Sioux Falls, SD, USA
N44MX
Mitsubishi MU2B
The pilot departed on a cross country flight in a turbine-powered, multiengine airplane at night and in visual meteorological conditions. Recovered GPS data revealed that as the airplane accelerated down the runway, it drifted to the right of the runway centerline. A video recording showed that shortly after takeoff, the airplane rolled right, the nose dropped, and the airplane impacted the ground. It came to rest on its left side with both wings separated and the fuselage was highly fragmented forward of the main landing gear. A post-accident examination of the airframe and engines found no mechanical malfunctions or anomalies that would have precluded normal operation. A witness that spoke to the pilot shortly before the accident flight stated that the pilot exhibited difficulty in completing some paperwork; however, no medical reasoning for this difficulty could be determined based upon the available evidence. The investigation determined that at the time of the accident the pilot had been on duty for about 19 hours and 20 minutes, which was contrary to duty and rest regulations. At his estimated arrival time into the destination, the pilot would have accumulated about 20 hours and 54 minutes of duty time. The investigation was unable to determine if the pilot took advantage of the opportunity for rest that existed during the day, and therefore could not determine if fatigue contributed to the accident. Investigators were unable to determine the reason for the loss of control on takeoff with the available information.
HISTORY OF FLIGHTOn June 7, 2020, about 0425 central daylight time, a Mitsubishi MU-2 airplane, N44MX, was destroyed when it was involved in an accident near Sioux Falls, South Dakota. The pilot was fatally injured. The airplane was operated as a Title 14 Code of Federal Regulations (CFR) Part 135 on-demand cargo flight. The flight, operated by McNeely Charter Service, Inc., originated at Snohomish County Airport (Paine Field) (PAE), Everett, Washington, about 2115, and was originally destined for Huron Regional Airport (HON), Huron, South Dakota, for a fuel stop. Air traffic control information and weather data was consistent with the pilot diverting to Joe Foss Field Airport (FSD), Sioux Falls, South Dakota, due to weather at HON at the time of intended arrival. The flight landed at FSD at 0140. The final destination was Kokomo Municipal Airport (OKK), Kokomo, Indiana. Figure 1: Final segment of inbound leg that had originated from Everett, Washington. Recovered GPS data revealed that the airplane departed FSD from runway 15 at 0426. According to a video recording from FSD, the airplane appeared to have a normal takeoff roll. After rotation, a high pitch angle was established for initial climb out and the right wing began to dip. As the airplane climbed, the right wing continued to drop, and the airplane rolled over to the right side. The airplane nosed over on the right side and continued in a nose down attitude and impacted terrain. Radar track data for the flight began when the airplane reached about 45 ft above ground level (agl) and was limited to 3 radar hits in 3 seconds. Figure 2: A Google Earth plot showing the accident aircraft’s ground track and altitude depiction. PERSONNEL INFORMATIONA review of McNeely Charter Service, Inc. (McNeely) personnel records indicated that the pilot completed recurrent company training in the SA-226/227 on September 3, 2019. He completed an airman competency/proficiency check in accordance with Part 135.293, 135.297, and 135.299 on September 11, 2019, in the SA-227. The instrument proficiency check in accordance with 135.297 listed an expiration date of March 31, 2020. The most recent competency check in accordance with 135.293 in the MU-2B was accomplished on March 23, 2019. His most recent MU-2 Special Federal Aviation Regulation (SFAR) training was completed on March 16, 2020, with Howell Enterprises, Inc. At the time of the accident, the pilot was operating under Federal Aviation Administration (FAA) exemption 18510 as listed in operations specifications paragraph A005 which allowed two additional grace months for the completion of the training and qualification requirements of 14 CFR 135.293 for the MU-2B. WRECKAGE AND IMPACT INFORMATIONThe airplane wreckage was located in the infield area north of taxiway B3 between taxiway B and runway 3-21. It came to rest on its left side with both wings separated and the fuselage was highly fragmented forward of the main landing gear. During a post-accident examination, flight control continuity was established from the main cabin to all respective control surfaces. Examinations of the airframe and engines, which included the fuel control units and propeller governors did not reveal evidence of any pre-existing anomalies that would have precluded normal operation. ADDITIONAL INFORMATIONMcNeely operated without assigned duty/rest periods. According to Part 135.267(d), each crewmember must have had at least 10 consecutive hours of rest during the 24-hour period that preceded the planned completion time of the assignment. The Aircraft and Engine Log was recovered in the debris field following the accident. Two entries were made on the form for June 5, 2020. The first entry was for a flight from West Memphis, Arkansas, (AWM) to Scottsbluff, Nebraska (BFF). For this flight, an “out” time of 1552 was listed with an” in” time of 1754. The second entry was for a flight from BFF to PAE. For this flight an “out” time of 1926 was shown with an “in” time of 2321. According to family members, on June 5th, the accident pilot left home to go to his office about 0800 where he remained until the flight to PAE. It was estimated to take about 30 minutes to drive from the pilot’s home to his office. According to cell phone records for the pilot on June 6th, the first company email was sent from the pilot at 0906, followed by a text message conversation with the company president from 1026 until 1044. Text messages, phone calls, and emails continued until about 1245 and then began again about 2023. The investigation was unable to determine if the pilot took advantage of the opportunity for rest during the day. FAA Legal Interpretations In 2016, the FAA published a legal interpretation of the rest requirements provided in 14 CFR 135.267(b) and (d). The FAA’s interpretation stated: “Section 135.267(b) provides that a one-pilot crew, not in a regularly assigned duty period, may not exceed 8 hours of flight time during any 24 consecutive hours. Each flight-time assignment must provide for at least 10 consecutive hours of rest during the 24-hour period that precedes the planned completion time of the assignment. In addition, under the “moving 24 consecutive hour” limitation of § 135.267(b), operators may use a duty or on-call schedule that requires pilots to respond and report for duty at varying times from day to day. Although § 135.267 does not contain an explicit duty time limitation, crewmember schedules must fulfill the rest requirements of § 135.267(d). The FAA has consistently interpreted the term “duty” for purposes of § 135.267 to mean actual work for an air carrier or present responsibility to work should the occasion arise. Legal Interpretation to Mr. David Bodlak from Donald P. Byrne, Chief Counsel, Regulations and Enforcement Division (Oct. 28, 1991). Regarding rest, a pilot’s rest for purposes of § 135.267 must be (1) continuous, (2) determined prospectively (i.e., known in advance), and (3) free from all restraint by the certificate holder, including freedom from work or freedom from present responsibility from work should the occasion arise. The hypothetical scenario you present for consideration does not clarify where the pilot’s rest would be determined in advance; the scenario only states the pilot may be considered for assignments at various times. Therefore based on the scenario you posit, the FAA cannot determine whether the rest is determined prospectively, or known in advance. For the purposes of § 135.267, the period of rest cannot consist of required on-call or standby status while awaiting a possible assignment of flight duty throughout the entire 24-hour day…A 24-hour oncall schedule cannot meet the rest requirements of 135.267(d) because, in such a situation, the rest period is not known in advance nor is it free from all restraint.” MEDICAL AND PATHOLOGICAL INFORMATIONAn interview with the line service technician who fueled the airplane just before the accident stated that he observed the pilot have difficulty filling out fueling paperwork, but the pilot gave no explanation for the difficulty. According to the autopsy performed by the Sanford Health Pathology Clinic, the cause of death was blunt force injuries, and the manner of death was accident. The examination was limited by the degree of injury. Atherosclerotic stenosis (80%) of the circumflex coronary artery was identified without any evidence of scar from previous ischemia. No other natural disease was identified. Toxicology tests performed by the FAA Forensic Sciences Laboratory did not identify any tested-for substances. ORGANIZATIONAL AND MANAGEMENT INFORMATIONMcNeely Charter Service, Inc. was a Part 135 air carrier that held on-demand operations specifications. The air carrier was authorized to conduct business exclusively under the business name “McNeely Charter Services, Inc.” The director of operations (DO) was the pilot-in-command of the accident airplane. Section 2 of the General Operations Manual stated that the DO was responsible for the management of the FAA issued Air Carrier Certificate as well as the “administrative head for McNeely Charter Service, Inc. flight department, maintenance department and other operations personnel” and exercised operational control. The chief pilot stated in an interview that the accident pilot was primarily the “DO, overseeing the operations and oversight” and also flew “when he needed to.”
The pilot’s failure to maintain control of the airplane during takeoff for reasons that could not be determined.
Source: NTSB Aviation Accident Database
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