Michigan

Shortly after takeoff in the pressurized twin-engine airplane, the pilot was cleared to climb and maintain 16,000 feet. The pilot reported passing through instrument conditions with heavy snow and that he cleared the tops of the clouds at 7,000 feet. The pilot was then cleared to climb and maintain flight level (FL) 230. Radar data showed the airplane's altitude and course varied throughout the flight after having reached FL 230. Several times during the flight the air traffic controller questioned the pilot regarding his altitude and/or course. Each time the pilot responded that he was at the correct altitude and/or course. The radar data showed that after each of these conversations, the airplane would return to the assigned altitude and/or course. The controller then informed the pilot that, because radar showed the airplane’s altitude fluctuating between FL 224 and FL 237, he was going to have to descend out of positive controller airspace. The pilot acknowledged this transmission. The controller instructed the pilot to descend to 17,000 feet. The last transmission from the pilot was when he acknowledged the descent. Radar data showed that one minute later the airplane was at FL 234. During the last minute and 12 seconds of radar data, the airplane reversed its course and descended from FL 233 to FL 214, at which time radar data was lost. Witnesses reported hearing loud engine sounds and seeing the airplane in a spiraling descent until ground impact. Post accident inspection of the engines did not identify any anomalies that would have precluded normal operation. Most of the fuselage was consumed by fire; however, flight control continuity was established. Given the pilot’s experience and the flight’s altitude and course variations the investigation considered that the pilot may have suffered from hypoxia; however, due to the post impact fire the functionality of the airplane’s pressurization system could not be observed and no conclusive determination could be made that the pilot as impaired.

The airplane was on a visual approach to an airport when the engine stopped producing power. The pilot subsequently landed the airplane in a field, but struck trees at the edge of the field during the forced landing. Examination of the engine, engine fuel controls, and Power Analyzer and Recorder (PAR), provided evidence that the engine shut down during the flight. Further examination of engine and fuel system components from the accident airplane failed to reveal a definitive reason for the uncommanded engine shut-down.

The pilot reported that during cruise descent the airplane accumulated about 1/2-to 3/4-inch of rime ice between 8,000 and 6,000 feet. During the approach, the pilot noted that a majority of the ice had dissipated off the leading edge of both wings, although there was still trace ice on the aft-portion of the wing deice boots. The pilot maintained an additional 20 knots during final approach due to gusting winds from the north-northwest. He anticipated there would be turbulence caused by the surrounding topography and the buildings on the north side of the airport. While on short final for runway 28, the pilot maintained approximately 121 knots indicated airspeed (KIAS) and selected flaps 30-degrees. He used differential engine power to assist staying on the extended centerline until the airplane crossed the runway threshold. After crossing the threshold, the pilot began a landing flare and the airspeed slowed toward red line (92 KIAS). Shortly before touchdown, the airplane "abruptly pitched up and was pushed over to the left" and flight control inputs were "only marginally effective" in keeping the wings level. The airplane drifted off the left side of the runway and began a "violent shuddering." According to the pilot, flight control inputs "produced no change in aircraft heading, or altitude." The pilot advanced the engine throttles for a go-around as the left wing impacted the terrain. The airplane cartwheeled and subsequently caught fire. No pre-impact anomalies were noted with the airplane's flight control systems and deice control valves during a postaccident examination. No ice shapes were located on the ground leading up to the main wreckage. The reported surface wind was approximately 4 knots from the north-northwest.

The airplane, operated as an emergency medical flight, received substantial damage when it veered off the edge of runway 32 (5,235 feet long by 100 foot wide asphalt, slush and snow covered) and impacted a snow bank during landing roll at a non 14 CFR Part 139 airport. Night instrument meteorological conditions prevailed at the time of the accident. The pilot stated that during a non precision approach while two miles from the runway, he observed it to be completely covered in snow and slush. He continued the approach and upon touchdown the airplane decelerated in deep slush and veered to the left after a rollout of 1,200 feet. The pilot reported that prior to accepting the emergency medical flight, he obtained a weather briefing from a flight service station during which time no notices to airman (NOTAMs) existed that pertained to the destination airport. The pilot reported that he knew the airport was getting rain and was expecting the runway to be clear. He was surprised that the runway was covered with heavy slush. The airport manager stated that the runway was covered with wet, slushy snow as there had been periods of wet snow and rain that occurred late the previous day and evening of the accident. The airport weather observation recorded the presence of light snow in a period of approximately 24 hours before the accident. The pilot "wondered" why no NOTAM was issued relating to the runway condition. The Airport Facility Directory and the FAA's web site provides a list of 14 CFR Part 139 airports which are inherently required to issue NOTAMs. However, Advisory Circular 150/5200-28C states, the management of a public use airport is expected to make known, as soon as practical, any condition on or in the vicinity of an airport, existing or anticipated, that will prevent, restrict, or present a hazard during the arrival or departure of aircraft. Airport management is responsible for observing and reporting the condition of airport movement areas. Public notification is usually accomplished through the NOTAM system. The Aeronautical Information Manual, states that NOTAM information is information that could affect a pilot's decision to make a flight. It includes information such as airport or primary runway closures, changes in the status of navigational aids, ILS's, radar service availability, and other information essential to planned en route, terminal, or landing operations.

