue arose during the investigation of the January 26, 2012, allision of the M/V Delta Mariner with the Eggner’s Ferry Bridge at mile marker 41.7 on the Tennessee River. The accident completely sheared away a 322-foot span of the bridge. Fortunately, no fatalities or injuries resulted. The NTSB is participating in a formal U.S. Coast Guard investigation concerning the accident. While additional factors are being investigated in this accident, the NTSB regards the bridge lighting issue as critical, warranting that we issue a safety recommendation in advance of the final NTSB accident report. The 287-foot-long Delta Mariner had been under way for about a day on its regular route from Decatur, Alabama, to Cape Canaveral, Florida, when the accident occurred. Shortly before 20001 central standard time on the evening of January 26, 2012, the Delta Mariner was heading downbound on the Tennessee River as it approached the Eggner’s Ferry Bridge. The bridge has four navigable spans, one of which is designated as the main navigation span. Delta Mariner crewmembers on board said only one span of the bridge was lighted two red lights marking the concrete bridge piers and a green light marking the center of the span. The Coast Guard–approved lighting plan calls for red and green lights to mark all four navigable spans as well as three white lights in a vertical line to mark the center of the main navigation span. Crewmembers indicated that they steered towards the sole lighted span and eventually struck it.
Recommendation: TO THE COMMONWEALTH OF KENTUCKY: Verify the status and proper operation of navigation lighting on all Kentucky bridges over navigable waters in accordance with U.S. Coast Guard–approved lighting plans.
Original recommendation transmittal letter: PDF
Overall Status: Closed - Acceptable Action
Mode: Marine
Location: Aurora, KY, United States
Is Reiterated: No
Is Hazmat: No
Accident #: DCA12FM006
Accident Reports: ​Allision of the Cargo Vessel M/V Delta Mariner with Eggner’s Ferry Bridge
Report #: MAR-13-02
Accident Date: 1/26/2012
Issue Date: 7/25/2012
Date Closed: 11/20/2012
Addressee(s) and Addressee Status: Commonwealth of Kentucky (Closed - Acceptable Action)

Safety Recommendation History
From: NTSB
To: Commonwealth of Kentucky
Date: 11/20/2012
Response: We note that the KYTC verified the status and proper operation of navigation lighting on all Kentucky bridges over navigable waters in accordance with Coast Guard–approved lighting plans, as requested. Accordingly, Safety Recommendation M-12-4 is classified CLOSED—ACCEPTABLE ACTION.

From: Commonwealth of Kentucky
Date: 9/12/2012
Response: -From Michael W. Hancock, P.E., Secretary, Kentucky Transportation Cabinet, Commonwealth of Kentucky: Please allow this letter to serve as the response of the Commonwealth of Kentucky to the above-referenced Safety Recommendations contained in your letter dated July 25, 2012, addressed to Governor Steve Beshear ["Recommendation Letter"]. That letter has been referred to me with the request that I inform the National Transportation Safety Board ["NTSB"] of efforts made by the Kentucky Transportation Cabinet ["KYTC"] which I believe address the NTSB's safety recommendations. The question of liability connected with the above-referenced allision is the subject of a lawsuit pending in the U. S. District Court for the Western District of Kentucky styled In re: Foss Maritime Company, Case No. 5:12-CV-00021-TBR. In addition, the allision is currently the subject of separate but related proceedings styled In re Allision of the MN Delta Mariner with Eggners Ferry Bridge, U. S. Coast Guard, Formal Investigation and Board, Marine Information for Safety and Law Enforcement, Activity No. 4233522 and also United States of America, National Transportation Safety Board, Docket No. DCA 12-LM-006. In the interest of promoting public safety, the NTSB should be aware that some of the material facts recited in the Recommendation Letter were erroneously stated or incomplete. As a result, the letter was inaccurate and confusing. The matters which were erroneously or incompletely stated in the Recommendation Letter that should be clarified or corrected include the following: • The third paragraph states that "[t]he bridge has four navigable spans, one of which is designated as the main navigation span." The use of this terminology without further explanation could cause a great deal of confusion. While it is true that the Coast Guard lighting plan provided that four spans were to be lit, it is also significant that, at the time of the allision, the Eggners Ferry Bridge had only one "Channel Span" per the Corps of Engineers river chart. Therefore, it is believed that a better description would be that "the bridge had four lit spans, but only one span was deSignated as the 'Channel Span' according. to Corps navigation charts in effect at the time of the allision. n Such a statement would clarify the fact that there was only one span designated as the "Channel Span" at the time the Delta Mariner allided with the Eggners Ferry Bridge. • The fifth paragraph might be construed to mean that no work had been performed on the bridge lights since December 15, 2011. However, in