Coroner backs family's anger with navy culture

Byron Solomon loved the navy and loved being at sea. His parents knew their son's fledgling career on a warship carried a degree of risk.

But they assumed his employers took seriously their responsibility to minimise any hazards.

"Byron was entitled to carry out his duties in the knowledge that all practical steps had been taken to ensure his safety," his mother, Jayne Carkeek, told the inquest into his death last February.

He drowned in October 2007 when a patrol boat launching exercise went wrong with HMNZS Canterbury making just over seven knots in a moderate swell off Cape Reinga.

He was trapped in the lifting strops of a Rhib (rigid hulled inflatable) which broached and overturned while still hooked up to its hoisting davit and may have been knocked unconscious.

It took 25 minutes to extract him from the upturned boat, despite frantic efforts by crew who jumped from the moving ship in defiance of standing orders.

Coroner Brandt Shortland's findings, released yesterday, back the family's long-held conclusion that the loss of life was foreseeable and avoidable and resulted in part from the navy's "make-it-work" culture.

Nearly four years on, Mr Shortland has linked the tragedy to the haste with which the $177 million ship was rushed into service.

Byron Solomon, 22, was a promising trainee navigator who had won awards and the respect of his naval colleagues and superiors. He was also a son, a trout fishing buddy to his father, Bill, and a brother to younger sisters Nicole and Deborah.

"They have had to complete their studies without him," Ms Carkeek noted yesterday, in her East Auckland home where portraits of Byron with his sisters feature prominently.

"It has been a traumatic experience having Byron ripped from our lives," she said. "We are left with grief and anger, a surreal disbelief of the tragedy we are now living with."

His drowning was inevitable, she said. Discrepancies between the contract requirements for the new ship and the capabilities of the Rhib launch system were masked by certification errors and the navy was tasked with making it work.

The navy had a culture of unsafe work practices, which made the incident "inevitable".

Yesterday, she slammed the oversight of the project by the joint Ministry of Defence/NZ Defence Force team.

"They were weak, there was no leadership, and they were in over their heads."

She is pleased with Mr Shortland's findings that the death was unnecessary and preventable and that pressure to rush the ship into service contributed.

Volendam Lifeboat Fatality: Davit Design Issue » Maritime Accident ...

Investigations into the failure of lifeboat falls during maintenance, which led to the death of a seafarer have identified the design of the vessel’s lifeboat davits as a possible contributor to the incident.

Two seafarers in a team greasing the vessel’s number seven lifeboat falls fell when the forward fall parted. One crewmember died, the other survived. Both had been wearing a safety harness attached to a safety line stretched between the forward and aft lifeboat lifting hook arrangements.

The hydraulic telescopic davits were manufactured by Italy’s Navalimpianti Tecnimpianti Group. The lifeboats were designed and manufactured by Schat Harding and were of the MPC 36 SV partially enclosed lifeboat design.

New Zealand’s Transport Accident Investigation Commission interim report into the accident aboard the Holland-America Lines Volendam in January 2010 says: “The Commission believes it is a safety issue that the design of the SPTDL-150P lifeboat davit does not facilitate a thorough examination or effective lubrication of the standing part of the wire falls where they pass around the fixed guides before terminating. Lack of effective lubrication in this area will promote rapid corrosion and possible premature failure of the wire rope fall. Difficulty in conducting a thorough examination of the wire rope in this area could result in the risk of possible premature failure of the wire rope going undetected.