Lanai City, HI, USA
N319FC
Piper PA-28-140
The aircraft collided with terrain during a night cross-country dual instructional flight. Prior to the flight, the student obtained an abbreviated weather briefing. A preflight specialist advised, "VFR flight was not recommended" along a portion of the planned flight route. Along the planned route of flight multiple scattered to broken cloud layers were forecast from 2,000 feet msl to 6,500 feet, with few clouds at 1,000 feet, and tops at 8,000 feet. The student filed a flight plan for cruise flight at an altitude of 3,000 feet msl between islands. The accident site was at 1,760 feet msl. The flight departed its home base about 1945. Sunset was at 1910, and the end of civil twilight was 1934. During an en route contact with an FAA Automated Flight Service Station, the student asked if the filed destination airport was public or private. The specialist advised the student that it was a private airport. The student cancelled the flight plan, and indicated that they were returning to the departure airport. The student pilot was flying the airplane and as weather conditions deteriorated, the certified flight instructor (CFI) advised the student to make a right turn. Instead, the student made a left, descending turn into a cloud. The CFI took control of the airplane, and initiated a climb; however, the airplane impacted the ground. Post accident examination revealed no mechanical anomalies with the airframe or engine.
HISTORY OF FLIGHT On June 14, 2001, at 2044 Hawaiian standard time, a Piper PA-28-140, N319FC, impacted level terrain 5.4 miles northwest of the Lanai Airport (LNY), Lanai City, Hawaii. Mueller Aviation operated the airplane under the provisions of 14 CFR Part 91. The airplane was destroyed. The student pilot sustained fatal injuries; the certified flight instructor (CFI) sustained serious injuries. The instructional cross-country flight departed Honolulu International Airport (HNL), Honolulu, Hawaii, about 1945, en route to Kapalua Airport (HJH), Lahaina, on the island of Maui. Night visual meteorological conditions prevailed, and a visual flight rules (VFR) flight plan had been filed. In a post accident interview, the CFI reported that the purpose of the flight was to do a night cross-country in preparation for the student's private pilot check ride. After receiving a weather briefing, the student pilot filed a flight plan to HJH at 3,000 feet. The intent was to execute a night landing at the Kahului Airport (OGG), Kahului, Hawaii, or LNY. As the flight proceeded towards Lanai, weather conditions deteriorated. The CFI told the student to make a right turn. Instead, the student made a left descending turn and they entered instrument meteorological conditions (IMC). The CFI took the controls and initiated a climb on a heading of approximately 270 degrees when the airplane impacted the ground in a level attitude. The National Transportation Safety Board investigator-in-charge (IIC) reviewed recorded radio transmissions between the pilot and the Honolulu Automated Flight Service Station (HNL AFSS). The student contacted an air traffic control specialist at the HNL AFSS prior to the flight and requested the following information: winds aloft forecast; Notices to Airmen (NOTAM); significant weather; and Kapalua weather. The specialist provided the information and advised, "VFR flight was not recommended" on the windward and mountain sections, and on the windward coastal sections of Maui. The student queried the "VFR not recommended" advisory. The specialist gave him the advisory a second time, and again advised "VFR flight was not recommended." The student was in radio contact during the flight with an air traffic control specialist at the HNL AFSS. The student's final position report was Heleolono Harbor. He reported reaching Heleolono Harbor, and then queried the specialist as to whether or not HJH (his filed destination) was a private or public airport. The specialist advised the student that it was a private airport. The student closed his flight plan and the specialist queried as to his destination. The student reported that he was turning around, with the intent to return to HNL. The specialist then stated, "flight plan closed." Coast Guard rescue personnel reported that dark, moonless lighting conditions existed during the rescue operations. The accident site was located approximately 5 hours 30 minutes after it occurred. According to a Federal Aviation Administration (FAA) inspector, the pilots were not in radio contact with Federal Aviation Administration (FAA) facilities at the time of the accident. PERSONNEL INFORMATION A review of FAA airman records revealed that the CFI held a commercial certificate with ratings for single engine land, multiengine land, and instrument airplanes. The CFI also held a certified flight instructor certificate with ratings for single engine and multiengine land airplanes. The CFI held a first-class medical certificate issued on March 02, 2001. It had no limitations or waivers. An examination of the CFI's logbook indicated he had accumulated an estimated total flight time of 382 hours. He logged 63 hours in the last 90 days, and 45 hours in the last 