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Human failings serve as NASA wake-up call

Over the past few months, space engineers have been forcibly reminded that booster seals and wing panels aren't the only things that can crack in space: Humans can, too.

Over the past few months, space engineers have been forcibly reminded that booster seals and wing panels aren't the only things that can crack in space: Humans can, too.

To the embarrassment of NASA officials, and to the glee of far too many outside cynics, the public has been treated to a ghastly parade of human failings from space workers that might have led to disaster if they occurred during flight: February's story of a love triangle gone wrong, which resulted in the arrest of astronaut Lisa Nowak; a murder-suicide at NASA's Johnson Space Center; and last month's tales of heavy alcohol use in the astronaut corps.

Still more stories circulate among the astronauts themselves. One account focuses on a spaceflier who had a detached retina corrected "on the outside" without NASA's knowledge. Another story tells of a veteran shuttle commander who should have been disqualified on medical grounds, but was allowed one last flight when the medical team acquiesced.

Engineers are accustomed to measuring the reliability of space hardware. They have developed tests and measurements that can go a long way toward winnowing out the "failure points" in mechanisms, designs or operational plans.

Where disaster has occurred, investigation boards have determined them to be the result of human failings somewhere along the line — for example, skipping procedures that were already known to be necessary.

But how about people? How can they be measured, and how can weaknesses be filtered out so that there is not a loss of concentration at a critical time, or a loss of the mental or physical ability to react properly?

Medical issue is a complex one
Applying medical standards to astronauts was the main theme of the report issued last month by an independent panel of eight physicians — the report that stirred all the controversy over alcohol use. Commissioned by NASA Administrator Michael Griffin in the wake of Nowak's arrest, the report assessed the space agency's ability to monitor the "psychosocial health of astronauts" and identify "potential system vulnerabilities" in current practices.

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At the same time, I've been conducting a private, informal survey of two dozen former astronauts and flight surgeons, and comparing the comments with information gleaned during my two decades at Mission Control in Houston. The results have convinced me that the issue of maintaining medical standards for flight crews is a complex one.

The astronauts say some people have flown even though they shouldn't have, and some people have been grounded even though they shouldn't have. Some of these cases have had significant impacts on individuals — and yet this process, for all its flaws, appears to have functioned sufficiently well to forestall any significant impact on U.S. human spaceflight so far.

This is despite the stories of a few men and women who flew sometimes with illnesses, sometimes with surgical complications, sometimes with physical disqualifications, sometimes with unverified psychological balance.

Privacy shrouds process
As with the anecdotes mentioned in the last month's report — such as the stories of pre-flight alcohol abuse, which monopolized the public's attention to the disregard of the report’s more central findings — these stories are unverified. (In fact, NBC News reports that investigators have been unable to substantiate the claims about alcohol.)

Medical anecdotes are difficult to confirm because NASA follows the federal government's policy on protecting the medical privacy of employees. "All individuals have a right to medical privacy. NASA respects that right for all its employees, including astronauts," NASA spokesman James Hartsfield told me at Johnson Space Center in Houston.

"The policy we have with regard to astronauts and missions, that are of high national interest, is [that] we would respect the medical privacy issue unless there is a matter that significantly impacts the mission,” Hartsfield said. For example, NASA has in the past disclosed medical conditions that affected launch schedules, spacewalks and other mission activities — while withholding comment on medical matters extraneous to such activities.

Meanwhile, the medical standards process, in public and in private, remains hit or miss. It seems based on judgments that are sometimes skewed by careerist strategies — for example, not angering people who could help dictate the future assignments of those making the decisions.

Getting away with such a strategy "so far" may seem not unlike "getting away" with plume leakage from the shuttle's solid rocket boosters, until Challenger ... or getting away with debris damage to the shuttle's underbelly dozens of times, until Columbia. Is it only a matter of time before undetected weaknesses in this component conspire with other failures to create conditions for another tragedy in space?

The medical stresses will grow more severe as NASA moves through a string of complex missions on the international space station, through the twilight years of the space shuttle era, and onward to a new era that will take humans beyond low Earth orbit. Human weaknesses that may have been tolerable before now may, at some point, reach a breaking point. To forestall such disasters, a fuller appreciation of the history of medical screening is needed.

A catalog of medical crises
All of the individuals who responded to my inquiries did so under the condition that their names not be used. The only guarantee of authenticity that I can give in this analysis is that they are all people I have known and worked with, often for decades. I have relied on their judgment and candor in the past, and I still do.

Only a handful of astronaut medical disqualifications are in the public record. The problems of Mercury astronauts Deke Slayton (heart murmur) and Alan Shepard (inner-ear disorder) are well known, and both eventually were restored to flight status and flew in orbit. John Bull, selected as an astronaut in 1966, was later dismissed after displaying a significant intolerance to aspirin. Doctors insist Bull's dismissal was a good call, even as they express sympathy.

The famous grounding of would-be Apollo 13 flier Ken Mattingly for indirect exposure to German measles was controversial at the time and remains so. He later flew a very successful lunar mission. One astronaut involved in 1970's Apollo 13 drama noted that Mattingly played a crucial role in developing procedures for reviving the imperiled spacecraft. “Ken’s presence on the ground was of inestimable value in returning the crew safely,” he said.

One veteran flight surgeon endorsed the view that astronauts were usually given the benefit of the doubt on medical calls. "I think overall the number of 'breaks' the crew gets far outweigh the hits,” he said in an e-mail.

He said the final fly/no-fly decision was often out of his hands, and over his head: “Most of the time 'management' seems to make the decisions (as they probably should, since I would submit every decision is a balanced risk). They probably don't weigh the medical opinion as much as I would, but that's a biased opinion to be sure.” A good example of this might be one very successful pilot astronaut who, it was discovered late in his career, was color-blind. He seemed to fly OK, so the condition was "exempted."

Renal stones and retinal detachment
The flight surgeon listed other cases: "We flew a guy with a positive hepatitis antibody [and] we flew [a guy with] known renal stone history." In a more serious case, he added, “We found out about a guy who had a retinal detachment lasered on the outside but didn't report it. [We] only found out after the fact but still could have hit his pension."

Renal stones, better known as kidney stones, can be problematic for spaceflight because the dehydration that commonly occurs in zero-gravity could lead to rapid precipitation of painful stones during a mission. But after several cases of astronauts receiving private treatment for such conditions (without telling NASA about it), and then flying without incident, NASA seemed to lighten up on that constraint.

One astronaut on a later flight said in an e-mail: “I do know of a case of kidney stones for one of our payload specialists, which occurred a few months before flight. NASA took him to have them ultrasound zapped, and he was able to fly.”

Bending the rules seemed acceptable in such cases — except, apparently, when the astronaut in question was European, and a history of kidney stones had been the reason NASA gave officially in 1980 for keeping him out of mission specialist training. He later flew several times as a payload specialist, which is a different astronaut classification.

Case of the arthritic astronaut
Another aging astronaut reportedly developed an arthritic shoulder prior to his flight. The astronaut had "difficulty raising his right arm above shoulder level," a crewmate reported to me.

"This matter was never brought up in any briefings or meetings that I recall," the crewmate continued.  "[He] flew with distinction, and his experience and expertise contributed significantly to the successful mission." Back on Earth, the astronaut had the shoulder replaced with a mechanical joint, with good results. Whether the shoulder would have proven a barrier to successfully evacuating the shuttle in an emergency was apparently an issue that NASA never tackled.

A shuttle astronaut (and physician) pointed out that crew surgeons have brought about medical "saves," in which disputes were resolved in favor of some crew members through successful treatments and other countermeasures before flight. One veteran astronaut told me that in the year leading up to launch of a science mission for which he had been on the "support crew," he was twice notified he might have to step in and fly in the place of a crew member who was struggling with a potentially disqualifying medical condition.

"In both cases, the problems were actively addressed and resolved," he reported. No medical issues arose during flight.

Another pilot astronaut gave a similarly positive review for NASA's medical team. "My experiences with flight medicine were all very positive," he said in an e-mail, "and in fact I always felt that they were very proactive in doing everything possible to work through any medical issues to make certain crew members got fair opportunities."

Bending to the breaking point
But sometimes, yet another veteran astronaut told me, the bending of the rules got to the breaking point.

"There was one instance of a shuttle commander with a flight-disqualifying medical episode that the flight surgeons 'nursed along' so that he could make one last flight and not cause the agency any 'embarrassment'" he said in an e-mail. "I have names, etc., but really cannot release them."

The independent panel behind last month's report likely heard these sorts of stories, and more. The report referred to problems with NASA's medical screening process — and concluded, as my own informal survey suggested, that such problems had not received adequate attention for a very, very long time.

"Many of the cultural and structural issues identified as problematic have existed for many years," the report noted. "The current medical and operational leadership at NASA inherited most of the cultural and structural issues identified in this report, [and] the issues are so ingrained and longstanding that it will take senior leadership action to remediate them.”

Now that the issues have reached the attention of top NASA leadership — and the attention of Congress and the public as well — that remediation seems assured. This year's painful embarrassments for NASA may prove to be a blessing in disguise, balanced against potential future human failures in space that now might, just might, be avoided.

James Oberg, space analyst for NBC News, spent 22 years at NASA's Johnson Space Center as a Mission Control operator and an orbital designer.