SHERIFFDOM OF LOTHIAN AND BORDERS AT EDINBURGH [2017] FAI 26 UNDER THE FATAL ACCIDENTS AND SUDDEN DEATHS INQUIRY (SCOTLAND) ACT 1976 DETERMINATION By Sheriff Kenneth Maciver QC Following an Inquiry into the circumstances of the deaths of JOY PAULA ROBSON JOHN LEONARD STERN ELIZABETH ALLAN IAIN JOHN PROVAN Edinburgh 20 November 2017: The Sheriff, having heard and considered all the evidence and the submissions of parties, finds and determines as follows: 1. In terms of section 6(1)(a) of the Fatal Accidents and Sudden Deaths Inquiry (Scotland) Act 1976 A. That Joy Paula Robson, born 20 October 1961, latterly resident in Portree, Isle of Skye died within Glenurquhart Forest, near Balnain, Highland Region, at approximately 11.00am on 16 February 2013. B. That John Leonard Stern, born 27 November 1942, latterly resident in Bearsden, Glasgow died near to the Leet Bridge, Swinton, Scottish Borders Region, at approximately 16.30 hours on 31 May 2014. C. That Elizabeth Allan, born 18 January 1951, latterly resident in Barrhead, Glasgow died near to the Leet Bridge, Swinton, Scottish Borders Region, at approximately 16.30 hours on 31 May 2014. D. That Iain John Provan, born 10 January 1950, latterly resident in Barrhead, Glasgow died near to the Leet Bridge, Swinton, Scottish Borders Region, at approximately 16.30 hours on 31 May 2014. 2. In terms of section 6(1)(b) of the Fatal Accidents and Sudden Deaths Inquiry (Scotland) Act 1976 A. The cause of death of Joy Paula Robson was the sustaining of multiple injuries due to a collision with a motorcar (spectator at a car rally). B. The cause of death of John Leonard Stern was the sustaining of multiple injuries due to a collision with a motorcar (spectator at a car rally). C. The cause of death of Elizabeth Allan was the sustaining of multiple injuries due to a collision with a motorcar (spectator at a car rally). D. The cause of death of Iain John Provan was the sustaining of multiple injuries due to a collision with a motorcar (spectator at a car rally). E. The cause of the accident and the collision with a motorcar which resulted in the death of Joy Paula Robson, was the involuntary loss of control of motor vehicle T414 KRD, then being driven by Graham Schoneville during the running of the Highland Car Club 2013 Snowman Rally, following upon said motor vehicle running at speed in competition and striking stones in the roadside verge, as a consequence of which it left the track, struck trees and caused said vehicle and trees to contact and fatally injure Joy Paula Robson. F. The cause of the accident resulting in the deaths of John Leonard Stern, Elizabeth Allan and Iain John Provan, was the involuntary loss of control of a motor vehicle registered number KR900 PC, then being driven by David Carney during the running of the Jim Clark Rally 2014, when said motorcar, while running at speed in competition and for reasons which cannot be precisely ascertained, slewed and skidded on the road there before leaving the road and entering a field where it collided with John Leonard Stern, Elizabeth Allan and Iain John Provan, causing fatal injuries in each case. 3. In terms of section 6(1)(c) of the Fatal Accidents and Sudden Deaths Inquiry (Scotland) Act 1976 In terms of 6(1)(c) the following are the reasonable precautions whereby the deaths might have been avoided. 2 A. In the case of the Highland Car Club Snowman Rally 2013, there are no reasonable precautions which I can identify whereby Mrs Robson’s death or the accident causing her death might have been avoided. B. In the case of the Jim Clark Rally 2014, I identify the following reasonable precaution: “For the designated prohibited area north of the Leet Bridge to have been created, delineated and identified in accordance with the 2014 Jim Clark Rally setup plan so that it clearly prohibited spectators or photographers from standing anywhere in that area”. 4. In terms of section 6(1)(d) of the Fatal Accidents and Sudden Deaths Inquiry (Scotland) Act 1976 This subsection deals with the defects, if any, in any system of working which have contributed to the deaths or any accident resulting in the deaths, and in this Inquiry I have decided that the organisation and running of a rally is properly to be considered as “a system of working” and thus is covered by the terms of the subsection. A. In respect of the Highland Car Club Snowman Rally 2013, I make no findings under this subsection. B. In respect of the Jim Clark Rally 2014, I find that there was a weak, ambiguous, and ultimately inadequate verification system for checking the proper performance of the work of stage commanders or stage setup crews in delineating and clearly identifying areas which, for safety reasons, were prohibited for spectators. 