Crash of a Cessna 421C Golden Eagle III in Bursa: 3 killed

Date & Time: Feb 16, 1998
Operator:
Registration:
TC-BAS
Survivors:
No
Site:
Schedule:
Istanbul - Bursa
MSN:
421C-0331
YOM:
1977
Country:
Region:
Crew on board:
2
Crew fatalities:
Pax on board:
1
Pax fatalities:
Other fatalities:
Total fatalities:
3
Circumstances:
While descending to Bursa Airport by night, the twin engine aircraft struck the slope of a mountain and was destroyed upon impact. All three occupants were killed.

Crash of a Cessna 421C Golden Eagle III in Elkins

Date & Time: Dec 28, 1997 at 1340 LT
Registration:
N1348T
Flight Phase:
Survivors:
Yes
Schedule:
Elkins - Orlando
MSN:
421C-1059
YOM:
1981
Crew on board:
2
Crew fatalities:
Pax on board:
5
Pax fatalities:
Other fatalities:
Total fatalities:
0
Captain / Total flying hours:
3100
Captain / Total hours on type:
60.00
Aircraft flight hours:
3593
Circumstances:
The pilot/owner and a flight instructor had flown in to pick-up passengers. The owner was not multiengine rated and was receiving instruction from the instructor. The airplane was fueled and two adults and three children were boarded about 1 hour later. The owner was the flying pilot in the left seat. The owner stated that the 4,500 foot long runway was covered with 2 1/2 to 3 inches of snow and slush. He further stated that during the takeoff roll, 'The snow was so bad we could not get off the ground...' The pilot estimated that he aborted the takeoff at 100 mph, the braking action was zero, and the airplane went off the end of the runway. According to a witness, the five passengers arrived with 'lots of heavy bags.' After the accident, the baggage was removed before it could be weighed. An estimated airplane takeoff weight of 7,856 pounds was computed without baggage, based upon weights from the airplane weight and balance form, the police report, and FAA records. According to the Pilot's Operating Handbook, the maximum takeoff weight was published at 7,560 pounds.
Probable cause:
The flight instructor's failure to identify an unsafe runway condition and his delay in aborting the takeoff. Contributing was the aircraft's maximum takeoff weight exceeded, and a snow covered runway.
Final Report:

Crash of a Cessna 421C Golden Eagle III in Donzeil: 8 killed

Date & Time: Nov 7, 1996 at 1029 LT
Operator:
Registration:
HB-LRX
Flight Phase:
Survivors:
No
Schedule:
Geneva - Bordeaux
MSN:
421C-0217
YOM:
1976
Location:
Country:
Region:
Crew on board:
1
Crew fatalities:
Pax on board:
7
Pax fatalities:
Other fatalities:
Total fatalities:
8
Captain / Total flying hours:
7047
Captain / Total hours on type:
113.00
Aircraft flight hours:
2488
Circumstances:
The twin engine aircraft departed Geneva-Cointrin Airport at 0842LT on a charter flight to Bordeaux-Mérignac, carrying one pilot and seven passengers. At 0903LT, while cruising at an altitude of 20,000 feet, the pilot informed ATC about the failure of the right engine and was cleared to reduce his altitude and to divert to Limoges Airport. The pilot elected to restart the engine below FL100 but was unable to do so. Due to high drag, the aircraft continued to lose height and was unable to reach Limoges Airport. At 1029LT, the aircraft went out of control and crashed in an open field, bursting into flames. The wreckage was found near Donzeil, between Guéret and Aubusson, about 60 km northeast of Limoges. The aircraft was totally destroyed by impact forces and a post crash fire and all eight occupants were killed.
Pilot:
Jean-Claude Kaufmann.
Passengers:
Jacques Faini,
Serge Frochot,
Didier Hostettler,
Étienne Moinat,
Jean-Claude Paccaud,
Michel Rothen,
Jean-François Troger.
Probable cause:
It was determined that the accident was the consequence of an inappropriate management of the flight following jamming of the propeller in an intermediate position after the RH crankshaft rupture. The inappropriate management was due to:
- The pilot's relative lack of experience on this aircraft type,
- His false notions about the aircraft's performance and about the existence of a flight level to maintain level flight with an unfeathered propeller and an heavy aircraft,
- A series of misjudged strategies to attempt to continue the flight then to land at Limoges when the aircraft's altitude no longer made this possible.
The lack of instructions relative to inspections by a reliable method for detection of cracks on crankshafts installed on GTSIO-520 engines was a contributory factor.
Final Report:

Crash of a Cessna 421C Golden Eagle III near Cleveland: 6 killed

Date & Time: Dec 21, 1995 at 1442 LT
Registration:
N421EP
Flight Phase:
Flight Type:
Survivors:
No
Schedule:
Tulsa - Aspen
MSN:
421C-1236
YOM:
1982
Crew on board:
1
Crew fatalities:
Pax on board:
5
Pax fatalities:
Other fatalities:
Total fatalities:
6
Captain / Total flying hours:
1320
Circumstances:
At 1350 cst, a McAlester FSS specialist gave a preflight briefing to a Cessna 421 pilot concerning IMC (instrument meteorological conditions) along the route & advised that VFR flight was not recommended. Cloud tops were at 12,000', & freezing level was at 1,600'. A PIREP at 1416 cst reported light mixed icing from 6,400' to 9,000' at Oklahoma City. At 1424 cst, the pilot departed Tulsa (VFR), then radar service was terminated. No further communication was received from the airplane. Radar data showed that it climbed westerly, reaching 9,800' at 1440 cst; during the next 88 seconds, its heading & altitude deviated until it descended through 3,200'. Ground witnesses saw the airplane descend out of low clouds in a 'flat spin' & crash. No preimpact mechanical failure was found. The airplane's gross weight was about 150 lbs over its maximum limit. In November 1995, the pilot received 10 hrs of Cessna 421 simulator training; his instructor noted in training records that he met minimum standards for VFR, but 'under IMC conditions,' he 'could not maintain altitude within 1,300 feet or heading within 40 degrees.' Postmortem toxicology tests showed 0.079 mcg/ml Nordiazepam (metabolite of Valium) in kidney fluid, 0.044 mcg/ml Desipramine (metabolite of Imipramine, an antidepressant) in spleen fluid, 0.733 mcg/ml Diphenhydramine (Benadryl) in spleen fluid, & 0.353 mcg/ml Diphenhydramine in lung fluid. These medications are not approved by the FAA for use while flying. The airplane was equipped for flight in icing & IFR
conditions.
Probable cause:
The pilot's continued VFR flight into instrument meteorological conditions (IMC), and his failure to maintain control of the airplane after encountering adverse weather conditions, which resulted in a stall/spin. Factors relating to the accident were: pilot impairment due to a medication that was not approved by the FAA for use while flying, the adverse weather conditions, and the pilot's lack of instrument proficiency in the Cessna 421 airplane.
Final Report:

Crash of a Cessna 421C Golden Eagle III in Battle Creek: 1 killed

Date & Time: Oct 21, 1995 at 2120 LT
Registration:
N421TV
Flight Type:
Survivors:
No
Schedule:
Broomfield - Battle Creek
MSN:
421C-0334
YOM:
1977
Crew on board:
1
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
1
Captain / Total flying hours:
890
Captain / Total hours on type:
218.00
Aircraft flight hours:
3779
Circumstances:
While receiving radar vectors for an approach to land, the airplane (a Cessna 421C) departed controlled flight and impacted the terrain. Witnesses reported that they heard the engines operating before the plane crashed. During an investigation, no mechanical anomalies of the airplane were found. The pilot of a Boeing 727 reported that his airplane accumulated a 'quick load' of ice during his descent to land at the same airport within an hour of the accident.
Probable cause:
The pilot's decision to fly in adverse weather (icing) conditions; the accumulation of airframe ice; and the pilot's failure to maintain adequate airspeed for the situation, which resulted in a loss of aircraft control. The icing condition was a related factor.
Final Report:

Crash of a Cessna 421C Golden Eagle III in Deer Valley: 2 killed

Date & Time: Sep 2, 1995 at 1216 LT
Operator:
Registration:
N3911C
Flight Type:
Survivors:
No
Schedule:
Deer Valley - Deer Valley
MSN:
421C-0138
YOM:
1976
Crew on board:
1
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
2
Captain / Total flying hours:
879
Captain / Total hours on type:
10.00
Circumstances:
The pilot was cleared to land, and while on short final the airplane was observed to roll right then left into a yaw and then descend nose down into a parking lot. Witnesses reported the airplane being very low on final approach. According to the pilot's wife, his last flight was about 83 days prior to the accident. No current logbook or other maintenance-type records were recovered except for an invoice. The invoice was dated 12/20/94, and was for an annual inspection and for the replacement of six fuel inlet float valves in compliance with an airworthiness directive. Postaccident examination of the engines, propellers, and airframe components were conducted, with no discrepancies found. Symmetrical power signatures were observed on both propellers. An autopsy revealed mild focal patchy inflammation and mild cardiomegaly, and enlargement of the heart with focal patchy replacement fibrosis. Toxicology revealed Diphenhydramine, Naproxin, acetaminophen, and Salicylate in the blood and the urine at therapeutic levels. Diphenhydramine, at therapeutic levels, causes drowsiness.
Probable cause:
The pilot's failure to maintain positive aircraft control, a proper airspeed and fly a proper approach path during final approach. Contributing factors to the accident were the pilot's physiological condition, impairment as a result of using a sedating medication, and lack of recent experience.
Final Report:

Crash of a Cessna 421C Golden Eagle III in Mesquite: 8 killed

Date & Time: Sep 2, 1995 at 0838 LT
Operator:
Registration:
N6234G
Survivors:
No
Schedule:
North Las Vegas - Yellowstone
MSN:
421C-0265
YOM:
1977
Location:
Crew on board:
1
Crew fatalities:
Pax on board:
7
Pax fatalities:
Other fatalities:
Total fatalities:
8
Captain / Total flying hours:
18628
Captain / Total hours on type:
86.00
Aircraft flight hours:
5461
Circumstances:
After climbing to 18,400 feet msl, the pilot reported a turbocharger problem and reversed course. He said he 'may lose the left engine' and that he was unable to maintain altitude. He diverted to an alternate airport. During a right turn onto final approach, the airplane was observed to cross (overshoot) the extended centerline of the runway. It continued in a right turn back toward the centerline, and then entered a left turn to intercept the inbound course. The turn steepened, and then the airplane entered a spin and crashed 1/2 mile short of the runway. A warped flange and evidence of exhaust gas leakage were found on the Inconel exhaust system Wye collector, at the wastegate outlet of the left engine. Neither propeller was in a feather position. There was evidence that the left engine was providing low power during impact. A note on the pilot's clipboard indicated that the (left engine) fuel flow and cylinder head temperature went to zero, and the manifold pressure dropped to 10 inches. The note also indicated that the pilot switched the 'boost pump' to high, the fuel flow went to 260 psi, and manifold pressure increased to 18.5 inches. Calculations showed that the airplane's gross weight (GW) and center-of-gravity (CG) were 7,645 pounds and 158.32 inches. The maximum allowable GW and CG were 7,450 pounds and 158 inches. During impact, the flaps were fully extended. The 'Engine Inoperative Landing' procedure stated, 'Wing Flaps - DOWN when landing is assured.' Most of the pilot's flight time in the Cessna 421 was before 1985; no record was found of recurrent training in the airplane since 1984. Annual and turbocharger inspections were made at 78 and 120 flight hours, respectively, before the accident, but no logbook entries were made concerning maintenance or replacement parts for the exhaust system. All eight occupants were killed.
Probable cause:
Failure of the pilot to maintain adequate airspeed, while maneuvering on approach, which resulted in an inadvertent stall/spin and uncontrolled collision with terrain. Factors relating to the accident were: the pilot allowed the aircraft weight and balance limitations to be exceeded; the pilot's lack of recurrent training in the make and model of airplane; inadequate maintenance/inspection of the engine exhaust systems; a warped and leaking exhaust system flange on the left engine, which resulted in a loss of power in that engine; and the pilot's improper use of the flaps.
Final Report:

Crash of a Cessna 421C Golden Eagle III off Middleton Island: 4 killed

Date & Time: Jul 29, 1995 at 1150 LT
Registration:
N800DD
Flight Phase:
Flight Type:
Survivors:
No
Schedule:
Juneau - King Salmon
MSN:
421C-0469
YOM:
1978
Crew on board:
1
Crew fatalities:
Pax on board:
3
Pax fatalities:
Other fatalities:
Total fatalities:
4
Captain / Total flying hours:
2000
Aircraft flight hours:
4912
Circumstances:
The flight departed Juneau, Alaska on a VFR flight to King Salmon, Alaska. When the flight was 50 miles southwest of the Yakutat VOR, the pilot requested an IFR clearance. He was cleared direct to Middleton Island VOR, then direct to King Salmon VOR. When the flight was 20 miles northwest of Middleton Island, the pilot contacted ARTCC and indicated his right engine had come apart. The pilot attempted to fly to and land at Middleton Island, Alaska. During the flight, the airplane consistently lost altitude. He flew past the island and was southeast of the island, when radar contact was lost. The airplane was not recovered. Flight crew of rescue aircraft stated they saw bubbles, an oil slick, and airplane debris in the ocean approximately 3 miles south of the Middleton Island Airport. The 1126 adt weather at the airport was in part: 600 feet broken, visibility 5 miles, wind from 117° at 17 gusting 25 knots.
Probable cause:
Mechanical loss of engine power for undetermined reason(s), and subsequent in-flight collision with water (or ditching at sea).
Final Report:

Crash of a Cessna 421C Golden Eagle III near Taos: 4 killed

Date & Time: Mar 5, 1995 at 1355 LT
Registration:
N421BL
Flight Phase:
Flight Type:
Survivors:
No
Site:
Schedule:
Oklahoma City - Taos
MSN:
421C-0605
YOM:
1979
Location:
Crew on board:
1
Crew fatalities:
Pax on board:
3
Pax fatalities:
Other fatalities:
Total fatalities:
4
Captain / Total flying hours:
809
Captain / Total hours on type:
195.00
Circumstances:
The pilot obtained a weather briefing for the IFR flight to Taos, New Mexico, and was advised of forecast conditions for light to moderate rime icing and moderate turbulence at his destination. During descent, about 30 nm east of the Taos VOR, at 15,200 feet, the pilot reported 'light rime icing' and 3 minutes later 'freezing rain.' The airplane was cleared for the VOR DME-B approach to the Taos Airport, and radar services were terminated. The airplane impacted the ground in a steep nose down attitude 7 nm southeast of the VOR and 1 nm right of the inbound approach course. Weather data indicated that the airplane entered clouds about 6 nm east of where 'light rime' was reported and remained in the clouds until it descended below 10,000 feet. Meteorological investigation indicated that the freezing level was about 10,700 feet. Radar data revealed cyclic variations in the airplane's ground speed from 120 to 190 knots, as it crossed the high mountain range east of taos. There was a pirep of severe turbulence on the eastern slope of the mountain range. All four occupants were killed.
Probable cause:
The pilot's decision to continue flight into known adverse weather conditions and the ensuing inadvertent stall due to airframe ice. Factors were the weather conditions.
Final Report: