CAT File No. O-1600-60
MoT File No. 124714
CIVIL AVIATION TRIBUNAL
Captain Yves Picard, Applicant
- and -
Minister of Transport, Respondent
Aeronautics Act, R.S.C. 1985, c. A-2, s. 7.1(1)(b)
PPC, Pilot Proficiency Check
Allister W. Ogilvie
Decision: May 3, 1999
I confirm the Minister's decision to issue to Captain Picard an unsatisfactory assessment regarding a pilot proficiency check on Airbus A320.
A Review Hearing on the above matter was held Wednesday, April 14, 1999 at 09:00 hours at the Federal Court of Canada, in Montreal, Quebec.
Captain Yves Picard is an Air Canada pilot. He began flying with the company 21 years ago, serving on a variety of aircraft, both as first officer and Captain. In 1997 he had been promoted to Captain on the A320 Airbus aircraft. On March 7, 1998, Captain Picard had undertaken his pilot proficiency check (PPC) after having completed his recurrent training. The PPC was assessed as being unsatisfactory. Captain Picard appealed that decision to the Civil Aviation Tribunal resulting in this hearing of Wednesday, April 14, 1999.
Mr. Fred Pratt was the case presentation officer for the Minister of Transport. Mr. Pratt called Captain R. Quickfall as a witness for the Minister. Captain Quickfall is an Air Canada pilot, who on March 7, 1998 was serving as a delegate of the Minister of Transport to conduct a PPC in the simulator on Captain Picard and his first officer.
Captain Quickfall utilized a document entitled PPC/IFT-C1: A320, valid October 1, 1997 to March 31, 1998 (Exhibit M-2), which may be called a script. This script sets out the purpose of check, the items that are to be tested, the role of check pilot and the particular scenarios to be flown in the simulator. The same script is used for all the crew members on that type of aircraft during the validity period of the script.
The script called for four flight legs, the Captain being required to fly the first two. On the first leg from Ottawa to Toronto, a pressurisation malfunction was called for, resulting in the aircraft (simulator) having to return to Ottawa. Upon reaching Ottawa, the weather limits in the simulator were set low so as to require the aircraft to overshoot and go around.
Captain Quickfall testified that the script called for an engine failure to occur during the go-around somewhere above 1000 feet above ground level (AGL) because of a double FADEC fault (FADEC – Fully Authorizing Digital Engine Control). The engine failure would have two indications: First, the failed engine instrumentation indicates orange semi-arcs and XXXs instead of its normal green; the ECAM is the Electronic Central Aircraft Monitoring. It provides a variety of information to the crew, which varies dependent upon the phase of flight and the configuration of the aircraft. It does not give an engine failure warning until the aircraft is above 1500 feet. The second indication would be the reducing pitch attitude of the aircraft as it attempts to maintain speed with the reduced thrust. However, if pitch is not reduced either manually or by the auto pilot, the airspeed will decrease.
In this instance the auto pilot was engaged for the go-around, and the Captain selected TOGA (Take-Off and Go-Around). In this particular configuration the auto pilot attempts to maintain a trajectory from present altitude and configuration to the selected level off altitude, based on the assumption of no loss of thrust. The ALT star (ALT*) mode engages when the aircraft reaches the altitude capture zone defined by the aircraft vertical speed. When an engine failure occurs during the ALT* phase the AFDS (Auto Pilot Flight Director System) does not protect the airspeed.
The application of TOGA power caused the aircraft to pitch up to about 15° accompanied by a high rate of climb at speed of Velocity Approach (VAPP) or greater. The high nose attitude combined with a power loss would result in a dramatic loss of airspeed unless the aircraft attitude is reduced by intervention with the auto pilot or by disconnecting the auto pilot and manually reducing pitch attitude to regain airspeed.
Captain Quickfall asserted, that when the FADEC fault was recognized by the crew, no attempt was made to reduce pitch attitude to control the decaying airspeed. He observed that the aircraft decelerated to a configuration called the AFloor (Alpha floor). That speed was 20+ knots below VAPP, which he stated, was below an acceptable standard for safe flying. The AFloor function is a stall protection mode whereby the aircraft automatically lowers the nose to an angle of attack that prevents a stall. Additionally, during this manoeuvre Captain Quickfall observed the speed Trend Vector to indicate a large downward trend.
To assist the pilot flying (PF) the pilot not flying (PNF) is to call out any airspeed deviation above or below a safe speed for the particular configuration (Exhibit M-4). He stated that during this phase the PNF either did not make the appropriate "Airspeed" call or that it was not emphatic. In any case, during the overshoot, the PF did not control the speed.
Captain Quickfall submitted that in any case the pilot must monitor the basic flight instruments, speed, heading, altitude, and vertical speed. Reference was made to the A320 Flight Crew Operating Manual (FCOM), Standard Operating Procedures (SOPS) (Exhibit M-5), which makes several references to the crew's responsibility to monitor and check Auto pilot and/or Flight Director functions, and to disengage those instruments should they not be guiding the aircraft to where it is expected.
The check ride was not immediately terminated after the airspeed loss and recovery, but continued for about another 10 minutes. Upon its termination, the crew was debriefed and a check report completed (Exhibit M-8). The missed approach section was judged unsatisfactory. Under comments, it states that during the missed approach a FADEC fault was introduced, speed control not monitored, resulting in an AFloor activation.
During the debriefing, Captain Picard asserted that he had not received any training on the double FADEC fault. The PNF was knowledgeable regarding it and made reference to a bulletin entitled "Land Green" which is an Air Canada Newsletter regarding Airbus aircraft (Exhibit M-6). At pages 5 and 6 of the April 1995 issue, the procedure for airspeed loss in like circumstance is addressed. The script calling for this fault had been in place for five months and Captain Quickfall had utilized it to perform about 20 checks on other crews.
Under cross-examination Captain Quickfall stated that he had not terminated the check ride immediately after the missed approach as he wanted to further assess the performance.
Numerous questions were posed as to the availability to the PF of other indication of faults. It was established that the ECAM does not provide warning of this fault while below 1500 AGL, as the ECAM is inhibited in that range. A fault such as an engine fire is not inhibited, as such fault requires pilot input immediately whereas the double FADEC failure does not.
A page from the FCOM, Abnormal and Emergency, Power Plant p. 23 (Exhibit D-1) addressing Engine FADEC FAULT, indicates other system pages such as Hyd Elec or Bleed must be used to confirm engine status when the FADEC fault occurs.
It was determined that the clues available in the cockpit during certain windshear encounters were similar to those encountered when this fault occurs.
In Captain Picard's 21 years of flying at Air Canada he had always maintained a very high standard, except for his check of March 7. He did a re-check shortly thereafter and again attained a very high standard. His unsatisfactory performance on that day was an exception and was very disturbing for him. He sought to explain the circumstances and show that he flew safely at all times.
His remembrance of the flight differs somewhat from Captain Quickfall's. He asserts that he and the First Officer did not identify the FADEC fault, nor did First Officer call a power loss, but the First Officer did call "Airspeed".
He felt that the only indication of this fault was the airspeed loss but this could also have been attributed to windshear. Captain Picard asserted that he had received no training for this particular fault. After the fact, he was made aware of Land Green articles addressing the subject (Exhibits D-2 and M-6) but points out that the publication has no official authority but rather is only informational.
He described his action during go-around. When he became aware of the decaying airspeed, he disconnected the auto pilot and pushed the nose down to gain airspeed. Captain Picard acknowledged that during this recovery he encountered the AFloor regime, but maintains that the AFloor is there to offer protection, that it is not a device to fail you.
Upon cross-examination Captain Picard acknowledged that at the start of the go-around, the aircraft speed was about VAPP + 10, but that it fell below VAPP, eventually falling to a speed that engaged the AFloor.
Captain Provost appeared on behalf of Captain Picard. His credentials were such that he was qualified to be called as an expert on the A320 aircraft.
Regarding the engine indications of orange semi-arcs and XXXs he explained that such indication was given when the sensors were not sure of the signal. Therefore, it was necessary to consult the ECAM and refer to the Quick Reference Handbook (QRH) before being certain that the indication was an engine failure. The ECAM inhibits certain messages during critical phases of flight, depending on the urgency of action required to deal with the problem.
Captain Provost also stated that he had not been trained or briefed on an engine failure during the ALT* phase of flight.
He testified that it is not forbidden to activate the AFloor regime, as it is designed to help the crew recover from certain situations such as windshear encounter, collision avoidance and low energy situations (Exhibits D-5 and D-6). As well, he testified that computers monitor trends and rates rather then just set figures. Because of this, the point at which the computer activates certain modes (eg. ALT*) can vary.
Exhibit D-6 from the A319/A320 FCOM, giving SOPS for Handling of Emergencies, including Windshear Warnings and Ground Proximity Warning (GPWS) stipulates at p. 12, at 3, that if one engine is inoperative, ... reduce speed with care below VLS (velocity lowest selectable) .... This he says contradicts Captain Quickfall's evidence that one is forbidden to reduce speed below that figure.
