WASHINGTON - The Chicago Transit Authority, already preparing to balance its budget by increasing fares and cutting service, was rocked Tuesday by a federal report that blamed missing and falsified records, deferred rail maintenance and poor safety oversight for a 2006 Blue Line subway derailment.
A yearlong National Transportation Safety Board investigation into the July 11, 2006, derailment and fire that injured more than 150 passengers found that the probable cause was "the CTA's ineffective management and oversight of its track inspection and maintenance program and its system safety program, which resulted in unsafe track conditions."
"The track had clearly been deteriorating for a long time," said Bob Chipkevich, director of the safety board's office of railroad, pipeline and hazardous materials investigations. "It did not happen overnight."
The CTA's track inspection and maintenance, Chipkevich said, were the worst he has seen at any U.S. transit agency.
CTA President Ron Huberman said the agency has made strides since the 2006 incident in correcting problems cited by the NTSB."We are auditing everything, we are reviewing everything," Huberman said.The safety board's report blasted the Regional Transportation Authority for failing to fulfill its safety monitoring responsibilities over the CTA. It said the RTA contributed to the accident by neglecting to require the CTA to fix unsafe track conditions.
In addition, the report said the Federal Transit Administration provided "ineffective oversight" of the RTA, an agency poised to assume huge new responsibilities over daily transit operations and safety under proposed legislation before the Illinois General Assembly.
The NTSB issued 14 recommendations to the CTA, the RTA and the state and federal governments to improve safety inspections and prevent future accidents, both in Chicago and other cities.
"The bottom line is that as a result of either action or inaction, we had an accident down there that should have been prevented," said safety board Chairman Mark Rosenker. "It's disturbing."
Under the circumstances, the rookie motorman operating the Blue Line train did his job well, the safety board found. The motorman trouble-shot the problem and escorted frightened passengers along a catwalk to an emergency exit stairway about 350 feet in front of the train that led to the street above.
But citing a litany of unacceptable practices and violations of federal rules, one NTSB official characterized the CTA rail inspection process as "a case study in organizational accidents."
Inoperative emergency call boxes in the tunnel the day of the accident and outdated subway maps at the CTA control center caused confusion about the eight-car train's location in the tunnel, between the Clark/Lake and Grand/Milwaukee stations in downtown Chicago, the safety board said. The disorder fueled a 22-minute lag in the Chicago Fire Department's arrival to evacuate the approximately 1,000 passengers aboard the evening rush-hour train, the board's report said.
There also were problems with the 55-year-old tunnel's ventilation system in removing smoke caused by electrical arcing between the last car and the 600-volt third rail, the NTSB said.
Investigators determined within days that some wheels on the last car of the Blue Line O'Hare branch train lost contact with the rails because the track was out of alignment.
But a subsequent examination of documents, interviews with CTA workers and repeated walk-throughs with track inspectors in the Blue Line tunnel turned up severe systemic problems, the safety board said in a blistering report.
More than 80 percent of inspection records were missing for the Blue Line, the board's report noted.
CTA tracks are supposed to be inspected twice a week, but one track inspector told a safety board investigator that he had inspected his assigned area only once in five months, the report said.
"We found hundreds of records missing, literally hundreds," said Cy Gura, an investigator who served as chairman of the safety board's track, signal and engineering group. "The CTA said the work was done, but there was no record. The [track] gauge problem was not reported and the fixes were not reported."
In many other instances, investigators found that inspection reports were falsified to indicate that track was inspected when in fact it was not, the report said.
Gura, who accompanied CTA inspectors on their rounds, said they routinely marked off on their reports as having walked and measured track in all 6 miles of their territories, even though they usually came up about 1 1/2 miles short by the time their shift ended.