30 days. The CFI had logged 54 hours as a CFI with 2 hours of night instruction given. He had 54 hours in this make and model. A review of FAA airman records revealed that the second pilot was a student pilot. The student pilot held a first-class medical certificate issued on May 26, 2001. It had no limitations or waivers. The CFI described the student pilot as an excellent student. The student had about 15 hours total time, and soloed after 1 week of instruction. AIRCRAFT INFORMATION The airplane was a 1968 Piper PA-28-140, serial number 28-25157. A review of the airplane's logbooks revealed a total airframe time of 9,081.86 hours at the last 100-hour inspection. The 100-hour inspection was completed on May 1, 2001. At the time of the last inspection, the tachometer read 2,318.96, and the Hobbs hour meter read 1,818.0. The tachometer read 2,343.76 at the accident scene, while the Hobbs hour meter read 1,838.3. The last annual inspection was completed on February 23, 2001, at 8,883.0 hours. The engine was a Textron Lycoming O-320-E2A engine, serial number L-14033-27. Total time on the engine at the last 100-hour inspection was 1188.0 hours. METEOROLOGICAL INFORMATION The closest official weather observation station was Lanai Airport (LNY), Lanai, located 5.4 miles southeast of the accident site. The elevation of the weather observation station was 1,308 feet msl. Hawaiian Airlines personnel, located at LNY, who were National Weather Service (NWS) certified, took a weather observation at 2045. It stated: winds from 040 degrees at 20 knots; visibility 10 miles; few clouds at 1,000 feet, 2,000 feet scattered, and 4,000 feet scattered; temperature 69 degrees Fahrenheit; dew point 68 degrees Fahrenheit; altimeter 29.99 InHg. The next closest official weather observation station was Molokai Airport (HMO), Molokai, located 20 miles north-northeast of the accident site. The elevation of the weather observation station was 454 feet msl. Reported weather at 1954, was: winds from 060 degrees at 14 knots gusting to 18 knots; visibility 10 miles; few clouds at 3,500 feet, scattered clouds at 6,500 feet; temperature 74 degrees Fahrenheit; dew point 66 degrees Fahrenheit; altimeter 29.99 inHg. The next closest official weather observation was Kahului Airport (OGG), Maui, located 29 miles east-northeast of the accident site. The elevation of the weather observation station was 54 feet msl. Reported weather at 1954 was: winds from 060 degrees at 13 knots gusting to 19 knots; visibility 10 miles; few clouds at 4,000 feet, scattered clouds at 7,000 feet; temperature 72 degrees Fahrenheit; dew point 66 Fahrenheit; altimeter 29.97 inHg. The area forecast for the Hawaiian Islands was valid from June 14, 2001, at 1800 until June 15 at 0600. The windward coastal mountain sections of Maui, and adjacent coastal waters from 2000 were forecasted for the following: scattered clouds at 2,500 feet msl, scattered and broken clouds at 4,000 feet, and broken to scattered clouds at 6,000 feet, with tops to 8,000 feet. There were isolated broken clouds at 2,500 feet with visibility between 3 to 5 miles in light rain showers and mist. The forecast for HNL to Maui for the same time period was as follows: expect scattered clouds at 2,500 feet msl, broken to scattered clouds at 4,500 feet with tops to 7,000 feet. An isolated broken cloud layer existed at 2,500 feet with light rain showers. The outlook from 0700 to 1300 was for VFR conditions to prevail for the area. The terminal aerodrome forecast for LNY was issued at 1320 on June 14, 2001, valid from 1400 until 1400 on June 15. The forecast indicated wind was from 060 degrees at 8 knots; visibility better than 6 miles; scattered clouds at 2,000 feet, and 4,000 feet. A temporary condition existed between 1500 and 2100 for: broken ceilings at 2,000 feet, with a second broken layer of clouds at 6,000 feet. After 1000, the wind was forecast from 290 degrees at 8 knots; visibility better than 6 miles; scattered clouds at 2,000 feet, and a secondary layer at 4,000 feet. Temporary conditions existed between 1000 and 1500, called for broken clouds at 2,000 feet, and a broken cloud layer at 4,000 feet. According to the United States Naval Observatory Sun and Moon information available for the day of the accident, sunset occurred at 1910, and the end of civil twilight occurred at 1934. AIDS TO NAVIGATION The airplane was equipped with a Very High Frequency (VHF) omni-directional range (VOR) receiver. The frequency for Koko head VOR (113.9) was in the primary receiver window and the frequency for Lanai (117.7) was in the standby window. WRECKAGE AND IMPACT INFORMATION Investigators from the Safety Board, the FAA, New Piper Aircraft, and Textron Lycoming, who were parties to the investigation, examined the wreckage at the accident scene. The primary wreckage was at 20 degrees 51 minutes north latitude and 156 degrees 58 minutes west longitude. The airplane came to rest upright at a global positioning system (GPS) elevation of 1,760 feet. The accident area was known as the "bombing range" on the outskirts of the "Garden of the Gods." The accident site was 5.4 miles from LNY on a 332-degree magnetic bearing. The first identified point of