The destruction of space shuttle Columbia and the death of its seven astronauts were caused by a self-protective culture at Nasa, investigators said today.
The US space agency is driven by schedule, starved for funds and burdened with an eroded, insufficient safety programme, revealed the investigation into the disaster.
The Columbia Accident Investigation Board, in a wide-ranging analysis of decades of Nasa history, said the space agency's attitude toward safety is little improved since the 1986 Challenger disaster, which also killed seven, and that without fundamental changes more tragedies will occur.
"The board strongly believes that if these persistent, systemic flaws are not resolved, the scene is set for another accident," the report said.
In events leading up to the loss of Columbia, the report said, Nasa mission managers fell into the habit of accepting as normal some flaws in the shuttle system and tended to ignore or not recognise that these problems could foreshadow catastrophe.
This is an "echo" of some root causes of the Challenger accident, the board said. "These repeating patterns mean that flawed practices embedded in Nasa's organisational system continued for 20 years and made substantial contributions to both accidents," the 248 page report said.
During Columbia's last mission, Nasa managers missed opportunities to evaluate possible damage to the craft's heat shield from a strike on the left wing by flying foam insulation.
Such insulation strikes had occurred on previous missions and the report said Nasa managers had come to view them as an acceptable abnormality that posed no safety risk. This attitude also contributed to the lack of interest in getting spy satellite photos of Columbia, images that might have identified the extent of damage on the shuttle and came to incorrect conclusions.
But most of all, the report noted, there was "ineffective leadership" that "failed to fulfill the implicit contract to do whatever is possible to ensure the safety of the crew."
PA