fact, KYTC personnel had been working on the bridge lights since that date; moreover, KYTC personnel had been working on those lights during the week prior to the allision. That work was interrupted by inclement weather creating a hazardous situation for KYTC workers, who would otherwise have been exposed to serious injury or death. Consequently, it should be noted that the KYTC notified the United States Coast Guard, prior to the allision and while this work was underway, that the bridge lights were out. Furthermore, and perhaps more importantly, prior to the al/ision, the Coast Guard had issued multiple broadcast notices warning mariners that the lights were out on the bridge. The failure to monitor the Coast Guard frequency by the pilot and crew of the Delta Mariner and their failure to heed these warnings was an indefensible oversight on their part leading up to the allision. Your omission of these facts misled the public to erroneously conclude that there was no effort by the KYTC to repair the lights and to warn of the outage when, in fact, the opposite is true. These relevant issues should be recognized by the NTSB so that there can be a fair and accurate understanding of the facts. • The fifth paragraph also states that "[i]t is likely that the white lights had not been operation for at least a year and possibly much longer." In fact, the evidence indicates that at least the bottom white light had been operational prior to the repair work underway at the time of the allision because that light illuminated when it was re-energized after the accident. • Finally, the fifth paragraph additionally states that "[a]lthough the lighting on the Eggner's [sic] Ferry Bridge has been corrected, no formal training has been provided to acquaint personnel responsible for maintenance with the required bridge lighting in the district." However, such training has already occurred as described in greater detail below. In addition to the foregoing corrections, I will address the two recommendations contained in the NTSB's Recommendation Letter, which are: M-12-4: Verify the status and proper operation of navigation lighting on all Kentucky bridges over navigable waters in accordance with U.S. Coast Guard - approved lighting plans. M-12-5: Develop inspection and maintenance procedures so that bridge lighting functions reliably and is maintained in accordance with U.S. Coast Guard - approved lighting plans. Train Kentucky Transportation Cabinet personnel in these procedures. Before the issuance of the recommendations, KYTC took steps to address these issues via the subsequent remedial measures as described below. With respect to the training recommendation (M-12-5), relevant KYTC personnel participated in classes dealing with bridge navigation lighting entitled The Why's and What's and How's. One training session took place in Frankfort, Kentucky on March 20, 2012, with representatives of District Nos. 5,6, and 9 in attendance. Another second training session took place in Madisonville, Kentucky on March 21, 2012, with representatives of District Nos. 1 and 2 in attendance.2 The following topics were covered during these classes: • Navigation lighting history dealing with the Coast Guard's permitting process and federal regulations. • Summary guidelines for green, red, and white lights. • Specific guidelines for the use of green span lights along with example drawings of light detail. • Specific guidelines for the use of white lights to mark the navigation span. • Specific guidelines for multiple channel situations. • Specific guidelines for the use of red lights on piers and margins along with example drawings of light detail. • An example of single-fixed bridge lighting. • An example of multiple-span fixed bridge lighting. • Vertical clearance gauge markings. • An emphasis on the need for a continuing program of inspection and maintenance. • Communication between the KYTC Districts and the Coast Guard, particularly when there are light outages or corrective work. • The names and contact information for Coast Guard personnel. At these meetings, the district representatives were shown a Power Point presentation and were given a pamphlet from the U.S. Coast Guard Office of Bridge Administration entitled Bridge Lighting and Other Signals. Participants were also given a print out from the Coast Guard website containing all district contacts and appropriate citations from the Code of Federal Regulations concerning bridge lighting. A copy of the Power Point presentation and related class material will be submitted by separate transmittal. In regard to inspection and maintenance procedures (M-12-5), KYTC district representatives, at both of the above-mentioned meetings, were given the following directions: • To make provision for maintaining lights, reflectors and markings by reviewing the requirements for each bridge under the Coast Guard permit for that particular bridge and to thereafter perform monthly inspections. • During the monthly inspections to check the main electrical cabinet for disconnects, breakers and photocells, to check each individual light for operation, to check that all required signs/reflectors were present, and (if the system