The airplane was operated as an on-demand cargo flight that impacted trees and terrain about one mile from the destination airport during a non-precision approach. Night instrument meteorological conditions prevailed at the time of the accident. The airplane was equipped with an "icing protection system" and a report by another airplane that flew the approach and landed without incident indicated that light rime icing was encountered during the approach. Radar data shows that the accident airplane flew the localizer course inbound and began a descent past the final approach fix. No mechanical anomalies that would have precluded normal operation were noted with the airplane.

The single-engine airplane experienced a loss of engine power during cruise flight at flight level 190 (19,000 feet) and impacted the terrain while performing a forced landing to a nearby airport. Visual meteorological conditions prevailed at the time of the accident with clear skies and unrestricted visibilities. The pilot reported the loss of engine power about 16 minutes prior to the accident and requested clearance to the nearest airport. Air traffic control (ATC) issued vectors to the Southwest Michigan Regional Airport (BEH). About 10 minutes prior to the accident, the airplane was positioned approximately 1.3 nm north of BEH at 13,500 feet. The pilot elected to follow ATC vectors verses circling down over BEH. ATC provided vectors for runway 27 at BEH. Witnesses to the accident reported seeing the airplane "spiraling down and crashing into the ground." The wreckage was located on the extended runway 27 centerline, about 1.12 nm from the runway threshold. The distribution of the wreckage was consistent with a stall/spin accident. Approximately four minutes before the accident, the airplane was on a 9.5 nm final approach at 6,700 feet. Between 9.5 and 5.3 nm the airspeed fluctuated between 119 and 155 knots, and the descent rate varied between 1,550 and 2,600 feet/min. Between 5.3 nm and the last radar return at 1.5 nm the airspeed dropped from 155 to 78 knots. According to the Pilot Operating Handbook (POH) the accident airplane should be flown at best glide speed (92 knots) after a loss of engine power. An average engine-out descent rate of 700 feet/min is achieved when best glide speed is maintained during engine-out descents. An engine teardown inspection revealed that the crankshaft was fractured at the number five crankpin journal. Visual examination of the crankshaft (p/n 13F27738, s/n V537920968) showed a fatigue-type fracture through the cheek, aft of the number five crankpin journal. The exact cause of the crankshaft failure could not be determined, due to mechanical damage at the fatigue initiation point. The fracture features for the accident crankshaft was consistent with 14 previous failures of the same part number. The engine manufacturer determined the failures were most likely due to the overheating of the steel during the forging process.

The airplane was destroyed when it impacted the ground while maneuvering at a low altitude following a loss of control in instrument meteorological conditions. The airplane was on a flight in instrument meteorological conditions when radar and voice contact were lost. Prior to the loss of communication, controllers advised the pilot to check altitude. At this point, the radar data shows that the airplane was about 400 feet below the assigned altitude. Subsequently, the pilot said, "roger sir my auto pilot i just cut off uh correcting immediately." This was the last received transmission from the pilot. The radar data shows that the airplane then began a descending right turn at an average rate of descent of 1,276 feet per minute. This descent was followed by a climbing left turn with an average rate of climb of 5,423 feet per minute. The radar data shows that the radius of the left turn continued to decrease until radar contact was lost about 500 feet above the last assigned altitude. A witness who saw the airplane just prior to impact described the airplane maneuvering beneath the clouds prior to pulling up sharply and then pitching down and impacting the ground. There was a utility wire and associated poles running across the airplane's flight path in the field where the wreckage was located. The airplane exploded and burned upon impact. No anomalies were found with the airplane or associated systems. The autopilot section of the Pilot's Operating Handbook states, "Sustained elevator overpower will result in the autopilot trimming against the overpower force." The result is that if up elevator pressure is applied with the autopilot engaged, the autopilot will trim the airplane nose down.

The airplane sustained substantial damage on impact with terrain and objects after traveling off the end of the runway during a main wheels up landing. The captain reported that prior to takeoff, he closed the cargo door and the copilot confirmed the door light was out. After takeoff at an altitude of about 600 feet, the cockpit door popped open and the crew noticed the cargo door was open. The captain elected to return to land. The captain reported he requested repeatedly for gear and flaps extension, but the copilot was late in doing so and it "caused us to overshoot the runway centerline." The copilot then began calling for a go around/missed approach at which time he raised the gear and the retracted some of the flaps. The copilot reported the captain continued to descend toward the runway and overshot the runway centerline to the right. The copilot reported that at this time he lowered the gear. The nose gear extended prior to touchdown, however the main gear did not. The airplane touched down approximately 1/2 way down the runway and traveled off the end. A witness reported noticing that the exterior door latch was not down as the airplane taxied to the runway.