A B757-200 was dispatched overwater in non compliance with two fan duct exit guide vanes deferred mi...

Attributes
ACN	627081
Time
Date	200408
Day	Mon
Local Time Of Day	0601 To 1200
Place
Locale Reference	airport : zzz.airport
State Reference	US
Altitude	agl single value : 0
Aircraft 1
Operator	common carrier : air carrier
Make Model Name	B757-200
Operating Under FAR Part	Part 121
Flight Phase	ground : parked ground : preflight
Flight Plan	IFR
Person 1
Affiliation	company : air carrier
Function	flight crew : captain oversight : pic
ASRS Report	627081
Person 2
Affiliation	company : air carrier
Function	flight crew : first officer
Events
Anomaly	aircraft equipment problem : critical maintenance problem : improper maintenance non adherence : far non adherence : published procedure non adherence : company policies
Independent Detector	other flight crewa other flight crewb
Resolutory Action	none taken : detected after the fact
Consequence	other other other other
Factors
Maintenance	contributing factor : schedule pressure performance deficiency : inspection performance deficiency : logbook entry performance deficiency : non compliance with legal requirements performance deficiency : scheduled maintenance
Supplementary
Problem Areas	Maintenance Human Performance Flight Crew Human Performance Chart Or Publication Aircraft
Primary Problem	Maintenance Human Performance

Narrative:

I'm writing regarding a flight from ZZZ to ZZZ1 on aug/mon/2004. The history is as follows: the aircraft arrived ZZZ as flight xyz from ZZZ2 at xa:55. This aircraft had a deferral regarding the right engine. Specifically, two missing exit guide vanes and one exit guide vane bowed. A cockpit review of the airplane logbook reflected a proper release, including the extended range twin engine overwater operations service check complete. During the first officer's exterior preflight, he found 3 more guide vanes missing and one piece of a broken blade in the right engine. In addition, he found the right engine oil service door open. The final pattern of missing and intact exit guide vanes resulted in one bowed with two adjacent missing, four intact, three adjacent missing. This was determined to be out of limits and the airplane was taken out of service. My safety concerns are: 1. This airplane was released extended range twin engine over water operations improperly with defects. 2. Use of this aircraft on extended range twin engine overwater operations flight segments with missing exit guide vanes. 3. MEL requirements? It should be required that the engine be inspected before and after each flight segment. 4. Passenger safety concerns after the cancellation of this flight which will be addressed in a separate email to pilot organization and the air carrier office. In closing, it should be noted that this engine problem went unnoticed from the aircraft's arrival at xa:55 until our preflight at approximately xi:00, some 7 hours. Callback conversation with reporter revealed the following information: the reporter stated this maintenance problem was compounded by the discovery of the additional damage to the guide vanes seven hours after arrival on the preflight check. The reporter stated the arrival station was not a maintenance station, but did have contract technicians on call. The reporter said the airplane was maintenance ferried to a maintenance station where the engine was replaced due to the vane damage being out of limits.

Original NASA ASRS Text

Title: A B757-200 WAS DISPATCHED OVERWATER IN NON COMPLIANCE WITH TWO FAN DUCT EXIT GUIDE VANES DEFERRED MISSING. PRE-FLT INSPECTION FOUND ONE VANE BOWED, FIVE VANES MISSING AND FOUR INTACT. ENG WAS REPLACED.

Narrative: I'M WRITING REGARDING A FLT FROM ZZZ TO ZZZ1 ON AUG/MON/2004. THE HISTORY IS AS FOLLOWS: THE ACFT ARRIVED ZZZ AS FLT XYZ FROM ZZZ2 AT XA:55. THIS ACFT HAD A DEFERRAL REGARDING THE R ENG. SPECIFICALLY, TWO MISSING EXIT GUIDE VANES AND ONE EXIT GUIDE VANE BOWED. A COCKPIT REVIEW OF THE AIRPLANE LOGBOOK REFLECTED A PROPER RELEASE, INCLUDING THE EXTENDED RANGE TWIN ENG OVERWATER OPS SVC CHECK COMPLETE. DURING THE FO'S EXTERIOR PREFLT, HE FOUND 3 MORE GUIDE VANES MISSING AND ONE PIECE OF A BROKEN BLADE IN THE R ENG. IN ADDITION, HE FOUND THE R ENG OIL SVC DOOR OPEN. THE FINAL PATTERN OF MISSING AND INTACT EXIT GUIDE VANES RESULTED IN ONE BOWED WITH TWO ADJACENT MISSING, FOUR INTACT, THREE ADJACENT MISSING. THIS WAS DETERMINED TO BE OUT OF LIMITS AND THE AIRPLANE WAS TAKEN OUT OF SVC. MY SAFETY CONCERNS ARE: 1. THIS AIRPLANE WAS RELEASED EXTENDED RANGE TWIN ENG OVER WATER OPS IMPROPERLY WITH DEFECTS. 2. USE OF THIS ACFT ON EXTENDED RANGE TWIN ENG OVERWATER OPS FLT SEGMENTS WITH MISSING EXIT GUIDE VANES. 3. MEL REQUIREMENTS? IT SHOULD BE REQUIRED THAT THE ENG BE INSPECTED BEFORE AND AFTER EACH FLT SEGMENT. 4. PAX SAFETY CONCERNS AFTER THE CANCELLATION OF THIS FLT WHICH WILL BE ADDRESSED IN A SEPARATE EMAIL TO PLT ORGANIZATION AND THE ACR OFFICE. IN CLOSING, IT SHOULD BE NOTED THAT THIS ENG PROBLEM WENT UNNOTICED FROM THE ACFT'S ARR AT XA:55 UNTIL OUR PREFLT AT APPROX XI:00, SOME 7 HOURS. CALLBACK CONVERSATION WITH RPTR REVEALED THE FOLLOWING INFO: THE RPTR STATED THIS MAINT PROB WAS COMPOUNDED BY THE DISCOVERY OF THE ADDITIONAL DAMAGE TO THE GUIDE VANES SEVEN HOURS AFTER ARR ON THE PREFLT CHECK. THE RPTR STATED THE ARR STATION WAS NOT A MAINT STATION, BUT DID HAVE CONTRACT TECHNICIANS ON CALL. THE RPTR SAID THE AIRPLANE WAS MAINTENANCE FERRIED TO A MAINT STATION WHERE THE ENG WAS REPLACED DUE TO THE VANE DAMAGE BEING OUT OF LIMITS.

Data retrieved from NASA's ASRS site as of July 2007 and automatically converted to unabbreviated mixed upper/lowercase text. This report is for informational purposes with no guarantee of accuracy. See NASA's ASRS site for official report.

A B757-200 was dispatched overwater in non compliance with two fan duct exit guide vanes deferred missing. Pre-flight inspection found one vane bowed, five vanes missing and four intact. Engine was replaced.