operated via solar power) to check the battery, LED light, solar panel output and to make sure that all solar panels are present. • That if notified of an outage to investigate promptly and, if the problem were not fixed immediately, that each district's Traffic Supervisor should schedule repair work and notify the Coast Guard of the outage. • When notifying the Coast Guard of an outage that each district's Traffic Supervisor should provide an estimated completion date of the expected work and, after the repairs were concluded, to follow up and notify the Coast Guard that corrective work had been completed. • The contact information and telephone numbers for the Coast Guard bridge personnel in the Ohio Valley Sector were given to the district representatives. In regard to verification and operation of bridge lighting (M-12-4), each District containing navigable bridges was directed to conduct an inspection of the lights, signs, and markings for each bridge and make reports to the KYTC Central Office of Traffic Operations. Inspection reports for each district were completed as follows: District 1: District 2: District 5: District 6: District 9: Reports on March 26-28 and July 27, 2012. Reports on March 21-23, 26-28, April 2, and July 12, 2012. Reports on March 26-27, 2012. Reports on March 29 and June 5, 2012. Reports (undated) made in March-April 2012. Copies of the bridge inspection reports for each district will be submitted by separate transmittal. These inspections/reports revealed that bridge navigation lighting was functioning properly in many instances. However, in other instances, and depending upon the circumstances existing at a particular bridge, recommendations were made for subsequent remedial measures. Accordingly, subsequent remedial measures were directed as warranted in each situation as follows: District 1 : This district implemented a new monthly bridge lighting inspection form that will be filled out and filed for all bridges each month, and a preventative maintenance program on all cabinets (including navigation lighting boxes). Location specific improvements were made to the Cairo Bridge (complete overhaul of system on U.S. Highway 60 Lucy Jefferson Memorial with a new Coast Guard lighting plan obtained to match existing light locations), 1-24 Cumberland River Bridge (began service and cabinet relocation with work expected to be completed in mid-August 2012), 1-24Highway Bridge (began service relocation outside flood zone expected to be completed in mid-August 2012), Brookport Bridge (replaced green light over main channel on U.S. Highway 45 bridge), and U.S. Highway 68 Henry Lawrence Memorial Bridge (lights were repaired and a new Coast Guard light plan was obtained to match existing light locations). District 2: This district reports location specific work as follows: Owensboro Blue Bridge (reset green navigation light on channel 1 and wired green navigation light on channel 2 direct until a 12v photo cell can be installed), Shawnee Town Bridge (replaced electronic board on downstream red navigation light on pier B), Spottsville Bridge (all navigation lights now operational), Calhoun Bridge (all navigation lights now operational), Rockport Bridge (one red pier light inoperable and thus far unsuccessful restoration of operation due to damaged conduit), Ky. Highway 56 (replaced battery on upstream red descending navigation light), and Livermore Bridge (continuing to take inventory of signs and lights over Green River). District 5: This district reports that it checks navigation lighting monthly to make sure that all lights are illuminated as a part of this district's monthly roadway lighting inspections. The district traffic engineer is currently attempting to verify whether the channel lights on the Ky. Highway 22 Gratz Bridge can be lowered as a part of the construction project that installed the lights. District 6: This district reports that all navigation lights that were not burning at the time of inspection have been repaired and are in working order. District 9: This district reports that all burnt-out bulbs have been replaced, as needed. The navigation lights are inspected twice per month per a master lighting agreement. KYTC district officials have taken appropriate subsequent remedial measures in each instance or each district is continuing to take appropriate subsequent remedial measures in order to address the results of the statewide bridge inspections. KYTC continues to provide a safe, efficient, and reliable transportation system. The Cabinet further maintains that there were systemic failures by Foss Maritime Company and/or its affiliates, agents and/or employees that caused this allision. I have little doubt that no bridge in this country is safe when a ship, such as the MN Delta Mariner, fails to keep proper lookout in brown water navigation, fails to heed warnings issued by the Coast Guard, and fails to utilize state of the art navigational tools on board the vessel. In closing, I believe that you will find that the subsequent remedial measures taken by the Cabinet are acceptable. If you have any further questions or comments, please direct them to me so that they can be promptly addressed.