Well, yes -- but the intent of making this deeper assessment is to get at the root of why the pilot may have made the error.
Let's say we do some deep dive assessment and we find that there's several contributions (all contrived for discussion): (1) during summer, sun sets directly behind runway 28R, (2) lighting system activates at 1 hr before sunset, (3) lighting system was refreshed with LED bulbs this year, (4) taxiway C is 30% wider than median taxiway in US airports of size similar to SFO, (5) the A320 (used by Air Canada 759) has reclining seats in the cockpit and this pilot was shorter than the prior pilot for this plane.
If you had an assessment like that you could reasonably take action on some of these without waiting for a fatal accident. The action wouldn't even necessarily have to be to remove/replace/alter these things, it could even be to commission a study to see the wider impact of LED lighting or reclining seats or something. Changing the runway orientation is a very large expense, but constraining 28R use during the critical sunset period is a little less so.
If this pilot made the error, it stands to reason that other pilots may make the same mistake. If we consider a near miss as seriously as we consider a fatal accident we can still learn great things. A near miss is likely only a failure of (N - 1) elements out of the critical N required for a fatal accident.
Let's say we do some deep dive assessment and we find that there's several contributions (all contrived for discussion): (1) during summer, sun sets directly behind runway 28R, (2) lighting system activates at 1 hr before sunset, (3) lighting system was refreshed with LED bulbs this year, (4) taxiway C is 30% wider than median taxiway in US airports of size similar to SFO, (5) the A320 (used by Air Canada 759) has reclining seats in the cockpit and this pilot was shorter than the prior pilot for this plane.
If you had an assessment like that you could reasonably take action on some of these without waiting for a fatal accident. The action wouldn't even necessarily have to be to remove/replace/alter these things, it could even be to commission a study to see the wider impact of LED lighting or reclining seats or something. Changing the runway orientation is a very large expense, but constraining 28R use during the critical sunset period is a little less so.
If this pilot made the error, it stands to reason that other pilots may make the same mistake. If we consider a near miss as seriously as we consider a fatal accident we can still learn great things. A near miss is likely only a failure of (N - 1) elements out of the critical N required for a fatal accident.