Posted: Tuesday, August 26, 2003
GEHMAN: The intent of our report and all of the many hours that we put into this investigation were done to reflect favorably and reflect with honor on the efforts of the crew, Rick Husband, Willy McCool, Mike Anderson, Dave Brown, Casey Chawa, Laurel Clark and Ilan Ramon.
The lives of these people are very precious to us, and the board considered that very serious matter that these brave people thought that what they were doing was important, that it was significant, that it was part of human space exploration, that the things that were going to be learned from this mission were worth the risk that they were taking.
And if this board has any impact whatsoever, we felt that the loss of their lives had better make a difference, or both them and us have wasted our time. The board would also like to express, and I as a chairman would like to express our most profound thanks to a lot of people.
I would like to express my profound thanks to my 12 fellow board members who essentially gave up their lives for six and a half months to put an awful lot of effort into this report. We essentially worked seven days a week, but most of these people either, one, they put their previous life aside and devoted 100 percent to this investigation, or, two, some of them began leading two lives and keeping two jobs, and they did the investigation in the daytime, and they did their other duties at night.
We had about a staff of about 120 people on the investigation team. To them, I owe a lot. They worked very, very tirelessly. They did brilliant work. They probably will never get their names in the newspapers or on television, but they did a wonderful job. And we, as a board, are indebted to them.
To the hundreds and hundreds of NASA employees who assisted us with this, we are indebted to them. They also made a great contribution. And lastly, as I have mentioned in almost every press conference I have been in, the 25,000 to 30,000 private individuals who helped us, mostly in the area of the debris collection, but in lots of other ways, too, we owe a great debt to all of them.
As you may be aware, for example, we had over 3,000 unsolicited public inputs, either in the sense of letters, or e-mails to our Web site. We had all those debris collectors who marched shoulder to shoulder through the state of Texas, picking up that debris, which turned out to be so significant.
We had people who contributed photography and videography, all of which contributed to this accident investigation. So we owe a lot of people thanks, and we are the first to acknowledge that we could not have done this by ourselves.
Let me say at the outset that this board, and I think I can speak pretty confidently for the 13 members -- for the other 12 members of the board. This board comes away from this experience convinced that NASA is an outstanding organization. It's full of wonderful people who are trying very, very hard to do very unique and very special things, things that are not done any other place in the world, and for the most part have never been done by mankind before.
And we would like to make sure that the American people realize that they have an institution which they should be very, very proud in the form of NASA.
If this board had set out to spend seven months listing all the good things that NASA does, the report would be thicker than this. Unfortunately, that's not what our task was.
In the nature of these investigations, causes all of the good work and all of the wonderful things that are accomplished to get lost, and I think it's worth this we take a second and say that we are impressed by the work force, we are impressed by the people, we are impressed by what NASA has accomplished.
Nevertheless, there are some things they can do better, and it is our intent by this -- by the publishing of this report that those things that they need to do better get documented and that we provide the impetus for those changes.
Next, I think I speak confidently for the board in which we can state a conclusion that the space shuttle is not inherently unsafe, and that this board was under no pressure to say anything to the contrary.
The fact that the International Space Station is up there, the fact that the United States has obligations to finish the International Space Station, and that lots of other factors like the sunk costs that are already in the shuttle, et cetera, I can speak confidently for myself, and I think I can speak confidently for the 12 members, that this board was under no pressure to say that the shuttle could continue to be operated. If we thought the shuttle was unsafe, we would have said so.
Now, that is not to say that there aren't a lot of things they need to improve the safety of the shuttle, but if we thought that this shuttle was just inherently unsafe, we would have said so.
However, that does not mean that there aren't lots of things that they should do to operate this thing more safely, and that's essentially the context of our report.
There are some things that need to be done immediately. We have listed those, and we call those return to flight items. We'll be glad to talk about them as the time goes on. And then there's a second group of recommendations, which we call continuing to fly.
The board feels that there will be so much vigilance, and so much zeal and so much attention to detail for the next half dozen flights that anything we say probably is an understatement compared to the energy and the diligence that will be -- that NASA will naturally put into making the first couple flights safe.
The board however is concerned that over a period of a year or two the natural tendency of all bureaucracies, not just NASA, to morph and migrate away from that diligent attitude is a great concern to the board, because the history of NASA indicates they have done it before.
Therefore, we have a group of recommendations that are designed to prevent that, that backsliding or atrophy of energy and zeal, and those are the second group of recommendations that we call continuing to fly. And those are more fundamental and harder to do, but they are just as important, perhaps more important than the return to fly recommendations.
And we are careful not to create any hierarchy of recommendations. We don't have a set of recommendations, which are more important than others, and a second group that is less important and a third group which is third important. We were careful not to make that distinction.
You will not find in this report terms like "contributing factors" or "underlying causes." We don't believe in those terms. We believe that these other organizations -- these other organizational kinds of recommendations are just as important as the return to fly ones.
Then there's a third group of findings, observations and recommendations that consists of all the things we observed or noted that we were not particularly pleased with, but didn't have anything directly to do with this accident.
But they might contribute to a future accident, and we strongly recommend that NASA pay attention to them, too. We once again suggest to our readers of this report that you not mentally categorize these three categories of findings and recommendations in any kind of hierarchal order.
To us, the golden nugget which may prevent the next accident could be in that third group, and just because it didn't have anything to do with this accident, that's -- you should not prioritize them in any other way. So we feel very strongly about that.
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