[House Hearing, 117 Congress]
[From the U.S. Government Publishing Office]

A REVIEW OF COAST GUARD EFFORTS TO IMPROVE SMALL PASSENGER VESSEL
SAFETY

=======================================================================

(117-44)

FIELD HEARING

BEFORE THE

SUBCOMMITTEE ON
COAST GUARD AND MARITIME TRANSPORTATION

OF THE

COMMITTEE ON
TRANSPORTATION AND INFRASTRUCTURE
HOUSE OF REPRESENTATIVES

ONE HUNDRED SEVENTEENTH CONGRESS

SECOND SESSION

__________

MARCH 21, 2022 (Santa Barbara, California)

__________

Printed for the use of the
Committee on Transportation and Infrastructure

[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

Available online at: https://www.govinfo.gov/committee/house-
transportation?path=/browsecommittee/chamber/house/committee/
transportation

______

U.S. GOVERNMENT PUBLISHING OFFICE
48-364PDF WASHINGTON : 2022

COMMITTEE ON TRANSPORTATION AND INFRASTRUCTURE

PETER A. DeFAZIO, Oregon, Chair
SAM GRAVES, Missouri ELEANOR HOLMES NORTON,
ERIC A. ``RICK'' CRAWFORD, Arkansas District of Columbia
BOB GIBBS, Ohio EDDIE BERNICE JOHNSON, Texas
DANIEL WEBSTER, Florida RICK LARSEN, Washington
THOMAS MASSIE, Kentucky GRACE F. NAPOLITANO, California
SCOTT PERRY, Pennsylvania STEVE COHEN, Tennessee
RODNEY DAVIS, Illinois ALBIO SIRES, New Jersey
JOHN KATKO, New York JOHN GARAMENDI, California
BRIAN BABIN, Texas HENRY C. ``HANK'' JOHNSON, Jr.,
GARRET GRAVES, Louisiana Georgia
DAVID ROUZER, North Carolina ANDRE CARSON, Indiana
MIKE BOST, Illinois DINA TITUS, Nevada
RANDY K. WEBER, Sr., Texas SEAN PATRICK MALONEY, New York
DOUG LaMALFA, California JARED HUFFMAN, California
BRUCE WESTERMAN, Arkansas JULIA BROWNLEY, California
BRIAN J. MAST, Florida FREDERICA S. WILSON, Florida
MIKE GALLAGHER, Wisconsin DONALD M. PAYNE, Jr., New Jersey
BRIAN K. FITZPATRICK, Pennsylvania ALAN S. LOWENTHAL, California
JENNIFFER GONZALEZ-COLON, MARK DeSAULNIER, California
Puerto Rico STEPHEN F. LYNCH, Massachusetts
TROY BALDERSON, Ohio SALUD O. CARBAJAL, California
PETE STAUBER, Minnesota ANTHONY G. BROWN, Maryland
TIM BURCHETT, Tennessee TOM MALINOWSKI, New Jersey
DUSTY JOHNSON, South Dakota GREG STANTON, Arizona
JEFFERSON VAN DREW, New Jersey COLIN Z. ALLRED, Texas
MICHAEL GUEST, Mississippi SHARICE DAVIDS, Kansas, Vice Chair
TROY E. NEHLS, Texas JESUS G. ``CHUY'' GARCIA, Illinois
NANCY MACE, South Carolina ANTONIO DELGADO, New York
NICOLE MALLIOTAKIS, New York CHRIS PAPPAS, New Hampshire
BETH VAN DUYNE, Texas CONOR LAMB, Pennsylvania
CARLOS A. GIMENEZ, Florida SETH MOULTON, Massachusetts
MICHELLE STEEL, California JAKE AUCHINCLOSS, Massachusetts
Vacancy CAROLYN BOURDEAUX, Georgia
KAIALI`I KAHELE, Hawaii
MARILYN STRICKLAND, Washington
NIKEMA WILLIAMS, Georgia
MARIE NEWMAN, Illinois
TROY A. CARTER, Louisiana
------ 7

Subcommittee on Coast Guard and Maritime Transportation

SALUD O. CARBAJAL, California, Chair
RICK LARSEN, Washington BOB GIBBS, Ohio
JAKE AUCHINCLOSS, Massachusetts, RANDY K. WEBER, Sr., Texas
Vice Chair MIKE GALLAGHER, Wisconsin
SEAN PATRICK MALONEY, New York JEFFERSON VAN DREW, New Jersey
ALAN S. LOWENTHAL, California NICOLE MALLIOTAKIS, New York
ANTHONY G. BROWN, Maryland Vacancy
CHRIS PAPPAS, New Hampshire SAM GRAVES, Missouri (Ex Officio)
PETER A. DeFAZIO, Oregon (Ex
Officio)

CONTENTS

Page

Summary of Subject Matter and U.S. Coast Guard Chart: ``Fire
Safety SPV IR--2020 CGAA Crosswalk''........................... v

STATEMENTS OF MEMBERS OF THE COMMITTEE

Hon. Salud O. Carbajal, a Representative in Congress from the
State of California, and Chair, Subcommittee on Coast Guard and
Maritime Transportation, opening statement..................... 1
Prepared statement........................................... 3
Hon. Bob Gibbs, a Representative in Congress from the State of
Ohio, and Ranking Member, Subcommittee on Coast Guard and
Maritime Transportation, opening statement \\.......... 4
Hon. Peter A. DeFazio, a Representative in Congress from the
State of Oregon, and Chair, Committee on Transportation and
Infrastructure, prepared statement............................. 45

WITNESSES

Rear Admiral John W. Mauger, Assistant Commandant for Prevention
Policy, U.S. Coast Guard, oral statement....................... 5
Prepared statement........................................... 7
Hon. Jennifer Homendy, Chair, National Transportation Safety
Board, oral statement.......................................... 9
Prepared statement........................................... 11

APPENDIX

Questions from Hon. Salud O. Carbajal to Rear Admiral John W.
Mauger, Assistant Commandant for Prevention Policy, U.S. Coast
Guard.......................................................... 47
Questions from Hon. Salud O. Carbajal to Hon. Jennifer Homendy,
Chair, National Transportation Safety Board.................... 55

----------
\\ Hon. Bob Gibbs did not submit a prepared statement.

[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

March 16, 2022

SUMMARY OF SUBJECT MATTER

TO: LMembers, Subcommittee on Coast Guard and Maritime
Transportation
FROM: LStaff, Subcommittee on Coast Guard and Maritime
Transportation
RE: LHearing on ``A Review of Coast Guard Efforts to
Improve Small Passenger Vessel Safety''
_______________________________________________________________________

PURPOSE

The Subcommittee on Coast Guard and Maritime Transportation
will meet on Monday, March 21, 2022, at 10:00 am PT at the City
of Santa Barbara Council Chambers and virtually via Zoom to
explore small passenger vessel safety in light of recent
maritime casualties and to examine the effectiveness and
implementation status of recent safety legislation. The
Subcommittee will hear from the United States Coast Guard
(Coast Guard) and the National Transportation Safety Board
(NTSB).

BACKGROUND

The passenger vessel industry contributes substantially to
the economy as millions of passengers embark on such vessels
each year.\1\ The safe carriage of passengers and operation of
these vessels is critical to the maritime sector. Passenger
vessels include ferries, dive boats, tour boats, overnight
boats, and dinner boats, among others, that operate on domestic
voyages and are typically classified by tonnage and number of
passengers carried. These factors determine which Coast Guard
regulations apply.\2\ Vessels classified under 100 gross tons
that carry 150 or fewer passengers or that have overnight
accommodations for 49 or fewer passengers are subject to the
safety regulations in subchapter T of Title 46 Code of Federal
Regulations (CFR).\3\ Subchapter T vessels are small passenger
vessels defined under section 2101(45) of title 46, United
States Code. Such vessels are required by law to be inspected
if they carry more than six passengers, at least one of whom is
a passenger for hire.\4\ Passenger vessels that do not require
inspection are uninspected passenger vessels (UPVs) as defined
in section 2101(51) of Title 46, United States Code. Such
vessels carry less than 6 passengers for hire, not including
the Master and paid crew. These are also referred to as ``six-
packs.'' SPV and UPVs are chartered vessels.
---------------------------------------------------------------------------
\1\ Bureau of Transportation Statistics. Maritime Trade and
Transportation by the Numbers. https://www.bts.gov/archive/
publications/by_the_numbers/maritime_trade_and_
transportation/index
\2\ 46 CFR Chapter I.
\3\ 46 CFR Subchapter T.
\4\ Coast Guard. COMDTPUB P16700.4 NIVC 7-94. Navigation and Vessel
Inspection Circular No. 7-94: Guidance on the Passenger Vessel Safety
Act of 1993. September 30, 1994. https://www.dco.uscg.mil/Portals/9/
DCO%20Documents/5p/5ps/NVIC/1994/NVIC%207-94%20Full%20Version.pdf.
---------------------------------------------------------------------------
The Coast Guard oversees the use of chartered vessels to
ensure compliance with the appropriate passenger vessel
regulations. Bareboat chartered vessels are passenger vessels
that are chartered or rented to a person to oversee all aspects
of the vessel's operation. In this case, the owner typically
does not provide the crew (i.e. a Master with an appropriate
license) but these vessels must be inspected by the Coast Guard
if carrying more than 12 passengers.\5\ Chartered vessels are
required to be inspected when the owner provides crew for the
vessel to the customer and when they carry more than 6
passengers.\6\ Since bareboat charters allow more passengers
before being required to undergo inspection, they tend to have
more requirements than other chartered vessels. To be
classified as a bareboat charter the following conditions must
be met: the owner shall not provide a master or crew; food,
fuel and stores must be provided by the charterer; port changes
and pilot fees paid by the charterer; and charterer has
complete command, control, and possession of the vessel.\7\
---------------------------------------------------------------------------
\5\ Id.
\6\ Id.
\7\ Id.
---------------------------------------------------------------------------
Larger passenger vessels are typically subject to safety
regulation under either subchapters K or H. Passenger vessels
classified under 100 gross tons with more than 150 passengers
and/or more than 49 overnight passengers fall under subchapter
K regulations.\8\ Passenger vessels over 100 gross tons fall
under subchapter H regulations.\9\ These regulations do not
apply to foreign flagged vessels, like cruise vessels, whose
country is a party to the Safety of Life At Sea (SOLAS)
convention. Oversight of passenger vessels in the United States
falls under the responsibility of the United States Coast Guard
with the assistance of other U.S. agencies.\10\ The Coast Guard
promulgates regulations and enforces them through regular
inspections.
---------------------------------------------------------------------------
\8\ 46 CFR Subchapter K.
\9\ 46 CFR Subchapter H.
\10\ Depending upon the vessel and requirement, this can include
the Environmental Protection Agency, and Customs and Border Protection.
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MARINE INSPECTIONS

The Coast Guard's marine inspection program is integral to
ensuring safety of passengers and crew onboard all vessels,
including small passenger vessels. For decades, the Coast Guard
has faced challenges maintaining an adequate staff of
experienced marine safety personnel. According to the Coast
Guard's staffing model, there was a shortage of over 400 marine
inspectors in 2021.\11\ In January 2022, the Government
Accountability Office (GAO) reported on steps taken by the
Coast Guard to address its marine inspection workforce needs
and found that the Coast Guard has developed action plans and
implemented initiatives addressing marine inspection workforce
gaps in four key areas--training and skills, technology,
workforce staffing levels, and workforce structure.\12\
However, GAO also found that some of these initiatives face
implementation challenges and the tools to assess staffing
levels and skills have limitations.\13\ As a result, GAO has
recommended ways to better predict--and meet--the Coast Guard's
marine inspector needs through the use of better data
collection, development of performance measures with targets,
and implementation and assessment of a workforce improvement
plan.\14\
---------------------------------------------------------------------------
\11\ GAO. Coast Guard: Enhancements Needed to Strengthen Marine
Inspection Workforce Planning Efforts. January 12, 2022. GAO-22-104465.
https://www.gao.gov/products/gao-22-104465.
\12\ Id.
\13\ Id.
\14\ Id.
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MV CONCEPTION

Early in the morning on September 2, 2019, an overnight
dive boat, the MV Conception, caught fire off the coast of
Santa Cruz Island, California, and sank, resulting in the
deaths of 33 passengers and one crew member.\15\ The Conception
was a small passenger vessel classified under subchapter T
requirements but at the time was exempt from certain subchapter
T requirements.
---------------------------------------------------------------------------
\15\ Gregory Wallace, Rene Marsh. CNN. NTSB preliminary report says
Conception dive boat did not have crewmember on roving overnight watch
as required. September 12, 2019. https://www.cnn.com/2019/09/12/
politics/ntsb-report-conception-dive-boat-overnight-watch/index.html
---------------------------------------------------------------------------
The regulations under this subchapter were significantly
updated in 1996, and vessels constructed after 1996 are
required to comply with all the current regulations. When
referring to the post-1996 regulations, Coast Guard inspectors
use the term ``New Subchapter T'' or, more simply, ``New T''
regulations, and when referring to the pre-1996 regulations,
they use the term ``Old Subchapter T'' or ``Old T.'' Exemptions
or ``grandfathering'' of certain passenger vessels from
subchapter T requirements under title 46 CFR has occurred
generally to allow older vessels to operate while gradually
applying new regulations prospectively to newly built vessels.
Passenger vessels with a keel laid date before March 10, 1996,
are inspected under the ``Old T'' requirements, not the ``new
T'' requirements published after 1994.\16\ Vessels constructed
before 1996 are required to comply with portions of the current
regulations, including those pertaining to inspections and
certification, vessel control and other systems and equipment,
and operations but exempt from other requirements of the
updated subchapter T requirements.\17\ For regulations relating
to construction and arrangement, lifesaving equipment, some
fire protection equipment, machinery installation, and
electrical installation, vessels that existed prior to 1996 are
subject to those portions of Subchapter T regulations that were
in force at the time the vessel was built, with certain
exceptions.\18\ As a vessel built in 1981, the Conception was
considered an existing vessel and therefore subject to portions
of both the pre- and post-1996 regulations. At the time of the
casualty, the Conception complied with Coast Guard requirements
and had passed its recent inspection.\19\
---------------------------------------------------------------------------
\16\ 46 CFR Subchapter T Sec. 175.118
\17\ Id.
\18\ Id.
\19\ Information obtained directly from the U.S. Coast Guard.
---------------------------------------------------------------------------
The NTSB report found that smoke alarms on the vessel only
sounded locally and were not interconnected throughout the
vessel. As a result, the crew above deck were not alerted.\20\
All 33 passengers and one crewmember died of smoke inhalation
after they were trapped in the berthing area while a fire raged
on the deck above.\21\ Both exits from the berthing area led to
the fire and smoke-filled enclosed area above.\22\ The NTSB
also found the absence of a required roving patrol on the
Conception likely delayed the initial detection of the fire,
allowed for its growth, and precluded firefighting and
evacuation efforts which directly led to the high number of
fatalities in the accident.\23\ As a result, the NTSB called on
the Coast Guard to develop and implement an inspection program
to verify that roving patrols are conducted--as required--for
the safety of sleeping passengers and crew.\24\ The Coast Guard
Marine Board Investigation's examination of the casualty is
still underway and has been delayed due to the ongoing criminal
investigation.\25\
---------------------------------------------------------------------------
\20\ National Transportation Safety Board. Fire Aboard Small
Passenger Vessel Conception. October 20, 2020. https://www.ntsb.gov/
investigations/Pages/DCA19MM047.aspx
\21\ Id.
\22\ Id.
\23\ Id.
\24\ Id.
\25\ Information obtained from the U.S. Coast Guard.
---------------------------------------------------------------------------
On January 1, 2021, Congress passed section 8441,
Regulations for covered small passenger vessels, of the Elijah
E. Cummings Coast Guard Authorization Act of 2020, P.L. 116-
283, which included new requirements for covered small
passenger vessels--vessels that have overnight accommodations
or cross the U.S. boundary line.\26\ These new requirements for
covered passenger vessels include interconnected fire detection
equipment and additional firefighting equipment, monitoring
equipment to ensure wakefulness of the night watch, improved
marine firefighting training programs, increased fire detection
and suppression systems in unmanned areas, no less than two
means of escape for all general areas available to passengers,
consideration of the handling of flammable items such as
rechargeable batteries, providing of egress plans and drills to
passengers onboard, and integration of these requirements into
safety management systems (SMS).\27\
---------------------------------------------------------------------------
\26\ William A. Thornberry National Defense Authorization Act of
2020, P.L. 116-283, https://www.congress.gov/116/plaws/publ283/PLAW-
116publ283.pdf
\27\ Id. at page 1356.
---------------------------------------------------------------------------
Marine SMSs are programs designed to identify hazards and
reduce risk to ensure safety at sea, prevent injury or loss of
life, and avoid damage to the environment and vessels. An SMS
ensures that proper procedures are in place aboard a vessel
during normal operations or in emergencies. Processes for
conducting regular maintenance on the vessel and its equipment
also are included. An SMS is also required to include an
internal audit process, conducted by the vessel owner, to
identify when the SMS is not followed and a system of
corrective actions to address deficiencies.\28\ Prior to
enactment of the Small Passenger Vessel Safety Act, SMSs were
not required for small passenger vessels. As a result of the
new law, the Coast Guard issued an advanced notice of proposed
rulemaking which would require SMSs for small passenger
vessels.\29\
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\28\ 86 FR 3899. https://www.federalregister.gov/documents/2021/01/
15/2021-01058/safety-management-systems-for-domestic-passenger-vessels.
\29\ Id.
---------------------------------------------------------------------------
In 2021, the NTSB released a ``Most Wanted List'' that
identified recommended safety improvements across all modes of
transportation. The ``Most Wanted List'' includes the below
recommendations for small passenger vessels:

``Fires pose a catastrophic threat to passenger vessels, as we
saw in the Conception dive boat accident off the coast of
California in which 34 people died. Our investigations have
revealed that crew training and safety regulations for these
vessels vary, increasing the risk to passengers and crew. To
prevent needless deaths and mitigate injuries, passenger
vessels should have safety management systems, use voyage data
recorders, and provide adequate fire-detection and
extinguishing systems and enhanced emergency egress options.
Operators need to ensure their crews have enhanced training
that includes fire drills and firefighting techniques. We also
need to see more roving patrols on our waterways to ensure
passengers are being transported safely.'' \30\
---------------------------------------------------------------------------
\30\ NTSB Most Wanted List: Improve Passenger and Fishing Vessel
Safety. https://www.ntsb.gov/Advocacy/mwl/Pages/mwl-21-22/mwl-ms-
01.aspx.

Many of these recommendations come as a result of prior
NTSB investigations including the Conception investigation and
closely align with the requirements under the Section 8441. On
December 27, 2021, the Coast Guard issued an interim rule on
the statutorily mandated requirements for fire safety on
covered small passenger vessels.\31\ The Coast Guard has
determined that the most appropriate way to meet the intent of
the statute was to ensure that ``covered small passenger
vessels'' were required to meet ``New T'' in the
rulemaking.\32\ This interim rule is currently open to public
comments until June 27, 2022.\33\
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\31\ 86 FR 73160 https://www.federalregister.gov/documents/2021/12/
27/2021-27549/fire-safety-of-small-passenger-vessels.
\32\ Id.
\33\ Id.
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AMPHIBIOUS DUKW-TYPE VESSELS

Amphibious DUKW-Type Vessels or ``duck'' boats are another
type of passenger vessel of which the NTSB has identified
safety recommendations as part of their ``Most Wanted List.''
On July 19, 2018, the Stretch Duck 7, a 33-foot-long, modified
World War II-era duck boat passenger vessel, sank during a
storm with heavy winds that moved rapidly on Table Rock Lake
near Branson, Missouri. Of the 31 people aboard, 17 died.\34\
The NTSB determined the continued operation of waterborne tours
after a severe thunderstorm warning was issued for Table Rock
Lake, exposed the vessel to a derecho, resulting in flooding
through a non-weathertight air intake hatch on the bow.
Contributing to the sinking was the failure to maintain
sufficient reserve buoyancy, an issue with all amphibious
vessels.\35\ Contributing to the loss of life was the lack of
emergency egress due to fixed canopies which impeded passenger
escape.\36\ The Coast Guard investigation into the casualty is
still underway and delayed due to the ongoing criminal case.
The Coast Guard is in the process of revising the Navigation
and Vessel Inspection Circular (NVIC) NO. 1-01 which provides
guidance for duck boat operators and was last updated in 2000.
In 2020, the Coast Guard released voluntary recommendations
that duck boat owners remove all canopies from the vessels.\37\
No new mandatory requirements or rules for duck boats have been
released by the Coast Guard since the NVIC 1-01 update in
2000.\38\
---------------------------------------------------------------------------
\34\ NTSB. Sinking of Amphibious Passenger Vessel Stretch Duck.
https://www.ntsb.gov/investigations/Pages/DCA18MM028.aspx.
\35\ Id.
\36\ Id.
\37\ Work Boat. MSIB: Recommendation for DUKW Passenger Vessel
Canopy Removal. April 20, 2020. https://www.workboat.com/passenger-
vessels/coast-guard-recommends-duck-boats-remove-canopies
\38\ Id.
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WITNESS LIST

LRear Admiral John W. Mauger, Assistant Commandant
for Prevention Policy, United States Coast Guard
LThe Honorable Jennifer Homendy, Chair, National
Transportation Safety Board

Attachment
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

Fire Safety SPV IR--2020 CGAA Crosswalk
------------------------------------------------------------------------
Implementation Timeline, Notes
& Regulatory Cites (Covered
Vessels--Subchapter T/K
2020 CGAA Section 8441(a)(n)(3)(A) vessels on oceans/coastwise
route, or overnight
accommodations, 1130 vessels)
------------------------------------------------------------------------
i. Marine firefighting training programs Within 90 days--03/28/2022
Adds required crew training in
the use and location of
firefighting equipment,
general firefighting
knowledge, and training
aspects. ``Monthly'' and
``new crew member'' training
requirements are added. (46
CFR 122.420(b) & 185.420(b)).
------------------------------------------------------------------------
ii. Interconnected fire detection 1 year--12/27/2022
equipment and additional firefighting Requires interconnected fire
equipment. detection systems in all
enclosed areas including
accommodation spaces &
machinery spaces. (46 CFR
118.400(d)) & 181.405(c)).
------------------------------------------------------------------------
iii. Monitoring devices to ensure Submit plan to OCMI within 90
wakefulness of night watch (overnight days--03/28/2022
accommodations). Requires a monitoring device
for the night watch that will
ensure the wakefulness of
crew, it must remain operable
during the nighttime watch,
and be arranged to ensure
proper coverage of onboard
spaces. (46 CFR 122.410(b) &
185.410(b)).
------------------------------------------------------------------------
iv. Increased fire detection and 1 year--12/27/2022
suppression systems. Required to be followed
regardless of keel laid date.
(46 CFR 118.500 & 181.500).
------------------------------------------------------------------------
v. No less than two independent avenues 2 years--12/27/2023
of escape for all general areas Amends the requirement for
accessible to passengers (overnight vessels with overnight
passenger accommodations). accommodations for passengers
to meet two means of escape
requirements, regardless of
keel laid date. Adds
requirements to ensure the
two means of escape are
unobstructed and the door,
hatch, or scuttle is not
located directly above, or
dependent, on a berth. (46
CFR 116.115(c), 116.500(o),
177.115(c), 46 CFR
177.500(n)).
------------------------------------------------------------------------
vi. Handling, storage, and operation of Within 90 days--03/28/2022
flammable items (lithium-ion batteries). Adds ``flammable items not
covered by the regulations of
this subchapter, such as
rechargeable batteries,
including lithium ion
batteries utilized for
commercial purposes, must be
handled, stored, and operated
in a way that mitigates the
risk of hazardous
conditions.'' (46 CFR 122.364
&185.364).
------------------------------------------------------------------------
vii. Requirements for passenger Within 90 days--03/38/2022
emergency egress drills (overnight Requires the master to conduct
accommodations). passenger emergency egress
drills prior to excursions;
defines an excursion as
anytime vessel gets underway
or passengers remain
overnight. Note:
recordkeeping portions
delayed pending review by
OMB. (46 CFR 122.507 &
185.507).
------------------------------------------------------------------------
viii. Provide all passengers a copy of Within 90 days--03/38/2022
emergency egress plan (overnight Requires passenger safety bill
accommodations). if the vessel has overnight
accommodations for
passengers, regardless of
size. Note: recordkeeping
portions delayed pending
review by OMB. (46 CFR
122.515 & 185.515).
------------------------------------------------------------------------
[Editor's note: This chart has been reformatted from its original
version to fit this document. References to the date ``03/38/2022''
are as they appear in the original chart.]

