When Alex Richman’s son “did not survive” the 1991 crash of US Air Flight 1493, his and his wife’s grief turned to frustration, then anger and finally resolve as they set out to make flight safer for all of us.
This column first appeared in the Halifax Examiner February 18, 2019
“Alex was laid to rest beside his son David in Shaarey Zedek Cemetery, Winnipeg on Sunday, February 3rd.”
—Obituary, Alex Richman
Halifax Chronicle-Herald, February 8, 2019
While researching Flight 111, my book about the 1998 Swissair crash off Nova Scotia, I first stumbled across the story of Alex Richman.
At first blush, there wasn’t much to connect Richman with the tragic events of Sept. 2, 1998. At the time, Richman was a respected psychiatrist and professor of epidemiology at Dalhousie University who specialized in applying epidemiology to planning and evaluating mental health services.
But it turned out his life — and that of his wife Shifra — had “dramatically changed” the day their son David, a brilliant young mathematician, “did not survive” the 1994 crash of US Air Flight 1493 crash in Los Angeles. Their grief turned to frustration, then anger and finally resolve as they set out to make flight safer, in part by applying Richman’s epidemiological expertise to the airline industry.
I became so fascinated with Richman’s story that, when I wrote the first draft of my book, it began with his story and that of another parent, Hans Ephraimson-Abt, an American whose 23-year-old daughter was killed when Soviet jets shot down Korean Airlines Flight 007 in 1983. Ephraimson-Abt went on to become one of the world’s leading lobbyists on behalf of those who lose their loved ones in plane crashes.
My editor gently, firmly, correctly made the point that readers of a book about a 1998 plane crash off Nova Scotia might not be willing to first read 11,000 words on two men who — though they each played peripheral roles in the Swissair aftermath — were not central to the story I was writing. Their contributions mostly ended up on the cutting room floor.
I was reminded of Alex Richman’s story again last week when I read his obituary in the Chronicle Herald. He had died in Halifax in late January at the age of 90, and is now buried beside his son in Winnipeg, the city where Alex and Shifra first met as graduate students in the early 1950s.
I was struck, not only by the obituary’s reminder of David Richman’s place of burial but also to a phrase in the text that referenced their son’s death: “did not survive,” a clear indication they still believed he could have, and should have survived.
As a tribute to Alex — and his widow Shifra — here is the story of how they turned their own personal tragedy into an important public service.
US Air Flight 1493
Halifax, February 3, 1991
Alex Richman saw the story on television. More than once. The networks had gotten spectacular video of a still burning aircraft on the runway at Los Angeles International Airport, so they repeated it endlessly. Alex Richman watched the images on CNN. He appreciated, in a detached, isn’t-that-interesting kind of way, the emotive power of the visuals. But he didn’t pay much attention to the particulars. It’s just a plane crash, he thought. It’s just the news. And this news had happened thousands of miles from his Halifax home. What could it possibly have to do with him?
Shortly after 6 p.m. on Friday, February 1, 1991, an air traffic controller at Los Angeles International Airport had authorized a US Air Boeing 737 jet with 89 passengers aboard to land on Runway 24 Left, not realizing a Skywest commuter aircraft with 20 passengers and a crew of two was already sitting on that same runway, awaiting clearance to take off. The huge jet plowed into the back of the tiny Skywest Metroliner, crushing it under its left side and dragging it 600 feet along the runway before the now fused-together planes finally veered left together and smashed into a vacant fire station at the edge of the runway.
Everyone aboard the Skywest plane died instantly as a result of the impact of the collision with the jet. But all of the passengers and most of the crew aboard the much larger US Air jet survived the crash itself, and were alive when the plane finally skittered to a stop. Most managed to escape within a minute or so through the plane’s emergency exits. But leaking fuel from the jet touched off a fire inside the plane, engulfing the forward cabin between the first class and coach sections in flames. For many of the passengers seated in the front section of the aircraft, their only possible escape route now was through the overwing emergency exits at aisle 10. But the passenger seated beside the opening in 10F “froze.” She couldn’t move, couldn’t make herself open the window exit beside her seat. Finally, another passenger seated behind her climbed over the seat, forced open the exit, pushed her out on to the wing, and then followed her to safety.
By then, however, the heat inside the aircraft had become unbearably intense, the smoke from the burning cabin linings thick, choking and toxic. And there were too many too desperate people trying to get through too small a passageway between the two rows of seats. Two male passengers even got involved in what a later report described as an “altercation” as they tried to force their way into the narrow exit aisle. They didn’t make it. They weren’t the only ones. In little more than a minute, 19 passengers and one flight attendant from US Air Flight 1493 were dead. They died of “asphyxia due to smoke inhalation” from breathing in poisonous carbon monoxide and hydrogen cyanide gases produced by the burning plastic cabin linings, the medical examiner reported. Eleven of them had died within a few feet of the exit door. Among them was a mathematician whose body was found pinned between the seats in rows nine and 10. His name was David Richman.
Alex Richman knew that his son, a 34-year-old professor at the University of South Carolina in Columbia, was planning to go to Taiwan to spend three months of his sabbatical at the National University of Taiwan. They’d discussed those plans in a phone call a few days earlier. But he didn’t know exactly when, or on what flight David would be booked. Somehow, he simply didn’t connect the mundane reality that his son’s travel plans would take him through L.A. with that horrific image of the far-away burning plane he’d seen on his television screen.
Until he got the telephone call.
It came at 1 a.m. Sunday morning, more than 30 hours after the collision. Do you have a son named David? At first, Alex Richman couldn’t comprehend what the man at the end of the line was telling him. Then he couldn’t find the words tell his wife Shifra just what the man had told him. He had to hand her the telephone, had to ask the man to explain it again to his wife.
David, the second-oldest of their four grown children, was a brilliant young mathematician who’d attended Harvard, studied at M.I.T. and earned his Ph.D. from Berkeley by the time he was 23. His research into the intricacies of number theory, invariant theory, game theory and combinatorics may have seemed esoteric to outsiders — even, from time to time, to his own parents — but he was so passionate about whatever mathematical puzzle he was puzzling his way through at the time it was difficult not to get caught up in the grand sweep of his intellectual enthusiasm.
By February 1991, everything in David Richman’s life seemed to have fallen into place as neatly as a mathematical puzzle. After having been on the faculty at the University of South Carolina since 1982, he had earned tenure and was about to begin his first sabbatical. He’d also begun experimenting with an idea that would later become known in mathematical circles as Richman Games: two-player contests in which the players, instead of alternating turns, each bid a sum of money for the next turn, with the higher bidder paying the other player for the right to make the next move. The mathematical trick was that each player had to weigh how important it was to make the next move in the game against the wisdom of keeping the money to bid on later turns. Many fellow mathematicians had encouraged him to put his ideas on paper and he’d promised he would. But he never quite got around to it. He was simply too busy. His personal life had come together nicely too. He’d met Shu-mei, a Taiwanese woman who was a graduate student in one of his classes, and they’d gotten married in 1989. They had a 16-month-old daughter named Miriam, and Shu-mei was now six months pregnant with their second child.
Partly because of her pregnancy, partly because of visa problems back in her homeland and partly because she was in the process of finishing her own Ph.D. at the University of Virginia in Charlottesville, Shu-mei had decided to stay behind in the U.S. while David spent the first three months of his sabbatical conducting research in Taiwan. He would be back in plenty of time for the birth of their son in April.
But he wouldn’t.
David was dead.
Alex Richman tried to process that information. His mind wouldn’t handle it. Even as he and Shifra hurriedly packed and headed to the Halifax International Airport, where a plane was standing by to fly them to L.A., Richman — a highly respected psychiatrist and epidemiologist who prided himself on his pragmatic, just-the-facts approach to research — kept trying to come up with rational reasons to explain why David couldn’t or wouldn’t have been on that plane. Or scenarios in which David had somehow, soap-opera-like, survived the crash and fire, then wandered away from the plane, dazed but unhurt, and would — probably by the time they got to L.A. — have recovered and be waiting at the airport to greet them. They’d have a good laugh about it then.
But they wouldn’t.
In the beginning, Alex Richman remembers today, US Air couldn’t have responded more professionally or sympathetically. The man who telephoned to tell them David was dead was a former military officer with plenty of experience in notifying next of kin. He was, says Alex, “sensitive and solicitous.” Later, he attended David’s funeral service.
The airline flew Alex and Shifra to Pittsburgh, one of its regional hubs, so they could meet up with Shu-mei and fly the rest of the way to Los Angeles together. They flew Shu-Mei’s family in from Taiwan too. Later, when the family decided it wanted to bury David in Winnipeg, Manitoba, where Alex and Shifra had gone to university and first met, the airline not only flew many of their relatives in for the funeral service but it also interceded with overly bureaucratic Canadian immigration authorities who were reluctant to allow the pregnant Shu-mei into the country in case she gave birth prematurely and became a burden on the state.
“The airline couldn’t have been more accommodating,” Shifra says.
Until they began to ask questions about how the accident happened, or wanted to meet the families of some of the other victims. “At that point,” says Alex, “they gave us the four-year-old treatment. They patted us on the head, but they wouldn’t tell us anything. After a while, we began to think that was deliberate.”
They discovered more about what had caused the accident from watching CNN or reading the newspapers than they did from the airline. They discovered there were too few air traffic controllers on duty that day at the L.A. Airport, for example, and that the air traffic controller who directed the plane to the wrong runway had been involved in a previous crash but been reinstated.
They also discovered that the plastic linings in the aircraft’s cabin were made of flammable and toxic materials and, worse, that regulatory authorities knew all about it. Since 1990, the U.S. Federal Aviation Administration, the FAA, which oversees the airline industry in the United States — and, by extension, most of the world — had required aircraft manufacturers to use safer materials in their planes.
Theoretically at least. Largely at the behest of the major airlines, which claimed it would be too expensive for them to meet the new requirements, the FAA didn’t make airlines retrofit their old planes until the airlines themselves — in their own good time — completely refurbished a plane’s interior.
The aircraft David Richman died on was among those built before 1990 and never upgraded.
What was happening here?
Shortly after they buried their son, Alex and Shifra travelled to Charlottesville, Virginia, to spend time with their granddaughter and Shu-mei. Alex spent countless hours in the local library, reading newspaper accounts of airline accidents on CD-ROM. He also read a book about the dangers of flying called The Myth of Safety, and then began obsessively seeking out every other book he could find on the subject of airline safety.
The more he read the more he decided something was terribly amiss.
While they were still in L.A., Alex Richman read a report in the Los Angeles Times quoting a spokesperson for the Aviation Consumer Action Project (ACAP), an airline consumer lobby group formed by Ralph Nader in 1971, that described the Los Angeles collision as a “survivable accident.” The passengers who died, the report said, could have been saved if the aircraft had been equipped with smoke hoods passengers could wear in case of a smoke emergency.
Richman called Nader’s Action Project, which put him in touch with U.S. Representative Barbara Boxer, who was organizing Congressional hearings on “aircraft cabin safety and fire survivability.”
On April 11, 1991 — just over two months after the collision — Alex Richman and two survivors of the crash told their stories to Boxer’s committee. Since February 1, Richman testified, “our family has learned that the skies are not friendly, most aircraft are hazards, many airports are dangerous and that government agencies delay safety. My son died one row from the exit. David could have survived if there had been less smoke and toxic fumes, if the exits were more accessible, or if he had a smoke hood.”