impact (FIPI) was an initial ground scar, which was oriented along a 346-degree heading. The ground scar consisted of three parallel scrape marks that were separated by distances consistent with the distance between the fixed landing gear of the airplane. A portion of the nose gear was about 25 feet from the beginning of the ground scar. About 3 feet beyond the nose gear, were a series of slash marks. The slash marks continued for a distance of 36 feet. The slash marks were perpendicular to the scrape marks. The airplane collided with a 4-foot dirt berm located 27 feet beyond the ground scar. Debris located between the berm and the main wreckage included the top rudder and vertical stabilizer fairing. The distance between the FIPC to the main wreckage was 250 feet on a 351-degree magnetic bearing. Investigators examined the airframe and engine at the accident site on June 16, 2001. The airplane fuselage remained mostly intact. The forward cockpit and instrument panel were bent downward. The front left seat separated from the floorboard. The lap belt remained fastened together; however, the inboard section of the lap belt detached at its attach point. The outboard portion remained attached to the structure. The front right seat separated from the floorboard. The lap belt remained fastened together, and attached to the structure via its attach point. Shoulder harnesses were not available on the airplane, nor were they required at the time of manufacture. According to 14 CFR Part 23 entitled "AIRWORTHINESS STANDARDS: NORMAL, UTILITY, ACROBATIC, AND COMMUTER CATEGORY AIRPLANES, section 23.2 Special retroactive requirements," aircraft manufactured before December 12, 1986, were not required to have shoulder harnesses. http://www.airweb.faa.gov/Regulatory_and_Guidance_Library/rgFAR.nsf/0/977510BFCE21709685256687006B60A7?OpenDocument The left wing remained partially attached to the fuselage. The main wing spar was attached, but bent forward at the root. The wing was displaced forward and the leading edge rotated downward. The flap, aileron, and landing gear remained attached to the wing. The right wing separated at the wing root, and came to rest inverted underneath the fuselage. The lower wing skin exhibited chordwise scratches from the wingtip to midspan. The fuselage skin in the wing root area exhibited cable saw signatures that traveled in a downward direction. The aileron cables remained attached to the aileron bellcrank assembly. The aileron remained attached to the wing. The flap separated from the wing, and came to rest near the fuselage. The landing gear separated from the wing and came to rest in the debris path. The tail section remained mostly intact and remained attached to the empennage. The top (upper) portion of the rudder and stabilizer tips separated from their respective surfaces after contact with the ground, and were located in the debris path. The rudder tip incorporated the balance weight. The tops of the rudder and stabilizer surfaces were bent to the right. Control cables remained attached to the rudder, stabilizer, and trim surfaces. The Safety Board IIC established flight control continuity. The engine separated from the right side of the firewall. It remained attached to the left portion of the firewall and was lying on its left side. Investigators removed the top spark plugs to facilitate crankshaft rotation. Manual rotation of the crankshaft via the accessory gear case produced thumb compression in all cylinders, with valve action observed on the right side of the engine. Investigators removed the bottom spark plugs (the No. 2 spark plug could not be removed due to the position of the engine). According to the Champion Aviation Check-A-Plug chart AV-27, the removed spark plugs were consistent with normal wear. Fuel was present in the engine driven fuel pump. The vacuum pump rotated freely, and the fuel filters were clean of foreign debris. Both magnetos were attached to their respective mounting pads on the engine. Ignition wires were in place. Investigators removed the magnetos, and manual rotation produced sparks at their respective terminals. The carburetor remained attached to the carburetor-mounting pad. The carburetor bowl was broken at the throat area between the throttle valve and venturi. The propeller blades exhibited chordwise and diagonal scratches. Both blade tips were bent aft and curled. Investigators noted no mechanical anomalies with the engine. MEDICAL AND PATHOLOGICAL INFORMATION The Maui Memorial Medical Center in Wailuku, Hawaii, completed an autopsy of the student pilot. The FAA Civil Aeromedical Institute (CAMI), Oklahoma City, Oklahoma, performed toxicological analysis from samples obtained during the autopsy. The results of analysis of the specimens were negative for carbon monoxide, cyanide, volatiles, and tested drugs. ADDITIONAL INFORMATION The Safety Board released the wreckage to the owner on June 16, 2001. No components were retained.
the CFI's inadequate in-flight planning/decision making, inadequate supervision, and his delayed remedial action, which resulted in controlled flight into terrain.
Source: NTSB Aviation Accident Database
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