The audio is chilling—the conversations between the officer of the deck and the captain of the USS Porter (DDG-78) in the moments that preceded the collision of two massive ships. This tape is played as part of a bridge scenario during the pipeline training of every surface warfare officer for the past several years. As the one-year mark passes of the deadly Seventh Fleet collisions that took the lives of our shipmates, having read—and written—a number of articles, blog posts, and discussions about the lessons learned, I find myself coming back to one conclusion: the Navy is failing to capture an opportunity to mitigate or prevent another mishap by not disclosing the detailed results of the investigations.
To protect its legal case, the Navy has placed the contents of the investigation under lock and key to prevent disclosure of information that could be damaging. As a result, many of the findings of fact and recommendations of two highly qualified officers are not available to the rest of the fleet, and this comes at the expense of possible improvements that could save lives and prevent future mishaps. An example was shared by Vice Admiral Joseph Aucoin in a recent Naval Institute podcast; as commander, Seventh Fleet, he was unable to access to the report of a collision from a Third Fleet ship in his area of responsibility (read that again and let it sink in). A few months later, two collisions killed seventeen sailors. Would some tidbit or observation from the previous event have prevented one of these? We will never know.
As I have previously shared in this forum, after the USS Porter (DDG-78) collided with an oil tanker in August 2012, I was appointed investigating officer, completed a JagMan report and reported the findings and a set of recommendations. I have been told that when the recent collisions occurred, staffs went scrambling to that document to see if there had been follow up. Now that I’m retired, I do not have access to that document and cannot see how the results played out, and my team (at least this member) was never approached in any official capacity to explore commonalities between the events. I believe one recommendation was to consider a policy mandating the use of a digital voice recorder on the bridge during certain transit evolutions to record the conversations to make it easier to reconstruct a collision. The bridge recording was a game-changer in the Porter investigation. If that recommendation were taken, we would have recordings of the events on the bridges of the USS John S McCain (DDG-56) and Fitzgerald (DDG-62) last year. At a minimum, they would have shaped the ongoing legal cases, but, more importantly, they could have shone light on lessons for future generations. While the Porter tape did not prevent the collisions last year; but did it may have prevented others. We will never know the past, and there is no way to prove a negative, but we can change the future by changing the policy now.
A few examples can illustrate the larger point—that the Navy has not become a true, transparent, learning organization:
- A recent Navy Times article shared that some of the families of those killed on board the John S. McCain and Fitzgerald reported learning more from the press than from the Navy about what happened on those nights, and that they were calling for the Navy to release the investigations. The Navy does liaison with the families, but this does not serve the broader purpose of sharing with the fleet.
- One active-duty officer reached out to me recently to discuss coauthoring an article on lessons from these events, then told me that the article was “shut down” by the local chain of command as “too controversial.”
- After a recent article of mine, “Time to Make a SWO Movie,” that seemed to be well received as a venue for sharing lessons with today’s video-savvy generation, nothing has happened; I was told that such a film cannot be made “for legal reasons.”
So much for Ready Relevant Learning!
The investigating officers of these two collisions moved on to other jobs and are in a position to take action on the recommendations from their documents—and, largely in the policy and procedures domain, they are. There also is a list of action items that was distilled from the “Comprehensive Review of Surface Fleet Incidents” (CR) and “Strategic Readiness Review” (SR). But what other lessons lurk in the pages of their hard work? While the clock ticks toward the next collision, what a shame if that investigating officer has to start out by scrambling around to see what detailed recommendations from Admirals Brown and Fort’s JagMan reports were not acted on. What opportunities for discussions in wardrooms, at all levels of Surface Warfare Officer School, and at the Naval War College are not being had because these reports are not available to the? I do not mean to denigrate the extensive corrective actions being undertaken in the SWO training pipeline, advances in crew endurance policy, and other laudable efforts, nor to imply that Navy leaders are not working to make course corrections. But as noted by many of my peers in the year after the CR and SR, even a group of very smart people will not dig out all of the possible lessons and improvements. What nuggets would our junior officers and academic mariners dig up from the complete reports?
I am getting tired of saying “we will never know.”
What is different this time? People died. Waiting for the litigation process to assign “percentages of fault” could take years. While the legal basis for withholding details may have been valid last time around, the stakes are higher now, and the benefits of officially sharing any lessons learned very soon—even if doing so entails an eventual financial cost in Admiralty Court—while Navy ships are plying the same dangerous waters around the world are worth considering; How soon is soon enough? I submit we are already past and opening. There were five years between Porter and Fitzgerald, two months between Fitzgerald and John S. McCain, and more than a year since the combined events that drove the CR. Let’s not wait for the next incident to decide.
