INQUEST DAY TWENTYFIVE - Thursday 29th February 1996



         This morning there was a very formal lectern installed in front of the jury box so that counsel could stand and address the jury during their summations. The courtroom was certainly emptier than it has been. Huddled in a small group were some dark skinned and Asian people, members of the families of the deceased. Ms. Szabo's brother was there as was Mr. Robert Jeffrey. The rest of the court - public, media, jury, counsel, coroner are all Anglo-Saxon/European and, with a couple of exceptions, all male. It has been one of the stark contrasts of this Inquest.


         There have been 25 days of testimony, 35 witnesses and over 100 exhibits.


         The summations were started by Mr. Birenbaum, the lawyer for the family of Christina Munar Reyes. He told the jury the course of the Inquest changed during the last two months concentrating latterly on the finances of the TTC. He wanted to stress safety during his summation.


         In Mr. Birenbaum's opinion, the subway was not safe on August 11th, 1995 and he urged the jury to examine the question of safety. He described the TTC as complacent and smug. They have been used to back slapping peers and a lot of self back slapping which has caused this complacency and smuggness.


         He recommended that a simulator be used in training and that the training testing should be tightened up. He said that new drivers should not be let out alone until they felt comfortable with the system.


         Mr. Birenbaum said the signal system is anti intuitive and that red means stop. He suggested the jury not be concerned with costs when considering safety problems. There is plenty of money available (where???).


         Mr. Gomberg (Kinga Klara Szabo) thanked everyone he could think of and he said the system wasn't safe on August 11th as well. He urged the jury not to make a lot of recommendations as the good ones would get lost in the crowd. He criticized Mr. Leach's political non-commitment stance and accused the politicians of intruding into life and death. He argued for the trip arm behind the train being up. He asked the jury to recommend that the current 68% funding from the fare box not be allowed to climb up into the 70's as had been suggested by some of the provincial witnesses. This, he said, would have a disastrous effect on safety.


         He recommended that the jury support a new Transit Control Centre, a collision avoidance system, overhaul of training by the academics in the city, all trip cocks be activated on the trains, elimination of the lunar white, better communications and an outside monitoring agency with clout. He thanked the jury for their civic duty.


         Mr. Kemp (Xian Hui Lin) also thanked lots of people. He reviewed Mrs. Lin's death due to loss of blood and recommended that when extrication of injured people is complicated, a doctor should be called and a chart should be kept of the vital signs of trapped people.


         Mr. Falzone (Robert Jeffrey and Local 113 of the Amalgamated Transit Union) suggested this whole process has humanized the TTC and the public has been well served by it. In his opinion a rigorous public review of this sort when required is much better than any standing review. (I agree.)


         Mr. Falzone suggested that there was an over reliance on the fail safe properties of the system and this caused the accident (complacency??). Any recommendations the jury makes should be on the basis that nothing has happened since the accident despite any evidence to the contrary (like a few train stop modifications). He suggested that the track should be fixed so that signal violations are signal violations and not due to track circuit problems. He suggested the creation of a safety auditing function. He described himself and his fellow lawyers as seven litigious lawyers who have changed and improved enormously during this process.


         Mr. Baldwin (Department of Ambulance Services) reminded the jury of Dr. McCallum's evidence about the death of Mrs. Lin from loss of blood. He then shot down in flames both of Mr. Kemp's recommendations. He had much praise for the heroes of the Ambulance, Fire and Police departments.


         Ms. Mendelssohn (Fire Department) wants the communication system improved so that the external agencies (to the TTC) can have direct communication with their agencies without going through Transit Control.


         Mr. Leck was most profuse with his thanks, especially to the police for their involvement in the investigation afterwards. He said that to characterize the signal system equipment as junk was not appropriate and not true. With consultants reports still streaming in, some dated as late as last week, he advised the jury to take all of the consultants' reports with a grain of salt. After all, they are only after more consultative work - how true !! Mr. Leck also advised the jury that there were over two hundred recommendations of various sorts in the documentation they have and he echoed Mr. Gomberg in advising the jury to keep the list short. He handed them a list of four basic recommendations - get the funding fixed, an outside auditor (such as APTA, NTSB(US) and Transport Canada), Signal System review and more disaster simulations with the other Metro Agencies.


         Mr. Punter thanked everyone especially The Punter Youth who he named by their Christian names. He described the process we have experienced over the last two months and even mentioned "unexploded ammunition" to guffaws in the court!! He believes this forum has produced a more rounded analysis than any other forum. Even to letting members of the public have their say.


         In compliance with the Coroners Act he described in detail for the jury's benefit, using Dr. Deck's pathological evidence, the actual causes of the three ladies deaths. He ascribed the accident to human error on many levels over a long period of time. He suggested that the jury's recommendations be very carefully crafted and unambiguous. He reiterated some of the recommendations already made and added one we had not heard before. He advised the jury to recommend that the Chief Coroner call a public conference a year from now to report on the accomplishments made by then in improving the TTC.


         Dr. Huxter looked at his watch (it was about 3:30 p.m.) and then said he had never given a jury charge on a Leap Day and he wasn't about to start now (more guffaws) and he adjourned till 9:30 a.m. tomorrow.


         No comments today - time for reflection!!


                 Dave Irwin   -   29th February 1996




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