R Line Derailment (2022)

Sep 26th, 2022 – 9NEWS Releases Derailment Video

An Aurora Police Department camera at the intersection of Exposition Ave and Sable Blvd captured the derailment and the footage was obtained by 9NEWS

Oct 31st, 2022 – Colorado PUC Opens Investigatory Proceedings

On October 31st, 2022, the Colorado PUC issued Decision No. C22-0675 which opened investigatory proceedings. The proceeding no. is 22I-0471R.

The decision notes the previous derailment in 2019 at the same location stating “the previous corrective actions conducted at this intersection / crossing may not have mitigated the issues as identified in the previous corrective action”.

An accident investigation report, A1-09212022, will remain confidential due to Colorado Revised Statute § 40-18-104.

Nov 4th, 2022 – RTD Submits Corrective Action Plans CAP01 and CAP02

On November 4th, 2022, RTD submitted Corrective Action Plans CAP01 and CAP02 to the Colorado PUC which concluded that the cause of the derailment was the train entering the 10 mph curve at 38.8 mph.

RTD’s interim recommendations were:

1. Stop and proceed implemented prior to revenue service. TTI [Train Traffic Interface] will require coordination between RTD and City of Aurora.
2. Consider further enhancements to the Fit for Duty process.
3. Conduct Fatigue Awareness Campaign, which includes information regarding the hazards of operating a vehicle while taking certain medications.

RTD’s final recommendations were:

1. Reduce speed on Track A [southbound] approaching the Sable Boulevard and Exposition Avenue curve from 35 MPH to 25 MPH.
2. Additional signage on Track A to warn of the Sable Boulevard and Exposition Avenue curve.
3. Relocation of radar sign further north to allow more advanced warning.
4. Develop a formal plan for implementation of ATS (Automatic Train Stop) to be installed north of curve on A Track.
5. Strengthen safety assurance efforts for operator ride checks and ensure appropriate staff supervisory efforts LRT 121-06 – Operator Ride Checks.
6. Create monthly report for lagging indicators and determine appropriate leading indicators for quality assurance and radar checks.
7. Evaluation of on-time performance metric and other metrics that may promote undesired behaviors.
8. Evaluation of schedule to reduce on-time performance pressure.
9. Light Rail Operations to develop a business case for supervisors’ roles and responsibilities in determining appropriate staffing levels
10. Evaluate supervisor assignments throughout the system.

While the recommendation to upgrade the Automatic Train Stop (ATS) safety system so it can protect against overspeed into the curve is welcome, the proposed implementation is extremely narrow, given that there are five other locations on the R Line where speed is restricted to 10mph due to curves. That said, the proposed implementation would have prevented this incident.

The operator left RTD shortly after the incident.

These CAPS were initially filed as highly-confidential, but were subsequently released to the public following PUC Decision C22-0763 on November 23rd, 2022.

Nov 18th, 2022 – Colorado PUC Approves Stop and Proceed Operations But but Requires Additional Information

On November 18th, 2022, the Colorado PUC issued Decision No. C22-0721 which approved the implementation stop and proceed operations at the Sable Boulevard and Exposition Avenue curve and a reduction in speed from from 35 MPH to 25 MPH.

However it required RTD to file additional information for the CAP regarding the proposed new sign and location, and information showing where the radar sign is proposed to be (re)located by November 30, 2022.

Nov 23rd, 2022 – RTD Submits Additional Information Regarding New Signs

On November 23rd, 2022, RTD submitted additional information regarding new signs to the Colorado PUC as requested in PUC Decision No. C22-0721.

Attachment 4 shows how the existing location of the radar sign would give the operator of a speeding train little distance (and therefore time) to react to the warning before the curve is reached.

Nov 23rd, 2022 – Colorado PUC Orders Corrective Action Plans CAP01 and CAP02 to be Made Public

On November 23rd, 2022, in a welcome decision, the Colorado PUC issued Decision No. C22-0763 which ordered Corrective Action Plans CAP01 and CAP02 to be reclassified as non-confidential and released to the public.

Nov 29th, 2022 – The ‘R’ Line Reopens

The stretch of ”R’ Line track affected by the incident reopened on November 29th, 2022.

Nov 30rd, 2022 – RTD Submits Safety Assurance Analysis

On November 30th, 2022, RTD summitted its Safety Assurance Analysis to the Colorado PUC which reviewed the effectiveness of the safety recommendations made after the previous derailment in 2019 at the same location. While the document starts off by detailing the progress in installing speed and radar based speed violator strobe signs, things start to get on point when the narrative shifts to Enhanced Automatic Trian Control (EATC), which would provide signaling safety systems that would automatically apply the brakes on any trains entering curves at too high a speed.

Unfortunately the budgets are way off. Such EATC systems are estimated to cost $100m across the RTD light rail system to install, while the RTD budget has only only $12-15m available, spread over five years until 2027.

Dec 7th, 2022 – Colorado PUC Approves Corrective Action Plans CAP01 and CAP02

On December 7th, 2022, the Colorado PUC issued Decision No. C22-0786 which approved RTD’s Corrective Action Plans CAP01 and CAP02.

Jan 25th, 2023 – Colorado PUC Requires RTD to File an Additional Corrective Action Plan Regarding Cameras

Following the previous derailment in 2019 the Colorado PUC added rule 4 CCR 723-7 7349(b), which requires the installation and use of forward facing and operator facing in-cab cameras on all light rail vehicles (LRVs) by June 30, 2027.

During the Colorado PUC’s review of the (confidential) Accident Investigation Report A1-09212022, it was identified that the lead LRV in this derailment did have an in-cab and forward-facing camera. However, the camera had been turned off at some point and not turned back on meaning no footage could ben provided to assist the investigation. In-cab and forward-facing footage was provided from the second LRV but was not helpful to the investigation.

Therefore On January 25th, 2023, the Colorado PUC issued Decision No. C23-0044 which required RTD to file an additional Correction Action Plan to investigate why the camera had been turned off, to review procedures to ensure that if the camera is turned off that it is turned on again for the LRV starts operating again, and to investigate any issues with the use of the in-cab and forward-facing cameras.

Feb 14th, 2023 – RTD Submits Corrective Action Plan CAP03

On February 14th, 2023, RTD submitted Corrective Action Plans CAP03 to the Colorado PUC which concluded that the reason for the leading LRV (#316) not having video was that the camera system was determined to have been powered off at the locked breaker panel, which operators and mechanics both have access to.

It is not stated, nor clear when the camera system was powered off. This could have been any time before the accident at the maintenance facility or in the immediate aftermath of the incident.

The CAP also raises questions with the “chain of custody” of hard disc drives (HDD) containing the video as the Security Division initially placed it in a docking station for review, and determined there was no video recorded. However, the CAP goes on to state that there have been occasions LRV Maintenance was able to access video footage from HDDs that were previously identified by the Security Division as having no video. Sadly in this case it was confirmed that LRV Maintenance didn’t make an second attempt to retrieve the video as, after the Security Division were unsuccessful, LRV 316’s HDD was placed back into revenue service on another LRV and overwritten.

Finally the poor reliability of the camera systems is identified with a March 2021 check identifying that just 21% of LRVs (56 out of 201) had functional camera HDDs.

RTD’s interim recommendations were:

1. The LRV Maintenance division will wire all current 4C DVR surveillance systems directly to the power source via remote fuse to ensure tamper resistance.
2. The LRV Maintenance division will update the existing surveillance systems with new Solid State Drives (SSDs) until the new Denver VIII style surveillance system is installed on all LRVs.
3. Update procedures for handling of cameras, hard drives, and DVRs, including hard drive installation, troubleshooting, recovery, retention, and chain of custody.
4. Train all impacted employees on procedures above.
5. Conduct LRV operator education campaign on rule infraction for obstructing or tampering with onboard cameras (Rule 3.6 and Bulletin TR-22-05), including operator signed acknowledgement of receipt of Bulletin.
6. Evaluate potential for alternative remote access to retrieve video files.

Mar 8th, 2023 – Colorado PUC Approves Corrective Action Plan CAP03

On March 8th, 2023, the Colorado PUC issued Decision No. C23-0160 which approved RTD’s Corrective Action Plan CAP03.

July 27th, 2023 – RTD Notifies the PUC that All Actions in CAP01, CA02 and CAP03 Are Complete

On July 27th, 2023, RTD notified the Colorado PUC that all actions in Corrective Action Plans CAP01, CAP02 and CAP03 have been completed. Back up documentation was submitted at the same time.

And the big news here is the release of a report by consultant HNTB that details a scheme to install Automatic Train Stop (ATS) projection should trains be detected as approaching the curve at too high a speed. While all the other safety recommendations and corrective actions related to this incident no doubt have value, this is the one singular item that is guaranteed to prevent a repeat incident.

Jul 28th, 2023 – RTD Submits a Motion Requesting Confidential Accident Reports Be Released to the Police

On July 28th, 2023, RTD submitted a motion the Colorado PUC requesting permission to release confidential accident investigation reports and information, confidential under 4 CCR 723-7 7349(d), to an unnamed law enforcement agency after a subpoena was summitted on the agency.

It should be remembered that following the previous derailment in 2019, Aurora Police looked at filing assault charges against the operator for injuries sustained by passengers on the train. These charges were ultimately dropped as there was not enough evidence to prove the operator acted recklessly in 2019, and Colorado state law excludes train operators from many driving offenses as trains don’t constitute “vehicles” in the same way as cars and trucks do.

Aug 7th, 2023 – Colorado PUC Approves Corrective Action Plan CAP03

On August 7th, 2023, the Colorado PUC issued Decision No. C23-0521-I which approved RTD’s motion.

Sep 12th, 2023 – Colorado PUC Closes Corrective Action Plans CAP01, CAP02 and Partially Closes CAP03

On September 12th, 2023, the Colorado PUC issued Decision No. C23-0598 which closed RTD’s Corrective Action Plans CAP01 and CAP02 and educational campaign corrective action part of CAP03.

Any outstanding questions from CAP01 and CAP02 will be dealt with before CAP03 is closed.

Feb 6th, 2024 – RTD Notifies the PUC that All Remaining Actions in CAP01, CA02 and CAP03 Are Complete

On February 6th, 2024, RTD notified the Colorado PUC that all remaining questions and actions in Corrective Action Plans CAP01, CAP02 and CAP03 have been completed following Decision No. C23-0598. Major updates include:

• The Automatic Train Stop (ATS) installation project (to prevent overspeed into the Sable & Exposition curve) was fully funded in the 2024 RTD budget for 2024.
• The ATS installation project is currently at 90% system design.
• Procurement of ATS equipment will commence after a Notice of Proceed (NTP) is issued to the selected construction contractor. It is currently anticipated that the NTP will be issued in third quarter 2024 and that equipment procurement will be completed by fourth quarter 2025, assuming no supply chain impediments.
• It is anticipated that the ATS installation project will be completed by second quarter 2026.
• The hiring of 14 additional field Supervisors and lead field supervisors, as recommended in the North Highland report will occur during 2024.
• RTD completed the hardwiring all current 4C DVR surveillance systems on all 174 LRVs (all except the “Denver 8”, which have a more modern system) directly to the power source via remote fuse by December 2023.
• RTD replaced the hard disc drives (HDDs) used on the surveillance system with new solid-state drives (SSDs) on all 174 LRVs by December 16, 2023.
• Procedures for handling cameras and SSDs in the aftermath of an accident / incident were updated including the introduction of an evidence preservation process to allow for further investigation and troubleshooting of the associated equipment before it is released back for normal use.

Jul 12th, 2024 – RTD Issues Request for Proposals for the ATS Installation Project

On July 12th, 2024, RTD Issued a Request for Proposals (RFP) for the ATS Installation Project. The deadline for bids is August 29th, 2024 with final selection expected a week later on September 5th.