A REVIEW OF COAST GUARD EFFORTS TO IMPROVE SMALL PASSENGER VESSEL
SAFETY

----------

MONDAY, MARCH 21, 2022

House of Representatives,
Subcommittee on Coast Guard and
Maritime Transportation,
Committee on Transportation and Infrastructure,
Washington, DC.
The subcommittee met, pursuant to call, at 1:03 p.m., Santa
Barbara City Hall, Council Chambers, 735 Anacapa St., Santa
Barbara, California, and via Zoom, Hon. Salud O. Carbajal
(Chair of the subcommittee) presiding.
Members present in person: Mr. Carbajal and Mrs.
Napolitano.
Members present remotely: Mr. Larsen of Washington, Mr.
Lowenthal, Mr. Gibbs, and Mr. Weber of Texas.
Mr. Carbajal. Welcome, everyone. The subcommittee will come
to order.
I ask unanimous consent that the chair be authorized to
declare a recess at any time during today's hearing.
Without objection, so ordered.
I also ask unanimous consent that Members not on the
subcommittee be permitted to sit with the subcommittee at
today's hearing and ask questions.
Without objection, so ordered.
As a reminder, please keep your microphones muted unless
speaking. Should I hear any inadvertent background noise, I
will request that the Member please mute their microphone.
And to insert a document into the record, please have your
staff email it to DocumentsT&I@mail.house.gov.
Welcome, everyone. Good morning.
And welcome again to today's important hearing on small
passenger vessel safety.
Before we get started, I want to take a minute to
acknowledge the passing of my colleague, the Dean of the House
and a member of this subcommittee, Congressman Don Young. He
was a fierce advocate for the people of Alaska and over his 25
terms, that is 50 years, serving in Congress, was a former
chair of the Transportation and Infrastructure Committee--that
is the overall governing committee of the subcommittee that I
am a part of and that this hearing is for--and pushed for
investments in our Nation's infrastructure. My thoughts are
with his family.
Moving on to today's hearing, it is taking place in my
district, beautiful Santa Barbara, California. The location is
also unfortunately significant for another reason. Twenty-seven
miles south of here on September 2, 2019, 34 individuals
tragically lost their lives. On that date the dive boat
Conception caught fire while all the passengers were asleep.
Because there was no interconnected fire alarm system on the
vessel, the passengers and crew were not alerted to the fire as
smoke filled the lower levels. A roving night watch was
required by law to be awake. And if they were, they might have
been able to alert the passengers. Unfortunately, that did not
happen.
I share my deepest condolences to the victims' families,
some of whom have joined us here today. I cannot begin to
understand the sorrow these families have gone through. Going
forward, we must ensure that safety measures are adopted so
that no other family must endure this pain.
I hope Admiral Mauger and Chair Homendy can take the time
to visit with the families who are in attendance today to hear
their thoughts and worries, and also so that progress to make
our waters safer can be made together.
At this moment, I would like to ask for a moment of silence
in honor of each of the 34 individuals who lost their lives.
[A moment of silence is observed.]
Mr. Carbajal. Today, I hope to hear how the Coast Guard has
taken steps to address National Transportation Safety Board
recommendations and implement regulations required in my bill,
the Small Passenger Vessel Safety Act, which passed into law at
the end of the 116th Congress as part of the Elijah E. Cummings
Coast Guard Authorization Act of 2020.
We need to know that the Coast Guard-inspected vessels will
be as safe as possible for passengers, as well as crewmembers.
At the time of the tragedy, the Conception was exempt from
certain requirements that apply to newer vessels and was in
compliance with those that did apply. Updated laws and
regulations must be immediately implemented when deficiencies
are identified.
It is the responsibility of Congress to prioritize the
lives and public safety of crews and passengers. This hearing
is needed to evaluate the oversight of small passenger vessels
and identify what is working and what needs improvement.
The United States has a history of taking a reactionary
approach to safety, creating maritime safety laws after
tragedies, rather than preemptively strengthening safety
requirements for a more robust industry, one that is
effectively regulated and inspected.
I share the NTSB's concerns that recent accidents on small
passenger vessels demonstrate that poor preventative
maintenance, lax fire prevention, and inadequate crew training
all continue to be contributing factors leading to disasters.
The Board also highlights the importance of safety management
systems on all types of vessels to prepare crews for emergency
scenarios. These important recommendations were policies that I
included in my Small Passenger Vessel Safety Act, and recently
the Coast Guard released new interim rules for overnight
passenger vessels.
These are important steps towards full implementation of
improved safety standards, but I share concerns in the Coast
Guard's response. It took nearly 1 year for the interim rules
to be released after passage of the act, even though the
National Transportation Safety Board provided these
recommendations years before the Conception's tragedy.
It took congressional action to force the Coast Guard's
hand. This is of great concern to me. I expect the final rule
to come out promptly and to address every requirement in my
legislation, including requirements to document and monitor the
training certifications of all crewmembers.
Going forward, there is more work to be done, not just by
the Coast Guard and NTSB, but by Congress as well.
Included in the upcoming House Coast Guard Reauthorization
Act is my other legislation, the Small Passenger Vessel
Liability Fairness Act, which will update antiquated liability
laws so that the victims and their families receive just
compensation in the wake of such tragedies. No amount of
compensation can bring back a loved one or make the pain go
away, but it is necessary to hold the responsible parties
accountable.
We have also included a requirement that the Coast Guard
respond to all NTSB recommendations, which I hope will help
improve the working relationship and make the Coast Guard act
quicker.
Oversight of safety measures is vital to protecting lives
and property. It is incumbent on the industry in conjunction
with the Coast Guard to provide a safe, reliable experience for
passengers. It is also the job of this committee to conduct
proper oversight so that everyone who steps onto a vessel
reaches the end of their voyage safely.
[Mr. Carbajal's prepared statement follows:]

Prepared Statement of Hon. Salud O. Carbajal, a Representative in
Congress from the State of California, and Chair, Subcommittee on Coast
Guard and Maritime Transportation
Good morning, and welcome to today's important hearing on small
passenger vessel safety. This hearing is taking place in my district,
beautiful Santa Barbara, California. But the location is unfortunately
significant for another reason. Twenty-seven miles south of here, on
September 2, 2019, 34 individuals tragically lost their lives. On that
date, the dive boat Conception caught fire while all the passengers
were asleep. Because there was not an interconnected fire alarm system
on the vessel, the passengers and crew were not alerted to the fire as
smoke filled the lower levels. A roving night watch was required by law
to be awake and if they were, they might have been able to alert the
passengers. Unfortunately, that did not happen.
I share my deepest condolences to the victims' families, some of
whom have joined us here today. I cannot begin to understand the sorrow
these families have gone through. Going forward, we must ensure that
safety measures are adopted so that no other family must endure this
pain. I hope Admiral Mauger and Chair Homendy take the time to visit
with the families who are in attendance today, to hear their thoughts
and worries, so that progress to make our waters safer can be made
together.
Today I hope to hear how the Coast Guard has taken steps to address
National Transportation Safety Board recommendations and implement
regulations required in my bill, the Small Passenger Vessel Safety Act,
which passed into law at the end of the 116th Congress as part of the
Elijah E. Cummings Coast Guard Authorization Act of 2020.
We need to know that Coast Guard-inspected vessels will be as safe
as possible for passengers as well as crew members. At the time of the
tragedy, the Conception was exempt from certain requirements that apply
to newer vessels and was in compliance with those that did apply.
Updated laws and regulations must be immediately implemented when
deficiencies are identified.
It is the responsibility of Congress to prioritize the lives and
safety of crew and passengers. This hearing is needed to evaluate the
oversight of small passenger vessels, and identify what is working, and
what needs improvement.
The United States has a history of taking a reactionary approach to
safety; creating maritime safety laws after tragedy rather than
preemptively strengthening safety requirements for a more robust
industry, one that is effectively regulated and inspected.
I share the National Transportation Safety Board's concerns: recent
accidents on small passenger vessels demonstrate that poor preventative
maintenance, lax fire prevention and inadequate crew training all
continue to be contributing factors leading to disaster. The Board also
highlights the importance of Safety Management Systems on all types of
vessels to prepare crews for emergency scenarios. These important
recommendations were policies that I included in my Small Passenger
Vessel Safety Act, and recently the Coast Guard released new interim
rules for overnight passenger vessels. These are important steps toward
full implementation of improved safety standards. But I share concerns
in the Coast Guard response. It took nearly a year for the interim
rules to be released after passage of the Act even though the National
Transportation Safety Board provided these recommendations years before
the Conception tragedy. It took congressional action to force the Coast
Guard's hand. This is of great concern to me. I expect the final rule
to come out promptly, and to address every requirement in my
legislation, including a requirement to document and monitor the
training certifications of all crew members.
Going forward, there's more work to be done. Not just by the Coast
Guard and NTSB, but by Congress as well. Included in the House Coast
Guard Authorization Act is my legislation, the Small Passenger Vessel
Liability Fairness Act, which will update antiquated liability laws so
that victims and their families receive just compensation in the wake
of tragedy. No amount of compensation can bring back a loved one or
make the pain go away, but it is necessary to hold the responsible
parties accountable. We've also included a requirement that the Coast
Guard respond to all NTSB recommendations which I hope will help
improve the working relationship and make Coast Guard act quicker.
Oversight of safety measures is vital to protecting lives and
property. It is incumbent on the industry, in conjunction with the
Coast Guard, to provide a safe and reliable experience for passengers.
It is the job of this committee to conduct proper oversight so that
everyone who steps on a vessel reaches the end of their voyage safely.

Mr. Carbajal. I now call on the ranking member of the
subcommittee, Mr. Gibbs, for an opening statement.
Mr. Gibbs. Thank you, Chairman Carbajal, and thank you for
holding this important hearing today.
Like you, I wish to express my condolences to Chairman Don
Young's family, his passing Friday. Don was a very good friend.
He was an icon on this committee. He was chairman of this
committee years ago and also chairman of the Natural Resources
Committee and the Dean of the House, the longest serving
Member. So, we are really going to miss Don Young and all his
humor and also his knowledge, historical knowledge. It is going
to be greatly missed. So, my sympathies to his family and his
wife.
I know that small passenger vessel safety is particularly
important to you, given the tragic dive boat fire that occurred
in your district in 2019. You responded quickly after the fire.
And as a result of your efforts, Congress enacted section 8441
of the Elijah E. Cummings Coast Guard Authorization Act of
2020, regulations for covered small passenger vessels. I look
forward to hearing today about the Coast Guard's plans to
implement section 8441.
Today's hearing will also look at the regulation of vessels
popularly known as duck boats. These vessels have been involved
in several significant marine casualties including the 2018
accident in the Table Rock Lake in Missouri. I am pleased that
H.R. 6865, the Coast Guard Authorization Act of 2022, includes
a provision to strengthen the regulation of these vessels.
Chairman DeFazio sponsored H.R. 6865. Chairman Carbajal and I
and the full committee ranking member, Sam Graves, are original
cosponsors.
The provision related to the duck boats is based on
legislation introduced by Congressman Carson and Senator
Hawley. Both are from Missouri. I commend them for their
important work on this issue.
As for small passenger vessels without overnight
accommodations, I look forward to hearing what actions the
Coast Guard is planning to improve duck boat safety.
Mr. Chairman, I am sorry that my schedule didn't allow me
to join you today in your district. But I am glad that you are
holding this hearing. I look forward to the witnesses'
testimony.
And I yield back the balance of my time.
[Mr. Gibbs did not submit a prepared statement.]
Mr. Carbajal. Thank you, Mr. Gibbs.
And thank you for joining us virtually, nonetheless. You
are missing out on visiting paradise, but we will discuss that
later.
With that, let's move on to our witnesses.
I would like to welcome all our witnesses. Today we have
Rear Admiral John Mauger, Assistant Commandant for Prevention
Policy for the United States Coast Guard, and the Honorable
Jennifer Homendy, Chair of the National Transportation Safety
Board.
Thank you both for being here today, and I look forward to
your testimony.
Without objection, our witnesses' full statements will be
included in the record. Since your written testimony has been
made part of the record, the subcommittee requests that you
limit your oral testimony to 5 minutes.
With that, Admiral Mauger, you may proceed.

TESTIMONY OF REAR ADMIRAL JOHN W. MAUGER, ASSISTANT COMMANDANT
FOR PREVENTION POLICY, U.S. COAST GUARD; AND HON. JENNIFER
HOMENDY, CHAIR, NATIONAL TRANSPORTATION SAFETY BOARD

Admiral Mauger. Good morning, Chairman Carbajal, Ranking
Member Gibbs, and distinguished members of the subcommittee.
Thank you for the opportunity to discuss passenger vessel
safety and the Coast Guard's role in advancing a safe and
secure U.S. maritime industry.
On behalf of the Coast Guard, I express our deepest
sympathies to the families and loved ones of those who perished
in the tragedies on board the dive boat Conception and the
amphibious passenger vessel Stretch Duck 7. I see many family
members of those who have lost loved ones on board Conception
here today and recognize the work that Advocacy 34 has done to
honor their lives and prevent future tragedies.
Passenger vessel safety is personal. The fleet of U.S.
small passenger vessels carry our families and friends to work
and school and provide once-in-a-lifetime adventures.
The victims of these two casualties and their families are
at the forefront of our minds here in the Coast Guard as we
work to strengthen safety standards, enhance oversight, and
ensure compliance so that loved ones are transported safely on
small passenger vessels.
The Coast Guard's approach to small passenger vessel safety
is guided by our prevention concept of operations which
includes standards, compliance, and assessment.
The Coast Guard sets standards for the safe, secure, and
sustainable operation of vessels, facilities, mariners, and the
waterways. In the field, Coast Guard personnel verify
compliance with those standards through plan review,
inspection, and document verification. When accidents occur,
Coast Guard marine casualty investigators conduct thorough
investigations to learn from these casualties and improve our
standards and compliance activities.
In addition to conducting our own assessments, the Coast
Guard looks to other leading safety organizations including the
National Transportation Safety Board for insights and
continuous improvement. The Coast Guard works closely with NTSB
and values our strong relationship and the expertise and safety
recommendations that NTSB provides.
With tremendous support from Congress and the Elijah E.
Cummings Coast Guard Authorization Act of 2020, the Coast Guard
accelerated the development and publication of significant new
safety regulations which address all of the contributing
factors to the loss of life on board Conception.
On March 28, just 1 week from today, the interim rule for
fire protection on small passenger vessels will implement key
safety provisions to address new requirements in the law. This
rule substantially increases the safety of small passenger
vessels by requiring increased fire detection, increased fire
suppression, improved means of escape, safer handling of
flammable items, additional crew training, and monitoring of
night watches on board vessels.
These changes, together with pending safety management
system requirements, address all of the National Transportation
Safety Board recommendations stemming from the fire on board
Conception.
These new requirements also reinforce that vessel safety is
a shared responsibility between the owner-operator, the captain
and crew, and the Coast Guard.
The owner-operator sets the overall safety culture for the
company and provides the captain and crew with resources to
maintain, train, and equip the safe operation of their vessel.
The captain and crew require training and credentials to
perform their duties and are ultimately responsible for the
safe operation of their vessels.
The Coast Guard sets the standard, enforces compliance with
those standards, and drives continuous improvement through
assessments.
In the immediate aftermath of the Conception fire, the
Coast Guard implemented a new tiered approach to allocate our
most experienced inspectors to the highest priority small
passenger vessel safety inspection. The Coast Guard gathered
data from previous inspections, investigations, and subject
matter expertise and employed machine learning to gain new
insights and prioritize the risks.
Under this policy, every small passenger vessel is
inspected annually, and the highest priority vessels are
inspected more frequently by our most experienced inspectors.
This change to our compliance policy has successfully
identified and corrected deficiencies, thereby preventing
serious consequences.
Mr. Chairman, with the strong support of Congress in fiscal
year 2020 through 2022, the Coast Guard is increasing the
readiness of our marine inspection workforce. One hundred
twenty-six new marine safety boats were added to the Coast
Guard over the past 3 years. Eighty-seven of those are in the
field. With funding provided through the CARES Act and
subsequent fiscal year appropriations, the Service is
transforming our mobile solutions to make our inspectors and
investigators more capable.
To better train the workforce, the Coast Guard is employing
ready learning technology as part of the Marine Inspector
Performance Support Architecture to ensure that marine
inspectors have the knowledge and skills that are required to
keep pace in this dynamically changing maritime industry.
Mr. Chairman, passenger vessel safety is a Service priority
and it is personal to each of us. Again, thank you, Mr.
Chairman, for your oversight and for your support of the Coast
Guard.
I look forward to your questions.
[Admiral Mauger's prepared statement follows:]

Prepared Statement of Rear Admiral John W. Mauger,
Assistant Commandant for Prevention Policy, U.S. Coast Guard
Introduction
Good morning Chairman Carbajal, Ranking Member Gibbs, and
distinguished members of the Subcommittee. Thank you for the
opportunity to be here today to discuss the state of passenger vessel
safety and the Coast Guard's role in regulating a safe, secure, and
environmentally responsible U.S. maritime industry.
I would like to begin by expressing the Service's sincere
condolences to the family and friends of the victims and all those
affected by the tragic loss of the dive boat CONCEPTION and the
amphibious passenger vessel STRETCH DUCK 7. The Coast Guard continues
to keep these unfortunate events in the forefront of our minds as we
take specific actions to address contributing factors to these
casualties and improve Coast Guard readiness to execute our Marine
Safety mission.
In my role as the Coast Guard's Assistant Commandant for Prevention
Policy, I am responsible for setting standards for safety, security,
and environmental stewardship for commercial vessels, facilities, and
mariners; establishing programs to ensure compliance; and ensuring
investigations are properly conducted when casualties occur. Today I
will discuss the Coast Guard's role in regulating small passenger
vessels and the critical safety enhancements we have made as we
exercise our authorities to protect the public.
Small Passenger Vessels are vital to the Nation's Marine Transportation
System
The transportation of cargo on water by the global maritime
industry is the most economical, and efficient mode of transport. An
estimated 90 percent of U.S. imports and exports move by ship through
361 commercial ports, along 95,000 miles of shoreline and 25,000 miles
of navigable river and coastal waterways. The Marine Transportation
System, or ``MTS,'' supports $5.4 trillion in annual economic activity
and more than 30.8 million jobs. A key component of our MTS is the
active U.S. commercial fleet, comprised of over 19,000 cargo, towing,
offshore supply, research, nautical school, barges, and passenger
vessels.
Small passenger vessels account for one-third of the U.S.
commercial fleet and are essential to the MTS. Communities all across
the nation depend on small passenger vessels to ferry employees to
work, children to school, and support local economies. Small passenger
vessels are also a source of enjoyment for millions of people each year
and provide the opportunity to experience and appreciate the marine
environment. The owners and operators of these vessels provide
essential services to the American people. Protecting the lives of
passengers and crew aboard these vessels is among the Coast Guard's
most vital missions.
The U.S. fleet of small passenger vessels also possesses the
greatest diversity of vessel type, design, construction, age, and
operation. In Camden, Maine, a two-masted schooner built in 1871 meets
applicable requirements and holds a Coast Guard Certificate of
Inspection. In Louisville, Kentucky a passenger vessel built in 1914 is
propelled by steam. Meanwhile, in San Francisco, the Coast Guard is
working with the maritime industry to inspect and certificate the first
hydrogen fuel cell ferry--a promising technology to eliminate maritime
pollution. The common regulations applicable to all small passenger
vessels set a baseline standard for safe design, construction, and
operation.
Passenger Vessel Safety: The Prevention Concept of Operations
As the lead federal maritime regulator, the Coast Guard ensures the
safety, security and sustainability of the MTS through the execution of
the Prevention Concept of Operations: Standards, Compliance, and
Assessment. These three lines of effort guide all of our prevention
activities, including passenger vessel safety. Our work begins by
establishing clear expectations for the MTS. Regulations and standards
provide minimum requirements for safety, security and sustainability
and establish governance. The standards drive compliance activities,
which systematically verify that the governance regime is working.
Compliance inspections are critical to ensuring that the minimum
standards are met, while also identifying and correcting potential
issues before they can cause harm to passengers or mariners. Our
assessment program includes both proactive and reactive activities to
audit our work and investigate the root cause of casualties.
Assessments provide feedback and drive continuous improvement to both
compliance standards and compliance activities. Additionally, we also
use external input from the National Transportation Safety Board
(NTSB), Government Accountability Office and Congress to inform those
efforts.
Passenger vessel safety is a shared responsibility which relies on
vessel owners and trained operators executing their operations in
accordance with Coast Guard regulations. A vessel's master and crew are
on the front lines of passenger vessel safety and are expected to
comprehend the standards, recognize problems, take early corrective
actions, and provide feedback to improve the system. The Coast Guard
licensed master on every small passenger vessel is responsible for
ensuring the vessel's condition and operation complies with Coast Guard
regulations, which includes the training of unlicensed crewmembers.
Additionally, the vessel's owner has an obligation to support the
master in carrying out their responsibility to maintain and operate the
vessel safely. Through annual inspections and routine engagement, such
as unit industry days and regional and national association events, the
Coast Guard actively promotes passenger vessel safety, communicates
lessons learned and solicits feedback from the industry.
When the existing safety framework fails to mitigate a casualty,
the Coast Guard investigates the cause and assesses the need for new
regulations or policy to prevent future occurrences. A vital component
of this feedback loop is our collaboration with the NTSB. The Coast
Guard and NTSB work side-by-side to investigate the most serious marine
casualties. I appreciate the expertise, skill, and professionalism of
the NTSB, and value the candor of their recommendations and perspective
on ways to improve vessel safety.
Small Passenger Vessel Safety Improvements following CONCEPTION fire
In the aftermath of the dive boat CONCEPTION fire, the Coast Guard
continues to utilize preliminary findings from the ongoing Coast Guard
Marine Board of Investigation and the recommendations from NTSB's
investigation to improve small passenger vessel safety. Immediately
following the incident, my predecessor chartered a Small Passenger
Vessel Safety Task Force to establish and implement key program
enhancements. In addition to coordinating a special concentrated
inspection on every overnight passenger vessel in the U.S. fleet, the
Task Force leveraged ten years of vessel data, Subject Matter Expert
feedback, and machine-based learning to assist our field commanders in
determining which vessel inspections should be conducted by their most
experienced Marine Inspectors. This initiative, still active today,
resulted in the identification and correction of more than 1,000 safety
deficiencies. As we improve our IT systems, we will continue to
leverage technology to improve data management and analysis to inform
resource allocation.
We also appreciate the extensive Congressional support to
expeditiously improve small passenger vessel safety. Last December, we
issued an interim final rule to implement the requirements of the
Elijah E. Cummings Coast Guard Authorization Act of 2020. Leveraging
the authorities granted by Congress to exempt this regulation from
specific provisions of the Administrative Procedures Act, the rule
takes immediate actions to address critical safety gaps that the NTSB
cited in their report of investigation as contributing factors to the
fire and loss of life on CONCEPTION. The Act also adds additional
safety requirements for small passenger vessels with overnight
accommodations for passengers or operating on Oceans or Coastwise
routes, excluding fishing vessels and ferries. Those requirements
include passenger drills, additional crew training, improved fire
detection and means of escape, and handling of flammable items. The
Service will ensure these changes are fully implemented, continue to
evaluate their impact and, if necessary, make additional changes in the
eventual Final Rule to achieve the desired results.
Prevention Readiness Initiative
The complexity and size of the MTS continues to grow as our nation
seeks to increase capacity, while limiting environmental impact. Those
drivers: more capacity, reduced environmental impact, and increased
complexity are re-shaping the industry and placing greater demands on
Coast Guard readiness.
With Congressional oversight through the Marine Safety Performance
Plan and specific legislation, including the Hamm Alert Maritime Safety
Act of 2018, the Service has embarked on transforming the training and
continued development of our Prevention workforce. Our comprehensive
training and competency effort, known as the Marine Inspector
Performance Support Architecture (MIPSA), aligns Marine Inspector
workforce and performance requirements, bolsters individual training
factors, and builds a sustainable and highly proficient marine
inspection workforce. The Fiscal Year 2022 President's Budget builds on
those efforts by adding 32 billets positioned at Sectors, Training
Centers, and Force Readiness Command to ensure that our marine
inspection workforce will continue to receive needed training as the
industry evolves.
In December 2020, the Coast Guard implemented the Prevention
Program Readiness Initiative (PRI) to address challenges associated
with changes in the maritime industry, and developed a detailed action
plan to improve readiness over the next five years. The action plan,
which focuses on improving proficiency, governance and technology while
continuing to engage partners and execute a risk based approach to
safety, security and sustainability, incorporates the external drivers
along with internal and external stakeholder feedback, Congressional
intent and oversight, and recommendations from Government
Accountability Office reports. We also continue to refine training
under MIPSA and leverage new technologies to augment or replace aging
data systems.
With your ongoing support, the Coast Guard will continue to
transform the way the Service supports our enduring Prevention Concept
of Operations through a technology and innovation forward approach.
This will require continued investment to revitalize our Prevention
workforce, effectively manage risk, improve knowledge management, and
strengthen partnerships while continuously advancing our goals for a
safe, secure, and environmentally responsible U.S. maritime industry.
Conclusion
I appreciate the opportunity to testify before you today regarding
small passenger vessel safety. This topic has the Service's utmost
attention, and we will continue to make enhancements to our Prevention
program to protect those on the water, keep pace with the maritime
industry, and respond to new passenger vessel operations. I am
confident in our ability to remain ``Always Ready'' to serve and
protect the American people and our vital national interests in the
MTS.