Five months later, he and Shifra travelled to Tokyo to attend memorial services and present a paper — “Safe Skies: What are the next steps” — at the International Rally of Endeavours to Improve Air Safety, a symposium organized by families and survivors of Japan Air Lines Flight 123, which had smashed into the side of Mount Ogura, Japan, just five minutes after taking off on a flight from Tokyo to Osaka on August 12, 1985. Its 520 deaths — four people survived — lent it the dubious distinction of being the worst crash in aviation history.
“Every inquiry of every airline disaster reminds us of earlier recommendations, which were not followed — unlearnt lessons of the past,” Richman told the symposium. “A denial syndrome affects both industry and governments in recognizing the need for prevention — the Post-Tragedy Denial Syndrome. PTDS is characterized by denial, delays and exaggerated emphasis on the obstacles to prevention.”
A month later, writing in a personal letter about the impact of the conference and their trek up the mountain for a memorial service to commemorate the JAL 123 disaster, Richman concluded: “When apologies and regrets are combined with remedies, skies will become safer.”
He and Shifra were moving quickly from grieving parents to angry activists.
Despite the airline’s reluctance to let him meet other family members who’d lost relatives aboard Flight 1493, the Richmans did inadvertently discover the name and address of one family before they’d left L.A. Relatives of the victim had stayed briefly in the same airport hotel room as the Richmans, and had left directions for a funeral on a sheet of paper in the room.
Alex contacted them. He later learned the names of a few others from newspaper accounts and got in touch with them too. But when he drafted a letter to send to all the other family members, inviting them to join with him and the others in organizing a family support group, US Air refused to forward the letter to the other families. The Richmans, using news stories and word of mouth, finally cobbled together a mailing list of most of the families; six replied to their letter.
At the same time, Chris Witkowski of Nader’s ACAP, suggested Richman contact the leaders of family groups from the recent Lockerbie and Sioux City crashes for advice and support for his family group. “I called both of them, and the first one who answered was Tom O’Mara.”
O’Mara, a former advertising representative for the Wall Street Journal, had lost his 24-year-old daughter Heather in the crash of United Airlines Flight 232 at Sioux City, Iowa, two years earlier. One of the DC-10’s three engines had exploded in mid-air, crippling the plane and leading to the tarmac crash landing that killed 112 of the 296 people aboard.
Like the Richmans, O’Mara was exceedingly proud of his daughter, a lawyer for the U.S. army. In an open letter to the Chair of the U.S. National Transportation Safety Board after the crash, O’Mara noted that, “two days before her death, Heather successfully prosecuted a drug dealer. She put him away for 15 years of hard time at Fort Leavenworth.” He added a bitter postscript: She was promoted to Captain in the U.S. Army as scheduled,” he wrote, “after her death on Flight 232.”
By the time he wrote that letter, a year after the Sioux City crash, O’Mara had already lost faith in the airline industry’s overseers to look out for the interests of airline consumers. He’d formed his own group called Dads Against Defective DC-10s.
When Alex Richman called him, O’Mara shared with him his frustrations. By then, Richman was beginning to feel the same mix of pain and anger. They hit if off. “We exchanged recipes and sympathies,” Richman says. They talked often over the next few years. “Then, one day in the summer of ’92, we were bitching and complaining to each other about how writing letters didn’t seem to be doing any good,” Richman says. “So we thought, it’s an American election year. Why don’t we be like Judy Garland? You know, ‘Let’s put on a show.’”
They talked it over with Witkowski at ACAP, who suggested they make their “show” international by inviting victims’ families from England and Japan too to a meeting in Washington one week before the U.S. elections.
It was the beginning of what would become the International Air Disaster Coalition — later the National Air Disaster Coalition — another lobby group made up of survivors and victims’ families from 16 different crashes worldwide. Eventually, the group’s focus became primarily pressing for ways to guarantee the rights of family members in the aftermath of a plane crash.
That was fine as far as it went, but it didn’t go nearly far enough for Alex Richman. “This was supposed to be an air disaster group,” he says today. “I believed it had to be concerned with the whole spectrum of safety, security and survivability.” Those issues — the issues that had cost his son his life — seemed to be slipping through the cracks in Washington. And had been for years. The more he looked into the cozy relationship between the FAA and the airlines — and the relationship between the cost of improving safety and the costs of death — the more troubled he became.
He discovered a 1982 report prepared for the FAA, for example, which concluded that equipping airplanes with smoke hoods would make it far more likely that passengers could survive an accident like the one that had killed David. But the report also calculated that installing smoke hoods on every aircraft would cost the airlines $140,000 for each death it prevented. That was too expensive as far as the airlines were concerned, and the FAA went along with them. Smoke hoods still aren’t required on passenger aircraft.
Neither are wider exit aisles. The week before Richman appeared before the Boxer Commission, the FAA did issue a “notice of proposed rule-making” that called on airlines to either expand the space between rows at window exits or eliminate the seat next to the exit to make it easier for passengers to get out. While that initially sounded promising to him, Richman soon discovered that experts had been calling for such measures for 25 years. The FAA had recommended the same thing itself six years earlier but then did nothing about it. Just as it did almost nothing with its notice of proposed rule-making. Even though it did issue regulations in 1992, calling for the width of emergency exit aisles to be increased from 15 to 60 centimetres, most of the major airlines simply sought — and received — exemptions from the regulations from the FAA.
“My son died for nothing,” Shifra Richman says bitterly.
David Richman’s death transformed both his parents’ lives. Before the accident, “we thought that people who had a fear of flying were neurotic.” Now they think people who don’t fear flying are the ones to worry about. So they’ve dedicated the rest of their lives to making the skies safer for others. They’ve become so obsessed with their mission, in fact, it is difficult to have a conversation with either of them these days that does not quickly veer into a discussion of lax safety standards in our skies.
Alex makes no apologies. “Some people,” he says dismissively, “believe this crap that you have to get on with your lives.”
Before the accident, Alex admits, he couldn’t have told you the kind of aircraft he flew on. Now, with a quick glance at an aircraft’s identifying tail number, he can often quote from memory the entire history and safety record of the individual plane. Is it a reliable aircraft or an always-in-the-shop “hangar queen?” How many unscheduled landings has it recorded in the last year? He and Shifra have become so expert in figuring out which individual aircraft are the most likely to run into difficulties they now compile an annual list of airplane tail numbers “to be wary of,” and send them to friends as Christmas gifts.
Before the accident, Alex says he never read aircraft safety cards, never listened to the flight attendant’s predictable pre-flight safety spiel. Now, when he and Shifra fly, they carry their own smoke hoods — to the chagrin of the airlines, no doubt — and earnestly explain to any passenger who asks exactly what they’re for and why they should have one too. Just as they point out to unsuspecting fellow travelers what murderous weapons their carry-on luggage could turn into in the event of an accident. “I used to be one of the ones who tried to bring aboard as much baggage as possible,” Alex explains. “Now I know better. But not everyone does.” So he tells them.
Just as he and Shifra make it a point to file an official report with the FAA whenever they see what they consider a breach of security. Like the incident during their recent stopover in Salt Lake City when they saw a police car “followed by a car with a professional driver. The car stopped by the plane and a young man got out with a stroller and boarded the plane. Now perhaps that was OK, but did it breach security?” Alex wonders. “So we’ll file a report — for all the good it does.”
Airplane crashes don’t transform people into something that they weren’t before the accident, Alex Richman tells me. “But they do make the person much more of who they were before.”
Before, Alex Richman was an obsessively compulsive medical researcher — and a damn fine one at that. Now he is an obsessively compulsive aircraft researcher — and a damn fine one at that too.
The son of Russian immigrants, Richman, 70, grew up in western Canada, earning his medical degree — and meeting and marrying Shifra, a social work student on the same campus — at the University of Manitoba in 1953.
They moved to Montreal where he did his residency in psychiatry at McGill University, then headed back out west to Vancouver where Richman had landed a teaching job in the University of British Columbia’s newly established psychiatry department. Two years later, he returned to school — this time to Johns Hopkins in Baltimore where he did post-graduate work in epidemiology and public health research.