5. In terms of section 6(1)(e) of the Fatal Accidents and Sudden Deaths Inquiry (Scotland) Act 1976 In this subsection I am required to set out any other facts which are relevant to the circumstances of the deaths and I now do so. 3 In my narrative of facts there are many circumstances which in the case of each of the rallies may have had a bearing on the eventual outcome, but these facts do not all have direct relevance, and some are more heavily weighted than others. Where a combination of facts has produced a consequence, I have not thought it appropriate to detail under subsections (c) or (d), each of those facts, but rather to identify in these subsections only discrete areas which qualify by virtue of direct relevance for selection as specific precautions or defects. However, I have detailed in the Note which follows a number of situations which lead me now to consider that they are relevant under this subsection for the purpose of making recommendations. These recommendations are specific and seek to deal with matters which are close to the heart of the issues which have led me to deal as I have done with the above precautions and defects. There are other matters, perhaps somewhat more peripheral, which I deal with under the section which follows, since it is appropriate for me at this Inquiry to suggest other matters which should be taken into consideration by those who organise and run rallies. 6. Recommendations I make the following recommendations: A. The organisers of the Snowman Rally and generally the organisers of rallies with forest stages, should in all of their pre-event publicity ensure that potential spectators are fully and properly advised of the geography of more remote locations, are clearly directed to safe viewing areas, and are actively discouraged from entering potentially difficult or dangerous viewing locations. B. That in all rallies there should be clear and properly prepared plans in relation to the setup arrangements for areas which have been identified by the rally organisers as areas in which there will be a prohibition for spectator viewing. C. These prohibited area setup plans must be given to marshals who are allocated to these areas so that they are clear as to the precise limits of the areas of prohibition, and are thus able to ensure that they do not permit entry by spectators into these locations. 4 D. That the crews of all safety cars should have these setup plans, so that it is clear to everyone, including race officials, marshals, other course cars and spectators, that the area is prohibited for viewing. E. That at least one safety car has a specific remit in relation to ensuring that prohibited areas are fully and properly marked out at the setup stage. F. That rally organisers seek to institute a system of recording crashes, accidents, cars leaving the track, or significant “near misses” which will permit them to identify areas of their rally course, which in the past appear to have a history of track departures which, if repeated, could place spectators at risk of injury. G. That until the Motor Sports Association institute a warning light system within rally cars, the current yellow flag arrangements should be urgently reviewed in order to ensure that as many cars as possible can be stopped as quickly as possible in the event of stage commanders or rally control being advised of an incident requiring stage stoppage. H. That all marshals be clearly clothed with coloured and marked tabards to ensure that there is no confusion in the minds of spectators as to their identity and role. I. That the Motor Sports Association consider including in their marshal training scheme, specific advice and information on how to deal with situations where spectators put themselves on a live rally track for whatever reason. J. That the Scottish Government Review Group recommendation in relation to the appointment of an event safety delegate, is treated by the Motor Sports Association as a matter of the utmost importance and that a high standard of training of these safety delegates is maintained. K. Rally organisers must at an early stage of planning appoint a spectator safety officer and event safety officer and must create an event safety plan based on an assessment of all of the risks. L. The Motor Sports Association should arrange training for event safety officers and spectator safety officers and should understand that the creation and 5 submission by the rally organisers of an acceptable event safety plan, will be a condition of the granting of a rally permit. 7. Matters for consideration While I have not seen fit to deal with the following matters as specific issues of precaution; defect or recommendation, they are nonetheless matters which are important and which I suggest be given consideration by those concerned.