Mr. Carbajal. Thank you, Admiral Mauger.
Next, we will proceed to Chair Homendy. You may proceed.
Ms. Homendy. Thank you, Chairman Carbajal, Ranking Member
Gibbs, and members of the subcommittee. It is an honor to
appear here today.
Admiral Mauger, thank you for your commitment to safety.
And on behalf of the NTSB, we greatly appreciate the Coast
Guard's collaboration with us in our investigations which we
carry out with mutual respect and the goal of improving safety
on our Nation's waterways.
I would also like to take a moment to once again offer my
sincerest condolences to those who have lost loved ones in the
tragedies that we will discuss today. I especially want to
acknowledge the families of those who perished on the
Conception, many of whom are here in this room or watching
remotely today. I can't imagine all that you have been through
since September 2019. I greatly admire your strength, your
courage, and your commitment to ensuring no one else loses a
loved one in another tragedy on our waterways.
The Conception investigation was my first marine
investigation as a Board Member. The experience deepened my
commitment to improve marine safety. In my first meeting with
the victims' families, I gave them the only promise we at the
NTSB have to give: that we would investigate and issue safety
recommendations aimed at preventing similar suffering for other
families. And then we would vigorously work, I would vigorously
work to ensure those safety recommendations are implemented.
I want to thank you, Chairman Carbajal, your colleagues in
the California delegation, and the members and staff of this
subcommittee for your efforts to enact legislation that address
our recommendations to improve marine safety, many of which
stem from the Conception investigation.
Unfortunately, the Conception isn't the only deadly
passenger vessel tragedy in recent history. Since 1999, we have
investigated three accidents involving passenger ferries in New
York, a deadly fire on the small passenger vessel Island Lady
in Florida, and duck boat accidents in Arkansas, Pennsylvania,
and Missouri.
Including the Conception, a total of 86 people died in
these tragedies, 86 lives lost unnecessarily, 86 people who
have left behind bereaved families and friends. That is a lot
of lives impacted.
Following these investigations, we issued multiple
recommendations to the U.S. Coast Guard and the maritime
industry aimed at closing known safety gaps. And we included
passenger vessel safety on our Most Wanted List of
transportation safety improvements. There are currently 19 open
NTSB recommendations regarding small passenger vessels.
One of those recommendations would require operators to
implement a preventative maintenance program. We issued it 20
years ago. Another would require operators to implement a
safety management system, which we also issued 20 years ago. We
reiterated that in 2012, again in 2018, and again in 2020,
following numerous tragedies. We are pleased the Coast Guard
has issued a rulemaking to move SMS forward.
For two decades, we have also recommended that the Coast
Guard address significant safety issues with duck boats. Had
those recommendations been acted upon following the sinking of
Miss Majestic in 1999, the tragedy in Branson and the 17 lives
lost likely would not have occurred.
Thank you for including provisions to address this in the
Coast Guard authorization bill that the House is considering,
and thank you to the Coast Guard for moving forward with our
recommendations on fire safety and emergency egress in an
interim final rule.
But it shouldn't take an act of Congress to address known
safety issues with duck boats or any other vessel.
A few weeks ago, I spoke before the passenger vessel
association. I was asked what keeps me up at night. It is the
next mother, father, sister, brother, son, or daughter who
loses their life in a tragedy we investigate. It is knowing
that we have previously investigated a similar tragedy. And it
is knowing that it was preventable, had our recommendations
been implemented.
I want to close by thanking those who dedicate their lives
and livelihoods to improving marine safety and who inspire me
every day to do all I can to support them and their efforts,
our Office of Marine Safety. With me today is the director of
the office, Morgan Turrell, and Adam Tucker, who is the
investigator in charge of the Conception investigation.
Thank you, Chairman Carbajal, thank you Ranking Member
Gibbs, and thank you to the subcommittee members for your
continued support of the NTSB and your continued work to
improve marine safety, as well as safety in other modes of
transportation.
[Ms. Homendy's prepared statement follows:]

Prepared Statement of Hon. Jennifer Homendy, Chair,
National Transportation Safety Board
Good morning, Chairman Carbajal, Ranking Member Gibbs, and members
of the subcommittee. Thank you for inviting the National Transportation
Safety Board (NTSB) to testify, discuss our marine accident
investigations and the lessons we have learned from those
investigations, and reiterate how critical it is for our federal agency
partners, our partners in industry, and for the Congress to heed those
lessons learned and take action to help avoid future accidents.
As you know, the NTSB is an independent federal agency charged by
Congress with investigating every civil aviation accident in the United
States and significant events in other modes of transportation--
highway, rail, marine, pipeline, and commercial space. We determine the
probable cause of the events we investigate, and issue safety
recommendations aimed at preventing future occurrences. In addition, we
conduct special transportation safety studies and special
investigations, and coordinate the resources of the federal government
and other organizations to assist victims and their family members who
have been impacted by major transportation disasters. We also serve as
the appellate authority for enforcement actions involving aviation and
mariner certificates issued by the Federal Aviation Administration
(FAA) and the United States Coast Guard, and we also adjudicate appeals
of civil penalty actions taken by the FAA.
The NTSB does not have authority to promulgate operating standards,
nor do we certificate organizations, individuals, or equipment.
Instead, we advance safety through our safety recommendations. Those
recommendations are issued to any entity that can improve safety,
including the United States Coast Guard (USCG).\1\ Our goal is to
identify issues and advocate for safety improvements that, if
implemented, would prevent tragedies and injuries, and save lives.
---------------------------------------------------------------------------
\1\ There are currently 93 open safety recommendations to the USCG,
32 of them with the status ``Open--Unacceptable Response.'' Of the 93
recommendations, 24 are associated with our Most Wanted List of
Transportation Safety Improvements item, ``Improve Passenger and
Fishing Vessel Safety,'' and 8 of those are currently classified
``Open--Unacceptable Response.'' These recommendations are included in
the appendix to this testimony.
---------------------------------------------------------------------------
Marine Safety and Reauthorization
Before we get too far, I do want to thank the Coast Guard for
collaborating with us to investigate marine casualties and improve
marine safety. We conduct our marine safety investigations concurrent
with the USCG's, and we often reach the same conclusions; on the
occasions when we reach different conclusions, we regularly make
recommendations to address identified issues in the USCG's regulations
and processes. Either way, we approach these investigations with mutual
respect and with the goal of improving safety on our nation's
waterways.
We have a broad mandate when it comes to marine safety. The NTSB
investigates ``major marine casualties,'' \2\ which can be anywhere in
the world if a US-flagged vessel is involved. Our work touches vessels
owned by the US government as well as private vessels. We also
investigate select catastrophic marine casualties involving foreign-
flagged vessels in international waters, especially if US citizens are
on board.
---------------------------------------------------------------------------
\2\ Defined in 49 Code of Federal Regulations 850.5 as a ``casualty
involving a vessel, other than a public vessel, that results in (1) The
loss of six or more lives; (2) The loss of a mechanically propelled
vessel of 100 or more gross tons; (3) Property damage initially
estimated as $500,000 or more; or (4) Serious threat, as determined by
the Commandant and concurred in by the Chairman, to life, property, or
the environment by hazardous materials.''
---------------------------------------------------------------------------
Our current authorization expires at the end of this fiscal year.
We have transmitted to Congress a reauthorization proposal to provide
more resources and flexibilities which will allow us to hire, invest in
our workforce in terms of training and development, and purchase
equipment. Even as we have seen tremendous growth and change in
transportation over the last two decades, the agency is the same size
as it was in 1998. In just the last ten years, the NTSB's Office of
Marine Safety has dramatically increased its number of investigations.
Before 2012, the office investigated and developed six reports annually
on average. Subsequently, the office has been investigating all major
marine casualties. Now, the caseload is over 40 per year, and at times
over 50, while the cases have also grown more complex. However, our
marine investigative staff has not grown with that increase, and we
currently have 11 marine investigators. It is critical to have
additional resources to respond to casualties without impacting
timeliness, quality, and our independence. Our reauthorization proposal
to Congress included a request for resources and hiring flexibilities
to increase the number of investigators in our Office of Marine Safety,
as well as in our other modes. These resources will allow us to hire
professionals with the needed skills, purchase the equipment necessary
for those skilled professionals to do their jobs, and invest in staff
training and development. Our workforce is our greatest asset and is
essential to our mission.
The Conception: Lessons Learned
I want to thank you, Chairman Carbajal, your colleagues in the
California delegation, and the members of this committee for your
commitment to marine safety and for enacting small passenger vessel
safety provisions as part of the Elijah E. Cummings Coast Guard
Authorization Act of 2020.\3\ This legislation addressed 11 NTSB
recommendations to improve small passenger vessel safety. Of those, 7
were made to the USCG as a result of our investigation of the September
2, 2019, fire and resulting sinking of the Conception here, near Santa
Cruz Island, California. The Conception was a 75-foot commercial diving
vessel on its last night of a 3-day diving trip with 39 people on
board. The vessel caught fire while anchored in Platts Harbor, and 33
passengers and one crewmember died, making this the largest loss of
life in a US marine casualty in decades and the greatest maritime loss
of life in California in more than 150 years.
---------------------------------------------------------------------------
\3\ Enacted as part of the National Defense Authorization Act for
Fiscal Year 2021 (PL116-283, Division G, sec. 8441).
---------------------------------------------------------------------------
We determined the probable cause of the accident was the failure of
the operator, Truth Aquatics, Incorporated, to provide effective
oversight of its vessel and crewmember operations. The lack of both
oversight and adherence to certain safety requirements allowed a fire
of unknown cause to grow, undetected. In addition, the lack of a USCG
regulatory requirement for smoke detection in all accommodation spaces
and inadequate emergency escape arrangements from the vessel's bunkroom
contributed to the undetected growth of the fire and the high loss of
life.
The Conception investigation was my first maritime investigation as
an NTSB Board member, and the experience deepened my commitment to
improving marine safety. During my time on scene, I met with the
families of those on board the vessel and gave them the only promise we
at the NTSB have to give: that we would find out what caused the fire
aboard the Conception, to prevent similar suffering for other families.
Today, I will share some of the lessons learned from our
investigation of the Conception accident and the roughly 50 marine
accidents that we typically investigate annually. In particular, I will
focus on the importance of safety management systems (SMSs); fire
safety aboard small passenger vessels; safety issues unique to
amphibious vessels, known as DUKW boats; and adequate options for
emergency escapes in all cases. Additionally, although beyond the scope
of this hearing, we have made equally important recommendations to the
USCG to improve fishing vessel safety. These recommendations, which are
included in the appendix, remain open because the USCG has taken
unsatisfactory or no action to address them.
The NTSB has made multiple recommendations to the USCG and the
maritime industry that must be implemented to close known safety gaps
and to avoid another tragedy like the Conception. These recommendations
specifically address:
inadequate company oversight;
voyage data recorders;
insufficient regulations for means of emergency egress;
lack of regulations requiring fire and smoke detection in
machinery and all accommodation spaces of small passenger vessels;
neglected nighttime roving patrols;
insufficient reserve buoyancy; and
insufficient watertight integrity of vessels.
Safety Management Systems
For two decades, the NTSB has advocated for all passenger vessel
operators to implement an SMS: a comprehensive, documented system to
enhance safety. This call to action was first on our Most Wanted List
of Transportation Safety Improvements over 10 years ago, and is again
on our current list under ``Improve Passenger and Fishing Vessel
Safety.'' \4\ In fact, the NTSB has recommended SMSs in all modes of
transportation--aviation, rail and transit, pipelines, marine, even
manufacturers. In 2015, the Federal Aviation Administration (FAA)
required commercial airliners to develop a comprehensive SMS to improve
safety for the flying public, and this mandate has contributed to the
remarkable record of safety in commercial passenger aviation. In fact,
in 7 of the last 10 years, there have been no major commercial airline
passenger fatalities. The number of accidents, the number of
fatalities, and the fatality rate across the aviation industry have
also decreased.
---------------------------------------------------------------------------
\4\ 2021-2022 Most Wanted List of Transportation Safety
Improvements. Improve Passenger and Fishing Vessel Safety. Washington,
DC: NTSB.
---------------------------------------------------------------------------
As an example, the FAA requires commercial airlines to develop and
implement an SMS with four components:
A safety policy that outlines the methods, processes, and
organizational structure needed to support safe operations.
A safety risk management process to constantly identify
new hazards and control risk.
Safety assurance methods, such as audits, to evaluate if
the desired safety outcomes are being achieved.
Safety promotion, also known as safety culture, which is
a less tangible--but no less vital--aspect of a successful SMS.

For marine passenger vessels, regardless of a company's size, an
SMS ensures that each crewmember is given standard and clear procedures
for routine and emergency operations. An SMS specifies crewmember
duties and responsibilities, as well as delineates supervisory and
subordinate chains of command, so that each crewmember understands what
to do during critical vessel operations and emergency scenarios.
Developing an SMS includes creating plans for crewmember responses to a
range of possible emergency situations. SMSs also include procedures
for performing and tracking preventive maintenance, as well as for crew
training, emergency preparedness, documentation and oversight, and
other actions that prioritize safe operations.
Since 2012, following the allision of the passenger ferry Andrew J.
Barberi with a terminal at Staten Island, New York, the NTSB has
recommended the USCG require all operators of US-flagged passenger
vessels to implement an SMS, taking into account the characteristics,
methods of operation, and nature of service of these vessels, and, with
respect to ferries, the sizes of the ferry systems within which the
vessels operate.\5\ This is consistent with requirements imposed by the
International Maritime Organization (IMO). In 2010, Congress mandated
that the USCG develop appropriate SMS regulations for all US-flagged
passenger vessels. As a result of the Conception investigation, we
reiterated this recommendation, and the USCG published an advance
notice of proposed rulemaking (ANPRM), ``Safety Management Systems for
Domestic Passenger Vessels,'' in January 2021.\6\ The Board submitted
comments to the ANPRM and subsequently updated the status of this
safety recommendation to ``Open--Acceptable Response.'' \7\
---------------------------------------------------------------------------
\5\ Safety Recommendation M-12-3.
\6\ Safety Management Systems for Domestic Passenger Vessels. 89
Federal Register (FR) 3899.
\7\ NTSB Comments on USCG-2020-0123.
---------------------------------------------------------------------------
The NTSB's investigation of the Andrew J. Barberi was hampered by a
lack of voyage data recorder (VDR) information. A VDR is a fire- and
crash-protected recorder that captures critical vessel information as
well as audio from the bridge environment. This information can be
accessed by investigators following accidents and reviewed by vessel
operators as part of their SMS programs to help prevent accidents. In
2014, we recommended that the USCG require installation of VDRs on new
and existing ferry vessels, where technically feasible, and develop a
standard for smaller ferry vessels.\8\ These recommendations are
currently classified ``Open--Unacceptable Response.''
---------------------------------------------------------------------------
\8\ Safety Recommendations M-14-3, -4, and -5.
---------------------------------------------------------------------------
Further, we have recommended that the USCG require that companies
operating domestic passenger vessels develop and implement a preventive
maintenance program for all systems affecting the safe operation of
their vessels, including the hull and the mechanical and electrical
systems.\9\ We generally expect recommended actions to be completed in
5 years, but this has languished for 20 years and, therefore, is in an
unacceptable status. This is our oldest open marine safety
recommendation. We have kept it open because the USCG has informed us
since 2012 that it would include this action as a component of a
broader requirement for SMS.
---------------------------------------------------------------------------
\9\ Safety Recommendation M-02-5.
---------------------------------------------------------------------------
We continue to believe that an SMS is an essential tool for
enhancing safety on board all US passenger vessels, and that the USCG
is the appropriate authority to require such systems. We fully support
the requirement mandated by Congress. We also believe that an SMS is
not a substitute for important safety regulations that are issued by
the USCG. Safety regulations need to be implemented and an SMS enhances
the impact of those regulations.
Fire Safety for Small Passenger Vessels
As a result of the Conception disaster, we issued seven new safety
recommendations specifically related to fire safety and egress. All
seven were addressed by the Elijah E. Cummings Coast Guard
Authorization Act of 2020 and are currently classified ``Open--
Acceptable Response.''
To ensure fire safety aboard small passenger vessels, redundancy is
critical. First, we made several recommendations to the USCG to update
its regulations regarding accommodation spaces in all passenger
vessels, including those constructed prior to 1996. We recommended that
they require all accommodation spaces, for new vessels and those
currently in service, have smoke detectors''.\10\ Second, we
recommended that the USCG develop and implement an inspection procedure
to ensure that operators are conducting ``roving patrols'' as required
by regulations and which has been codified in US law since 1871.\11\
The current statute states that ``the owner, operator, or charterer of
a vessel carrying passengers during the nighttime shall keep a suitable
number of watchmen in the vicinity of cabins or staterooms and on each
deck to guard against and give alarm in case of fire or other danger.''
\12\ This was not the practice on Conception, other vessels owned by
Truth Aquatics, nor, according to interviews, other dive boats in
Southern California.
---------------------------------------------------------------------------
\10\ Safety Recommendations M-20-14, -15, and -16.
\11\ Safety Recommendation M-20-17.
\12\ 46 United States Code (USC) 8102.
---------------------------------------------------------------------------
Even if a fire breaks out, loss of life is still preventable with
adequate options for and awareness of emergency egress. The Conception
had two means of escape from the bunkroom: spiral stairs forward and an
escape hatch aft, accessible from either port or starboard aisles by
climbing into one of the top aftermost inboard bunks. However, both
paths led to the salon, which was filled with heavy smoke and fire, and
the salon compartment was the only escape path to exterior (weather)
decks. Therefore, because there was fire in the salon, the passengers
and one crewmember housed below were trapped and were not able to
escape. If regulations had required the escape hatch to exit to a space
other than the salon, optimally directly to the weather deck, the
passengers and crewmember in the bunkroom would have likely been able
to escape. For those reasons, we recommended that the USCG update its
regulations for small passenger vessels with overnight accommodations,
including those constructed prior to 1996, to require a secondary means
of escape into a different space so a single fire will not affect both
escape paths and to ensure there are no obstructions to egress.\13\
These recommendations are currently classified ``Open--Acceptable
Response,'' because we understand that the Coast Guard has initiated a
rulemaking project to implement the recommendations for all small
passenger vessels with overnight accommodations, including vessels
constructed prior to 1996.
---------------------------------------------------------------------------
\13\ Safety Recommendations M-20-18, -19, and -20.
---------------------------------------------------------------------------
In addition to fire safety in vessels with accommodation spaces,
prior to the Conception tragedy, we issued two recommendations to the
USCG regarding unmanned spaces. We recommended that they require fire-
detection systems in unoccupied spaces with machinery or other
potential heat sources on board small passenger vessels, and for them
to issue a marine safety information bulletin regarding the need to use
only approved material and components in fuel tank level-indicator
systems.\14\ The USCG has issued the bulletin and the recommendation
has been closed successfully, but further action is needed to require
additional fire detectors.
---------------------------------------------------------------------------
\14\ Safety Recommendations M-18-13 and -14.
---------------------------------------------------------------------------
Again, we appreciate Congress addressing these safety issues in
legislation, and for the cooperation and partnership of the USCG. We
look forward to the USCG issuing a final rule to implement our
recommendations and improve safety.\15\ Until that time, the
recommendations will remain open. In the meantime, operators of vessels
with overnight accommodations can act now to improve the safety of
their passengers and crew. They can start with the following even
before the USCG completes rulemaking:
---------------------------------------------------------------------------
\15\ Fire Safety of Small Passenger Vessels. 86 FR 73160.
---------------------------------------------------------------------------
Install smoke detectors in sleeping quarters and ensure
they are interconnected so when one detector goes off, they all do. The
Conception crewmember who discovered the fire could not hear the fire
alarm from the crew berthing on the upper deck.
Ensure that the primary and secondary emergency escape
paths do not lead to the same space, which can be blocked by a single
hazard. The Conception had two means of escape from the lower deck
bunkroom, but both led into the salon, which was filled with heavy
smoke and fire. Tragically, the salon compartment was the only escape
path to the weather deck. Because there was fire in the salon, the
passengers were trapped.
Keep the escape routes unobstructed at all times.
Remind crewmembers to perform roving patrols and why they
are so important. Our investigation found that the Conception fire was
uncontrollable by the time it was discovered because the crewmember,
who ultimately died, was asleep in the bunkroom.
Amphibious Passenger Vessel Safety: The Importance of Action
Unfortunately, we know that the consequences of failing to address
the lessons learned from our safety investigations can be further
tragedies. Almost 20 years after the sinking of an amphibious passenger
vessel that killed 13 people in Arkansas, we investigated the sinking
of a DUKW amphibious passenger vessel, Stretch Duck 7, on Table Rock
Lake near Branson, Missouri.\16\ We discovered that long-known safety
issues caused the sinking and resulted in the loss of 17 lives. I want
to thank you for addressing these safety issues in H.R. 6865, the Coast
Guard Authorization Act of 2022.
---------------------------------------------------------------------------
\16\ Sinking of Amphibious Passenger Vessel Stretch Duck 7, Table
Rock Lake, near Branson, Missouri, July 19, 2018. (NTSB, MAR 20/01).
---------------------------------------------------------------------------
DUKW amphibious vehicles were designed and built in the 1940s for
military use during World War II; some were later converted for
commercial service.\17\ They are unique vessels with special challenges
that must be addressed to ensure passenger safety.
---------------------------------------------------------------------------
\17\ DUKW (pronounced ``duck'') is an acronym that signifies the
characteristics of the WWII amphibious vessel: D = 1942 (the year of
design); U = utility; K = front-wheel drive; and W = two rear-driving
axles. DUKW vessels are also referred to as vehicles due to their dual
function of being operated on land and in water.
---------------------------------------------------------------------------
Five minutes into its voyage on July 19, 2018, the Stretch Duck 7,
with 31 passengers aboard, encountered a severe storm known as a
derecho. While trying to reach land, 7 minutes into the voyage, the
vessel took on water and sank approximately 250 feet away from the exit
ramp. Passengers were caught by the vessel's canopy as it sank. Only a
few of the surviving passengers stated that they were able to float
free without encountering any obstructions. Several hours prior to the
accident, the National Weather Service had issued a severe thunderstorm
watch for the area, followed by a severe thunderstorm warning a minute
before the vessel departed.
NTSB investigators found that the accident vessel was originally
constructed with a low freeboard, an open hull, and no subdivision or
flotation, resulting in a design without adequate reserve buoyancy. We
determined the probable cause of the sinking was the operator's
continued operation of waterborne tours after a severe thunderstorm
warning was issued for Table Rock Lake, exposing the vessel to a
derecho, which resulted in waves flooding through a non-weathertight
air intake hatch on the bow. Contributing to the sinking was the USCG's
failure to require sufficient reserve buoyancy in amphibious passenger
vessels. Contributing to the loss of life was the Coast Guard's
ineffective action to address emergency egress on amphibious passenger
vessels with fixed canopies, such as the Stretch Duck 7, which impeded
passenger escape.
As noted, these safety issues were not new when the Stretch Duck 7
sank. They were identified after the 1999 sinking of the Miss Majestic,
another DUKW amphibious passenger vessel, on Lake Hamilton, near Hot
Springs, Arkansas.\18\ As a result of that sinking, 13 passengers died.
Survivors of the Miss Majestic accident confirmed that the vehicle sank
less than a minute after the deck edge at the stern was submerged,
leaving insufficient opportunity for passengers to escape. Vessel
maintenance, reserve buoyancy, and survivability--specifically,
impediments to passenger egress caused by the vessel's canopy--were
among the major safety issues identified by our investigation of the
Miss Majestic accident.
---------------------------------------------------------------------------
\18\ Sinking of the Amphibious Passenger Vehicle Miss Majestic,
Lake Hamilton, Near Hot Springs, Arkansas, May 1, 1999. (NTSB, MAR 02/
01).
---------------------------------------------------------------------------
As a result of the Miss Majestic sinking, we recommended that the
USCG require greater stability and reserve buoyancy in amphibious
passenger vessels.\19\ Further, until the goals of that recommendation
were achieved, we urged the USCG to require--among other measures--that
canopies be removed from waterborne vessels, or that such vessels have
installed a USCG-approved canopy that does not restrict horizontal or
vertical escape by passengers in the event of sinking.\20\ These
recommendations were closed unacceptably in 2003 and 2007,
respectively. Regrettably, had these recommendations been implemented,
a future tragedy could have been avoided.
---------------------------------------------------------------------------
\19\ Safety Recommendation M-02-1.
\20\ Safety Recommendation M-02-2.
---------------------------------------------------------------------------
More than 15 years later, because of the Stretch Duck 7, we
recommended again that amphibious passenger vessels have sufficient
reserve buoyancy so they remain upright and afloat in the event of
damage or flooding, and that for DUKW vessels without sufficient
reserve buoyancy, that they require the removal of canopies, side
curtains, and their associated framing during waterborne operations to
improve emergency egress in the event of sinking.\21\ The USCG has not
been able to identify a feasible solution to achieve the necessary
level of reserve buoyancy, and contracted with the National Academy of
Sciences (NAS) to conduct an independent review of potential
modifications. The USCG has also issued a marine safety information
bulletin recommending removal of canopies as an initial step.\22\ For
these reasons, both recommendations remain classified ``Open--
Acceptable Response.''
---------------------------------------------------------------------------
\21\ Safety Recommendations M-19-15 and -16.
\22\ US Coast Guard Marine Safety Information Bulletin.
Recommendation for DUKW Passenger Vessel Canopy Removal. Washington,
DC: 2020. MSIB-15-20.
---------------------------------------------------------------------------
In 2015, we investigated a highway crash of a DUKW in Seattle,
Washington.\23\ As a result, we recommended the USCG amend its
Navigation and Vessel Inspection Circular (NVIC) 1--01, a guidance
document that relies on voluntary compliance, to ensure passengers
unbuckle before waterborne operations and the crew confirms that
passengers have complied.\24\ Following the Stretch Duck 7 sinking, we
recommended reviewing and revising the NVIC.\25\ Although the USCG has
communicated to us it will make the recommended revisions, the NVIC has
not been updated; therefore, these recommendations remain classified
``Open--Acceptable Response.''
---------------------------------------------------------------------------
\23\ Amphibious Passenger Vehicle DUCK 6 Lane Crossover Collision
with Motorcoach on State Route 99, Aurora Bridge, Seattle, Washington,
September 24, 2015. (NTSB, HAR-16/02)
\24\ Safety Recommendation M-16-26.
\25\ Safety Recommendation M-20-2.
---------------------------------------------------------------------------
Lastly, the benefits of these safety improvements are not realized
if crews have insufficient awareness. Accordingly, we have recommended
that the USCG review and revise training, especially as it relates to
severe weather.\26\ Each of these recommendations is on our 2021-2022
Most Wanted List. Again, thank you for addressing these issues in the
pending Coast Guard authorization.
---------------------------------------------------------------------------
\26\ Safety Recommendation M-20-3.
---------------------------------------------------------------------------
Conclusion
The loss of 34 lives on the Conception, less than 100 feet from
shore, shook this community and the country. It reminds us that the
potential for catastrophe is always present, including on small
passenger vessels, and we must do what we can to prevent needless
deaths and mitigate injuries. Passenger vessels should have SMSs and
provide adequate fire detection and extinguishing systems and enhanced
emergency egress options. Inaction can lead to further tragedy, as we
saw with the Stretch Duck 7 almost 20 years after the Miss Majestic
sinking. We recognize the progress that has been made, yet, there
remains room for improvement. The NTSB stands ready to work with you
and this Committee to continue improving passenger vessel safety.
Thank you again for the opportunity to testify today. I am happy to
answer your questions.
Appendix

Open Safety Recommendations issued to the U.S. Coast Guard (as of March 8th, 2022)
----------------------------------------------------------------------------------------------------------------
Most Wanted List (2021-
Rec. Number Status 22) Recommendation Text
----------------------------------------------------------------------------------------------------------------
A-14-069............................. Open- Work with the US
Acceptable Response.... Department of the
Interior, Bureau of
Safety and
Environmental
Enforcement to
identify and develop
comprehensive systems
and procedures to
mitigate the risk of
ingestion of raw gas
discharges, such as
methane, by
helicopters operating
in the vicinity of
offshore oil
platforms.
----------------------------------------------------------------------------------------------------------------
A-14-070............................. Open- After appropriate
Acceptable Response.... mitigations are
developed as
recommended in Safety
Recommendation A-14-
69, require mobile
offshore oil platform
operators to implement
these systems and
procedures.
----------------------------------------------------------------------------------------------------------------
M-02-005............................. Open- Yes.................... Require that companies
Unacceptable Response.. operating domestic
passenger vessels
develop and implement
a preventive
maintenance program
for all systems
affecting the safe
operation of their
vessels, including the
hull and the
mechanical and
electrical systems.
----------------------------------------------------------------------------------------------------------------
M-09-004............................. Open- Require mariners to
Unacceptable Response.. report to the Coast
Guard, in a timely
manner, any
substantive changes in
their medical status
or medication use that
occur between required
medical evaluations.
(Supersedes M-05-005)
----------------------------------------------------------------------------------------------------------------
M-11-012............................. Open- Establish a structured
Acceptable Response.... data monitoring
program for your small
boats that reviews all
available data sources
to identify deviation
from established
guidance and
procedures.
----------------------------------------------------------------------------------------------------------------
M-11-013............................. Open- Conduct a ports and
Unacceptable Response.. waterways safety
assessment for the
Sabine-Neches
Waterway, determine
from that whether the
risk is unacceptable,
and if so, develop
risk mitigation
strategies.
----------------------------------------------------------------------------------------------------------------
M-11-023............................. Open- Yes.................... Establish standards for
Unacceptable Response.. new and existing
commercial fishing
industry vessels of 79
feet or less in length
that (1) address
intact stability,
subdivision, and
watertight integrity
and (2) include
periodic reassessment
of the vessels'
stability and
watertight integrity.
----------------------------------------------------------------------------------------------------------------
M-11-024............................. Open- Yes.................... Require all owners,
Unacceptable Response.. masters, and chief
engineers of
commercial fishing
industry vessels to
receive training and
demonstrate competency
in vessel stability,
watertight integrity,
subdivision, and use
of vessel stability
information regardless
of plans for
implementing the other
training provisions of
the 2010 Coast Guard
Authorization Act.
----------------------------------------------------------------------------------------------------------------
M-11-027............................. Open- Yes.................... Require all crewmembers
Unacceptable Response.. to provide
certification of
completion of safety
training before
getting under way on
commercial fishing
industry vessels, such
training to include
both prevention of and
proper response to
emergency situations
as well as actual use
of emergency
equipment.
----------------------------------------------------------------------------------------------------------------
M-12-003............................. Open- Yes.................... Require all operators
Acceptable Response.... of U.S.flag passenger
vessels to implement
safety management
systems, taking into
account the
characteristics,
methods of operation,
and nature of service
of these vessels, and,
with respect to
ferries, the sizes of
the ferry systems
within which the
vessels operate.
(Supersedes Safety
Recommendation M-05-
006)
----------------------------------------------------------------------------------------------------------------
M-12-008............................. Open- Align your standards
Acceptable Response.... for postaccident
toxicological testing
of Coast Guard
military personnel
with the requirements
specified in 46 Code
of Federal Regulations
4.06-3.
----------------------------------------------------------------------------------------------------------------
M-12-009............................. Open- Align your standards
Acceptable Response.... for postaccident
toxicological testing
of Coast Guard
civilian personnel,
seeking appropriate
legislative authority
if necessary, with the
requirements specified
in 46 Code of Federal
Regulations 4.06-3.
----------------------------------------------------------------------------------------------------------------
M-12-010............................. Open- Disseminate guidance
Acceptable Response.... within the Coast Guard
so that commanding
officers have
unambiguous
instruction detailing
the requirements for
timely drug and
alcohol testing of
Coast Guard military
and civilian personnel
whose work performance
may be linked to a
serious marine
incident.
----------------------------------------------------------------------------------------------------------------
M-13-002............................. Open- Work with the US
Acceptable Response.... Department of State to
develop a written
agreement between the
government of Mexico,
the US Coast Guard,
and the National
Transportation Safety
Board that will ensure
mutuality with regard
to: timely accident
notification;
expeditious access to
accident sites;
unimpeded ability to
gather evidence,
interview witnesses,
and establish facts;
logistical assistance
on scene; and
continuing liaison so
that problems and
differences are
minimized and promptly
resolved.
----------------------------------------------------------------------------------------------------------------
M-13-007............................. Open- Develop procedures to
Acceptable Response.... identify bridges
having chronic
navigation lighting
problems and work with
the states that own
those bridges to
rectify underlying
problems in a timely
manner.
----------------------------------------------------------------------------------------------------------------
M-13-008............................. Open- Review the process and
Acceptable Response.... means of delivering
broadcast notices to
mariners and identify
and implement methods
for providing timely
and easily accessible
navigation information
to mariners.
----------------------------------------------------------------------------------------------------------------
M-14-001............................. Open- Develop and implement
Acceptable Response.... human factors
standards for the
design of critical
vessel controls for US-
flag ships to include
clearly identifiable
and understandable
audible alerts and
displays indicating
which mode is engaged.
----------------------------------------------------------------------------------------------------------------
M-14-003............................. Open- Yes.................... Require installation of
Unacceptable Response.. voyage data recorders
that meet the
International Maritime
Organization's
performance standard
for voyage data
recorders on new ferry
vessels subject to 46
Code of Federal
Regulations
Subchapters H and K.
(Supersedes Safety
Recommendations M-10-
005 and M-10-006)
----------------------------------------------------------------------------------------------------------------
M-14-004............................. Open- Yes.................... Require installation of
Unacceptable Response.. voyage data recorders
that meet the
International Maritime
Organization's
performance standard
for simplified voyage
data recorders on
existing ferry vessels
subject to 46 Code of
Federal Regulations
Subchapters H and K.
(Supersedes Safety
Recommendations M-10-
005 and M-10-006)
----------------------------------------------------------------------------------------------------------------
M-14-005............................. Open- Yes.................... Develop a US voyage
Unacceptable Response.. data recorder standard
for ferry vessels
subject to 46 Code of
Federal Regulations
Subchapter T and
require the
installation of such
equipment where
technically feasible.
(Supersedes Safety
Recommendations M-10-
005 and M-10-006)
----------------------------------------------------------------------------------------------------------------
M-15-008............................. Open- Revise your existing
Acceptable Response.... guidance to define
inspection
requirements clearly,
including the
frequency of
inspection, for each
bridge in your
jurisdiction.
----------------------------------------------------------------------------------------------------------------
M-15-009............................. Open- Evaluate the activities
Acceptable Response.... and performance of
each branch office in
the bridge program to
identify areas that
need improvement; then
take the actions
necessary to ensure
the effectiveness of
existing policy,
procedures, and
regulations related to
drawbridge operations
and the overall safety
of navigation.
----------------------------------------------------------------------------------------------------------------
M-16-004............................. Open- Address the risks
Acceptable Response.... associated with watch
stander fatigue by
implementing
Commandant Instruction
3500.2, Crew Endurance
Management, issued on
March 30, 2006, in all
operational units.
----------------------------------------------------------------------------------------------------------------
M-16-005............................. Open- Revise and align Title
Unacceptable Response.. 33 Code of Federal
Regulations Part 161,
the Vessel Traffic
Service [VTS] National
Standard Operating
Procedures Manual, VTS
center internal
operating procedure
manuals, and training
curricula, as
necessary, to ensure
that VTS authority is
consistently applied
across the US Coast
Guard VTS system.
----------------------------------------------------------------------------------------------------------------
M-16-006............................. Open- Incorporate additional
Unacceptable Response.. training that
emphasizes realistic
vessel traffic service
(VTS) simulation
exercises, including
detecting and
responding to unsafe
traffic situations, in
your initial training
and proficiency
requirements for all
VTS watchstanders in
the US Coast Guard VTS
system.
----------------------------------------------------------------------------------------------------------------
M-16-007............................. Open- Require standard on-the-
Unacceptable Response.. job training (OJT)
mentor selection
criteria, including
appropriate vessel
traffic service
operator work
experience levels and
instructor training
requirements, for all
OJT mentors.
----------------------------------------------------------------------------------------------------------------
M-16-008............................. Open- Require all vessel
Unacceptable Response.. traffic service (VTS)
watch supervisors to
achieve a VTS operator
qualification and
complete a minimum
work experience
requirement as an
operator before
serving as a
supervisor.
----------------------------------------------------------------------------------------------------------------
M-16-009............................. Open- Modify your Vessel
Unacceptable Response.. Traffic Service [VTS]
National Standard
Operating Procedures
Manual, VTS center
internal operating
procedure manuals, and
training curricula, as
necessary, to ensure
that VTS watchstanders
share a common
understanding of how
to identify and
respond to situations
requiring navigational
assistance.
----------------------------------------------------------------------------------------------------------------
M-16-011............................. Open- Conduct or sponsor
Unacceptable Response.. research, with input
from appropriate
subject matter
experts, to develop
more effective
procedures or methods
for monitoring vessel
communications on the
bridge-to-bridge radio
frequency to identify
and address developing
unsafe situations in
vessel traffic service
areas.
----------------------------------------------------------------------------------------------------------------
M-16-012............................. Open- Once the research
Unacceptable Response.. recommended in Safety
Recommendation M-16-11
is completed, revise
your Vessel Traffic
Service [VTS] National
Standard Operating
Procedures Manual, VTS
center internal
operating procedure
manuals, and training
curricula, as
necessary.
----------------------------------------------------------------------------------------------------------------
M-16-013............................. Open- Work with the American
Unacceptable Response.. Pilots' Association
and the American
Waterways Operators to
conduct or sponsor
research to evaluate
and determine the
feasibility and
benefits of
professional mariner
representation on the
watchfloor at each of
the US Coast Guard
vessel traffic service
(VTS) centers, and
establish such
representation at VTS
centers, as
appropriate, based on
the findings of that
research.
----------------------------------------------------------------------------------------------------------------
M-16-014............................. Open- Revise your Vessel
Unacceptable Response.. Traffic Service [VTS]
National Standard
Operating Procedures
Manual, VTS center
internal operating
procedure manuals,
training curricula,
and VTS user manuals,
as necessary, to
ensure that VTS
watchstanders use
standard VTS
communication phrasing
and message markers
from the International
Maritime Organization
Standard Marine
Communication Phrases
during radio
communications with
mariners when
appropriate.
----------------------------------------------------------------------------------------------------------------
M-16-015............................. Open- Work with the Radio
Unacceptable Response.. Technical Commission
for Maritime Services
and the American
Waterways Operators to
modify regulations,
procedures, and
equipment standards,
as necessary, to
ensure that vessels
engaged in towing
operations broadcast
accurate automatic
identification system
information regarding
tow size and tow
configuration as well
as vessel size.
----------------------------------------------------------------------------------------------------------------
M-16-016............................. Open- Develop a continuous
Unacceptable Response.. risk assessment
program to evaluate
and mitigate safety
risks for each vessel
traffic service (VTS)
area in the US Coast
Guard VTS system that
includes input from
port and waterway
stakeholders.
----------------------------------------------------------------------------------------------------------------
M-16-017............................. Open- Develop a program for
Unacceptable Response.. conducting periodic
risk assessments of
the entire US Coast
Guard vessel traffic
service system that
includes input from
port and waterway
stakeholders to
evaluate and mitigate
system-wide safety
risks.
----------------------------------------------------------------------------------------------------------------
M-16-018............................. Open- Develop or revise, as
Unacceptable Response.. necessary, your
definitions of the
activity and incident
data collected by
vessel traffic service
(VTS) centers as
necessary to ensure
standardized and
routine reporting
across the entire US
Coast Guard VTS
system.
----------------------------------------------------------------------------------------------------------------
M-16-019............................. Open- Establish a program to
Unacceptable Response.. periodically analyze
the activity and
incident data
collected by vessel
traffic service (VTS)
centers to assess the
safety performance of
each VTS center and
the entire US Coast
Guard VTS system.
----------------------------------------------------------------------------------------------------------------
M-16-021............................. Open- Establish a program to
Unacceptable Response.. periodically review
each of the 12-vessel
traffic service (VTS)
areas and seek input
from port and waterway
stakeholders to
identify areas of
increased vessel
conflicts or accidents
that could benefit
from the use of
routing measures or
VTS special areas, and
establish such
measures where
appropriate.
----------------------------------------------------------------------------------------------------------------
M-16-026............................. Open- Amend Navigation and
Acceptable Response.... Vessel Inspection
Circular 1-01 to
ensure that (1)
amphibious passenger
vehicle (APV)
operators tell
passengers that seat
belts must not be worn
while the vessel/
vehicle is operated in
the water and (2)
before the APV enters
the water or departs
the dock, the master
or other crewmember
visually checks that
each passenger has
unbuckled his or her
seat belt.
----------------------------------------------------------------------------------------------------------------
M-17-001............................. Open- Establish a process
Acceptable Response.... whereby, at regular
intervals, all harbor
safety committees
identify the safety
risks posed by the
interaction of
commercial and
recreational vessels
in their respective
geographic areas;
where necessary,
develop and implement
practices to mitigate
those risks; and share
successful practices
among all harbor
safety committees.
----------------------------------------------------------------------------------------------------------------
M-17-002............................. Open- Seek statutory
Acceptable Response.... authority that
requires all
recreational boat
operators on waters
subject to the
jurisdiction of the
United States to
demonstrate completion
of an instructional
course or an
equivalent that meets
the National
Association of State
Boating Law
Administrators
standards.
----------------------------------------------------------------------------------------------------------------
M-17-003............................. Open- Work with the National
Acceptable Response.... Association of State
Boating Law
Administrators and the
National Water Safety
Congress to review and
update A Guide to
Multiple Use Waterway
Management at regular
intervals.
----------------------------------------------------------------------------------------------------------------
M-17-006............................. Open- Ensure that, at all
Acceptable Response.... times, at least one
crewmember on board
each type of response
boat is adequately
trained in the types
of medical emergencies
expected in a marine
environment and
qualified in the use
of all first-aid and/
or trauma equipment
carried on board.
----------------------------------------------------------------------------------------------------------------
M-17-007............................. Open- Develop a standard for
Acceptable Response.... the contents of First-
Aid and Trauma (FAT)
kits for each type of
Coast Guard response
vessel.
----------------------------------------------------------------------------------------------------------------
M-17-017............................. Open- In collaboration with
Acceptable Response.... the National Weather
Service, provide
timely broadcasts of
the Tropical Cyclone
Forecast/Advisories,
Intermediate Public
Advisories, and
Tropical Cyclone
Updates to mariners in
all regions via medium-
frequency navigational
TELEX (NAVTEX), high-
frequency voice
broadcasts (HF VOBRA),
and high-frequency
simplex teletype over
radio (HF SITOR), or
appropriate radio
alternatives (and
appropriate future
technology).
----------------------------------------------------------------------------------------------------------------
M-17-022............................. Open- Propose to the
Unacceptable Response.. International Maritime
Organization that
design maximum
operating angles of
inclination for main
propulsion and other
critical machinery be
included in damage
control documents,
stability instruments
and booklets, and in
the safety management
systems for all
applicable vessels.
----------------------------------------------------------------------------------------------------------------
M-17-023............................. Open- Propose to the
Unacceptable Response.. International Maritime
Organization that all
watertight access
doors and access hatch
covers normally closed
at sea be provided
with open/close
indicators both on the
bridge and locally.
----------------------------------------------------------------------------------------------------------------
M-17-024............................. Open- Propose to the
Acceptable Response.... International Maritime
Organization that on
new and existing
vessels, seawater
supply piping below
the waterline in all
cargo holds be
protected from impact.
----------------------------------------------------------------------------------------------------------------
M-17-025............................. Open- Propose to the
Acceptable Response.... International Maritime
Organization to
require that new cargo
vessels be equipped
with bilge high-level
alarms in all cargo
holds that send
audible and visible
indication to a manned
location.
----------------------------------------------------------------------------------------------------------------
M-17-026............................. Open- Propose to the
Acceptable Response.... International Maritime
Organization to
require that existing
cargo vessels be
retrofitted with bilge
high-level alarms in
all cargo holds that
send audible and
visible indication to
a manned location.
----------------------------------------------------------------------------------------------------------------
M-17-027............................. Open- Propose to the
Acceptable Response.... International Maritime
Organization that any
opening that must
normally be kept open
for the effective
operation of the ship
must also be
considered a
downflooding point,
both in intact and
damage stability
regulations and in
load line regulations
under the
International
Convention on Load
Lines.
----------------------------------------------------------------------------------------------------------------
M-17-029............................. Open- Propose to the
Unacceptable Response.. International Maritime
Organization that
existing cargo vessels
operating under the
International
Convention for the
Safety of Life at Sea
be required to have
damage control plans
and booklets on board
that meet current
standards.
----------------------------------------------------------------------------------------------------------------
M-17-030............................. Open- Propose to the
Unacceptable Response.. International Maritime
Organization that
damage control plans
and booklets required
by the International
Convention for the
Safety of Life at Sea
be class-approved.
----------------------------------------------------------------------------------------------------------------
M-17-031............................. Open- Publish policy guidance
Acceptable Response.... to approved maritime
training schools
offering bridge
resource management
courses to promote a
cohesive team
environment and
improve the decision-
making process, and
specifically include
navigational and storm-
avoidance scenarios.
----------------------------------------------------------------------------------------------------------------
M-17-032............................. Open- Require recurring
Acceptable Response.... bridge resource
management training
for all deck officers
when renewing their
credentials.
----------------------------------------------------------------------------------------------------------------
M-17-033............................. Open- Require that all deck
Acceptable Alternate officers, at both
Response. operational and
management levels,
take a Coast Guard-
approved advanced
meteorology course to
close the gap for
mariners initially
credentialed before
1998.
----------------------------------------------------------------------------------------------------------------
M-17-034............................. Open- Publish policy guidance
Acceptable Response.... to approved maritime
training schools
offering management-
level training in
advanced meteorology,
or in an appropriate
course, to ensure that
the curriculum
includes the following
topics:
characteristics of
weather systems
including tropical
revolving storms;
advanced
meteorological
concepts; importance
of sending weather
observations; ship
maneuvering using
advanced simulators in
heavy weather; heavy-
weather preparations;
use of technology to
transmit and receive
weather forecasts
(such as navigational
telex or weather-
routing providers);
ship-routing services
(capabilities and
limitations); and
launching of lifeboats
and liferafts in heavy
weather.
----------------------------------------------------------------------------------------------------------------
M-17-035............................. Open- Provide policy guidance
Acceptable Response.... to approved maritime
training schools
offering operational-
level training in
meteorology to ensure
that the curriculum
includes the following
topics:
characteristics of
weather systems,
weather charting and
reporting, importance
of sending weather
observations, sources
of weather
information, and
interpreting weather
forecast products.
----------------------------------------------------------------------------------------------------------------
M-17-036............................. Open- Require that vessels in
Unacceptable Response.. ocean service (500
gross tons or over) be
equipped with properly
operating
meteorological
instruments, including
functioning
barometers,
barographs, and
anemometers.
----------------------------------------------------------------------------------------------------------------
M-17-037............................. Open- Revise Title 46 Code of
Acceptable Response.... Federal Regulations
170.110 (stability
booklet) to require
(1) stability
instructions,
guidance, or data on
wind velocity used to
calculate weather
criteria; (2) list of
closures that must be
made to prevent
unintentional
flooding; (3) list of
closures that must be
made for an opening
not to be considered a
downflooding point;
and (4) righting arm
curve (metacentric
height) table to note
the angle at which
initial downflooding
occurs; also, add a
windheel table for
vessel full load
displacement or the
condition of greatest
vulnerability to
windheel.
----------------------------------------------------------------------------------------------------------------
M-17-038............................. Open- Update the guidance in
Unacceptable Response.. Navigation and
Inspection Circular 4-
77 (Shifting Weights
or Counter Flooding
During Emergency
Situations), based on
the circumstances of
the El Faro accident,
to include a warning
that actions by ship
personnel intended to
correct a list can
produce dangerous
results if roll-on/
roll-off cargo is
already adrift and
water has reduced the
coefficients of
friction for lashed
cargo.
----------------------------------------------------------------------------------------------------------------
M-17-039............................. Open- Conduct a complete
Acceptable Response.... review of the
Alternate Compliance
Program to assess the
adequacy and
effectiveness of the
program.
----------------------------------------------------------------------------------------------------------------
M-17-040............................. Open- Review and implement
Acceptable Response.... training of Coast
Guard inspectors and
accredited
classification society
surveyors to ensure
that they are properly
qualified and
supported to perform
effective, accurate,
and transparent vessel
inspections, meeting
all statutory and
regulatory
requirements.
----------------------------------------------------------------------------------------------------------------
M-17-041............................. Open- Review and implement
Acceptable Alternate training of Coast
Response. Guard inspectors and
accredited
classification society
surveyors to ensure
that they are properly
qualified and
supported to perform
effective, accurate,
and transparent vessel
inspections, meeting
all statutory and
regulatory
requirements.
----------------------------------------------------------------------------------------------------------------
M-17-043............................. Open-Await Response. Require that open
lifeboats on all US-
inspected vessels be
replaced with enclosed
lifeboats that meet
current regulatory
standards and freefall
lifeboats, where
practicable.
----------------------------------------------------------------------------------------------------------------
M-17-044............................. Open- To prevent future
Acceptable Response.... errors in converting
position data such as
occurred in the El
Faro accident, work
with manufacturers of
Global Maritime
Distress and Safety
System equipment,
communication
providers, and land
earth stations to
remove ambiguity from
the Inmarsat-C
distress alert
position reports.
----------------------------------------------------------------------------------------------------------------
M-17-045............................. Open- Yes.................... Require that all
Unacceptable Response.. personnel employed on
vessels in coastal,
Great Lakes, and ocean
service be provided
with a personal
locator beacon to
enhance their chances
of survival.
----------------------------------------------------------------------------------------------------------------
M-17-046............................. Open- Modify guidance and
Unacceptable Response.. training for marine
inspectors to ensure
that voyage data
recorder annual
performance tests
include the
replacement of locator
beacons prior to
expiration and that
audio used to evaluate
quality is recorded
while a ship is under
way using its main
propulsion unit.
----------------------------------------------------------------------------------------------------------------
M-17-047............................. Open- Propose to the
Acceptable Response.... International Maritime
Organization to amend
resolution MSC.333(90)
to specify that
``normal operations''
are defined as when a
ship is under way
using its main
propulsion unit and to
assess voyage data
recorder problems,
including not
capturing both sides
of internal phone
calls on the bridge
electric telephone and
unrecorded very-high-
frequency
communications, and
identify steps to
remedy them.
----------------------------------------------------------------------------------------------------------------
M-17-048............................. Open- If the actions
Acceptable Alternate recommended to the
Response. National Oceanic and
Atmospheric
Administration in
Safety Recommendation
M-17-52 establish that
the automatic
identification system
(AIS) is a viable
means by which to
relay (with acceptable
time delay)
meteorological and
oceanographic data and
metadata from vessels
at sea for use by
global meteorological
authorities, propose
to the International
Maritime Organization
that vessels required
to use AIS also be
equipped with
meteorological and
oceanographic sensors
including, at a
minimum, sensors for
barometric pressure
and sea-surface
temperature that will
automatically
disseminate the data
at high-temporal
resolution via AIS.
----------------------------------------------------------------------------------------------------------------
M-17-049............................. Open- Propose to the
Acceptable Alternate International Maritime
Response. Organization that
vessels under
regulations of the
International
Convention for the
Safety of Life at Sea
that are not already
automatically
disseminating
meteorological and
oceanographic data by
other means be
required to manually
disseminate such data
while at sea via the
automatic
identification system
or the Voluntary
Observing Ship program
at the times of 0000
coordinated universal
time (UTC), 0600 UTC,
1200 UTC, and 1800
UTC.
----------------------------------------------------------------------------------------------------------------
M-18-001............................. Open- Require operators to
Acceptable Alternate perform full function
Response. tests of quick-closing
valves during
inspections and
examinations, ensuring
that the associated
systems shut down as
designed and intended.
----------------------------------------------------------------------------------------------------------------
M-18-002............................. Open- Yes.................... Evaluate the
Acceptable Response.... feasibility of
creating a passenger
vessel safety
specialist billet at
each sector that has
the potential for a
search and rescue
activity characterized
by the need for
immediate assistance
to a large number of
persons in distress,
and staff sector-level
billets, as
appropriate, based on
the findings of that
evaluation.
----------------------------------------------------------------------------------------------------------------
M-18-013............................. Open- Yes.................... Require fire detection
Acceptable Response.... systems in unmanned
spaces with machinery
or other potential
heat sources on board
small passenger
vessels.
----------------------------------------------------------------------------------------------------------------
M-19-006............................. Open- In collaboration with
Acceptable Response.... the Corps of
Engineers, develop a
policy to ensure
fleeting areas are
maintained in
compliance with permit
requirements.
----------------------------------------------------------------------------------------------------------------
M-19-007............................. Open- Develop a regulated
Acceptable Response.... navigation area for
the Pittsburgh region
that would ensure the
integrity of fleeting
areas and include
detailed requirements
for barge moorings
during highwater and
ice conditions.
----------------------------------------------------------------------------------------------------------------
M-19-015............................. Open- Require DUKW amphibious
Acceptable Response.... passenger vessels
(commonly referred to
as original and/or
``stretch'' DUKWs) to
have sufficient
reserve buoyancy
through passive means,
so that they remain
upright and afloat
with a full complement
of passengers and
crewmembers in the
event of damage or
flooding.
----------------------------------------------------------------------------------------------------------------
M-19-016............................. Open- For DUKW amphibious
Acceptable Response.... passenger vessels
without sufficient
reserve buoyancy
(commonly referred to
as original and/or
``stretch'' DUKWs),
require the removal of
canopies, side
curtains, and their
associated framing
during waterborne
operations to improve
emergency egress in
the event of sinking.
----------------------------------------------------------------------------------------------------------------
M-20-001............................. Open- Yes.................... Require that amphibious
Acceptable Response.... passenger vessels
equipped with forward
hatches enable
operators to securely
close them during
waterborne operations
to prevent water
ingress.
----------------------------------------------------------------------------------------------------------------
M-20-002............................. Open- Yes.................... Review the
Acceptable Response.... circumstances of the
Stretch Duck 7 sinking
and other amphibious
passenger vessel
accidents, and revise
Navigation and Vessel
Inspection Circular
(NVIC) 1-01 to address
the issues found in
these accidents,
including operations
during imminent severe
weather and emergency
egress during rapid
sinking.
----------------------------------------------------------------------------------------------------------------
M-20-003............................. Open- Yes.................... Examine existing
Acceptable Alternate training and knowledge
Response. requirements for
understanding and
applying fundamental
weather principles to
waterborne operations
for Coast Guard-
credentialed masters
who operate small
passenger vessels;
and, if warranted,
require additional
training requirements
for these ratings on
recognition of
critical weather
situations in pre-
departure planning and
while under way.
----------------------------------------------------------------------------------------------------------------
M-20-014............................. Open- Revise Title 46 Code of
Acceptable Response.... Federal Regulations
Subchapter T to
require that newly
constructed vessels
with overnight
accommodations have
smoke detectors in all
accommodation spaces.
----------------------------------------------------------------------------------------------------------------
M-20-015............................. Open- Revise Title 46 Code of
Acceptable Response.... Federal Regulations
Subchapter T to
require that all
vessels with overnight
accommodations
currently in service,
including those
constructed prior to
1996, have smoke
detectors in all
accommodation spaces.
----------------------------------------------------------------------------------------------------------------
M-20-016............................. Open- Revise Title 46 Code of
Acceptable Response.... Federal Regulations
Subchapter T and
Subchapter K to
require all vessels
with overnight
accommodations,
including vessels
constructed prior to
1996, have
interconnected smoke
detectors, such that
when one detector
alarms, the remaining
detectors also alarm.
----------------------------------------------------------------------------------------------------------------
M-20-017............................. Open- Develop and implement
Acceptable Response.... an inspection
procedure to verify
that small passenger
vessel owners,
operators, and
charterers are
conducting roving
patrols as required by
Title 46 Code of
Federal Regulations
Subchapter T.
----------------------------------------------------------------------------------------------------------------
M-20-018............................. Open- Revise Title 46 Code of
Acceptable Response.... Federal Regulations
Subchapter T to
require newly
constructed small
passenger vessels with
overnight
accommodations to
provide a secondary
means of escape into a
different space than
the primary exit so
that a single fire
should not affect both
escape paths.
----------------------------------------------------------------------------------------------------------------
M-20-019............................. Open- Revise Title 46 Code of
Acceptable Response.... Federal Regulations
Subchapter T to
require all small
passenger vessels with
overnight
accommodations,
including those
constructed prior to
1996, to provide a
secondary means of
escape into a
different space than
the primary exit so
that a single fire
should not affect both
escape paths.
----------------------------------------------------------------------------------------------------------------
M-20-020............................. Open- Review the suitability
Acceptable Response.... of Title 46 Code of
Federal Regulations
Subchapter T
regulations regarding
means of escape to
ensure there are no
obstructions to egress
on small passenger
vessels constructed
prior to 1996 and
modify regulations
accordingly.
----------------------------------------------------------------------------------------------------------------
M-21-005............................. Open-Await Response. Conduct a study to
evaluate the effects
of icing, including
asymmetrical
accumulation, on crab
pots and crab pot
stacks and disseminate
findings of the study
to industry, by means
such as a safety
alert.
----------------------------------------------------------------------------------------------------------------
M-21-006............................. Open-Await Response. Based on the findings
of the study
recommended in Safety
Recommendation M-21-
05, revise regulatory
stability calculations
for fishing vessels to
account for the
effects of icing,
including asymmetrical
accumulation, on a
crab pot or pot stack.
----------------------------------------------------------------------------------------------------------------
M-21-007............................. Open-Await Response. Revise Title 46 Code of
Federal Regulations
28.530 to require that
stability instructions
include the icing
amounts used to
calculate stability
criteria.
----------------------------------------------------------------------------------------------------------------
M-21-008............................. Open-Await Response. Develop an oversight
program to review the
stability instructions
of commercial fishing
vessels that are not
required to possess a
load line certificate
for accuracy and
compliance with
regulations.
----------------------------------------------------------------------------------------------------------------
M-21-015............................. Open-Await Response. Propose to the
International Maritime
Organization to
eliminate
International Maritime
Dangerous Goods Code
special provision 961
for used and damaged
flammable-liquid-
powered vehicles
transported by roll-on/
roll-off vehicle
carriers.
----------------------------------------------------------------------------------------------------------------

Mr. Carbajal. Thank you, Ms. Homendy.
We will now move on to Member questions. Each Member will
be recognized for 5 minutes, and I will start by recognizing
myself.
Admiral Mauger, given that the investigations often result
in similar recommendations, why has the NTSB been more
expedient than the Coast Guard in investigating the Conception
incident? I understand the Coast Guard's own investigation
still hasn't come to a conclusion. I understand there is a
number of reasons for that. But if you could comment on that,
that would be great.
Admiral Mauger. Mr. Chairman, the Coast Guard and NTSB work
very closely together when there is a major marine casualty to
make sure that we bring the expertise of both organizations to
bear on determining the facts and the primary cause for that
casualty. But then we have different responsibilities in terms
of the investigations that we carry out.
One of the responsibilities that the Coast Guard has to
determine through our investigations is whether or not there is
any evidence of potential criminal activity as well. And when
there is evidence of potential criminal activity, then we work
very closely with the Department of Justice and the Federal law
enforcement agencies to refer our investigation to those
organizations for further consideration and prosecution.
In the case of Conception and Stretch Duck 7, our casualty
investigation information was referred to the Department of
Justice and is awaiting their results on the criminal
prosecution of both of those cases.
But we are not waiting to make sure that the lessons that
we learned from our investigation are applied. In the time
following both the Conception casualty and the Stretch Duck 7
casualty, we released policy statements, we changed our
compliance procedures, and we set about developing new safety
regulations that come into effect next week that make sure that
we strengthen the safety standards, even though our casualty
investigation hasn't yet been concluded.
Mr. Carbajal. Thank you.
Admiral Mauger, in its investigation of the Conception
incident, the NTSB reiterated its recommendations to the Coast
Guard that it require all operators of U.S.-flag passenger
vessels to implement a safety management system. And last year,
the Coast Guard issued a proposed rulemaking SMS requirement
for all passenger vessels.
Since it has been 2\1/2\ years since the Conception
tragedy, when can we expect implementation?
Admiral Mauger. Mr. Chairman, safety management systems are
a key portion of that safety responsibility. As I mentioned in
my opening statement, safety is a shared responsibility between
the owner, the operator of the vessel, the captain and crew on
board, and the Coast Guard. And the owner-operator is
responsible for setting that safety culture and providing those
resources to the captain and crew to do their job. And that is
what safety management systems are intended to provide.
Last January, we released an advance notice of proposed
rulemaking, describing our intent to issue safety management
system regulations for passenger vessels. Through the public
comment period for that rulemaking, we received over 134
comments. Some of the questions that we had asked were: What
were the benefits that industry members had seen for that? What
were benefits the public had seen from the implementation of
those safety management systems? How were they implemented? How
did they check compliance? What were the costs associated with
all those?
And so, with the 134 responses, we have got a wide range of
comments ranging from implementation in excess of half a
million dollars to implementation that was only in the tens of
thousands of dollars to implement.
And so, we are working through--and then the passenger
vessel industry, as well, is a very diverse industry. We are
working through very carefully to make sure that we take all of
that input into effect and put that together in a policy
statement that will come out as a notice of proposed
rulemaking. We are working very diligently to get that out as
quickly as possible.
Mr. Carbajal. Thank you.
Ms. Homendy, you spoke a lot about the importance of SMS on
all vessels in your testimony.
Would you care to comment on the Coast Guard's response?
Ms. Homendy. Yes. On SMS, I do understand rulemaking can be
difficult. But in the meantime, we continue to see tragedies
which have taken lives. So, moving forward in an expeditious
manner is important. But while the Coast Guard is moving
forward, there is nothing preventing the passenger vessel
industry from implementing SMS voluntarily. And they should.
And we have seen incredible benefits in other modes of
transportation including aviation where they have implemented
safety management systems successfully. In fact, in commercial
aviation--and I am sure Mr. Larsen can echo this--we have had,
over the past 7 of the past 10 years in commercial passenger
aviation, zero deaths. And that is what we want to see. That is
the goal in small passenger vessel operations as well.
Mr. Carbajal. Thank you.
Chair Homendy, in your testimony, you provided an appendix
which included the status of Coast Guard responses to NTSB
recommendations. This is extremely helpful to see. So, I thank
you for that information.
Could you explain what the NTSB considers an ``unacceptable
response'' from the Coast Guard?
Ms. Homendy. Yes. Thank you for the question, Mr. Chairman.
An ``unacceptable response'' would be one that does not
address our recommendation or fails to address it completely.
We have, right now, 19 small passenger vessel recommendations
that are open. Four of those are ``open--unacceptable.'' Those
are around voyage data recorders which, without voyage data
recorders, if you use aviation as an example, it would be like
conducting an investigation without a black box.
And that information is critical not just for NTSB's
investigation, but it is critical for the operator to know what
happened after an accident occurs. That information is key.
So, we have four. Those 4 are ``open--unacceptable'' right
now, and the rest of those 19 are ``open--acceptable.''
Overall, we have 93 open recommendations to the Coast Guard.
About 34 percent are ``unacceptable'' right now.
Mr. Carbajal. Thank you.
Chair Homendy, would you send your family out on an ``old
T'' overnight passenger vessel similar to the Conception?
Ms. Homendy. I have a daughter who is 14 and a husband, and
I would not. The Conception was designed so it had an emergency
egress and then the main entrance to the bunk area that both
ended up into the same area which was engulfed in flames. I
would not.
Mr. Carbajal. Thank you for your candid response, and I
think that speaks volumes. So, thank you for answering that
question.
With that, I am now going to move on to Ranking Member
Gibbs for his questions. And I just want to remind everyone
that we will have a second round of questions that I will be
leading after we finish this round.
So, with that, Representative Gibbs.
Mr. Gibbs. Thank you, Chairman.
Admiral Mauger, it is always preferable for the Coast
Guard's marine casualty reports on final action memos from the
Commandant before we move any legislation to improve on marine
safety.
We had the final action memo related to the El Faro
accident before we moved on the legislation. That related to
that accident. However, we still do not have a marine casualty
investigation on the Commandant's final action memo for either
the 2018 duck boat accident in Missouri or the 2019 Conception
dive boat fire which occurred in the chairman's district.
When do you expect these investigations to be available for
the subcommittee to review?
Admiral Mauger. Thank you, Ranking Member.
Our investigations are right now coordinated with the
Department of Justice, pending the results of their actions
with regard to criminal matters associated with both Stretch
Duck 7 and Conception.
But in the meantime, we are not waiting to identify any of
those safety lessons learned from either of those accidents and
take action on those safety lessons learned.
And so, we have looked to the National Transportation
Safety Board and to our own investigators to learn what we can
from those casualties and then implement regulations or
implement policies and regulations to address those particular
issues.
All of the provisions that were included in the Elijah E.
Cummings Coast Guard Authorization Act of 2020, for example,
have been incorporated into our regulations for small passenger
vessel fire safety which takes effect on Monday next week.
Mr. Gibbs. That's good. It sounds like you have moved on
the safety. Just waiting for DOJ for any liability or criminal
activity. So, I appreciate that answer.
Also, Admiral, I think this is already addressed. You said
it here, next Monday--March 28th, I think that is next week--
new rules to be for the small passenger vessel. I am looking
through here on this chart. I assume it is a typo. I just bring
this up just so they can correct it.
So, on some of those requirements in the chart, they say 3/
28/2022 but some say 3/38. So, you might want to correct that
typo. I don't think there are 38 days in March. That was tongue
in cheek there.
Anyway, also GAO, Admiral, issued a report January 12th of
this year, ``Enhancements Needed to Strengthen Marine
Inspection Workforce Planning Efforts.'' GAO made five
recommendations regarding marine inspection workforce planning.
I understand these recommendations remain open.
When does the Coast Guard intend to respond to the GAO's
recommendations?
Admiral Mauger. Thank you, Ranking Member.
We appreciate the oversight from Congress and the support
that has been provided to strengthen our marine inspection
program. And so, the GAO report identified a number of areas
where we can take further improvements by collecting additional
data and reporting on additional data. And so, we continue to
evaluate that and will look forward to responding to GAO as
quickly as possible with a detailed plan for how we are going
to address those recommendations.
We have incorporated many of the ideas identified in the
GAO report already into our prevention readiness initiative. As
you know, the Commandant has really been focused on the
readiness of the Coast Guard workforce in general.
And so, with the Commandant's support, the Coast Guard has
published a prevention readiness initiative which is really
aimed at making sure that we have the people and the governance
and the technology to enable our inspectors and investigators
and marine safety personnel to be as capable as they can
because their work is just so important.
Thank you.
Mr. Gibbs. I think, Mr. Chairman, I have got a couple more
questions. But I will wait for the second round since my time
is running low here.
I'll hold on for the second round, so I'll yield back at
this time. Thank you.
Mr. Carbajal. Thank you, Representative Gibbs.
We will now move on to Representative Larsen.
Mr. Larsen of Washington. Thank you, Mr. Chair.
First off, I do want to express my condolences, as well, to
the families of the victims of the Conception, as well as of
the duck boat incident in Missouri. We had our own incident,
duck boat incident, here in Washington State in Seattle. And my
first question is for Chair Homendy on that issue.
Your testimony references the investigation of a duck boat
crash in Seattle in 2015. That investigation led to the
recommendation that the Coast Guard amend its Navigation and
Vessel Inspection Circular 1-01 to ensure passengers unbuckle
before waterborne operations, and the crew confirms passengers
have complied.
Now, that recommendation has not yet been followed by the
Coast Guard but you classify that as ``open--acceptable
response.'' So, I was wondering, Chair, is the failure to
implement a recommendation an acceptable response? Can you
explain how the NTSB approaches that? How should we read that?
Ms. Homendy. Yes. Thank you for the question, Chairman
Larsen.
When we consider a recommendation status change, that does
come to the Board. And the Board considers staff
recommendations. When we look at all the factors, we look at:
Is there an opportunity, or has the Coast Guard moved in the
direction in any way of implementing that recommendation or
signaled that they may implement that recommendation? We don't
want to close it or close it ``unacceptable'' if there is a
possibility that that could move forward.
One thing to keep in mind is our reporting to the
committee, often you won't know when something is ``closed--
unacceptable'' but you will continue to be notified when
something remains ``open--unacceptable'' or ``open--
acceptable.'' So, we want to keep that open if there is any
possibility of moving forward on a recommendation. Otherwise,
it stops communication on that recommendation, especially with
the Coast Guard. So, we try to keep it open to move things
forward.
Mr. Larsen of Washington. All right. Your testimony also
states NTSB has recommended that Coast Guard require all
companies operating domestic passenger vehicles develop and
implement a preventive maintenance program for all systems
affecting the safe operation. That recommendation has been open
for 20 years, I think is what it shows.
What has been the impediment in having that recommendation
implemented?
Ms. Homendy. Great question. And the reason why we have
kept that one open for 20 years is the Coast Guard has
indicated that they may consider preventative maintenance as
part of the SMS program or SMS rulemaking that they are moving
forward. So, we are keeping that open.
The official response that we have heard from the Coast
Guard is that they had not intended to move that forward, but
we are keeping it open in hopes they do move that forward as
part of the SMS.
Mr. Larsen of Washington. We will track that.
Ms. Homendy. As far as why they have not implemented it,
possibly Admiral Mauger can discuss further.
Mr. Larsen of Washington. All right. Well, we will track
that. I have a different question for the admiral right now if
you don't mind.
Admiral, you mentioned the use of machine learning and
artificial intelligence tools in order to improve the
targeting, if you will, of what your inspectors look at. Can
you tell us what Coast Guard is doing to do the quality
assurance on those algorithms to ensure that the algorithms
that you are using in your machine learning actually spit out
the best areas for the Coast Guard to target for inspections?
Admiral Mauger. Congressman Larsen, what we have been able
to do is, first of all, we assembled a panel of experts,
collected information both from our own investigations and from
the NTSB investigations, and then the information that is
recorded in our internal databases of every inspection
investigation that have been conducted by the Coast Guard.
And then we used the machine learning to identify which of
those parameters were really key in identifying those risk
drivers.
And then to sort of validate that model, we sent folks out
into the field. We used our field inspectors to follow up and
conduct the inspections and look at those factors with specific
guidance and then bring that information back into our
database.
And so, through that targeting process that we have been
able to do, we have been able to correct a number of
deficiencies and have put our most experienced inspectors on
the highest risk or highest priority vessels and have put them
on there more frequently than we otherwise would have. And so,
it seems----
Mr. Larsen of Washington [interrupting]. Thank you.
Admiral Mauger [continuing]. From the information that we
have collected, it is working.
Mr. Larsen of Washington. Thank you. I have run out of
time.
But, Mr. Chair, I just don't want us to rely on the
algorithms to produce the responses. We need to be sure we keep
people in the loop on these, as well, and that was the purpose
of my question, Mr. Chair.
Thank you. I yield back. Oh, I have no time to yield back.
So, Mr. Chairman, please. Thank you.
Mr. Carbajal. Thank you, Mr. Larsen.
Next, we will go to Representative Weber.
Mr. Weber of Texas. Mr. Chairman, go ahead and pass me by
right now.
Mr. Carbajal. Thank you. We will now then move on to
Representative Lowenthal.
Mr. Lowenthal. Thank you, Mr. Chairman. Thank you for
holding this hearing. I, too, wish to send my condolences to
the families of those that died in the tragic accident in Santa
Barbara. And I also want to send my condolences to the family
of the Dean of the House of Representatives, Don Young.
My first question is to Admiral Mauger. In 2014, Admiral,
the NTSB recommended that the Coast Guard require installation
of voyage data recorders, or VDRs, that meet the international
IMO standard for voyage data recorders on new and existing
ferry vessels. Chair Homendy just talked about and reiterated
that recommendation.
Voyage data recorders aid in investigating and analyzing
the causes of accidents and identify remedial actions to help
prevent future occurrences. Thus, the overall benefit of the
system is enhanced passenger safety resulting in more lives
saved.
However, the Coast Guard's response to this recommendation
is currently classified as ``open--unacceptable response.''
Again, Chair Homendy talked about that. The Coast Guard has
indicated that an economic analysis shows that the benefits do
not outweigh the costs.
Admiral Mauger, can you elaborate on the reasoning behind
the Coast Guard's nonconcurrence?
Admiral Mauger. Congressman, as part of any rulemaking that
the Coast Guard undertakes, unless it is specifically directed
not to by Congress, the Coast Guard is required by Federal
regulations to conduct an economic cost-benefit analysis for
that rulemaking.
And so, in the case of voyage data recorders and the work
that was done and the standard that was referenced there, we
determined that for many of these small businesses, it would
have a significant economic impact.
That said, as marine safety professionals, we want to have
every available information to us to determine the cause and
contributing factors to a casualty and want to make sure that
we can do our best to learn from those and move forward.
And so, technology is changing very rapidly. Cell phones
and small electronics have the ability to track speed and
location and record information. And so, we are looking to see
if there is another technological solution to voyage data
recorders that might help to ensure safe operations, while also
providing information post-casualty that we can rely on.
Mr. Lowenthal. Thank you, Admiral.
I have another question that is related. Can you explain
why the Coast Guard supports the IMO's efforts for VDR
requirements on vessels traveling on international voyages but
does not support a VDR requirement domestically, specifically
for passenger ferries which transport millions of passengers
each year? Why do you support this on international voyages but
not on domestic voyages?
Admiral Mauger. Congressman Lowenthal, the rules that are
in effect have been applied to international operating vessels,
as you have identified. These vessels travel worldwide and can
be far out of the reach of marine safety law enforcement
agencies or marine safety agencies. And so, being able to see
what happens no matter where they are operating is very
important. There are also lots of lives and cargo at stake in
those operations as well. And so, having the VDR for those
international traveling vessels is something that has been a
key part of the international regulations.
We will continue to look to see what can be done here
domestically, albeit with a different standard, to make sure
that we have the benefits of that information.
Mr. Lowenthal. Thank you, Admiral.
I will follow up on these questions in the second round.
And I yield back.
Mr. Carbajal. Thank you, Representative Lowenthal.
Next we will go to Represent Napolitano.
Mrs. Napolitano. Thank you, Chairman Carbajal.
My condolences to my friend's family, especially his wife
Anne, for the passing of Don Young.
And to the families, keep up your voices. We represent you.
We need your input, definitely.
Thank you, Mr. Chairman, for holding this critical hearing
and I'm grateful for your incredible leadership on this
subcommittee and the great work you have done in the Coast
Guard. We must ensure that boaters, families, and customers are
protected in secure vessels that are operating safely.
Chairwoman Homendy, it is great to see you again. I recall
you being in my district 15 years ago to discuss rail safety.
And since we have implemented Positive Train Control, which has
created a safety for railroad, since that time, no more
hairline cracks in the rail. And that has proven to avoid
accidents such as the one we had several years back.
We are here again in California due to tragic accidents in
the maritime industry, but my concern is: Do you have enough
inspectors to do the job? Is the budget there for you to do
that job? And is there anything we can do, maybe provide more
policy, to speed up the response from the Coast Guard on the
length of time it takes to respond to some of the
recommendations the NTSB has?
Ms. Homendy. Thank you for your questions.
And it has been an absolute pleasure working with you,
Chair Napolitano, over the years on rail safety, grade crossing
safety, and a number of safety issues.
With respect to the NTSB, we submitted a proposal for
reauthorization. Our authorization expires at the end of this
year. So, we are up for reauthorization.
The size of our agency, frankly, has not grown since 1998.
Yet requirements have grown. Right now, in our agency, 30
percent of our workforce is retirement eligible--30 percent. In
the next 5 years, that grows to 50 percent. That shows the
commitment of our agency workforce to stay and work on safety
issues, even if they take 50 years like PTC did. But they need
additional resources. Our Office of Marine Safety has 11
investigators; our Railroad, Pipeline, and Hazardous Materials
Investigations Office, also 11 investigators. Our Highway
Safety Office is in the 20s for investigators. So, we need
resources.
We have a number of challenges. Transportation is growing.
New technologies are emerging. That creates complexities, and
so, we would need additional resources from Congress to help
make that happen.
We did submit a proposal to increase our authorization
levels, about $10 to $15 million annually over the next 5
years, which would grow from about $129 million to about $170
million or $175 million at the end of fiscal year 2027. So, we
would greatly appreciate your support on that.
With respect to recommendations, when the Coast Guard was
removed from DOT, there was no longer a requirement for the
Coast Guard to respond to the NTSB within 90 days of issuance
of a recommendation. Currently we have one recommendation where
we received an initial response but haven't heard anything from
them for 5 years. And so, creating more timely responses would
be helpful. And I know that is actually in the Coast Guard
reauthorization bill that is currently before the subcommittee
and the committee, and we would greatly appreciate that.
One thing that is not in there, which we would appreciate
you including, is the Secretary of Transportation is also
required to report annually on the recommendations in our Most
Wanted List that have not been implemented. That does not apply
to the Coast Guard right now also because that occurred after
they were removed from DOT. So, we would appreciate your
consideration of that as well.
Mrs. Napolitano. I am sure Mr. Carbajal will make sure that
goes into the record.
I think I will yield. Thank you.
Mr. Carbajal. Thank you, Representative Napolitano.
I will now recognize each Member again for an additional 5
minutes of questions.
I will start by recognizing myself, and I will start with
Chair Homendy.
Do you have concerns with the Coast Guard's current steps
to implement requirements from section 8441 of the Elijah E.
Cummings Coast Guard Authorization Act of 2020?
Ms. Homendy. Thank you for the question, sir. I had to
track which one was the section, the section number. I
apologize for that.
No. I appreciate the Coast Guard's efforts to move that
forward. I appreciate your action to include that in the
legislation, and I do appreciate they are moving that forward
on a timely basis.
So, thank you.
Mr. Carbajal. Proceeding from the perspective of NTSB, does
the Coast Guard have the resources it needs to enforce the
compliance of small passenger vessel safety regulations? I know
you touched on it from a global perspective, from the scope of
all the responsibility you have, from aviation, rail, marine
safety. But specifically for marine safety, since today we are
focusing on that, if you could elaborate, I would appreciate
it.
Ms. Homendy. For the Coast Guard resources?
Mr. Carbajal. Yes.
Ms. Homendy. Yes, I mean, the Coast Guard has been an
incredible partner with NTSB. And, frankly, they need more
resources as well. They have incredible personnel who are
dedicated to safety, and their leadership has really worked
well with the NTSB including Admiral Buschman, Admiral Mauger,
and then Captain Neubauer who works with us on our safety
recommendations and on our investigations. So, we appreciate
the safety partnership.
Mr. Carbajal. Admiral Mauger, that was an opportunity for
somebody to advocate for more resources for your department so
you wouldn't have to do it.
Ms. Homendy [to Admiral Mauger]. You can advocate for my
resources, though, next, if you would like.
[Laughter.]
Mr. Carbajal. Moving on, Chair Homendy, to what extent does
the Coast Guard work with the NTSB to respond to the issues
identified during accident investigations? Does the
collaboration also include the development and training
curriculum that covers accident investigations and the
consequences of poor inspections or inspection practices?
Ms. Homendy. Yes, sir. When we conduct any investigation,
we look at investigations from a very broad perspective. And
that, of course, includes training and inspection as well.
Mr. Carbajal. Thank you.
Admiral Mauger, according to the 2022 GAO report on the
Coast Guard's marine inspection program, the Coast Guard's own
analysis indicated that it had about 24 percent fewer marine
inspectors with the advanced qualifications than it needed to
conduct its work.
How does the Coast Guard plan to complete its inspections,
given the policy that these inspections be conducted by marine
inspectors with advanced qualifications?
Admiral Mauger. Mr. Chairman, we work very closely to make
sure that we have prioritized and allocated our resources to
the most pressing needs. And so, right after Conception, we
released an inspection policy, a revised inspection policy,
that put our most experienced inspectors on those vessels that
were presented the greatest risk. And we did so, making sure
that they were on there more than just once a year.
As we go forward, it is a combination of making sure that
we have the people. Over the course of the last 3 years, we
have, with congressional support, we have added 126 people to
the marine safety program. Eighty-seven of those are out in the
field, and we have added about $18 million as well.
But as we go forward, we will continue to build on those
requests because the industry that we operate in just is
getting increasingly more complex and more congested every day.
So, it is important that we stay after that.
Mr. Carbajal. Thank you.
Admiral Mauger, the NTSB's investigation of the Conception
incident found that the vessel and other vessels of the
operating company were regularly operating in contravention of
the regulations and the vessel certificate of inspection, which
required a roving patrol at night and while passengers were in
their bunks.
The NTSB recommended that the Coast Guard develop and
implement a means to verify that small passenger vessel owners,
operators, and charterers are conducting roving patrols as
required by 46 CFR Subchapter T and my bill, the Small
Passenger Vessel Safety Act, which required devices to ensure
crews on the watch are awake. The Coast Guard previously
indicated the requirements of the vessels will take effect on
or around March 28.
Can you comment on where this stands and if we expect
vessels to have the technology operational next week?
Admiral Mauger. So, under the regulations, Mr. Chairman,
they are required to submit their plans for how they will come
into compliance with the roving watches and the recording of
their watches. They are required to submit those plans next
week. And so, we will work very closely with the different
small passenger vessel operators to make sure that those plans
meet both the intent of the regulation and the safety
recommendations that have found.
In the interim, though, we have also deployed or conducted
operations where we have gone out and checked throughout the
summer, last summer, to make sure that vessels did have
somebody awake and alert and were standing proper watches while
they were underway, conducting their operations. And so, that
was a change from previous practice in this area.
Mr. Carbajal. Thank you, Admiral.
We will now move on to Representative Gibbs.
Mr. Gibbs. Thank you, Chairman.
Admiral, there's a concern out there about the IT failing--
IT infrastructure the Coast Guard has, and it has really placed
particular constraints on the marine inspectors because they
have been unable to implement those IT solutions. I guess a lot
of the inspector's work is done largely away from the office
and could benefit from more robust mobile computing
capabilities.
What efforts are being undertaken as part of the Coast
Guard's IT revolution to improve mobile IT resources for the
marine inspectors?
Admiral Mauger. Ranking Member, with support from this
subcommittee and from Congress through appropriations under the
CARES Act and through our fiscal year appropriations, Congress
has appropriated funds to allow us to really transform our
information technology backbone. And that's really important to
our marine safety program because, as we talked about earlier
in this hearing, we use the information that's collected during
those inspections and investigations to conduct targeting and
risk assessments and drive our policies and procedures forward
to ensure their safety.
And so, with the money appropriated under the CARES Act, we
have made investments in strengthening the overall IT
architecture and then have rolled out new mobile technology as
well, including the mobile inspect app, which allows our
inspectors to enter the results of their inspection while they
are out in the field. We look forward to continuing to build
out that capability as well going forward.
Mr. Gibbs. Well, that is good to hear, Admiral. I guess, in
future hearings, you can update us on the progress of that and
how it's rolling out and how it's improved efficiencies and all
that, so I appreciate that.
Also, Admiral, the committee has been requested from the
industry to double the time between inspection of the LNG
tankers due to problems with scheduling of those inspections.
We are told that is due to the limited availability of the
inspectors. Pursuant to those requirements, the National
Defense Authorization Act, the Coast Guard has set aside 64
billets, including 24 new billets to investigate and prosecute
sexual assault and sexual harassment in the Coast Guard.
How many new marine inspection billets does the Coast Guard
intend to create?
Admiral Mauger. So, the fiscal year 2022 appropriation
included a number of new inspection billets. We have a new
training program that allows folks that come into the Coast
Guard as enlisted members to become warrant officers and become
marine inspectors through that program. So, we have added about
a dozen additional billets to train and develop those.
We have also added a number of billets to the field, about
two dozen billets, to improve the training of our marine
inspectors out there in the field. So, this is an issue we take
very seriously. We have a prevention readiness initiative that
was developed under the direction of Admiral Schultz to make
sure that we continue to develop and grow the capacity and
capability that we need to oversee the safety within this
industry.
Mr. Gibbs. OK. Because I know, like I said, the industry is
really concerned about inspection timing. So, I appreciate that
and appreciate all the work you are doing and also Chair
Homendy.
Mr. Chairman, I yield back. I don't have any more
questions. Thank you.
Mr. Carbajal. Thank you, Ranking Member Gibbs.
Next, we will move on to the chairman of the Aviation
Subcommittee, Mr. Rick Larsen.
Mr. Larsen of Washington. Thank you, Chair. I appreciate
the opportunity to participate even remotely from just north of
you in Washington State. I am glad to be on today. I am glad
you invited me, let me know about it.
I wanted to follow up with the admiral with regards to the
question I had for Chair Homendy. I am just reading from my
notes here about the one recommendation that has been open for
20 years.
The NTSB testimony recommended that the Coast Guard require
all companies operating domestic passenger vessels develop and
implement a preventive maintenance program for all systems
affecting the safe operation of those vessels. That has been
open for 20 years.
Can you walk through--you weren't doing this 20 years ago,
but you are doing it now. Can you walk through a little bit how
a recommendation can go for 20 years instead of closed and
being successfully implemented? The admiral.
Admiral Mauger. Congressman Larsen, safety on board is a
responsibility of the owner-operator, the captain and crew and
the Coast Guard. So, the owner-operator is really responsible
for setting that safety culture, providing the resources and
training that the captain and crew need to do their job, and
following through with effective management and oversight of
the vessel.
So, from that perspective, programs like preventative
maintenance or safety management systems are really an
important part of that overall network and framework of safety
on board the vessels. We are also required, though, as I
mentioned previously, when we issue regulations, we are
required by Federal regulation or Federal mandates to take into
account cost-benefit for implementation of those policies. And
so, this is something that we have been working at and
continuing to look for opportunities to understand,
particularly as technology and policies adapt but as we learn
more too, to implement this. So, we have wanted to keep this
open and continue to continue to work at this and appreciate
the NTSB's continued emphasis on this point.
Mr. Larsen of Washington. I think Representative Gibbs
asked my questions about the--kind of how you develop your
inspectors because you are targeting your most experienced
inspectors on some things, but you need to ensure that you have
a pipeline of folks to fill those roles as those inspectors
either leave the Coast Guard or get their next job or so on.
Is there anything more you wanted to say to address that,
the pipeline of inspectors and ensure a qualified inspector
pipeline?
Admiral Mauger. Congressman Larsen, we want to make sure
that we have a strong inspection workforce to be able to carry
out this really important safety mission. And so, we have
worked very closely with Congress over the course of the past
10 years through the Marine Safety Performance Plan to report
out on statistics and report out on the status of our
inspection workforce. In the last 3 years, that has translated
into additional people doing this work. So, we have added 126
billets over the last 3 years. Eighty-seven of those are out in
the field, and they are doing the prevention work that needs to
be done.
One of the important pieces that we have added into that as
part of our overall readiness initiative is this program called
the Enlisted Marine Inspector Training Program, where we
transition members from their enlisted career into an officer
career through a focused mentorship and apprenticeship in
marine inspections. This has gotten a lot of great support from
the members within the Coast Guard who are excited to be able
to carry out those opportunities. And we expect that it will
have a real benefit for both us and the industry as we are
bringing, creating the opportunity for more marine inspectors
earlier in their career, which means that they should be able
to stick around for longer in their career.
So, we really appreciate the support from Congress on both
of those initiatives.
Mr. Larsen of Washington. Thank you.
Chair, if you will just indulge one question for Chair
Homendy about aviation. There was a crash this morning--
yesterday, in China, of a 737-800.
And if the Chair could just remind us what NTSB's role
plays when a U.S.-made airplane crashes in a foreign country
and what you are going to be doing in that regard.
Ms. Homendy. Yes. Thank you for the question.
We are currently speaking with the State Department and
others as the situation develops. But under Annex 13, we would
be technical advisors for the investigation. And so, with
respect to that particular accident, we will have more
information as the day goes on. So, if you are interested, I
would be happy to have a further conversation with you to let
you know what we intend to do.
Mr. Larsen of Washington. I appreciate that. Thank you.
Thank you, Mr. Chair.
Mr. Carbajal. Thank you.
Now, we will move on to the distinguished gentleman, Mr.
Lowenthal. I just want to say that Mr. Lowenthal has been a
great mentor. I am disappointed that he will be leaving us at
the end of this term.
In addition to being on this subcommittee, Mr. Lowenthal
sits on the Natural Resources Committee and is the chairman of
the Energy and Mineral Resources Subcommittee. But again, you
are going to be a big loss to our Congress, Mr. Lowenthal, and
I really appreciate you taking the time and being in our
hearing today.
You're next.
Mr. Lowenthal. Thank you, Representative Carbajal, Salud,
really, for those kind, kind words. I am going to be around for
a while, so we will have plenty of time to talk about the
future.
In my last questions, I asked Admiral Mauger, could he
explain the Coast Guard's ``open--unacceptable response'' to
the fact that the Coast Guard supports the IMO's efforts for
VDR requirements on vessels traveling on international voyages
but does not support a VDR requirement domestically,
specifically for passenger ferries, which transport millions of
passengers each year. And I thank the Admiral for his response.
But I would like to ask Chair Homendy: In your opinion,
Chair Homendy, is there any significant difference between
international voyages and domestic voyages that would warrant
this disparity in the Coast Guard's reasoning?
Ms. Homendy. There is not.
Mr. Lowenthal. Well, that's a really complete answer.
Ms. Homendy. There's no difference. And, Congressman, just
to add to that, Admiral Mauger had mentioned additional
information from cell phones and iPads. There is a big
difference between a cell phone and an iPad and a voyage data
recorder. This was a recommendation we issued a number of years
ago.
And, like I said, it is like investigating a plane crash
without a black box. This is critical information, not just to
our safety investigation, but it is critical information to
parties to the investigation. The parties to the investigation,
which would include companies and others, and they would get
access to that information early on so that they could take
measures to improve safety early.
And so, that's why we think it's critical to have voyage
data recorders. I think in order to move that forward, Congress
is going to have to require it. We have not seen progress with
the Coast Guard on this issue. And the response has focused on
the cost-benefit analysis. From NTSB's standpoint, lives are
priceless. And all lives--we should do everything we can to
save lives and to prevent tragedy. So, we currently are working
to continue to push VDRs and will continue to do that, and hope
that Coast Guard takes action.
Mr. Lowenthal. Thank you for that very complete answer.
Admiral Mauger, when it comes specifically to passenger
ferry vessels, what resources unique to vessel safety of this
class of vessels is the Coast Guard most efficient in that
would aid in its inspection of these vehicles?
Admiral Mauger. Congressman Lowenthal, in terms of the
passenger vessel ferry industry, as you mentioned in your
remarks, these are vessels that carry really millions of
passengers to work or school every day. And so, the inspection
that's required for those vessels still complies with our
regulations, but it really relies on that good field-level
working cooperation between the Coast Guard and the ferry
operations where they occur in the Nation.
In terms of how we roll that out at the national level,
it's really about getting more inspectors that are properly
trained and outfitted with the right capability to do their
job. Our prevention readiness initiative is increasing the
number of inspectors we have, is modernizing their training
system so that they can be more effective at their job, and
providing them with the technology that they need to be able to
enter and conduct their exams on board those vessels.
Mr. Lowenthal. Thank you, Admiral.
With that, I am going to yield back to the distinguished
chair, Chair Carbajal.
Mr. Carbajal. Thank you, Mr. Lowenthal.
With that, we will go to Representative Napolitano, who I
failed to mention earlier. She is the chairwoman of the
Committee on Transportation and Infrastructure's Water
Resources and Environment Subcommittee. If you noticed, many of
my colleagues that joined us today also happen to be in leading
roles on other subcommittees, and I am very grateful for all of
them taking the time to be part of our subcommittee hearing
today, not just those that serve on my subcommittee, but that
go above and beyond and have a relationship to our
subcommittee.
Chairwoman Napolitano.
Mrs. Napolitano. Thank you, Chairman Carbajal.
Admiral, the Coast Guard is underrecognized, as far as I am
concerned, in Congress, many of the agencies. You are critical
to a lot of our safety.
What about the funding that you are receiving? I know
sometimes we ask, and we get some answers based on the
administration side of it, but what do you really need to be
able to do a job that you are required to do, especially in
training the officers and making sure that we have enough
personnel? Like you are saying, is there a difference between
those that operate the vessels for work and school versus
tourism? How do you differentiate? How are you able to
prioritize any of these areas?
Admiral Mauger. Congresswoman, thank you for those kind
comments about the Coast Guard. The Coast Guard is committed to
Safety of Life at Sea. We work very hard to make sure that we
have the standards, the compliance activities, and learn from
every accident to improve those standards and compliance
activities.
In order to continue to move forward, this is an
increasingly complex maritime system that we operate in. There
are more vessels coming into the U.S., as you know, down in
your district, bringing cargo. It's absolutely necessary for
our economy and for our Nation, but it makes it a complex
environment for us to work in. And that's why we have really
focused on the readiness of our workforce.
And so, over the course of the past 10 years, we have been
submitting a Marine Safety Performance Plan to the subcommittee
to keep them apprised of our efforts in building that, but
under this Commandant, really dialed in on the readiness of the
people. And that's making sure that we have the right people
and the right technology and the right governance to do that
work.
So, that has resulted, in just the last 3 years, 126
billets coming in to do this work; 87 of those will be out in
the field. And they're getting after all elements of it from
improving our ability to conduct inspections, making sure that
we are addressing things like cybersecurity, and then also the
improvements of the training of our workforce, too. So, there
are a number of improvements made. We will continue to keep the
subcommittee apprised and continue to work on it.
Mrs. Napolitano. But what about the budget, sir? Be honest.
Admiral Mauger. Congresswoman, our readiness is wrapped up
in the budget that the President submits to Congress each year.
And so, we will continue to keep this subcommittee apprised of
our progress towards that prevention readiness initiative and
getting after that.
Mrs. Napolitano. Great. Well, as far as implementing a
recommendation from the NTSB, I understand the reticence of the
marine vessels' compliance with the regs; they would be brought
kicking and screaming just like they did with the railroads on
the Positive Train Control. But it saved many lives, and it's
worth it. And I hope the public recognizes that it is important
for them to understand why the regs are there and that it is
costing the vessels money, and thereby it increases the charge
for operating on these recreation/tourism areas. But I don't
think that we should be penny-pinching when it comes to safety.
Chairwoman Homendy, we are again, in California, due to
tragic accidents, and this time, of course, is the maritime, as
explained. What tools, infrastructure, and regulations are
needed to address maritime safety in the way we have been
successful with the railroad industry?
Ms. Homendy. Thank you for the question, Chair Napolitano.
There are many chairs here today. That's why I keep referencing
that. But thank you.
And it's implementing our recommendations. We have 93 open
recommendations to the Coast Guard, and it's implementing our
recommendations in moving forward.
One we that haven't discussed today is personal locator
beacons. We have a recommendation that came out of El Faro and
others to have personal locator beacons. And we are aware of
marine accidents where crewmembers and others were--we were
able to--or the Coast Guard was able to find them because they
had personal locator beacons. These are $300 GPS units that
were provided or used by crewmembers. And we have recommended
that that be mandated so that crewmembers are provided those
personal locator beacons just in case there is an accident, and
they can be located in waterways.
Mrs. Napolitano. Is there a reason, Admiral, that this is
not implemented?
Admiral Mauger. Congresswoman, we are working very closely.
This is another area where technology is emerging very quickly.
You mentioned in your remarks about that comparison between
cost and safety, and there shouldn't be a price on safety.
Under those Federal regulations that we are required to comply
with, we do have to make that economic analysis unless Congress
directs us not to.
Under the leadership of this subcommittee, through the
Elijah E. Cummings Coast Guard Authorization Act of 2020,
Congress directed the implementation of these important fire
safety regulations that are kind of coming into effect next
Monday. And they did so in a way that allowed us to move as
quickly as possible by bypassing the APA or provisions of the
APA for the development and implementation of the interim final
rule. So, that is one of the solutions and ways that Congress
has been very helpful in helping us move forward on this
important issue.
Mrs. Napolitano. Well, I hope it doesn't take forever to
implement some of these lifesaving techniques and
infrastructure, because it depends on who is on that boat whose
life you may save.
Thank you, Mr. Chair.
Mr. Carbajal. Thank you, Representative Napolitano.
This concludes our hearing. I want to thank the city of
Santa Barbara for making this hearing room available to us.
I would like to thank the witnesses for your testimony and
the answers to our questions.
Again, I want to recognize the families that are here who
have gone through so much. Thank you for being here.
I ask unanimous consent that the record of today's hearing
remain open until such time as our witnesses have provided
answers to any questions that may be submitted to them in
writing. I also ask unanimous consent that the record remain
open for 15 days for additional comments and information
submitted by Members or witnesses to be included in the record
of today's hearing.
Without objection, so ordered.
The subcommittee stands adjourned.
[Whereupon, at 2:25 p.m., the subcommittee was adjourned.]

Submissions for the Record

----------

Prepared Statement of Hon. Peter A. DeFazio, a Representative in
Congress from the State of Oregon, and Chair, Committee on
Transportation and Infrastructure
Although I'm not able to join you, I want to thank Mr. Carbajal for
organizing today's gathering. There is no better way to ensure that
government entities, who are tasked with protecting lives and promoting
safety, are held accountable than to discuss such matters in a public
space, particularly when active stakeholders are invited into the
process. To the family members of the victims of the CONCEPTION tragedy
that are listening today, I offer my condolences for your loss and
commend your bravery and empathy in engaging in these issues for the
benefit of others.
Today's witnesses are subject matter experts on small passenger
vessel safety. Specifically, they have invested significant time
investigating, reporting on, and learning from maritime disasters
including, but unfortunately not limited to, the CONCEPTION fire.
Admiral John Mauger, Assistant Commandant for Prevention Policy for the
Coast Guard, is responsible for the development of national policy,
standards, and programs promoting marine safety, security, and
environmental stewardship. The Honorable Jennifer Homendy is Chair of
the National Transportation Safety Board, an independent federal agency
charged with investigating maritime, aviation, and rail incidents that
resulted in loss of life. The Coast Guard and NTSB work together to
review transportation disasters to produce and implement
recommendations that save future lives. Today's hearing is a step in
that process.
In addition to fire safety recommendations, I expect the
subcommittee will discuss buoyancy requirements for DUKW-type boats--
those vessels that travel on both land and water--as well as Coast
Guard vessel inspector training needs, marine hazards communication,
and vessel-specific emergency response planning requirements. As the
Coast Guard develops its final rule on the new small passenger vessel
safety requirements, and as Congress creates and considers the Don
Young Coast Guard Authorization Act of 2022 and the National Defense
Authorization Act of 2023, I see ample opportunity to write the
recommendations we are discussing today into law so that improved
safety standards can be enforced both at sea and, if necessary, in the
courtroom.
I thank my colleagues, the witnesses, and the audience for their
attention to this cause and their participation in this hearing.

Appendix

----------

Questions from Hon. Salud O. Carbajal to Rear Admiral John W. Mauger,
Assistant Commandant for Prevention Policy, U.S. Coast Guard

Safety Regulation Violations
Question 1.a. In the case of the Conception, a previous captain
testified in an interview that the owner regularly did not require an
overnight watch. What should captain or crew do when faced with an
owner or captain that violates safety regulations (no night watch/
faulty fire detection & suppression systems)?
Answer. When a captain or crew is faced with an owner or captain
that violates, or directs them to violate, safety regulations, they
should notify the nearest Coast Guard Sector, Coast Guard Marine Safety
Unit, or Coast Guard Marine Safety Detachment to report the violation.
If the violation creates an emergency, requires immediate attention, or
results in a marine casualty, the captain or crew should contact the
Coast Guard via VHF Ch. 16 or via the local Coast Guard Sector Command
Center 24-hr emergency number.
Furthermore, 46 U.S.C. Sec. 3315, ``requires an individual holding
a license issued by the Coast Guard to assist inspection authorities
and to make defects and imperfections known to those authorities.
Anyone licensed also has a duty to report any marine casualty producing
serious injury to the vessel, its equipment, or individuals on board
the vessel. These licensed individuals who have this statutorily-
imposed duty to disclose are also protected by prohibiting any
government official from disclosing the identity or source of the
information except as authorized by the Secretary.''

Question 1.b. Does the Coast Guard have a reporting system set up
to take reports from captain or crew about deficient safety standards
on a vessel they are expected to work on?
Answer. The contact information for every Coast Guard Sector is
available online via USCG Homeport and uscg.mil. Additionally, Coast
Guard Sector Command Centers nationwide are staffed 24-hours a day and
are available to take reports over the phone and via VHF radio channels
16/22A when vessels are underway. These reports will be provided to a
Coast Guard Marine Inspector and/or Coast Guard Marine Casualty
Investigator for review and action, as appropriate.
Inspection Enforcement
Question 2. Up until the Conception, night watch requirements had
not been enforced. In the case of the Conception, the annual inspection
was done by one inspector, against regulation that has mandated two
inspectors for several years. What is the Coast Guard doing to address
these failures, and in the case of the annual inspections, the specific
chain of command failures that allowed this violation for 2-3 years?
Answer. The requirement for a fire patrolmen to guard against and
give alarm in case of fire or other danger has been in place and
enforced by the Coast Guard for decades. In response to the loss of the
M/V CONCEPTION, the Assistant Commandant for Prevention Policy
chartered the Small Passenger Vessel Safety Task Force to review
applicable inspections policies and procedures. An outcome of this Task
Force is the Small Passenger Vessel (SPV) Risk Based Inspections
program, which requires more experienced marine inspectors to inspect
higher consequence vessels (``Tier I''), and mandates notifications and
reporting of results to the Officer in Charge, Marine Inspections
(OCMI) following annual inspections. Steps were also taken to improve
the verification of night watchman requirements. The Coast Guard does
not have any regulation mandating two inspectors for a vessel
inspection.

Question 3. When Coast Guard inspectors conduct annual, biannual,
and five-year inspections and certifications of small vessels like the
Conception, what is done to ensure they follow the regulations,
protocols, and safety checklists that the Coast Guard has in place?
Answer. Upon completion of each inspection, Marine Inspectors
document their findings in the Marine Information for Safety and Law
Enforcement (MISLE) database. Procedures established since the loss of
the CONCEPTION now require that their work go through a two-tiered
review process by their supervisors.

Question 4. Is there any documentation from the Coast Guard that
the inspectors checked the wiring for the outlets to Conception to
assure compliance with safety standards?
Answer. The MISLE database contains a series of system checks for
which the Marine Inspector acknowledges were completed. These various
systems are inspected per Coast Guard policy and guidance.
Tracking Deficiencies
Question 5.a. How does the Coast Guard track deficiencies of the
inspection program such as a lack of night watch enforcement and no
chain of command repercussions for one inspector inspecting a vessel?
Answer. The Coast Guard tracks identified deficiencies and reports
of violations in a database records program called MISLE. Through the
Coast Guard's Mission Management System (MMS), field units conduct
internal review of MISLE activities to identify and correct any
deficient actions, and Coast Guard Headquarters (CGHQ) conducts
external MMS audits to identify non-conformities. The Coast Guard does
not have any policy that requires two marine inspectors for a vessel
inspection.

Question 5.b. These may not even be in databases, so how would they
ever be able to be prioritized by algorithms?
Answer. Marine inspectors are required to document all found
deficiencies in the MISLE database. All licensed mariners are required
by law (46 USC 3315) to report known deficiencies to their local marine
inspectors during an inspection.
Report Release
Question 6. Why does the Coast Guard need to wait to release their
investigation report when other federal agencies have released or
partially released their reports?
Answer. Pursuant to 46 C.F.R. Sec. 4.23, the Coast Guard referred
evidence of potential criminal liability to the U.S. Department of
Justice (DOJ) very early on in the marine casualty investigation. In
response to an inquiry from Coast Guard, DOJ preferred that potential
witnesses did not testify at public hearings.

Question 7. The Coast Guard has been conducting their own
investigation, but has still not released it. Was the U.S. Coast Guard
allowed access to all the evidence before it was being discarded? Were
they allowed to see the subpoenaed evidence from the Truth Aquatics
office and remaining vessels? The recovered hull of the Conception
before it was cleaned up and the recovered debris and recovered items
were discarded?
Answer. Yes. Special Agents with the Coast Guard Investigative
Service were allowed access to the physical evidence.
Rulemaking Timeline
Question 8. The Advance Notice of Proposed Rulemaking for Safety
Management Systems for Domestic Passenger Vessels was issued on January
14, 2021, and the comment period ended on June 1, 2021. Only 113
comments were posted in the docket to this notice. During the hearing,
Rear Admiral John Mauger, I asked when we can expect this regulation to
be moved forward into a proposed rulemaking. Can you provide a clearer
timeline on when we can expect this regulation to be moved forward?
Answer. As detailed in the Unified Agenda, the Coast Guard is
actively working on the Notice of Proposed Rulemaking (NPRM) for the
Safety Management Systems (SMS) for Domestic Passenger Vessels
rulemaking. The NPRM will include our responses to the public comments
on the Advance Notice of Proposed Rulemaking for Safety Management
Systems for Domestic Passenger Vessels, published on January 15, 2021.
We extended the comment period to June 1, 2021 at the request of a
commenter. The Coast Guard anticipates publishing the NPRM next year.
Higher Qualified Inspectors
Question 9.a. Rear Admiral Mauger, you talked about Most
Experienced or Higher Qualified Inspectors. What are the
qualifications/experience of these Higher Qualified Inspectors?
Answer. The Coast Guard uses the Apprentice-Journeyman-Master (AJM)
model for determining competency levels of Marine Inspectors (MI).
Coast Guard ``Master'' Marine Inspectors are called Advanced Journeyman
Marine Inspectors. Advanced Journeyman Marine Inspectors (AJMI) have
obtained at least 5 MI qualifications and have at least 6 years of
experience conducting inspections in the field.

Question 9.b. Were Higher Qualified Inspectors in use in this way
during and before 2019 or is this a new designation? And if Higher
Qualified Inspectors were in practice during and before 2019, in what
years were Higher Qualified Inspectors present during inspections of
passenger vessels owned and operated by Truth Aquatics?
Answer. The AJM model has been used since 2011. AJM includes a
combination of qualifications and time-based experience. The standard
for authorizing a marine inspector to complete an inspection on a
particular vessel is based on documented qualification earned through a
combination of on-the-job training, classroom work or online training,
knowledge and performance checks by senior inspectors, and a final
interview board. This was the model for all vessels, including the
CONCEPTION, before 2019. However, prior to the CONCEPTION tragedy the
Coast Guard did not require a heightened competency level to conduct
inspections. In 2021, the Coast Guard implemented the SPV Risk Based
Inspection program, which included requirements for AJMIs to complete
certain inspections. This requirement ensures more experienced
inspectors are assigned to these inspections.

Question 10. How long has the Coast Guard been without highly
qualified inspectors? Please confirm the number of highly qualified
inspectors the Coast Guard currently has and the number in the training
program you referenced to become highly qualified inspectors.
Answer. The Coast Guard began designating individuals in 2011 as a
result of the 2010 Marine Safety Enhancement Plan.
The Coast Guard has a total of 410 members with the AJMI competency
designation and 137 of those individuals are assigned to operational
units. The remaining 237 members are in senior leadership positions or
in staff assignments and do not currently perform marine inspections on
routine basis, but may be in a position to supervise these inspections.
There are 241 Journeyman Marine Inspectors and 423 Apprentice Marine
Inspectors who are working towards obtaining the required qualification
or experience required before they are eligible for the AJMI
competency.
Small Vessel Compliance
Question 11. How is the Coast Guard working to ensure that crews on
small passenger vessels are complying with the requirements to maintain
an overnight watch?
Answer. After the loss of the M/V CONCEPTION, the Coast Guard
initiated a nationwide concentrated inspection direction to review each
vessel that conducts overnight operations. Each OCMI selects
experienced marine inspectors to re-inspect each vessel and review
their Certificate of Inspection and vessel operations to ensure that a
roving watch was implemented. Some Coast Guard Sectors tasked law
enforcement vessels to conduct operations to perform at-sea night
approaches or boardings to confirm compliance with roving watch
requirements.
Implementation Date
Question 12. Regarding the implementation of a monitoring device to
ensure a roving watch is on duty, you stated that plans from vessel
owners were to be submitted by March 28, 2022, but gave no projected
implementation date. Why the delay and when will this life saving
requirement be implemented?
Answer. The delay allows operators the flexibility to choose an
arrangement of devices that would meet the requirements set forth in 46
C.F.R. Sec. Sec. 122.410(b) and 185.410(b), while allowing the Coast
Guard the necessary time to evaluate technology capable of achieving
the requirements. Within the interim final rule, we welcomed public
comments on the types of systems that are preferable or already in use,
if any. Upon conclusion of the comment period on June 27, 2022, the
Coast Guard is considering all comments in regards to the monitoring
device, and will determine a reasonable implementation timeline.
Civilian Inspectors
Question 13.a. Were/are civilian contracted inspectors being used
by the U.S. Coast Guard? If so, how many in the past and currently?
Answer. The Coast Guard does not use contracted civilians to
conduct statutory inspections. As required in 14 U.S.C. Sec. 312(b),
the Coast Guard utilizes officer, member, or civilian employees of the
Coast Guard to conduct marine inspections. There are currently 145
civilians in Apprentice, Journeyman, or Advanced Journeyman billets, of
which 12 are Advanced Journeyman and 118 are Journeyman.

Question 13.b. Does the Coast Guard plan on expanding its workforce
of civilian marine inspectors?
Answer. The proposal following the 2010 Marine Safety Enhancement
Plan was to grow the Coast Guard's civilian inspector workforce to 30
percent of the total marine inspector workforce. To date, the Coast
Guard civilian workforce constitutes approximately 28 percent of the
marine inspections workforce. The Coast Guard routinely analyzes
workforce capabilities based on workload. The requirement for a more
experienced inspector to conduct high consequence SPVs has been added
to the workforce analysis. Training, billet assignment, and resource
proposals will be adjusted to meet the increased need.
Inspections
Question 14. Do Coast Guard Inspectors inspect the same vessel(s)
multiple years in a row?
Answer. Each OCMI will assign marine inspectors per qualification
and proficiency requirements, as necessary to accommodate staffing,
workload, transfers and other constraints. OCMIs are encouraged to vary
inspectors annually, or send multiple inspectors pending resource
availability and training needs.
Board Investigation Review
Question 15. Will the Marine Board Investigation be available for
review prior to the trial of Captain Jerry Boylan or only after the
conclusion? If not until after, how long after the conclusion of the
trial of Captain Boylan do you expect it will be before the Coast Guard
will release the findings of the Marine Board Investigation?
Answer. The Marine Board of Investigation's (MBI) final report will
not be available until the criminal proceedings have been adjudicated.
The MBI is unable to provide an estimated timeframe for completion.
Once the criminal cases are adjudicated, the MBI will likely hold
public hearings to gather additional evidence that was outside the
scope of the criminal investigation.
Vision Inspection
Question 16. How was it possible for the Vision, sister ship to the
Conception owned by Truth Aquatics, Inc. at that time, to pass
inspection on April 4, 2019, with no deficiencies, but when re-
inspected on September 6, 2019, after the Conception disaster, 26
deficiencies were found, many relating to major electrical hazards?
Answer. A team of four MIs conducted the inspection of the VISION
on September 6, 2019 (versus one in April 2019), and were following
CGHQ directed concentrated inspection guidance that focused on fire
detection and firefighting equipment, means of escape, crew training
(including roving patrol requirements), passenger safety orientation,
and electrical installations.

Question 17. I reviewed the inspection of the Conception and the
Vision from February 2019. This was their annual inspection. The
Conception was also dry docked. They had the same inspector for the
past 5 years and the same dry dock inspector for the past 4 years. The
MV Vision was also inspected in April 2019 and she also had no
deficiencies. She was re-inspected on September 6, 2019, two days after
the Conception disaster. She had 26 deficiencies. I can only assume the
MV Conception had the same quality inspection the previous spring time.
How do you explain this?
Answer. The Coast Guard notes that a Captain of the Port (COTP)
Order was issued to the M/V VISION on September 6, 2019, four days
after the CONCEPTION tragedy. The COTP Order prohibited vessel
operations until a satisfactory Coast Guard inspection was completed.
This inspection was later conducted on October 2, 2019, as part of a
Coast Guard concentrated inspection campaign. The April 2019
inspections of VISION and CONCEPTION were conducted by a single Coast
Guard MI, which is a practice used at smaller Marine Safety Offices
that are billeted with as few as a single qualified MI and consistent
with Coast Guard regulations. A standard inspection starts with a
review of documentation, testing of vessel machinery and crew
knowledge. As the MI proceeds through the vessel, they will expand
their inspection to look at any new or modified systems.
Examining Wreckage
Question 18. Is the Coast Guard examining the recovered battery
husks and electronic equipment to determine what role they played in
the fire?
Answer. The MBI does not have access to the physical evidence.
However, the MBI is relying on the analysis of fire investigators from
the Bureau of Alcohol, Tobacco, Firearms, and Explosives.
Lithium-ion Batteries
Question 19.a. Before the fire involving the Conception, were any
inspectors aware that a fire occurred previously on the Vision in
October 2018 involving a lithium ion battery powered flashlight that
was charging in the salon?
Answer. The evidence collected by the MBI indicates that the M/V
VISION incident was never reported to the Coast Guard, because the 2018
incident did not reach the threshold of a reportable marine casualty
under 46 C.F.R. Sec. 4.05, and so Truth Aquatics was not required to
report it to the Coast Guard.

Question 19.b. What was done to investigate this as a potential
cause after the Conception fire occurred?
Answer. The MBI is investigating the possibility that a lithium-ion
battery may have been the source of the fire. The National
Transportation Safety Board (NTSB) also conducted an independent
investigation into the incident, and their final Marine Accident Report
determined that the unattended charging of the lithium-ion batteries
could have been the ignition source of the fire.