Captain Provost refers to FCOM regarding FMGS (flight management guidance system) Procedures, Go Around, 4.05.80 p. 5 at 5 (Exhibit D-7) where it states:
If ALT* engages out of SRS mode and an engine out occurs quasi simultaneously, an airspeed loss may be encountered during the altitude capture. No protection is provided at VLS when ALT* is engaged. Low speed protection is ensured by the Alpha floor. (emphasis added)
He states that this shows that AFloor regime is designed to be used for protection. (SRS – Speed Reference System)
Paragraph 7.1(1)(b) of the Aeronautics Act:
7. 1(1) Where the Minister decides
(b) to suspend or cancel a Canadian aviation document on the grounds that the holder of the document is incompetent or the holder or any aircraft, airport or other facility in respect of which the document was issued ceases to have the qualifications necessary for the issuance of the document or to meet or comply with the conditions subject to which the document was issued, or
the Minister shall, by personal service or by registered mail sent to the holder or the owner or operator of the aircraft, airport or facility, as the case may be, at the latest known address of the holder, owner or operator, notify the holder, owner or operator of the Minister's decision.
Mr. Pratt reiterated that the evidence showed the airspeed to have fallen below VAPP and subsequently the AFloor was activated. The speed was below the accepted standard for the manoeuvre, so Captain Quickfall had made the right decision in assessing the check as unsatisfactory.
Captain Dorée took us back through areas of controversy. He queried how one should react to a situation when one was not trained to recognize and react to it. He pointed out that the ride was continued for some time after the go-around which indicated to him that the failure was not obvious. Although the manoeuvre in the go-around had not been elegant, it had been handled safely.
He contended that the airspeed was the only obvious clue to the failure, and that it was not recognized by the Captain as a FADEC failure.
Captain Dorée queried why this type of malfunction was not found in the reference material when the Land Green publication described it as a potential trap. He argued that other manoeuvres, such as that required in Windshear on Terrain Avoidance, called for speeds below VAPP. As there were no clear procedures for this particular manoeuvre, how could one know the standard to be met?
The issue for me to decide is whether on March 7, 1998, Captain Picard failed to demonstrate the required standard for certain manoeuvres required for the PPC. The Minister must prove on a balance of probability that he did not meet the standard.
Regarding the standard to be met, Captain Quickfall testified that the minimum acceptable airspeed for the manoeuvre was VAPP. Flying below that speed was unacceptable at any time. It was his observation that his speed did go below that value and that the AFloor regime was activated.
Captain Picard admits that his speed did fall below the VAPP and that the AFloor activated. However, evidence given on his behalf casts doubt upon the applicability of the standard in the given situation. He raises other mitigating factors, such as lack of training for the scenario.
Captain Picard had always maintained a very high standard before this check and again attained that standard on the subsequent check. The PPC of March 7 remains an anomaly and raises the question of whether the anomaly was the standard required or his performance.
Captain Picard's representatives cast doubt upon the efficacy of the standard by illustrating that in certain circumstances the FCOM materials recognize that the airspeed required can be below VAPP.
However, the actions required in Exhibit D-6 re: Windshear/GPWS Warnings are classed as "Handling of Emergency Procedures". The reference regarding reducing speed with care below VLS, if one engine inoperative is found, under heading 3 "When Ground Contact is a Factor".
It may be that the minimum speed required during such manoeuvres is less than VAPP, as suggested by Exhibit D-6, but if so, it may be restricted to these specific emergency handling procedures, but that point was not the subject of direct testimony.
However, regarding the minimum speed in the manoeuvre in question, there is the direct testimony of Captain Quickfall, who, as delegate of the Minister, testified that the minimum speed could not fall below VAPP. He stated that he observed the speed to fall below that level. Captain Picard acknowledged that fact.
In this circumstance I must confirm the Minister's decision on the evidence given.
However, Captain Picard and his representatives have raised valid and compelling issues regarding the training and subsequent standards of performance which should be addressed. I do not possess the knowledge or experience to address those ancillary issues, but the parties before me do. All witnesses had an in-depth knowledge given of long study and experience with the aircraft and its systems. Representatives of the pilots, the Minister and the company whose interests are at stake should collectively address the ancillary issues raised.
I thank the parties for having presented the complex issues in such a competent and professional manner.
I confirm the Minister's decision to issue to Captain Picard an unsatisfactory assessment regarding a pilot proficiency check on Airbus A320.
Civil Aviation Tribunal
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