During the sixties, he became a well-known international consultant — he helped Jamaica devise a mental health plan in 1964 and later conducted studies of schizophrenia across cultures for the Geneva-based World Health Organization. In 1969, he was appointed associate director of psychiatry at Mount Sinai and Beth Israel Hospitals in New York. Seven years later, he joined the medical faculty at Columbia University and finally, two years after that, accepted what he calls a “very attractive offer” to relocate to Halifax to join the faculty at the Dalhousie University Medical School.
From the beginning, he says, his approach to his research — which included long-term studies of alcoholics and drug addicts — has always been to focus on patient histories. The theory is that the patient’s medical history provides the narrative that provides the clues that lead to the diagnosis.
After David’s death, Richman decided to try and apply the same techniques to the airline industry. “I’m a researcher. My life is devoted to asking why. So I just continued to ask why, but now I was asking why about airline safety. Epidemiology is the science of patterns. What are the factors that cause something to happen.”
One of the tricks to doing good epidemiological research is to begin with the “appropriate denominator.” When he looked at the way in which the airline industry reported its safety results, Richman could see right away that the figures made the skies seem safer than they really were. “If you base your calculations, as the industry prefers, on the number of crashes per millions of miles flown, flying seems very safe. But if you look more closely, you’ll find that most accidents happen within six minutes of takeoff or landing, and you’ll discover that the newer, bigger aircraft usually fly greater distances per flight, so then you realize that crashes per million miles is the wrong denominator to use.” Just as counting the number of crashes a particular type of aircraft is involved in is not the most logical way to predict how dangerous flying on such a plane might be.
Instead, like a doctor taking patient histories, Richman began to examine the publicly available Service Difficulty Reports — which include 750-character descriptions of incidents — airlines are required to file with the FAA whenever one of their planes is forced to make an unscheduled landing or develops a problem in flight. He also took a closer look at Mechanical Reliability Reports, which detail safety-related mechanical difficulties, defects and failures experienced by an aircraft. Those reports and others the FAA require of airlines, he says, are full of undiscovered “treasures.”
He compiled all the information he found for each individual aircraft operated by a major U.S. airline between 1989 and 1995 into a database and then analyzed it using a software program his youngest son had originally developed to help him make sense of individual medical histories. The result was an incredibly sophisticated way of identifying “high-risk airplanes” and types of aircraft. He discovered, for example that, between 1989-95, 700 aircraft that experienced one unscheduled landing reported a second one within 30 days of the first. And that more than 40 per cent of aircraft that experienced some form of reported mechanical difficulty had at least one unscheduled landing each year.
To get the message out about the kind of information he was uncovering, he and Shifra created their own consulting firm, setting up shop in a report-filled cubicle office next door to the Lord Nelson Hotel in Halifax and launched a quarterly newsletter entitled Aviation Quantitative Reports on Safety. They became regular participants at aviation industry safety conference and eventually developed their own mailing list of more than 500 industry insiders: airline operators, regulators, independent researchers, aviation investigators, lawyers, journalists — anyone they believed might make good use of the information.
While he will admit that the feedback “is not as much as any editor would want,” Alex Richman refuses to be disappointed. “We get feedback on what we write from [aviation reporters at the] Seattle Times, and Boeing now responds to us, all of which is a sign of progress.”
Besides, he adds, he’s in it for the long haul. “I spent 40 years in psychiatry promoting systems that were never implemented,” he says simply. “You can’t let that stop you. You just keep looking for opportunities to make your case.”
On September 2, 1998, when Swissair Flight 111 crashed into the ocean off Peggy’s Cove just a few kilometres from their Halifax apartment, Alex Richman knew there would soon be another opportunity. The media were full of reports about the pristine safety record of Swissair and its MD-11 aircraft.
Alex Richman wasn’t so sure. He decided to see what he could find on the airline and its airplane in his database.