Question 20. Did the Coast Guard become aware of information from
any federal agency involved in the investigation of the Conception
suggesting that lithium ion batteries or lithium ion powered devices
caused or contributed to the fire? If so, what information did you
obtain and from whom?
Answer. Yes. The NTSB's Marine Accident Report for the CONCEPTION
fire concluded that the unattended charging of lithium-ion batteries
was one of several possible ignition sources of the fire.

Question 21. Lithium battery fires have proven to be dangerous and
deadly. Has the Coast Guard come up with any requirements for vessel
owners as far as fire suppression of these type of fires?
Answer. The Coast Guard has published CG-CVC Policy Letter 20-03
providing guidance to OCMIs and MIs on how to evaluate the use of
lithium-ion batteries aboard SPVs in their ports, and to assess whether
the storage, charging, or use of these batteries creates potentially
hazardous conditions.

Question 22. Are there plans to require fire suppression training
for the owners of small passenger vessels in regard to lithium battery
fires? These fires seem to be unique in how they burn faster and hotter
and pose challenges for those putting them out.
Answer. At this time, the Coast Guard has instructed OCMIs and MIs
to assess the storage, charging, or use of lithium-ion batteries aboard
SPVs in their ports. MIs have been directed to restrict the operations
of any company failing to mitigate or properly manage severe unsafe
electrical or fire hazards found aboard their vessels.
New Small Vessel Regulations
Question 23. It's my understanding that on March 28, 2022, the U.S.
Coast Guard is issuing new small vessel regulations. I appreciate this
and the Coast Guard's effort, but it appears that regulations are only
a small portion of the problem. How can the victims' families be
reassured that not only these new regulations and existing ones will be
vigorously and completely enforced, like if someone's life depended on
it?
Answer. The Coast Guard is responsible for setting the standards
for safety, security, and environmental stewardship for commercial
vessels and mariners, ensuring compliance with those standards, and
conducting investigations of violations and accidents. We keep the
family and friends of the 34 victims aboard the CONCEPTION in the
forefront of our minds as we continue to make enhancements to our
marine safety program, to help the maritime industry avoid future
preventable tragedies. We have improved our targeting of SPVs for
enhanced oversight, which has proven effective in identifying and
remedying unsafe conditions on passenger vessels. We continue to seek
regulatory enhancements to improve the material and operational safety
of SPVs. We also continue to improve our marine inspector knowledge and
proficiency through an expansive revision of our training program.
Lastly, we will assess the implementation of any additional safety or
oversight recommendations that result from the CONCEPTION casualty
investigation.
Vessel App
Question 24. At approximately the one hour and four-minute mark of
the meeting on the 21st of March, you stated that there is a mobile
inspection app that your inspectors use. Have there been any thoughts
or discussions regarding an app for small passenger vessel employees?
For instance, you could have every owner fill out their vessel's
information in an app. When they hire an employee (cook, deckhand, etc)
the owner is to add that person to his/her app page. That person is
then emailed a link to set up their own private user/employee account
linked to the owner/vessel. When the employee signs into their private
account, they are first asked if they were provided with safety
training, with boxes of easily clickable topics. They also fill out the
date/time and with whom they received their safety training from. This
information would then be sent to that person for confirmation. Upon
completion of their safety training, they would be required while at
sea to access the app. Daily they would be asked: ``Who will be
providing fire watch/roving patrol duties tonight?'' A drop-down menu
could appear, and an employee would be selected. Another question could
be: ``Have you seen anything regarding safety or other issues (i.e.,
sparks, smoke, unsafe practices) aboard the vessel?'', with a follow up
question regarding if the employee had reported it to the captain. The
next day the employee could be asked if indeed that person they listed
the day before provided fire watch. They are also required to certify
every day that to the best of their knowledge that all their answers
were truthful. If there were any ``no'' answers or concerns, it would
alert the safety inspector. I took note that 4G networks now reach up
to 60 miles off coast since 2020, I would imagine that a lot of small
passenger vessels fall within these parameters. The cost benefit
analysis I believe would be positive. It would also provide data to
safety inspectors out in the field in real time, as to where their
priorities should be focused. If the app is set up to be user friendly,
it would take minimal effort and time for the employee to log in their
answers daily. Has something like this ever been discussed?
Answer. The Coast Guard is not considering development or
implementation of a mobile application for SPV employees as described.
Commercial entities offer vessel and crew management software
solutions.
Preventative Maintenance System
Question 25. Why would a preventative maintenance system NOT be
considered part of a safety management system?
Answer. The Coast Guard is evaluating the inclusion of preventative
maintenance requirements in its Safety Management Systems for Domestic
Passenger Vessels rulemaking under the requirements detailed in 46
U.S.C. Sec. 3203(a).
Potential Regulations
Question 26. What non-monetary considerations does the Coast Guard
utilize to evaluate potential regulations? How are those non-monetary
considerations weighed in the evaluation?
Answer. When reviewing and evaluating potential regulations on this
subject, the Coast Guard would consider NTSB recommendations, Federal
Advisory Committee recommendations and input, and any other public
comment received. In addition, the Coast Guard's evaluation of
potential regulations is guided by International Maritime Organization
(IMO) agreements and direction provided by the Coast Guard's Marine
Safety and Security Council. The Coast Guard evaluates all data,
information and recommendations from other entities regardless of
whether they are monetary or non-monetary.
Safety Requirement Costs
Question 27. What parameters are used to determine if safety
measures are too burdensome to require? What mathematical formula/s are
used to calculate Corporate/Owner financial cost? What considerations
are used to determine these costs?
Answer. Executive Order (EO) 12866 and OMB Circular A-4 direct
regulatory agencies such as the Coast Guard to maximize net benefits of
potential regulations. EO 12866 states that ``In choosing among
alternative regulatory approaches, agencies should select those
approaches that maximize net benefits (including potential economic,
environmental, public health and safety, and other advantages;
distributive impacts; and equity), unless a statute requires another
regulatory approach.'' The regulatory aim of the Coast Guard is to
maximize net benefits, i.e., satisfying the safety objectives in the
least burdensome way possible.
The Coast Guard maximizes net benefits by estimating and
aggregating the individual financial costs and comparing those to the
benefits estimated for each provision to determine the net benefits or
costs of the rule as a whole. Reviewing several alternatives--with
safety measures that include differing costs and benefits--also assist
to maximize the net benefits.

Question 28. What demarcation renders a safety requirement
beneficial or detrimental (rejected)?
Answer. The effectiveness of a proposed safety requirement is
measured by assessing net benefits from the calculations of the
estimated costs and benefits. However, the utilization of cost-benefit
analysis (as outlined by EO 12866 and OMB Circular A-4) is only one
tool used in assessing whether an agency should implement a new safety
measure. To perform this analysis, we estimate the costs and benefits
for each provision of a proposed or final rule and leverage Subject
Matter Experts within the Coast Guard or industry to determine the
effectiveness of any safety measure. No singular line or demarcation
dictates whether a safety requirement would be implemented or would not
be implemented (rejected).

Question 29.a. What is the numerical amount at which safety
measures are rejected as requirements?
Answer. There is no specific number at which a safety measure is
rejected as a requirement. Absent a Congressional mandate, the Coast
Guard, like all federal regulatory agencies, evaluates and assesses all
information, analyses, risks assessments, historical accidents and
public comments in the development and implementation of safety
measures.

Question 29.b. Which economic costs are considered?
Answer. Regulatory agencies are required to consider all economic
costs as part of any regulation as guided by EO 12866 and OMB Circular
A-4. Some examples of potential costs are equipment/material costs,
installation costs, maintenance costs, cost of time for installation/
maintenance of equipment, training costs, cost of time for training,
additional staff costs, opportunity cost if business models change, and
lost revenue from changes to activity.

Question 29.c. What formula/s are used to calculate economic costs?
Answer. There are no specific formulas used to calculate economic
costs in a regulatory analysis for a rulemaking. Most of our regulatory
analyses use basic arithmetic. We follow the principles and guidance of
EO 12866 and Circular A-4. In addition, our regulatory analyses provide
transparency so that a reader can replicate the math.

Question 30. Which entities provide data for the above
calculations?
Answer. Regulatory agencies are required to use the best, most
readily available information when considering regulations. EO 13563
states, ``Each agency is directed to use the best available techniques
to quantify anticipated present and future benefits and costs as
accurately as possible.'' The Coast Guard gathers data from industry,
subject matter experts, public databases, public comments, and any
other source that is reputable and readily available.

Question 31. For instances yielding rejections of key safety
measures due to cost, is there a process for developing alternative
solutions that can be required?
Answer. Regulatory analyses are required to consider alternatives
as part of the rulemaking process. The alternatives considered may be
more or less stringent than the regulation. In the development of a
rulemaking, the Coast Guard leverages the public comment period of a
proposed rule to receive additional information and data that would
assist the Coast Guard in assessing or implementing any alternative
solutions.
Black Box Instrument
Question 32. How much does a ``black box'' type instrument cost the
Owner/Operator? What source/s were used to provide that cost? What
affordable measures could provide similar data and benefits?
Answer. There are currently two types of ``black box'' type
instruments that are used by large commercial vessels that make
international trips: the Voyage Data Recorder (VDR) and the simplified
Voyage Data Recorder (SVDR). They are very similar in that they both
have the same specifications, with the exception that the SVDR records
less information. They differ in that the VDR records all items below,
and SVDR only what is marked SVDR. In the Coast Guard's VDR Report to
the House Committee on Transportation and Infrastructure (``Voyage Data
Recorder: A Cost Benefit Analysis'', Report to Congress April 28,
2022), we concentrated on VDRs as opposed to SVDRs due to fact that our
in-scope vessels used these primarily.
VDR costs incorporate not just the device itself, but also
installation, maintenance, and testing costs. Installation costs could
be significant due to all the wiring required to connect the input
devices (i.e., radar, wireless set, inputs from voice microphones,
etc.). There are also maintenance and testing costs associated with
VDRs, but these are small relative to the cost of the purchasing and
installing the VDR. Our outreach to several industry groups (including
manufacturers and installers) provided price ranges for VDRs. New VDR
system for large commercial IMO vessels in 2019 ranged from $22,562
(minimum), to $45,781 (median), to $69,000 (maximum). With an average
VDR lifespan of 13 years, cost calculations factor in depreciation.
There are currently two alternatives to VDRs: The SVDR and the Rose
Point Electronic Charting System, a proprietary system produced by the
company Rose Point. The SVDR records less data than a VDR, implying a
slightly lower cost black box due to the reduced costs associated with
wiring the needed inputs (as the SVDR measures less data than the VDR).
The Rose Point Electronic Charting System is a software application
that provides a vessel with the ability to record a variety of data
such as position, radar imagery, etc., similar to what VDRs and SVDRs
are able to record. Unlike SVDR, a VDR is recoverable under the worst
conditions (i.e. recovery from ocean depths, or survivability from
extreme damage, even if the vessel is otherwise badly damaged, but does
not sink).
Warning Systems
Question 33. What warning signage and/or systems for direct
passenger communication, education, and knowledge has the Coast Guard
actively put into place, will be putting into place, and considering
putting into place?
Answer. 46 C.F.R. Sec. Sec. 122.506 and 185.506 require all SPVs
to conduct a passenger safety orientation detailing the location of
emergency exits, stowage of life jackets and how to don a lifejacket,
and the location of the vessel's emergency procedures and instructions.
Furthermore, 46 C.F.R. Parts 122 and 185 have additional requirements
for emergency instruction placards and emergency signage. The Coast
Guard currently has no rulemaking projects on the Unified Agenda, nor
policy documents for changes to these requirements.
NTSB Concerns
Question 34. What has the Coast Guard put into place to address the
NTSB concern about escape area options and what are the Coast Guard
plans to address this more fully in the future?
Answer. The NTSB made recommendations to review the suitability of
Subchapter T regulations regarding the means of escape for vessels
constructed prior to 1996. The December 2021 Interim Final Rule with
request for public comment for Fire Safety of Small Passenger Vessels
implemented new applicability provisions in 46 C.F.R. Sec. Sec.
116.115(c) and 177.115(c), requiring vessels regulated by Subchapter T
or K that have overnight accommodations for passengers, regardless of
build date, to comply with the requirements for means of escape in
Sec. Sec. 116.500 and 177.500. Also included within the Interim Final
Rule are provisions that prevent a door, hatch, or scuttle utilized as
an avenue of escape to be located directly above or dependent on a
berth, for vessels regulated by Subchapter T or K that have overnight
accommodations for passengers, as outlined in revised Sec. Sec.
116.500(o) and 177.500(n).
Kitchen and Dining Areas
Question 35. It is common knowledge kitchen and dining areas pose
high danger threats. Clearly there needs to be an escape strategy
circumventing that area. What has been done and what will be done to
warn passengers of, and hopefully protect them from, such danger?
Answer. Current SPV regulations do not specifically require that a
means of escape circumvent kitchen and dining areas. However, 46 C.F.R.
Sec. Sec. 116.500 and 177.500 require that each passenger-accessible
space must have two means of escape. Due to the design of most vessels,
one of those means of escape likely circumvents a kitchen and/or dining
space. Furthermore, additional safety measures are in place for cooking
equipment due to the recognized potential hazard.
Public Site
Question 36. Is there a site for the public to read about the Coast
Guard steps being taken and their current status as related to these
laws?
Answer. Yes. The most current Coast Guard safety regulations can be
found at https://www.govinfo.gov/app/collection/cfr/2021/. The status
of rulemaking projects being undertaken by the Coast Guard are listed
on the Unified Agenda and can be viewed here: https://www.reginfo.gov/
public/do/eAgendaMain.
Most Important Knowledge
Question 37. As an esteemed safety and protective entity
specialized in this area, based on the 9/2/19 tragedy, what does the
Coast Guard see as the most important safety tools and knowledge to
provide passengers and the public their tragedies affect?
Answer. The Coast Guard provides updates to the public, including
mariners, regarding safety best practices through Marine Safety
Information Bulletins (MSIB). These can be found here: https://
www.dco.uscg.mil/Featured-Content/Mariners/Marine-Safety-Information-
Bulletins-MSIB/.
As an example, the Coast Guard released the following MSIB after
the CONCEPTION marine casualty: https://www.dco.uscg.mil/Portals/9/
DCO%20Documents/5p/MSIB/2019/MSIB_008_19.pdf?ver=2019-09-10-115632-287.
The Coast Guard Maritime Commons website is also a great resource
for passengers and mariners alike: https://mariners.coastguard.blog.
The public may view Coast Guard vessel compliance information and
policy by visiting the Office of Commercial Vessel website at: https://
www.dco.uscg.mil/Our-Organization/Assistant-Commandant-for-Prevention-
Policy-CG-5P/Inspections-Compliance-CG-5PC-/Commercial-Vessel-
Compliance/.
Finally, the public may find contact information for the local
Captain of the Port/OCMI by visiting the Port Directory at https://
homeport.uscg.mil.

Questions from Hon. Salud O. Carbajal to Hon. Jennifer Homendy, Chair,
National Transportation Safety Board

Introduction to responses from Hon. Jennifer Homendy, Chair,
National Transportation Safety Board: Thank you again for the
opportunity to discuss our marine accident investigations and the
lessons we have learned from those investigation. I am pleased to
answer the additional questions posed by Representative Carbajal,
below.
As I emphasized in my testimony, in just the last ten years, the
NTSB's Office of Marine Safety has dramatically increased its number of
investigations. Before 2012, the office investigated and developed six
reports annually on average. Now, the caseload is over 40 per year, and
at times over 50, while the cases have also grown more complex.
However, our marine investigative staff has not grown with that
increase, and we currently have 11 marine investigators. It is critical
to have additional resources to respond to casualties without impacting
timeliness, quality, and our independence. Our reauthorization proposal
to Congress included a request for resources and hiring flexibilities
to increase the number of investigators in our Office of Marine Safety,
as well as in our other modes. These resources will allow us to hire
professionals with the needed skills, purchase the equipment necessary
for those skilled professionals to do their jobs, and invest in staff
training and development. Our workforce is our greatest asset and is
essential to our mission.

Question 1. Why was the NTSB stopped from completing their
investigation that did not include crew interviews?
Answer. The NTSB was not stopped from completing any aspect of the
safety investigation. NTSB investigators interviewed three of the five
surviving crewmembers and received needed information regarding the
vessel's history, operations, systems, and maintenance.
There are always unique challenges that come with concurrent safety
and criminal investigations. Criminal investigations can impact the
timeliness of the NTSB's reports and issuing timely and accurate
reports improves safety. However, the NTSB is committed to working with
our law enforcement partners, to ensure that both criminal and safety
investigations are addressed.
In the case of the Conception, the NTSB was unable to speak with
the captain of the vessel due to the ongoing criminal investigation.
That interview could have provided additional information regarding the
vessel's history, operations, systems, and maintenance.

Question 2. When the vessel and debris were salvaged and taken to
Port Hueneme, the NTSB was prevented from entering and assisting for
weeks. Why?
Answer. NTSB investigators were not prevented from entering and
assisting at the examination site at Port Hueneme. NTSB investigators
were present when the Conception's hull arrived at the site and was
offloaded on September 13, 2019. Following the placement of the hull,
NTSB investigators were informed that it would take multiple days to
construct securing apparatus and scaffolding around the hull. Based on
this information, NTSB investigators departed Santa Barbara and
returned on September 25 and 26 after being informed the scaffolding
and securing apparatus was in place.

Question 3. Without complete access to all the evidence from the
salvaged vessel, salvaged and recovered debris, was the NTSB able to
complete the investigation?
Answer. The NTSB evaluated all available evidence from the salvaged
vessel, recovered debris, and testimony in completing its
investigation.

Question 4. The NTSB speculated that they would be able to
determine the cause of the fire through their investigation. This was
even told to the victims' families. They also speculated that the fire
was so fast, so hot and so furious that it most likely was a ``lithium
ion'' battery. On February 13, 2020 the FBI provided the NTSB
investigators a hard drive with scans of documents and photos taken
from the FBI Evidence Response Team. Did the NTSB ever get an
opportunity to inspect the electronics, batteries, and chargers that
were recovered? It seems that this part of the investigation would have
been exhaustive and extensive. The NTSB report seems to be lacking in
this coverage. How was the NTSB able to complete their investigation
without this? It's my understanding that the investigation should have
been complete, inclusive after all 34 people died and it's also a part
of a criminal investigation / prosecution.
When the NTSB did return to the Conception hull the next time, they
found that the salvaged hull of the Conception was pretty much all
cleaned up for them. It appears someone decided all the remaining
debris wasn't of any value and discarded. Is this true and how can we
ensure the NTSB has the ability in the future to review, preserve the
integrity of evidence, and investigate after other investigators (i.e.
Department of Justice or the Coast Guard) have had a chance to review?
Answer. NTSB investigators had an opportunity to inspect the
remains of all chargers, electronics, and batteries that were recovered
and processed by the Federal Bureau of Investigation (FBI) Evidence
Response Team.
During the investigation, NTSB investigators were in constant
communication with the U.S. Coast Guard (USCG), FBI, and the Bureau of
Alcohol, Tobacco, and Firearms (ATF) regarding the wreckage. Before the
NTSB returned to the wreckage examination site, debris and materials
from inside the hull were removed and processed by fire and evidence
experts with the FBI and ATF. Their efforts allowed NTSB investigators
to more efficiently review the wreckage. The NTSB maintains open
communication with other investigative agencies and will continue to do
so to ensure that the investigative needs of both the safety and
criminal investigations are met.
Lithium-ion batteries were one of many possible sources of the fire
that investigators analyzed. The area where the fire was reported to
have been first observed was destroyed, leaving minimal evidence to be
examined. Since the boat, particularly the salon and aft deck area, was
so consumed by fire, we could not conclude based on the physical
evidence that the batteries initiated the fire or whether the batteries
were exposed to the fire.

Question 5. Chair Homendy: ``The NTSB investigated the accident
under the authority of Title 49 United States Code (USC) 1131(a)(1)(E).
. . . and there was no request from either the Attorney General or any
other federal agency to the NTSB to relinquish investigative priority
under 49 USC 1131(a)(2)(B). Accordingly, the NTSB retained
investigative priority for the Conception accident throughout.'' Chair
Homendy, you were never allowed to visit and inspect the vessel when
they were first brought into Port Hueneme; the vessel was, ``At the
examination site, NTSB investigators found that most loose items
contained within the hull of the Conception had been removed, and items
determined by law enforcement investigators to be non-relevant were
placed into large plastic bags for disposal.''
Furthermore: The owner of Truth Aquatics, who was permitted to
inspect the wreckage at a later date with the insurance investigators,
advised the NTSB during the technical review of the fire and explosions
factual report that there were ``many parts of the upper deck. . . .
discovered during [Truth Aquatics'] site visit in piles and plastic
bags off to the side.'' When the items were confiscated by the U.S.
Attorney General and FBI from the Truth Aquatics office, you were not
allowed to participate, the information seized was scanned and
photographed and shared the following year. The electronics, lithium
batteries, chargers, cell phone, computers, underwater video cameras,
underwater cameras, strobes, dive computers, etc. Any electronic items,
and especially those with rechargeable batteries, you were never
allowed to examine, inspect, touch, or send off to your experts for an
independent examination.
Does this occur often that you are not allowed to participate in
the inspection of the vessel, involved in gathering evidence from the
office or sister vessels, and not allowed to inspect the electronic
evidence?
Answer. Every maritime safety investigation conducted by the NTSB
is done concurrently with the USCG Each agency cooperates during the
fact-finding portion, and then does its own analysis and report. At the
initial notification, one agency is designated as the lead. In this
case, the NTSB was made the lead investigative agency for the safety
investigation. When there is the possibility of a criminal prosecution,
as in this case, the NTSB works alongside the FBI, ATF, and USCG. NTSB
investigators were present when the wreckage and belongings were
recovered.
There are always unique challenges that come with concurrent safety
and criminal investigations. The NTSB continues to work closely with
the DOJ to ensure that the needs of both investigations are met. The
NTSB was not stopped from completing any aspect of this safety
investigation.

Question 6. Why would a preventative maintenance system NOT be
considered part of a safety management system?
Answer. A preventative maintenance system is typically an element
of a safety management program and is required for safety management
systems that are certified under the International Safety Management
Code.
Since 2002, the NTSB has been urging the USCG to address preventive
maintenance programs and safety management systems. We have issued two
safety recommendations:

M-02-5: Require that companies operating domestic passenger
vessels develop and implement a preventive maintenance program
for all systems affecting the safe operation of their vessels,
including the hull and the mechanical and electrical systems.
(Open--Unacceptable Response)

M-12-3: Require all operators of U.S.-flag passenger vessels to
implement safety management systems, taking into account the
characteristics, methods of operation, and nature of service of
these vessels, and, with respect to ferries, the sizes of the
ferry systems within which the vessels operate. (Open--
Acceptable Response)

For two decades, the NTSB has advocated for all passenger vessel
operators to implement a safety management system, and it has been on
our Most Wanted list for a decade. The NTSB has been waiting twelve
years for the Coast Guard to issue regulations that would require
passenger vessel operators to implement safety management systems, a
comprehensive, documented system to enhance safety.
For marine passenger vessels, regardless of a company's size, an
SMS ensures that each crewmember is given standard and clear procedures
for routine and emergency operations. An SMS specifies crewmember
duties and responsibilities, as well as delineates supervisory and
subordinate chains of command, so that each crewmember understands what
to do during critical vessel operations and emergency scenarios.
Developing an SMS includes creating plans for crewmember responses to a
range of possible emergency situations. SMSs also include procedures
for performing and tracking preventive maintenance, as well as for crew
training, emergency preparedness, documentation and oversight, and
other actions that prioritize safe operations.