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All Nippon Jetliner's 2011 Nosedive More Dangerous Than First Thought

Investigators' Final Report Likely to Refocus Industrywide Interest in Similar High-Altitude Incidents

By ANDY PASZTOR


An All Nippon Airways jet takes off. 

An All Nippon Airways Co. co-pilot who accidentally put his plane into a violent dive and roll in 2011 came closer to losing control of the Boeing Co. 737 than previously believed, according to data released by investigators.

The Japan Transport Safety Board's final report about the serious incident over the Pacific Ocean reveals there were multiple warnings of an impending aerodynamic stall, while the plane carrying 117 people exceeded its maximum operating speed a number of times. The report said the jet also exceeded its structural-load limit, or the most stress the aircraft is expected to experience in service.

After the co-pilot mistakenly operated a rudder-control switch at 41,000 feet, instead of a different switch that unlatched the cockpit door, the jetliner plummeted 1.2 miles in slightly more than 30 seconds and briefly flew nearly upside down. The recently released report provides some new details about the extent of the danger.

Two flight attendants were pinned to the cabin floor and were slightly injured. One attendant told investigators that after she felt "earthquake-like vertical shaking," she slumped to the floor on her knees from downward forces so strong she couldn't raise her arm.

The report is likely to refocus industrywide interest in high-altitude upsets, or incidents in which jetliners slow dramatically or end up with the nose or wings at unusually steep upward or downward angles.

The 100-page document also highlights the 38-year-old co-pilot's delayed and confused response, which investigators attributed to gaps in training, undue reliance on automation and seeming anxiety about quickly letting the captain back into the cockpit. According to the report, "excessive dependence on autopilot" exacerbated "lack of full awareness about the need to monitor" flight controls. The co-pilot couldn't recall the stick shaker's activation, it said.