Crash of a De Havilland DHC-6 Twin Otter 300 in the Pacific Ocean

Date & Time: Apr 12, 1997 at 2204 LT
Operator:
Registration:
N242CA
Flight Phase:
Flight Type:
Survivors:
Yes
Schedule:
Oakland - Honolulu
MSN:
342
YOM:
1972
Country:
Region:
Crew on board:
1
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
0
Captain / Total flying hours:
25000
Captain / Total hours on type:
1000.00
Aircraft flight hours:
9873
Circumstances:
On a ferry flight from Oakland, California, to Honolulu, Hawaii, the pilot declared a low fuel emergency and diverted toward Hilo, Hawaii. Approximately 2.5 hours later, the aircraft was ditched in the Pacific ocean. The pilot evacuated the aircraft before it sank and was rescued by the U.S. Coast Guard. He stated that, under flight planned conditions, the aircraft departed Oakland with sufficient fuel onboard to reach the intended destination with a 2-hour fuel reserve. However, the winds at flight altitude, which were reported as light and variable at the preflight weather briefing, developed into a significant headwind during the flight. At a point 7 hours and 10 minutes into the flight, the pilot determined that his fuel remaining was 8 hours and 40 minutes, with 7 hours and 40 minutes remaining to destination. Three hours later, the pilot determined that his 2-hour reserve was gone. He declared an emergency and diverted toward the closest airport, which was Hilo. Prior to fuel system exhaustion, the pilot elected to ditch the aircraft with power.
Probable cause:
The pilot's inadequate en route fuel consumption calculations, which led to his failure to recognize a deteriorating fuel duration versus time-to-go situation in a more timely way.
Final Report:

Crash of a Beechcraft H18 in Honolulu

Date & Time: Feb 22, 1997 at 0623 LT
Type of aircraft:
Registration:
N7969K
Flight Phase:
Flight Type:
Survivors:
Yes
Schedule:
Honolulu - Lanai
MSN:
BA-702
YOM:
1964
Flight number:
PLA222
Location:
Crew on board:
2
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
0
Captain / Total flying hours:
1867
Captain / Total hours on type:
142.00
Aircraft flight hours:
16600
Circumstances:
The airplane was loaded with mail & freight within 57 lbs of its max takeoff weight limit. No malfunction was noted during start or taxi. The pilot made a near-midfield intersection departure from runway 08L at 0622:35 local time. Seconds earlier, a Boeing 747 had completed its landing roll-out on runway 4R, which crossed runway 8L near its departure end. Winds were from 285° at 2 kts. The pilot and loader (a private pilot) said nothing unusual occurred during takeoff until the aircraft climbed to 100 feet agl, then 'suddenly the airplane yawed to the left as though the left engine had lost power.' Despite use of full right rudder, directional control was lost, and the pilot decreased the pitch attitude because of 'severe yawing and rolling tendencies.' The airplane's left wing tip impacted the right side of the runway, the tricycle gear collapsed, and the airplane slid to a stop and was consumed by fire. Due to fire damage and lack of accurate records, neither the total fuel load, the freight's actual weight, the cargo's preimpact location within the aircraft, nor the adequacy of the cargo tie down system could be validated. Weight and balance documents filed with the FAA were at variance with 'duplicate' documents held by the operator. Exam of the engines did not reveal evidence of a preimpact failure. Propeller ground scars on the runway indicated both engines were operating during impact. The accident occurred during the pilot's last flight as an employee with the company.
Probable cause:
Loss of aircraft control for undetermined reason(s).
Final Report:

Crash of a Cessna 402B in Kamuela: 1 killed

Date & Time: Jan 29, 1996 at 0435 LT
Type of aircraft:
Registration:
N999CR
Flight Phase:
Flight Type:
Survivors:
Yes
Schedule:
Kamuela - Honolulu
MSN:
402B-0616
YOM:
1974
Location:
Crew on board:
2
Crew fatalities:
Pax on board:
1
Pax fatalities:
Other fatalities:
Total fatalities:
1
Captain / Total flying hours:
3434
Captain / Total hours on type:
1250.00
Aircraft flight hours:
19764
Circumstances:
The aircraft departed at night from runway 4R on a flight to transport mail. The pilot-in-command (PIC) was in the left seat, a pilot-rated cargo loader was in the right seat, and another cargo loader was aboard the aircraft, but was not in a seat. During takeoff, the aircraft entered a turn and flew into gradually rising terrain. The initial impact point was about 15 feet higher than the runway elevation and about 0.3 miles abeam the departure end of the runway. Investigation revealed that the company allowed pilot-rated cargo loaders to fly the aircraft from the right seat during positioning and ferry flight segments (to build multiengine flight time) as part of their compensation. There was evidence that at the time of the accident, the aircraft was being piloted on this flight from the copilot's position. The right side of the instrument panel was equipped with only EGT gauges (no flight instruments on the copilot's side). There were cloud layers in the vicinity, no moon illumination, and no visible ground lighting in the direction of flight. No preimpact mechanical malfunction or failure was identified during the investigation. Except at the pilot and copilot positions, the airplane had no other seat and/or restraint system. The operator stated that the pilot was not authorized to carry company personnel or passengers without the required seating.
Probable cause:
Failure of the copilot (pilot-rated cargo loader, who was flying the aircraft) to establish and maintain a positive rate of climb after taking off at night; and inadequate supervision by the pilot-in-command (PIC), by failing to ensure that proper altitude was obtained and maintained during the departure. Factors relating to the accident were: darkness; the lack of visual cues; and the resultant visual illusion, which the copilot failed to recognize during the night departure. Also, the lack of a restraint system (seat belt and/or shoulder harness) for the passenger was a possible related factor.
Final Report:

Crash of a De Havilland DHC-6 Twin Otter 200 in the Pacific Ocean

Date & Time: Mar 16, 1995 at 0515 LT
Operator:
Registration:
N37ST
Flight Phase:
Flight Type:
Survivors:
Yes
Schedule:
Oakland – Honolulu – Majuro – Suva – Auckland
MSN:
207
YOM:
1969
Country:
Region:
Crew on board:
3
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
0
Captain / Total flying hours:
1100
Captain / Total hours on type:
200.00
Circumstances:
The aircraft departed overweight for a 17-hour ferry flight. Early in the flight the crew experienced some fuel problems and decided to continue when they resolved the problem. The crew indicated the en route winds were close to forecast. The ferry fuel system is a simple 5- tank gravity fuel feed into the fore and aft main tanks. About 6 hours from destination, they realized the ferry tanks were not flowing into the main tanks as planned. They began manually transferring fuel from the rear ferry tank to the forward ferry tank, and shut down the right engine to reduce fuel consumption. This did not stop the negative fuel flow from the main tanks. At the time of ditching, the crew estimated the fuel remaining in the ferry tanks was about 170 gallons, most of which was in the 3 aft ferry tanks. An aero engineer calculated that the aircraft was at least 10 inches behind the maximum aft cg at the time of ditching, and suggested that the ferry fuel system was not managed to maintain the cg within the allowable limits, a task made more difficult with the rear fuselage cargo.
Probable cause:
Intentional ditching due to the flightcrew's failure to properly manage the fuel system, and operation of the airplane in an excessively overweight condition.
Final Report:

Crash of a Britten-Norman BN-2B-20 Islander in the Pacific Ocean

Date & Time: Dec 2, 1994 at 1548 LT
Type of aircraft:
Registration:
N16VM
Flight Phase:
Flight Type:
Survivors:
Yes
Schedule:
Majuro - Honolulu
MSN:
2204
YOM:
1989
Country:
Region:
Crew on board:
1
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
0
Captain / Total flying hours:
9900
Captain / Total hours on type:
150.00
Aircraft flight hours:
2359
Circumstances:
The pilot, sole on board, was supposed to ferry the aircraft from Majuro, Marshall Islands, to Honolulu, Hawaii. About two hours into the flight, while cruising at the altitude of 7,000 feet, the pilot informed ATC about engine problems and decided to return to Majuro. Unable to maintain a safe altitude, the pilot was forced to ditch the aircraft about 320 km northeast of Majuro Atoll. A pilot who was flying in a second aircraft was able to give the exact position and the pilot was rescued 20 hours later. The aircraft sank and was not recovered.
Probable cause:
The left engine failed in flight for unknown reasons and the pilot was forced to feather its propeller. Due to lack of evidences, the exact cause of the accident could not be determined.

