US Coast Guard releases report calling Titan disaster a ‘preventable tragedy'
The submersible was on a commercial voyage to explore the wreck of the Titanic when it disappeared in the Atlantic, leading to the deaths of all five people on board. The ensuing search captured headlines around the world for days as it evolved from a potential rescue mission to a recovery operation.
On Tuesday, US Coast Guard investigators released their final report, spanning more than 300 pages, after a two-year investigation. What emerged was a scathing portrait of the company operating the Titan, OceanGate, and its CEO, Stockton Rush, who was among those who died.
Based on hearings involving more than two dozen people, including former employees, the report paints a picture of OceanGate as a company where employees were threatened with dismissal and belittled for raising concerns about safety. The result was a culture of downplaying, ignoring and even falsifying key safety information to improve its reputation and evade scrutiny from regulators.
'OceanGate's toxic safety culture, corporate structure, and operational practices were critically flawed and at the core of these failures were glaring disparities between their written safety protocols and their actual practices,' the report noted. 'For several years preceding the incident, OceanGate leveraged intimidation tactics, allowances for scientific operations, and the company's favourable reputation to evade regulatory scrutiny.'
Investigators found the Titan's design, certification, maintenance and inspection process were all inadequate.
'This marine casualty and the loss of five lives was preventable,' said Jason Neubauer, the chairman of the Coast Guard's Marine Board of Investigation, in a statement.
Employees told investigators Rush would often bypass established protocols and ignore the concerns of experienced employees and contractors.
'The cumulative effect was an authoritarian and toxic culture where safety was not only deprioritised but actively suppressed,' the report noted. 'This toxic environment, characterised by retaliation and belittling against those who expressed safety concerns combined with a lack of external oversight, set the stage for the Titan's ultimate demise.'
The report cited mounting financial pressures in 2023 as being behind a decision made by OceanGate to store the Titan submersible outdoors over the Canadian winter. 'During this time, the submersible was not covered or protected from the environmental elements, subjecting it to precipitation and repeated freeze-thaw cycles,' it said, likely leading to further degradation of the hull's structural integrity.
Investigators concluded Rush had 'exhibited negligence' that contributed to the deaths of four people. Had Rush survived, the case would have likely ended up at the US Department of Justice and he might have been subjected to criminal charges, the report noted.
In addition to Rush, the implosion killed the French explorer Paul-Henri Nargeolet, the British adventurer Hamish Harding and British-Pakistani businessman Shahzada Dawood and his 19-year-old son, Suleman.
OceanGate then wound down operations and focused its resources on cooperating with investigators, a company spokesperson said on Tuesday. In a statement, he added: 'We again offer our deepest condolences to the families of those who died on 18 June 2023, and to all those impacted by the tragedy.'
OceanGate began ferrying dozens of paying customers and researchers to the site scattered with debris from the Titanic in 2021, characterising the voyages as part of an ambitious push to foster deep-sea tourism.
Last year, the family of Nargeolet filed a wrongful death lawsuit seeking more than $50m amid accusations that the 'doomed submersible' had a 'troubled history', and that OceanGate had failed to disclose crucial facts about the vessel and its durability.
Neubauer expressed optimism that the investigation would help to prevent future tragedies. 'There is a need for stronger oversight and clear options for operators who are exploring new concepts outside of the existing regulatory framework,' he said.
That view was echoed by the Dawood family. 'No report can alter the heartbreaking outcome, nor fill the immeasurable void left by two cherished members of our family,' they said in a statement. 'We believe that accountability and regulatory change must follow such a catastrophic failure.'
The hope was that the tragedy would mark a turning point for the submersible industry, the family added. 'If Shahzada and Suleman's legacy can be a catalyst for regulatory change that helps prevent such a loss from ever happening again, it will bring us some measure of peace.'
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