Crash of a Douglas DC-10-30 in Dallas

Date & Time: Apr 14, 1993 at 0659 LT
Type of aircraft:
Operator:
Registration:
N139AA
Survivors:
Yes
Schedule:
Honolulu - Dallas
MSN:
46711
YOM:
1973
Flight number:
AA102
Crew on board:
13
Crew fatalities:
Pax on board:
189
Pax fatalities:
Other fatalities:
Total fatalities:
0
Captain / Total flying hours:
12562
Captain / Total hours on type:
555.00
Copilot / Total flying hours:
4454
Copilot / Total hours on type:
376
Aircraft flight hours:
74831
Aircraft flight cycles:
17920
Circumstances:
At the time flight AA102 landed at DFW Airport, it was raining and there were numerous thunderstorms in the area. Shortly after touchdown on runway 17L, the pilot loss directional control when the airplane began to weathervane and the captain failed to use sufficient rudder control to regain the proper ground track. The airplane eventually departed the right side of the runway. At the time of landing the wind (a cross wind) was blowing at 15 knots with gusts approximately 5 knots above the steady wind speed. The aircraft was damaged beyond repair and all 202 occupants were evacuated, among them 40 were injured, two seriously.
Probable cause:
Failure of the captain to use proper directional control techniques to maintain the airplane on the runway.
Final Report:

Crash of a Beechcraft C-45G Expeditor in Oakland

Date & Time: Mar 7, 1993 at 0302 LT
Type of aircraft:
Operator:
Registration:
N494
Flight Phase:
Flight Type:
Survivors:
Yes
Schedule:
Oakland - Honolulu
MSN:
AF-466
YOM:
1951
Crew on board:
2
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
0
Captain / Total flying hours:
2400
Captain / Total hours on type:
50.00
Copilot / Total hours on type:
25
Aircraft flight hours:
5480
Circumstances:
The non-certificated foreign military pilot (first pilot) and a U.S. Certificated airline transport pilot (second pilot) planned to ferry an airplane to Australia with an intermediate stop in Hawaii. Auxiliary fuel and engine oil tanks were installed in the airplane. The airplane had been authorized a special airworthiness certificate for over gross weight operations for the ferry flight. The first pilot had accrued 50 hours and the second pilot accrued 25 hours in the accident airplane prior to the overweight departure. During the takeoff, the airplane became airborne at 100 knots of airspeed. The airplane pitched up and began to dutch roll. At about 50 feet above the ground, the airplane stalled and descended to the runway. A fire erupted in the cabin area.
Probable cause:
A premature lift off and inadvertent stall by the pilot-in-command. Contributing to the accident was insufficient available aircraft performance data after a ferry tank installation and both pilots lack of total experience in the airplane.
Final Report:

Crash of a Beechcraft E18 on Mt Haleakala: 9 killed

Date & Time: Apr 22, 1992 at 1553 LT
Type of aircraft:
Operator:
Registration:
N342E
Flight Phase:
Survivors:
No
Site:
Schedule:
Hilo - Honolulu
MSN:
BA-308
YOM:
1957
Flight number:
SAT022
Crew on board:
1
Crew fatalities:
Pax on board:
8
Pax fatalities:
Other fatalities:
Total fatalities:
9
Captain / Total flying hours:
2100
Captain / Total hours on type:
465.00
Aircraft flight hours:
15925
Circumstances:
During the air tour flight the pilot had radioed his intentions to FSS to overfly an area about 5 miles southwest of the island of Maui. Approximately 10 minutes later the airplane impacted mountainous terrain on the island. IMC prevailed at the time and location of the accident. The pilot did not possess the minimum hours stipulated in the company ops manual to qualify as a captain. He falsified the employment application and resume. The company did not pursue substantive pre employment background checks, nor were they required by the FAA to do so. Regulations are needed for air tour operators that will enable FAA inspectors to require, rather than merely encourage, operators to adhere to procedures that offer the safety improvements of sfar 50-2 and FAA handbook 8400.10 bulletin 92-01. All nine occupants were killed.
Probable cause:
The captain's decision to continue visual flight into instrument meteorological conditions that obscured rising mountainous terrain and his failure to properly use available navigational information to remain clear of the island of Maui. Contributing to the accident was the failure of Scenic Air Tours to conduct substantive pilot pre-employment background screening, and the failure of the Federal Aviation Administration to require commercial operators to conduct substantive pilot pre-employment screening.
Final Report:

Crash of a Beechcraft H18 in Lanai

Date & Time: Feb 14, 1992 at 0815 LT
Type of aircraft:
Registration:
N33AP
Flight Type:
Survivors:
Yes
Schedule:
Honolulu - Lanai
MSN:
BA-748
YOM:
1967
Location:
Crew on board:
1
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
0
Captain / Total flying hours:
1571
Captain / Total hours on type:
464.00
Circumstances:
The pilot said that the approach to the airport was normal, with a 100 knot indicated airspeed. The pilot said the winds were about 110° at 10 knots during the approach; however, on short final he encountered a very strong gust from the right. The pilot corrected for the wind gust then it stopped and the aircraft suddenly dropped hard to the runway without warning. The pilot said he suspected a windshear encounter was responsible for the accident. Witnesses said the approach seemed normal when the aircraft suddenly dropped to the runway and bounced. The witnesses said that a thunderstorm had passed through the area just prior to the aircraft's approach.
Probable cause:
Failure of the pilot to compensate for an encounter with a windshear phenomena. Contributing to the accident was the lack of a low level windshear warning system or a system for the collection and dissemination of weather advisories.
Final Report:

Crash of a Rockwell Grand Commander 680FLP in Kona: 1 killed

Date & Time: Sep 10, 1989 at 1518 LT
Registration:
N22LR
Flight Phase:
Flight Type:
Survivors:
Yes
Schedule:
Kona - Honolulu
MSN:
680-1503-18
YOM:
1965
Crew on board:
1
Crew fatalities:
Pax on board:
1
Pax fatalities:
Other fatalities:
Total fatalities:
1
Captain / Total flying hours:
203
Captain / Total hours on type:
23.00
Aircraft flight hours:
4790
Circumstances:
As the aircraft was departing from runway 17, smoke was observed coming from the right engine. The pilot confirmed a loss of power and made a right turn back toward the runway, then reported he had 'lost both engines.' The aircraft was extensively damaged during a landing on rough, rocky terrain about 1/4 mile southwest of the runway threshold. Investigation revealed the aircraft had just changed ownership. During pre-purchase inspection in Florida, metal particles were found in the oil screens of both engines. Oil was changed and flushed, but metal particles were found after another engine run. In May 1989, the right engine was replaced with an engine from another aircraft. The aircraft was flown to Oakland, CA, where it was painted and new interior was installed. A local mechanic noted metal particles in both eng oil screens and recommended oil analysis, but ferrying pilot refused. After flight to Hawaii, no oil stain noted on fuselage before flight on 9/9/89. Exam of wreckage revealed both engines failed from detonation. Heavy oil streaks found behind right engine, some streaks of oil found behind left engine. Right engine crankshaft/rod bearing surface was 0.010' under standard, but rod bearings were standard size. While the passenger was seriously injured, the pilot was killed.
Probable cause:
Inadequate maintenance, and operation by the pilot with known deficiencies in the aircraft. Factors related to the accident were: excessive wear in both engines, improper use of powerplant controls by the pilot, subsequent overtemperature/detonation in both engines, improper emergency procedures by the pilot (including premature gear extension and/or failure to properly reduce drag on the aircraft after loss of engine power), and the pilot's lack of experience in multi engine and this make and model of aircraft.
Final Report: