A courageous client speaks to Stephen Stock about the risks to the flying public.
A courageous client speaks to Stephen Stock about the risks to the flying public.
In the face of intense market rejection, Icon says it has heard its customers and is going to revise the rather onerous purchase contract it planned to require of its buyers. It hasn’t yet made the new contract public. But in a statement it says that one thing the new contract will keep is the requirement that anyone buying an A5 sign away their rights to sue Icon after an accident.
Another fundamental tenet of ICON’s approach to safe flight operations, personal pilot responsibility, and product liability-cost reduction is the agreement not to sue ICON for accidents that are not determined to be our fault. Unfortunately, the overwhelming majority of product liability lawsuits are filed against manufacturers even when the manufacturer was not found to be at fault. We must address this. While there is no silver bullet for guaranteeing safety and eliminating all product liability costs, we are working hard to improve it. This is one of those steps. We invite our customers to help us set a new precedent in our industry and to improve this situation by releasing ICON from accidents deemed not to be our fault by the NTSB. Reducing product liability costs is important because it reduces the cost of aircraft and allows manufacturers to spend that money on product development instead of legal fees and lawsuit settlements.
At first blush, all that sounds reasonable. Why should an A5 buyer be able to sue Icon after a crash if the NTSB places the blame for an accident elsewhere?
Well, for one thing, the NTSB is not a fair forum. After any accident, the NTSB “invites” the aircraft’s manufacturer to participate in the investigation, relying on the manufacturer and its experts to help pinpoint the accident’s cause. But the NTSB never allows the pilot or the pilot’s passengers to participate, nor does the NTSB allow experts hired by the pilot or the passengers anywhere near the investigation. The pilot and passengers are entirely excluded. If that sounds like a conflict of interest, it is. It’s no wonder the NTSB seldom finds the manufacturers at fault. Nor is it surprising that courts of law, after hearing from both sides, frequently come to conclusions different than those reached by the NTSB.
And in fact, it is because the NTSB’s investigations are so one sided that NTSB’s conclusions are entirely inadmissible in any court of law anywhere in the country.
Looks like Icon’s new contract will be as unfair as the one the market rejected back in April. It’s hard to believe that any buyer who has done his homework would sign it.
Perhaps what is most troubling is its language that seeks to allow Icon to dodge liability for any accident, regardless of its cause.
Founder and CEO Kirk Hawkins told AOPA that Icon believes in "extreme responsibility."
What we’re trying to do, in a nutshell fundamentally, is put the responsibility [for accidents] where it belongs. . . If it’s our fault, we’ll own it. If it’s your fault, you own it.”
Seems fair enough, except that’s not what the agreement says. It says that if the accident is Icon’s fault because, for example, Icon screwed up the design or manufacture of the buyer's aircraft, the buyer and his family owns it, not Icon:
Owner and Managing Pilot understand that participating in ground, water and air operations and related activities could result in injuries from a variety of factors, including but not limited to . . . defects in the aircraft or components. . . Owner and Managing Pilot knowingly assume these risks on behalf of themselves and their Successors in Interest.
If Icon would like buyers or pilots to "knowingly" assume the risks of defects in its aircraft, maybe it should come out and tell us what those defects are.
This is not about "extreme responsibility" It's about extreme irresponsibility. Icon is trying to dodge liability for any defects resulting from its own actions and shift it onto others.
Who would buy an aircraft from a manufacturer who wants it in writing that if we made a mistake that injures someone, its your fault?
Piper N36402 departed Reid-Hillview Airport for Las Vegas as it was getting dark. The pilot had his wife and three children on board. Though the weather was challenging, the aircraft was turbocharged, which would have allowed the pilot to climb above at least some of the clouds.
The plane's flight path, speed, and altitude changes can be followed on FlightRadar24. The radar track shows that the aircraft made at least one 180 degree turn, but then resumed its course.
It wasn't long too long after that the pilot found himself in trouble. The radar data shows the aircraft's speed building excessively and its altitude dropping fast. The made two mayday calls (recording below) before the aircraft crashed, killing all aboard.
The flight conditions were ripe for airframe icing. The Piper Lance lacked deicing equipment. Airframe icing changes the aerodynamics of the wing and tail and can bring an aircraft down in a matter of minutes. The loss of control can be especially dramatic when it is the tail surface that ices up first.
Experimental amateur-built aircraft crash more often than those assembled in a factory. The Australian Transport Safety Bureau found that, when compared to factory-built aircraft used in similar flight operations, amateur-built aircraft crash three times as often. Our own National Transportation Safety Board studied the amateur-built accident rates and made similar findings.
One might expect that, because they are built by an amateur, an experimental aircraft’s wings would tend to fall off more often than those of a factory-built aircraft. But that doesn’t seem to be the case. Most experimental aircraft are structurally sound. Rather, according to NTSB data, the biggest issue is engine failure, often because of fuel flow problems.
And that’s exactly what brought down an experimental Van’s RV-10 aircraft in Toledo, Oregon, in June 2014. The aircraft lost power on takeoff, killing the pilot and his 4 year-old passenger. The NTSB concluded the engine failed because it wasn’t getting fuel. Investigators found broken fragments of sealant in the aircraft’s fuel line where, of course, it wasn’t supposed to be.
There are no statistics on how often the companies who sell kits get sued, but it’s hardly ever. After all, who is responsible for the defect in the aircraft’s manufacture or design that caused the crash? The company who sold the kit? Or the guy who spent several years putting the kit together in his garage? While some builders follow the kit maker’s directions to the letter, many do not, taking it upon themselves to modify at least some portion of the aircraft. That's allowed by regulations and seems to be part of the fun of building the aircraft. For example, John Denver was killed years ago when the amateur-built aircraft he was piloting crashed off the California coast. The amateur who put the kit together thought he had a better way of doing it and installed the aircraft fuel valve in a place other than as recommended by the kit's seller. The NTSB ultimately determined that it was that modification that led to the crash.
But even if the victim’s lawyer proves it was the kit maker, and not the builder, who was responsible for the defect, few kit makers carry insurance. That means a verdict against the aircraft company may be impossible to collect.
Despite the hurdles, the family of the girl killed in the Toledo crash has filed suit against Van’s Aircraft Inc., blaming it for exploiting FAA “loopholes” that allow it to sell aircraft that have not been properly tested and are thus unproven and unsafe. The suit goes on to allege that
Not only are Van’s aircraft designs untested and unsafe, but its assembly instructions are also inadequate and unsafe.
The suit goes on to allege that the fuel flow transducer that Van's supplied with the kit was dangerous because it was not capable of dealing with a blockage, as would be required of on a fuel flow transducer mounted on a factory-built aircraft.
We can expect Van’s to argue that their experimental aircraft are just that – experimental. They are not intended to have all the safety features included with factory-built aircraft. That is why the word “experimental” is required by law to be prominently displayed inside each one.
Nicholas Baer was body boarding in Carlsbad on the Fourth of July when a plane towing a banner crash-landed on the beach and injured him. The twelve-year-old is now suing the pilot and the company that owns the Piper that struck him. The boy's attorney argues that even though the Piper's engine failed, the pilot shouldn't have landed on the beach where someone could be injured. The pilot should have instead attempted to land in the water. Though the pilot might not have fared as well had he landed in the surf, there would certainly have been less chance of injuring beachgoers.
Seems that the boy's attorney has a point. And this particular scenario - beachgoers being injured or even killed when a pilot attempts to put his plane down on the beach - is not entirely unheard of. It happened in Florida a year ago. The pilot in that case tried to land his Piper Cherokee, and in the process hit and killed a man and a daughter who were walking on the beach. And it happened in 2010 when a Lancair pilot landed on a beach in Hilton Head after his plane lost its propeller. In that case it was a lone jogger who was killed.
In each of the cases, the victims were innocents. The risk of being injured by an airplane was certainly the furthest thing from their mind.
Robinson Helicopters began installing crash-resistant fuel tanks in 2010. Robinson Helicopters with fuel tanks installed before then tend to catch fire during accidents that, but for the fire, would have been survivable.
The Australian authorities thought that the safer tanks were a good idea. Enough Robinsons had caught fire after minor accidents that in 2013 the Australian government grounded all Robinson R44 helicopters operating in Australia until their owners installed the new-style fuel systems.
The NTSB asked the FAA to follow suit and issue a similar order grounding R44 helicopters in this country. But the FAA refused. Even assuming the old-style Robinson fuel tanks were needlessly dangerous, the FAA thought they really weren't all that different from the fuel tanks installed in many other older helicopters. If the FAA grounded Robinsons until they were fixed, they'd have to ground a lot of helicopters produced by other manufacturers as well.
But the FAA has known about the trouble with old-style fuel systems for a very long time. In fact, since 1991, FAA regulations have required manufacturers to install in their helicopters fuel systems that are proven "crash resistant." Trouble is, those regulations apply only to helicopters designed after 1994. They do not apply to helicopters that are manufactured today, but were designed (or certified) before 1994.
Unfortunately, the majority of light helicopters manufactured in the US today were designed before 1994, and so in practice the regulations seldom apply. The NTSB thinks its time for that to change. The NTSB's latest safety recommendation asks the FAA to:
Require, for all newly manufactured rotorcraft regardless of the design’s original certification date, that the fuel systems meet the crashworthiness requirements of 14 Code of Federal Regulations 27.952 or 29.952, “Fuel System Crash Resistance.”
What will the FAA do in response to the NTSB's recommendation? If history is a guide, unfortunately, the FAA will do nothing.
We don't know much yet about the plane crash in Alaska that killed the pilot and 8 tourists from the MS Westerdam. But the crash looks eerily similar to the Alaskan crash that killed Senator Ted Stevens and three others in 2010.
Like the plane that was involved in the Westerdam crash, the plane that crashed with Stevens aboard was a de Havilland Otter retrofitted with floats and a turboprop engine. Both tour pilots encountered adverse weather that is common in Alaska: Low Ceilings. Fog. Gusty winds.
In the Steven's crash, instead of turning around when he encountered the low clouds, the pilot pressed on. Unable to see where he was going, he inadvertently flew into the side of the mountain. (The local papers were calling the pilot a "hero" because not everyone aboard was killed. I had to disagree.)
In last week's crash at Ella Lake, the weather conditions were similar. It looks as though the pilot, employed by tour operator Promech Air, inadvertently flew into the clouds and struck the side of a cliff.
This sort of accident is not uncommon, particularly in Alaska and Hawaii. The type of accident is called "controlled flight into terrain." It is almost always due to pilot error.
Blue Hawaiian helicopters was probably the last tour operator that flew a perfectly good aircraft into the side of a mountain due to low clouds. Compare the photo of the weather conditions that contributed to the Blue Hawaiian crash (left) with the photo of the weather conditions that the Promech Air pilot tried to fly through. Note how, in both photos, the clouds obscure the mountain tops.
The Andreini family gave their first interview since Eddie's death to KTVU's John Sasaki. John asks us about the lawsuit we filed today against the United States Air Force.
Eddie Andreini's plane slid to a stop at show center and caught fire. Eddie was trapped inside. The crowd watched, prayed, and waited for fire trucks to arrive. Some bystanders wanted to rush to the plane to help Eddie get out, but the announcer warned everyone to stay back and "let the firefighters do their job."
But the firefighters didn't do their job. By the time the trucks showed up, almost 5 minutes had passed and it was too late. Eddie survived the impact unharmed, but died of burn injuries.
The Travis Air Force base fire trucks were supposed to be positioned at show center so that, in case of a crash, they would have immediate access to the runway. Where were they? Those who were at last year's "Thunder Over Solano" air show want to know and so does Eddie's family. But within hours of Eddie's death the Air Force closed ranks. Since then, it has simply refused to explain itself to anybody.
So what is the Air Force hiding?
It looks as though there are three three things the Air Force doesn't want to talk about.
First, Travis didn't place its trucks at show center as it was supposed to. Instead, it parked them more than a mile away. 1.3 miles away, to be exact.
Second, Travis brass told the firefighters that, in responding to any fire, they could drive their trucks down the taxiways no faster than 25 miles per hour. That speed limit applied to all the fire trucks, including the Air Force's so-called "Rapid Intervention Vehicle," designed and built to get to the scene at top speed and start applying foam before the big trucks arrive.
Third, the Travis firemen may not have been in their station and ready to respond like they were supposed to be. Rather, it looks as though they may have been out across the field taking pictures of airplanes parked on the grass.
Today we filed suit against the Air Force on behalf of Eddie's family. The Air Force has 60 days to respond.
Dr. Ken Gottlieb’s Cessna 182 took off from Napa Airport with only Dr. Gottlieb aboard. As the Cessna climbed from the runway, it turned in the wrong direction. It collided with high terrain just north of the airport. Dr. Gottlieb was killed on impact. His body was ejected and the aircraft exploded and burned.
The family asked us to investigate. We learned that Gottlieb’s instructor had flown with Gottlieb a few days before the crash. The instructor found Gottlieb (pictured right) to be well-versed in the Napa departure procedure and otherwise meticulous in his flying. The instructor felt it unlikely that Gottlieb would become confused and turn in the wrong direction. As far as the instructor was concerned, whatever caused the crash was “out of Ken’s control.”
Faride Khalaf (pictured below) was the plane's mechanic. We learned that Khalaf began working on general aviation aircraft only after he was fired from United Airlines. We uncovered evidence that Khalaf had performed maintenance on Gottlieb's aircraft without properly recording the work in the aircraft’s logs. In fact, Khalaf performed undocumented repairs on the pilot’s seat just a few weeks before the crash.
We examined what little remained of the wreckage and found two things that were unusual. First, we saw evidence that, at the moment of impact, the pilot seat was in the full aft position. Second, the pilot’s seat belt was unbuckled.
Based on their forensic work, our experts testified that as Gottlieb climbed away from the runway, his seat suddenly and unexpectedly slid to its full aft position and jammed. Gottlieb’s hands and feet could not reach the aircraft’s controls and the aircraft flew off course, out of control. Gottlieb unbuckled his seat belt so that he could scoot on his knees up to the aircraft’s control wheel. But before Dr. Gottlieb could regain control of the aircraft, it crashed into the hillside.
The pilot seat slid back and jammed because Khalaf’s undocumented work was improperly performed. He charged the aircraft owners for new seat parts, but did not install them. Instead, he illegally jury-rigged the existing seat release mechanism. The faulty repair held up for a while, but failed just as Gottlieb took off, causing the seat to slide back and jam in place.
Making matters worse, we found emails from Khalaf on Gottlieb’s hard drive. Gottlieb had asked Khalaf to perform an annual inspection of the aircraft just days before the crash. Khalaf's emails confirmed that he had in fact "finished with the annual" and that the plane was "good to go." Based on Khalaf's confirmation that the plane was safe to fly, Gottlieb departed on his flight from Napa. But, in fact, Khalaf never inspected the plane at all. All he did was change the oil, to make it appear as though he had serviced the aircraft when in fact he had not. Had Khalaf performed the inspection, he might have learned that his previous improper repairs were about to fail.
Earlier this afternoon, the jury entered its verdict against Khalaf for $13,360,000. The verdict is believed to be a record amount in California for the death of someone over age 65.
Khalaf's attorney quit the case one year before the trial was set to begin. Khalaf elected to represent himself during the 7 day trial. Adbi Anvari of Air West Aircraft Engines testified as Khalaf's expert. Khalaf called Dr. John Kane to testify about medical issues that Khalaf contended afflicted the pilot, but the judge ruled the doctor to be unqualified and refused to allow him to take the stand.
Dr. Gottlieb was a prominent San Francisco forensic psychiatrist. He left his wife Gale, daughter Tamar, and son, Mike who is a lawyer and special assistant to President Obama.
Before trial, Gottlieb's family offered to drop the suit entirely if Khalaf agreed to surrender his mechanic’s license. Khalaf refused. That means despite the verdict, Khalaf is still legally entitled to work on aircraft and return them to service.
Here are six ways an aircraft owner can be found liable even if he was not on board when the plane crashed:
Airport fire trucks must get to a burning plane within three minutes if they are going to save any lives. That's the maximum response time allowed by the National Fire Protection Association, the organization that sets the standard for airport firefighters, including those working at U.S. Air Force bases.
The survivable atmosphere inside an aircraft fuselage involved in an exterior fuel fire is limited to approximately 3 minutes if the integrity of the airframe is maintained during impact. This time could be substantially reduced if the fuselage is fractured. . . rapid fire control is critical. . .
Aircraft flown in air shows are usually smaller and less fire resistant than transport category aircraft. At air shows fire trucks need to get to crash sites even quicker – within 60 seconds or less.
The key to getting fire trucks to a crash quickly is to station the trucks near to where an accident is most likely to occur. Normally, that might be the end of the active runway. But most air show crashes occur at “show center” rather than the end of the runway. As one Travis Air Force witness put it, show center is where ‘the majority of dangerous events focus.” At air shows, that's where fire trucks should be waiting.
On May 4, Eddie Andreini was flying a routine at the Travis Air Force Base open house. He was attempting a stunt known as an inverted ribbon cut. Something went wrong. Eddie's Stearman slid upside down along the runway, coming to a stop at smack dab show center. Eddie was uninjured but was trapped inside. A fire started almost immediately. Air Force personnel say that they saw Eddie struggling to get out as he waited for the fire trucks to save him. One minute passed, then two, then three. But the crash trucks didn't come. When they finally did, it was too late.
The Air Force refused to explain why it took so long for its fire trucks to reach Eddie. So we sued it under the Freedom of Information Act. We now have internal Air Force documents showing that the brass didn’t understand the Air Force’s own regulations. They mistakenly believed regulations prohibited them from stationing fire trucks near show center. So instead, the Air Force positioned the fire trucks more than a mile and a half away.
The Travis speed limit for fire trucks is 45 mph. So it took the first fire truck (a “Rapid Intervention Vehicle”) more than four minutes to get to Eddie. Had the Air Force positioned even one truck at show center--as it was supposed to--firemen would have gotten to Eddie within a minute and Eddie would have been saved.
Regulations can be confusing. Was the Air Force’s mistake understandable? Not really. The manual that Travis show organizers had in hand--and agreed to follow--makes clear that fire trucks belong at show center. According to that manual, the personnel who were permitted in the “aerobatic box” (the area in which performers fly) included “demonstration teams and fire/rescue.” (Page 28.) The manual goes on to direct that fire trucks should be located “with immediate access to the show line” (page 34) – not a mile and a half away.
To the extent the Air Force brass was confused, the FAA cleared things up for them when, a week before the air show, it told Travis that crash trucks did indeed belong “in the box” near show center.
Our team, specifically the air ops staff, was led to believe that we could not put an emergency vehicle (or anything else) inside the Show Box at Show Center, because it was sterile and protected. We learned that this was not correct about a week before the show after [name redacted] discussed it with [name redacted] of the FAA. We learned that we could place airshow official vehicles or people in the aerobatic box."
Travis had time
The Air Force's own documents prove that Travis officials had a week before the show was to begin to correct their mistake and arrange for the trucks to be stationed at show center. But the Travis officials had already decided that the fire trucks were going to be positioned where they couldn't be of any use to a performer. Having made a plan, they weren't going to change, even if it put lives at risk unnecessarily.
"I'll say it again, I need the trucks on the runway! I need the trucks on the runway now!"
The Travis Command Post recording is difficult to listen to. After hearing it, it's hard to believe that Travis still tells the public that its fire department responded to the crash in an "exemplary" fashion.
(Notes: At 2:14, one of Eddie’s crew tried to fight fire with a hand-held extinguisher. The extinguisher was too small and was expended in seconds. By that time, the Rapid Intervention Vehicle had not yet even left its station. The Air Force documents do not explain why it took so long for the truck to roll. It finally arrives on scene after the 4 minute mark. The time stamps were placed on the photos by Air Force.)
USA Today ran Thomas Frank's story on the unnecessary risks posed by post-crash aircraft fires. According to Frank's article, small aircraft fires have killed at least 600 people since 1993, burning them alive or suffocating them after otherwise survivable accidents. Hundreds more have survived post crash fires but have been horribly burned.
I’ve written many times over the years that no one should be burned in an otherwise survivable aviation accident. The technology to prevent post crash fires has been around since the war in Vietnam.
The FAA has not required manufacturers to install such technology because it would be too costly – between $556 and $5,710 per aircraft. That doesn’t sound like much, but according to the FAA, it doesn’t pencil out when compared to the dollar value of the lives that would be saved. But the USA Today article points out that, in running the calculations, the FAA undervalued human life. For example, while the EPA used a value of $3.3 million per life when it justified regulation to protect the ozone, the FAA used a lower value -- just $1 million per life -- when it ran the numbers on post-crash fires. No wonder the costs didn’t pencil.
Of course, just because the FAA doesn’t require manufacturers to keep their aircraft safe from post-crash fires, it doesn’t mean that the manufacturers can’t do so on their own.
Today the manufacturers responded to the USA Today article, suggesting that it was inaccurate and one-sided.
GAMA’s Greg Bowles talked for more than three hours with Mr. Frank [the article’s author] about general aviation safety to include preventing post-crash fires through improved crashworthiness and manufacturers’ efforts to mitigate the effects of accidents for Mr. Frank’s previous series, “Unfit for Flight.” Unfortunately, Mr. Frank chose not to include the bulk of Mr. Bowles’ remarks that chronicled our industry’s successful efforts to continue to improve our safety record.
The GAMA response goes on to talk about all the things the manufacturers are doing to help prevent planes from crashing. It says nothing, however, about what it is doing to ensure that when they do inevitably crash, they don’t catch fire.
Hall of Fame Aerobatic pilot Eddie Andreini died during the "Thunder Over Solano" air show at Travis Air Force Base in May. There was a mishap during his routine, and his Stearman biplane slid to a stop on the runway. Eddie wasn't hurt, but he was trapped in the plane. He radio'd for help.
The Air Force had told the performers that its fire trucks would be positioned and ready to respond to such an emergency within seconds. But for some reason, the trucks were nowhere to be found during Eddie's routine. Instead of getting to Eddie in a minute or less, as they were supposed to, the trucks didn't get to Eddie for nearly five minutes. By then, Eddie's plane was engulfed in flames and it was too late. Eddie was gone.
Where were the firetrucks? What took them so long to get to Eddie? When the family asked the Air Force these questions, the Air Force closed ranks and went mum. So the family exercised its rights under the Freedom of Information Act. The family formally requested the Air Force to turn over to them the documents that would show why the Air Force fire trucks didn't come to Eddie's aid as it had promised, and instead let Eddie burn to death.
Under the law, the Air Force had 20 days to respond to the family's request. We had hoped that, out of respect for the family, it would have turned over documents right away. But that was not to be. The family made its request to the Air Force four months ago. Yet the Air Force has yet to turn over to the family even a single piece of paper.
We've just filed suit against the Air Force for violating the Freedom of Information Act. We want to know:
I just returned from the American Association for Justice's annual convention in Baltimore, where I spoke on the risks automation poses to the general aviation pilot. As luck would have it, my autopilot failed departing San Carlos, so I ended up hand flying coast-to-coast. No "deskilling" happening here.
Automation risk has become a popular topic over the past few years, but there's relatively little research on the subject. To prepare for the talk, I reviewed that research and summarized it below.
A few hours ago, USA Today published a lengthy investigative report devoted to small aircraft crashes. The conclusion: aviation manufacturers have long concealed the fact that their defectively designed products cause aircraft crashes and injures. And the investigating agencies, including the NTSB and FAA, let them get away with it.
The report covers many of the issues we’ve touched upon before on this blog, from defective carburetors, to defective pilot seats, to faulty ice-protection systems. The report also covered a subject we’ve covered on this blog extensively – post crash helicopter fires in otherwise survivable accidents:
One of the most gruesome and long-standing problems has caused scores of people to be burned alive or asphyxiated in fires that erupt after helicopter crashes. Such deaths are notorious because they can occur after minor crashes, hard landings and rollovers that themselves don't kill or even injure helicopter occupants. The impact can rupture helicopter fuel tanks, sending fuel gushing out, where it ignites into a lethal inferno.
Using autopsy reports and crash records, USA TODAY identified 79 people killed and 28 injured since 1992 by helicopter fires following low-impact crashes. In 36 non-fatal crashes, fire destroyed or substantially damaged helicopters after minor incidents such as rollovers, crash reports show.
The report didn’t mention the most recent Robinson fire that killed the R44's pilot at Birchwood Airport in Alaska just two weeks ago.
I've been saying for years that many crashes that the NTSB attributes to "pilot error" simply aren't. The USA Today report backs that up. The report discussed the fatal crash of a single engine Piper following engine failure. The NTSB chalked up the engine failure to pilot error. But, as it turns out, the crash was caused by a defective carburetor float. The judge handling the case noted that the carburetor manufacturer had received more than 100 warranty claims for similar problems before the crash. Yet none of that product history made it into the NSTB report.
Ruling against Lycoming [the engine manufacturer] and Precision [the carburetor manufacturer], Philadelphia Judge Matthew Carrafiello found evidence both might be culpable. Precision received more than 100 warranty claims concerning carburetor defects, the judge said, and Lycoming continued to use the carburetors even though it "knew of ongoing problems" with the carburetors "and of numerous plane crashes resulting from such problems.
None of that information was included in the NTSB investigation, which was aided by Lycoming and Precision and blamed Andy Bryan, the pilot, for "failure to abort the takeoff" and "failure to maintain adequate airspeed during takeoff."
According to the report, many of the crashes that the NTSB concludes are due to pilot error are actually due to defectively designed aircraft.
Federal accident investigators repeatedly overlooked defects and other dangers of private aviation as they blamed individual pilots for the overwhelming number of crashes of small airplanes and helicopters . . . The failure of crash investigators to find defective parts, dangerous aircraft designs, inadequate safety features and weak government oversight helped allow hidden hazards to persist for decades, killing or injuring thousands of pilots and passengers . . .
Manufacturers mislead the FAA
Part of the problem is that the NTSB does not travel to the site of many small airplane crashes, leaving the on-scene investigation to the FAA. Unfortunately, according to a former NTSB investigator, the FAA personnel don’t have the same investigative experience as the NTSB investigators and are easily duped by the manufacturers.
Many times what happens now is that when the accident occurs, the technical rep of the (manufacturing) company will call the NTSB and say we'll be party (to the investigation), we'll go out there and let you know what we see … the only people on scene would be perhaps an FAA guy and the field rep of the manufacturer," said Douglas Herlihy, a former NTSB investigator who now reconstructs crashes, often for plaintiffs in lawsuits against manufacturers.
"If you (the NTSB) are not there, you've got the representative from the company at the scene. His job is to skew the facts, to ignore the product difficulties and to remove the question of liability," Herlihy said.
Aircraft engine manufacturers recommend that owners overhaul their engines when the engines have accumulated a set number of flight hours. Depending on the make and model, the "Time Between Overhaul" ranges from 1200 to 2400 hours. No regulation requires the general aviation aircraft owner to comply with the manufacturer's recommended TBO. As far as the FAA is concerned, the owner is free to operate the engine indefinitely, as long as a certified mechanic has signed off the engine as airworthy within the preceding 12 months. And given recent advances in engine diagnostic equipment, more and more owners are feeling comfortable "busting" TBO.
I wrote about the practice years ago, in a post entitled "Running Past TBO: Smart Economics or Owner Negligence?" The NTSB recently came down on the side of "owner negligence," at least in the case of a Cirrus engine that was operated past Teledyne Continental's recommended 2000 hour TBO.
The National Transportation Safety Board determines the probable cause(s) of this accident to be: The inadequate servicing and maintenance of the engine and the airplane owner and maintenance personnel's disregard of the manufacturer's recommended engine overhaul schedule and service bulletins, which resulted in an in-flight internal failure and seizure of the engine.
In that case, the engine failed at 2978 hours. The NTSB also faulted the pilot for flying the aircraft with only 5 quarts of oil on board, instead of 6 quarts as recommended by the manufacturer.
Fortunately, no one was hurt. But an owner should think twice about running past TBO, regardless of whether an FAA-certified mechanic has pronounced the engine airworthy.
When the engine quits just after takeoff, the pilot has few options. One is to attempt to turn around and try to land at the airport. It's such a difficult maneuver that it's often referred to as "the impossible turn." I've written about the "impossible turn" before. AvWeb's Paul Bertorelli takes another look at the turn in the video below. Bertorelli suggests that the turn is an option that a pilot should not write off. But it does require practice.
My advice is to practice with plenty of altitude. I've had two cases involving fatalities resulting from turning back after simulated engine failures during flight training. One is here.
Some say that a properly designed aircraft should not catch fire in an otherwise survivable accident. We know this crash was survivable, because the pilot was able to walk away from the wreckage. If it weren't for the post-crash fire, the pilot likely would have survived.
The Cirrus Aircraft boasts many safety features, such as its rocket-propelled parachute. But the Bolingbrook crash is one more data point tending to show that the Cirrus seems to be unusually susceptible to post crash fires, especially when compared to other modern aircraft.
I really like the Avidyne PFD, MFD, and autopilot in my Cirrus.
In a nutshell, the Avidyne PFD and MFD tell the pilot flying in instrument conditions which way is up and how to steer a course that keeps you from hitting a mountain. The Avidyne autopilot is loaded with great safety features that can save your bacon if for some reason stuff hits the fan in the cockpit.
A few days ago, Avidyne offered me its new “AeroPlan” extended warranty for my equipment: pay $2000 per year and any repairs are free. If that sounds like a lot of money, keep in mind that without a warranty Avidyne charges a flat rate of $5900 to fix anything that might go on the fritz. (Ouch!)
Offer expires July 1.
All in all, it seemed like a deal that I couldn’t refuse.
Then I read the fine print.
Avidyne won’t sell owners the warranty unless they sign a “Waiver, Release and Indemnification.” At first blush, that document seemed like just another boilerplate form designed to protect Avidyne fromt frivolous suits. But when I read the form closely, I realized that by signing it, an owner puts his entire net worth on the line should Avidyne screw up and hurt someone that the owner may have never even met.
By signing, the owner agrees that he won’t sue Avidyne if he crashes, regardless of whether the crash was Avidyne’s fault. Hmmm. You’d think that if I could prove that I crashed solely because Avidyne’s product was defective, Avidyne would agree to at least pay my medical expenses
But it gets worse. By signing the agreement, the owner agrees that if one of his passengers is injured in a crash, and his passenger sues Avidyne, the owner will pay Avidyne’s attorneys fees in defending the case in court. Same goes for suits brought against Avidyne by anyone who is injured on the ground.
Furthermore, by signing the owner agrees to pay any court judgment that is awarded against Avidyne -- even though the accident turns out to be entirely Avidyne’s fault and not the owner's.
And there is no end date to the owner's obligation. So even after I sell the aircraft, I’m still on the hook. If the new owner crashes, and then sues Avidyne, I agree to pay for Avidyne’s attorneys and for any judgment that the new owner (or his passengers) obtain against it.
In short, anyone who signs this agreement becomes Avidyne’s insurance company. Forever. All to save a few bucks on repair work.
Who would agree to that? My understanding is that owners are rushing to beat the July 1 deadline. But I don’t think those folks know what they are getting themselves into.
A jury in Washington state handed down a $26 million verdict against Avco Lycoming as a result of a fatal Cessna 172 crash that killed three people in 2008. The jury's award included $6 million in punitive damages, designed to punish Lycoming for consciously disregarding the safety of the flying public.
It's the second time a jury has slammed Lycoming with punitive damages for its carb floats. In 2010, a jury awarded $89 million, including $64 million in punitive damages, as a result of 1999 Cherokee 6 crash that killed four and injured one.
This case, however, was a bit different. It was the judge who ruled that Lycoming was responsible for the crash before the case ever reached the jury. All that was left for the jury to decide was how much to include in its verdict. The judge ruled against Lycoming because it refused to turn over relevant documents in the case. Apparently, the documents were so incriminating that Lycoming felt it was better to suffer a certain jury verdict than to allow the documents to see the light of day.
[I]n December 2005, Lycoming participated in a series of emails discussing the leaking Delrin Float issue, none of which Lycoming produced during discovery. The series of emails informs Lycoming of the significance of the Delrin float leaking problem. In the emails, Lycoming employees state that it is clear that hollow plastic carb floats can leak, allowing fuel to enter the interior of the floats. The emails reflect that there was also a recent inflight [engine] stoppage. The email also recognized the danger of discussing the defects in writing: “It is too bad that we have to answer in writing on such a touchy issue.”
Plaintiffs asked Lycoming to turn over the rest of the emails on the subject, including those that went to upper managment. The emails would have been important evidence that Lycoming knew the floats leaked and could cause engine failure. But Lycoming refused. So the court ordered Lycoming to turn them over. Lycoming still refused.
Lycoming's willful and deliberate refusal to follow the court’s order prevented plaintiffs from proving their case. So the court did the only thing that was fair and ruled that the floats were defective and caused the accident.
The Judge's order is an interesting read.
An Fixed-Base Operator will sometimes tell the pilot to whom it rents an aircraft that, in the event of an accident, the pilot may be held responsible for the FBO's deductible. From that, pilots sometimes conclude that their liability will be limited to the amount of the deductible, and that everything else is "covered."
Not so. Not only can the FBO pursue the pilot for the deductible, but the FBO's insurance company can (and often does) pursue the pilot for the full amount it pays to the FBO for the damage to the aircraft. In other words, the renter pilot can be held responsible for the entire loss.
But more importantly, the FBO's policy doesn't necessarily cover the renter pilot for any injury or death he may cause to others. That was the recent holding in Knezovich v. Hallmark Insurance, an Illinois case arising from a fatal midair collision between a Cirrus and a Cessna in Wyoming. The families of those killed in the Cirrus sued the estate of Cessna pilot, claiming the Cessna pilot caused the crash. The court ruled that the FBO's insurance policy didn't protect the pilot at all (or, more accurately, his estate) and that the insurance company didn't even have to hire the renter pilot's estate a lawyer to defend against the wrongful death lawsuit brought against it. In short, the estate was on its own.
Aviation lawyer Greg Reigel sums it up:
Although this is an unfortunate situation for the deceased pilot's estate, this case serves as a reminder to anyone who rents aircraft to confirm that insurance coverage is in place that will protect the renter. It isn't enough to simply ask the FBO or aircraft owner whether they have insurance. You need to be sure that coverage is in place to protect you, the person renting the aircraft. If the aircraft owner's or FBO's insurance doesn't provide coverage, you need to know that so you can understand your risk and either obtain coverage elsewhere or go without.
Of course, not only was the situation unfortunate for the estate of the Cessna pilot, but it was unfortunate for the families of the others killed in the accident. Even assuming that they prove the crash was caused entirely by the Cessna pilot, unlike the FBO, its unlikely they will ever be fully compensated.
The NTSB has determined that the probable cause of the Galloping Ghost’s crash at last year’s Reno Air Races was flutter. No surprise there -- I wrote about flutter within hours of the accident. At its presentation, the NTSB even showed the same NASA video demonstrating flutter that I had posted last year.
Flutter can occur whenever an aircraft is flown faster than it is designed to fly. As it turned out, Jimmy Leeward, the pilot of Galloping Ghost, exceeded by nearly 40 mph the aircraft’s previous top speed without any previous testing to determine if the aircraft would be able to resist flutter at the new speeds. As it turned out, it couldn’t. Board member (and pilot) Robert Sumwalt was highly critical of Leeward’s decision to fly the aircraft in competition without first testing it at race speeds:
If you want to go out and fly fast and try to win, that's one thing. If you're modifying an aircraft without fully understanding how the modifications can affect the aerodynamics, you're playing Russian roulette.”
A loose trim tab assembly contributed to the flutter’s onset. The assembly came apart because the lock nuts that held it in place had been reused multiple times. That’s a no-no. Each time locknuts are removed and then re-tightened, they lose a bit of their ability to grip. That’s why once removed, locknuts should always be replaced with new.
What was surprising was the NTSB’s sentiments concerning “assumption of risk”. According to the NTSB board chair Deborah Hersman:
At the heart of the tragedy was the fatal intersection in transference of risks from participant to observers. One moment, spectators were thrilled at the spectacle of speed only to have it followed by inescapable tragedy. The pilots understood the risks they assumed. The spectators assumed that their safety had been assessed.”
Those sentiments echoed what I wrote here. Judging from readers’ comments to that post, many disagree.
Transcript of the NTSB presentation here.
All this blog's Reno Air Crash posts here.
Why doesn’t the FAA do a better job of promoting aviation safety?
1. The FAA’s Inherent Conflict of Interest. When the FAA was created, it was charged with both regulating aviation and promoting it. But most aviation regulations don't promote aviation -- they constrain it. The FAA’s inherent conflict of interest explains why the FAA so often ignores the NTSB’s aviation safety recommendations.
2. The Problem of the Captive Regulator. Putting aside the inherent conflict of interest, the FAA is simply too close to the industry it regulates to do an effective job. This problem is not unique to aviation. For example, the drug industry has tremendous influence over its regulating agency, the FDA. We saw that play out most recently last year, when we learned that a number of the FDA committee members who voted against requiring stronger warnings on a drug's label had economic ties with the drug's manufacturer. In California, we learned that the Public Utilities Commission was too cozy with the gas utility it was supposed to regulate. It let the utility slide again and again until September 2010 when a gas explosion in San Bruno killed 8 and damaged or destroyed more than 40 homes.
3. Bureaucratic Incompetence. Sometimes, it seems that bureaucratic incompetence is the simplest reason for the FAA’s failure to act in the face of a known ongoing hazard. What else explains the night vision goggle debacle?
At first glance, one might expect that high density altitude was the cause of last week’s fatal Comanche crash at Truckee-Tahoe airport. The pilot first attempted to depart with three aboard, but aborted the takeoff. He then offloaded his two passengers and tried again. It was on the second attempt that the pilot crashed into hangars.
No doubt about it: Because of its altitude, Truckee is a difficult airport, especially in the summer when the air is thinnest. In fact, last week’s crash was the ninth at the airport in the past four years. High density altitude played a role in a number of those crashes, including the Karen Trolan crash.
But the facts don’t quite add up on last week’s accident. The pilot flying the accident aircraft (Piper N8218P) was very experienced – he reportedly had in excess of 6000 flight hours. And though a departure with three aboard may have taxed the abilities of the plane and its pilot, with only the pilot aboard, there shouldn’t have been much of a problem.
Whenever an aircraft crashes on takeoff, the NTSB tests the fuel supply at the departure airport. It’s always possible that an engine failure contributed to the crash, and one possible cause of an engine failure is contaminated fuel.
Today word is out that the fuel supply at Truckee did not meet the standards.
From an email I received from San Mateo County Airport:
After a fatal accident at Truckee (KTRK) on the 2nd of August, the industry-standard practice of halting fuel service and testing the fuel in all tanks and trucks revealed that the 100LL fuel stored at KTRK did not meet the American Society for Testing and Materials (ASTM) standards for 100LL. As a result of these tests, 100LL fuel service at the airport continues to be suspended pending new fuel and testing of its quality.
Truckee Airport has been trying to get in touch with all pilots who purchased fuel between July 20th (the last fuel delivery) and August 2nd (the day of the accident) and have asked us to pass along this information to pilots at San Carlos/Half Moon Bay. Questions about the above-mentioned issue should be directed to World Fuel Service's area representative Mike Montalvo at: 510-604-6511.
The test results don't prove that bad fuel caused the Comanche crash but, at this point, bad fuel can't be ruled out.
Pilots have come to accept that aircraft fuel gauges just don’t work well. In fact, many pilots simply assume the fuel gauge is wrong, believing it’s safer to rely on their own calculations concerning the amount of fuel remaining rather than on the gauge. As the old saw goes, “never trust your life to a gauge.”
Good idea. Usually. But sometimes skepticism about fuel gauges can lead to an accident.
The pilot and one of his passengers were killed when the Cessna 172 crashed in Tennessee. The second passenger survived. The NTSB determined that the plane ran out of gas. How can this happen? According to the NTSB report, it seems the pilot may have miscalculated the amount of fuel necessary for the trip because he didn’t know the engine horsepower had been increased by an STC, and thus burned more fuel than an unmodified aircraft..
But still, the aircraft did have a working fuel gauge. What the NTSB’s report does not discuss is why the pilot ignored it.
The pilot and passengers were apparently from the U.K. Last week, the Welch coroner held an inquest, at which the surviving passenger testified. The passenger explained that he had been sleeping in the back seat. He woke up and:
I glanced over to look at the instruments and just noticed the fuel gauge had a low indication. I brought it to the knowledge of [the pilot]. He said ‘I’ve done a maths calculation about the distance and I trust my maths more than a 1969 fuel gauge’.
Was the pilot arrogant? Or was he just sucked in by the common belief that aircraft fuel gauges are seldom accurate?
More than 30 Cessna 208 and 208B Caravans have crashed when their wings iced up in flight. Victims’ families have filed many product defect lawsuits against Cessna, claiming that Cessna concealed from the pilots defects in the aircraft’s deicing system. Silvey v. Cessna is the first case to reach trial. At least the first that I know of.
Silvey, which is pending in federal court in Fort Worth, Texas, involves a Caravan that crashed near Parks, Arizona in November 2002. The pilot reported encountering light icing. According to the NTSB report, a short time later, a witness saw the aircraft come spinning out of the clouds with its nose pointed down. All four on board were killed on impact.
After that crash, the FAA issued at least three airworthiness directives against the Cessna Caravan, all concerning the aircraft’s deicing system. Cessna asked the Silvey trial judge, the Honorable Terry Means, to keep the airworthiness directives from the jury. Cessna argued that since the FAA didn't issue the airworthiness directives until after the accident, they are not relevant. The judge declined to rule whether the evidence will come in or stay out. Instead, he ruled that he’d have to see how the trials goes before deciding.
Three of the airworthiness directives at issue are:
No conclusion yet as to exactly what caused the Galloping Ghost to crash last September at the Reno Air Races. But the interim report the NTSB issued today disclosed that the Galloping Ghost experienced an “upset” 6 seconds before it lost its left elevator trim tab. That, in turn, caused the aircraft to go out of control. None of that information is really new, and was discussed shortly after the accident in this post and in the post's many thoughtful comments.
The NTSB also issued safety recommendations that specifically questioned whether the Galloping Ghost had been properly tested at race speeds or otherwise evaluated for resistance to “flutter;” an aerodynamic phenomenon that can destroy an aircraft in seconds. But that’s not news either -- flutter and its possible role in this crash was discussed the day after the crash here.
There is one fact, however, that we didn’t know before. Race officials inspected the aircraft just before the race and determined that the aircraft’s trim tab’s screws were too short. But the NTSB could find no documentation that the screws had been replaced and the discrepancy resolved before the race started. Though the race inspector stated that he verified that all the aircraft’s discrepancies had been resolved, the NTSB recommended that, in the future, race organizers develop a system that tracks discrepancies found during pre-race technical inspections and ensures that they have been resolved before an aircraft is allowed to race As the NSTB put it:
without a method to track discrepancies to resolution, conducting pre-race inspections is of limited value.
The NTSB’s interim report doesn’t say whether the screws were, in fact, replaced. For that, we’ll have to wait for the NTSB to issue its factual report. But even without a system for race officials to track discrepancies, whenever a mechanic performs any work on an aircraft, he is supposed to record that work in the aircraft’s maintenance logs. If there’s no entry in the Galloping Ghost’s logbooks showing that the screws were changed, that’s evidence that the work wasn’t done, or at least wasn’t done properly.
Besides recommending that race officials establish a better system of ensuring that aircraft discrepancies are repaired before race time, it issued recommendations that would, among other things:
Can any question remain about the R44's tendency to roll over and catch fire? It happened again yesterday, in Glendale Arizona. This time, the helicopter had barely gotten off the ground.
Fortunately, no one was hurt. But the story is becoming all too familiar. According to the Arizona Republic:
A mechanic was testing the engine of the Robinson R-44 helicopter when he lost control and it came down on its side and caught fire.
Helicopters aren't supposed to catch fire in survivable accidents. But Robinsons do just that because their fuel tanks are defectively designed. This latest fire happened little more than a few weeks after an R44 accident killed filmmakers Mike deGruy and Andrew Wight. That crash led well-known aviation attorney Ladd Sanger to call the Robinson R44 the "Ford Pinto" of helicopters.
Seems as though there may be something to that.
Foreign countries routinely bring criminal charges against pilots after an accident. But in the US, criminal charges are very rare. And that's a good thing because "criminalizing negligence" usually does little to promote safety.
But perhaps there are exceptions.
Pilot Steven Fay bought his 1960 Cessna in June 2010. He crashed it after dark on New Year's Day 2011. He survived with minor injuries but, sadly, his 35 year-old daughter -- the passenger on the plane -- did not.
A Massachusetts grand jury has now indicted him for involuntary manslaughter, which carries a possible 20 year prison term.
Fay's Cessna, a Cessna 310, was a "multi-engine, complex, high-performance airplane." Trouble is that:
According to the NTSB report, neither weather nor mechanical problems played a factor.
The pilot says he warned Lauren Scruggs away from his propeller. According to the NTSB's preliminary report:
After [the pilot] opened the door, [Scruggs] started to get out of the airplane. Upon noticing that she was exiting in front of the strut, the pilot leaned out of his seat and placed his right hand and arm in front of her to divert her away from the front of the airplane and the propeller. He continued to keep his arm extended and told [Scruggs] that she should walk behind the airplane. Once he saw that [Scruggs] was at least beyond where the strut was attached to the wing, and walking away, he dropped his right arm and returned to his normal seat position. The pilot then looked to the left side of the airplane and opened his window to ask who was next to go for a ride.
The pilot then heard someone yell, "STOP STOP," and he immediately shut down the engine and saw [Scruggs] lying in front of the airplane.
While the pilot apparently tried to keep Scruggs from the propeller, it wasn't enough. Sadly, the accident likely would have been avoided had the pilot followed the the general safety guidelines set forth here.
The NTSB says that during tomorrow’s hearing, it will be looking to industry leaders to give it a “deeper understanding of regulations” bearing on the operation of the nation’s air shows. Of course, the only regulatory body that has the authority to control air shows is the FAA. But what the Board will find -- if it asks the right questions -- is that for the most part, the industry regulates itself. According to one veteran air racer, Howie Keefe, the FAA is more or less “hands off” when it comes to air show safety. From Martha Bellisle’s article in the Reno Gazette-Journal:
Keefe said the industry is largely self-regulated because the pilots and engineers are the most qualified to determine whether another pilot can handle a certain race or course or whether a certain design can handle the stress of a trick or race. ‘The classes themselves can say yes or no to a person who wants to race — if they can’t do a roll, they can’t race,’ Keefe said. ‘The FAA can’t do that. We rely on the expertise of the people in the industry to make the decisions.’
Perhaps a “hands off” policy is fine for the participants. But not so much for the spectators, who expect that if the FAA approves an event, it is overseeing the event’s safety in some meaningful fashion, and not merely turning the reins over to the event sponsors.
This Board says that the purpose of tomorrow’s public hearing is to help it investigate future air show accidents. But this Board is more assertive than past boards. There’s little doubt that it will find the FAA’s oversight lacking. The question is whether it will do anything about it.
Some say that Cirrus aircraft are improperly designed because they tend to catch fire on impact more frequently than other aircraft, such as those manufactured by Cirrus competitors, like Diamond or Cessna. And there are plenty of examples of post-crash Cirrus fires to talk about. Critics argue that those fires prove that the aircraft is unduly dangerous and defective.
An aircraft should be designed such that no one is burned to death in an otherwise survivable accident. At least, that’s the design standard in the auto industry. It became the standard when, during the 1970's, Bell Helicopters showed that some simple engineering enhancements could virtually eliminate post-crash fires in survivable Huey helicopter accidents. That technology has been around now for 40 years. The technology works in helicopters and cars, so there’s no reason for a properly designed, modern airplanes to catch fire either.
But the key is that the crash must be otherwise survivable. If the crash is not otherwise survivable, the post-crash fire is irrelevant to the fate of the occupants. To date, the Cirrus fires that critics point to (like this one, and this one) were accidents that likely would have been fatal regardless of whether there was a post crash fire. So from those accidents, no conclusions about the fuel system's safety can be drawn.
But this morning, everything changed. A Cirrus crashed in Phoenix while on approach to land at Scottsdale Airport. Both the pilot and the passenger survived the impact. But then a fire broke out. The fire killed one occupant and badly burned the other.
Unlike other Cirrus crashes, the Scottsdale crash was undeniably survivable. The post - crash fire raises legitimate questions about whether the Cirrus fuel system is as crashworthy as it should be.
“Investigators aren’t sure why Scruggs didn’t see the propeller” she walked into last night.
Um, maybe because a spinning propeller is pretty much invisible? Especially at night?
News reports are that incidents such as Lauren Scruggs', who is a model and fashion blogger, are rare. Maybe, but it would depend on what one means by “rare.” Seems that someone is killed or seriously injured by a spinning prop every year. Some reports of incidents from my local area alone are here and here.
During the day, spinning propellers have a mesmerizing effect. People have been known to see them, yet walk right into them.
Of course, at night, propellers can be virtually invisible.
In almost all prop-strike cases, pilot error plays a role. A pilot needs to think carefully before allowing a passenger to deplane with the engine running. Here, apparently, the pilot allowed Scruggs to exit the aircraft with the engine running so that another passenger could take her seat. Certainly it would have been safer to shut down the engine of the Aviat Husky he was flying before allowing passengers to leave or approach the aircraft. “Hot loading” – allowing passengers to get into the aircraft with the engine running -- is safe only when the passengers have been carefully briefed on procedures. Even then, it's best permitted only with the help of a trained spotter who walks one passenger away from the aircraft and then walks the next passenger in.
Here are some common guidelines for propeller safety:
It looks as though it was the twin-engine Seminole that caused the mid-air collision between it and a Beech Bonanza near Newberg, Oregon. The crash killed the the 58-year old Bonanza pilot. The Oregonian quotes sources saying that:
the larger Piper PA-44 Seminole was executing training maneuvers in the area, making a series of rapid ascents and descents shortly after 4 p.m., when it came down upon a Beech Bonanza V35. . . [cutting it in two].
The Seminole (N3062H) was owned by Hillsboro Aviation, a flight school in Hillsboro, Oregon. As it turns out, the crash was not the flight school's first. In fact, in recent years the school has been plagued with training accidents. The most serious of those was in September, 2009, when both a Hillsboro Aviation flight instructor and his student were killed while training in a Robinson R22 helicopter.
In August 2010, the FAA indicated its intent to fine Hillsboro Aviation $580,000 for numerous safety violations, including improper maintenance of its aircraft. Though the FAA investigation looked into the September 2009 fatal helicopter crash, the FAA ultimately decided to levy the fine for violations unrelated to that crash -- specifically for what it found to be Hillsboro's intentional falsification of various aircraft maintenance records.
Of course, Tuesday's crash may be entirely unrelated to the previous Hillsboro Aviation training crashes and the conduct for which the FAA cited the flight school. Nonetheless, the school's safety record is abysmal.
Yet, Hillsboro Aviation remains in operation.
The NTSB excludes family members from its accident investigations. But it allows those who may have caused or contributed to a crash to participate. That's an obvious conflict of interest. As a result, NTSB probable cause findings are not always impartial. Instead, they tend to favor the industry players.
The industry players have long argued that, while they may be allowed behind closed doors to assist the NTSB in their investigations, they would never seek to influence the investigation's outcome.
The Reno-Tahoe Airport Authority, which owns Reno-Stead Airport, has dropped the pretense of "just wanting to help the NTSB find out what happened." Rather, it has gone whole-hog in seeking to actually influence the investigation of the Reno Air Race Disaster. In fact, it has hired professional help from a Washington lobbying firm.
You won't find that information on the Airport Authority's website. But you will find it in papers filed in Washington, DC. According to The Hill:
The Reno-Tahoe Airport Authority has hired Gephardt Government Affairs to lobby on the “government investigation of crash at Reno Air Races,” according to new lobbying forms released this week.
An NTSB investigation is not supposed to be a political process. It's hard to imagine anything more inappropriate than hiring lobbyists to influence its outcome.
But that is what it has come to.
Thankfully, we still have the jury system. No lobbying allowed there. Everything has to be done in open court, for all to see.
There are obvious dangers inherent in events such as the Reno Air Races. The victims of the disaster were undoubtedly aware of those dangers and attended the event anyway. Does that mean they should not be able to file lawsuits to obtain compensation for their loss?
Not at all.
Granted, Life is Full of Risks
There are risks involved in most everything. We take a chance every time we cross the street. But it’s nonetheless reasonable for us to believe we will be safe when we are in the crosswalk. When we use the crosswalk, we are where we are supposed to be.
If an SUV hits someone in the crosswalk, we may all agree it was “just an accident.” Yet, we require the driver to compensate the pedestrian for his injuries. If the driver couldn’t see the pedestrian because the crosswalk was poorly designed, we might require the city to compensate the pedestrian. In either case, we don’t tell the pedestrian that he is out of luck because he assumed the risks of getting hit by a car.
It doesn’t matter that the driver had a very good driving record up to that point in time. While we don’t punish those responsible for an accident, we do hold them accountable and require them to compensate the person who, through no fault of their own, is seriously hurt.
The victims at Reno undoubtedly understood that there were risks associated with the Air Races. But they were exactly where they were supposed to be. Sure, the crash was an accident. But that doesn’t mean whoever is responsible for the injuries – whether that is a mechanic or a course designer -- shouldn’t compensate the victims for their losses.
The Race Sponsors Were Supposed to Provide Patrons with a Safe Viewing Area
Some say that Nevada law lets sponsors off the hook for injuries to spectators. And it's true that, in Turner v. Mandalay Sports Entertainment, the Nevada Supreme Court said that a baseball stadium was not responsible for serious injuries a fan sustained when she was struck by a foul ball. But in that case, the fan was not in the viewing area. Had the fan been injured in a viewing area, the result might have been different. That’s because the court recognized that a ballpark has a duty to provide the patrons with at least some designated safe seating.
Once a stadium owner or operator complies with the rule's requirements by providing sufficient protected seating, the owner or operator has satisfied the legal duty of protection owed to its patrons.
The Reno Air Race victims were in the designated viewing area. They were exactly where they were supposed to be. But it appears that the sponsors failed to ensure that the area was safe. Turner v. Mandalay would thus seem to support the victims’ claims for compensation, not undercut it.
The Language on the Ticket Is Not a Contract
A reader of this post noted that, according to the tickets sold for the event, the spectators voluntarily assumed all the risks and released the event sponsors from liability for any injuries. Isn’t that the end of the matter?
Sure, a spectator can, by contract, agree ahead of time not to sue if he is injured, even if the person who caused the injury was negligent. But for there to be a contract, there has to be an agreement. If the spectator actually signed something, then that would be one thing. Without the victim’s signature, the fine print on the ticket won’t be binding on anyone.
Hall of Fame aerobatic champion Patty Wagstaff says that it was just bad luck that Jimmy Leeward's accident involved spectators.
At the speeds Leeward was moving, had the malfunction occurred four seconds earlier or later, or almost anywhere else on the course, it would have terminated in the desert. This was not an accident waiting to happen – this was a freak accident.
Patty, this was not the first time that flutter sent a highly modified warbird out of control during the Reno Air Races. It happened in 1998, when flutter ripped a trim tab from a P-51 called "Voodoo." Bob Hannah, the pilot, immediately found himself heading straight up, just as Jimmy Leeward did. Hannah lost consciousness from the high g-loading, but regained his senses as the aircraft rolled over the top. Unlike Leeward, Hannah landed safely.
So, though it's too early to say for certain, it looks like Leeward's precise airframe failure -- or something pretty darn close -- actually happened before. And sure, Leeward's failure could have just as easily occurred somewhere else along the nine mile course, and not at show center. But that doesn't make it a "freak accident," any more than losing at Russian Roulette can be considered a freak accident.
Nope. This was an accident waiting to happen.
The warbird pilots push their aircraft to their limits and beyond. That's why it's called "Unlimited" racing. No one would deny pilots, fully aware of the risks they are taking, the right to fly their aircraft to the point of destruction. It is, after all, their own lives that they are risking over the Nevada desert. But they should not be permitted to place spectators at risk. Pilots might be willing to flirt with death. But that's not what spectators bargain for.
Sorry, Patty. Leeward's crash was no "freak accident." And suggesting it was is not fair to the victims.
Related content on this blog:
Three Mooneys have crashed in two weeks. Each aircraft crashed on takeoff. Sadly, seven people were killed. Two of the accidents may have involved the "impossible turn."
First Crash: On July 5, a 1974 Mooney M20F (N7759M) crashed shortly after taking off from Watsonville, California. All four aboard were killed.
At first glance, the Watsonville crash and the Winslow crash seem eerily similar. The same model aircraft was involved in each. Each crashed just moments after takeoff.
But the two accidents are entirely different. The Watsonville crash is consistent with the pilot climbing too steeply to avoid a fog bank. There doesn't appear to be any evidence of an engine problem, at least at this point. Rather, as the pilot pitched the nose up, his airspeed bled off, and the wings (not the engine) stalled. According to one witness:
He was heading toward the coast and tried to climb . . .From the time he took off, he was going too steep, too slow. ... He spun to the left and you can see where the impact was.
In contrast, the pilot in the Winslow crash appears to have attempted to turn around and glide back to the runway after his Lycoming engine quit.
A Mooney departed then called with engine problems [saying he was] returning to the airport [from the] opposite direction. My friend circled giving the Mooney the right of way. . Later he asked the Mooney for a position, no response to a couple of calls. He circled for a while longer then landed. Rolling out he saw the Mooney off the departure end of the runway on its back. He said it looked like the typical return to the airport stall spin accident.
The attempt to return to the airport after an engine failure is often called "the impossible turn," because it so frequently ends in the aircraft stalling during the turn and spinning in, with fatal results.
Plots are trained never to turn back to the runway after an engine failure unless they have adequate altitude. Instead, land straight ahead, or slightly to the right or to the left. Better to land in the trees, but under control, then lose control of the aircraft and spin in. While a crash landing in rough terrain may result in serious injury or even death, spinning into the ground is almost always fatal. Losing control of the aircraft after engine failure must be avoided at all costs. Unfortunately, the temptation to try the "impossible turn" and make it to the runway can be irresistible.
This video shows a Mooney pilot attempting the impossible turn after engine failure near Sacramento, California in 2009. Both he and his passenger were killed when the aircraft spun in.
Third Mooney Crash: Finally, on July 18, a 1979 Mooney 20K (N777CV) crashed at Augusta Regional Airport while taking off, killing the pilot and sole occupant, a Mooreville doctor. That aircraft also came to rest within the airport boundaries. It appears this pilot also experienced engine failure, and also may have attempted to turn back to the airport, stalled, and spun in. Too early to tell.
Running out of gas is a leading cause of piston aircraft engine failures. So you'd think that pilots would have zero tolerance for the shoddy fuel gauges installed in many aircraft, such as the ones installed in the Cirrus SR22. But instead, they tend to make excuses for the manufacturers. "It would be too expensive to make gauges that work." Or, "you shouldn't trust a fuel gauge anyway." Or, my favorite:
Well, you know, the regulations require that the gauge be accurate only when reading empty."
That last one makes the least sense of all. A pilot doesn't need a gauge to tell him his tanks have just reached "empty." The aircraft has another way of informing the pilot the very moment that happens.
I don't know how this stuff about the regulations started. But I've heard it from dozens of pilots over the years. Even from those who work for manufacturers, and so should know better.
The Regulations Do Not Say that the Fuel Gauge Must be Accurate "Only When Reading Zero"
Most aircraft carry "unusable fuel." For example, perhaps there are three gallons that sit in a fuel line that can't be pumped to the engine. So while the aircraft carries 53 gallons of fuel on board, only 50 are "usable." The federal aviation regulations, not surprisingly, require that the gauge read "zero" when there are three gallons left on the aircraft, since that's when the engine will stop.
Each fuel quantity indicator must be calibrated to read "zero" during level flight when the quantity of fuel remaining in the tank is equal to the unusable fuel supply . . ."
Put another way, the gauge must read "zero" when there is no usable fuel on board. But it doesn't follow that when there is usable fuel on board, the gauge need not be accurate.
The Gauge Must Be Accurate At All Fuel Levels.
The regulations require the gauge to show the quantity of usable fuel in each tank "during flight." It doesn't matter whether there is a quarter tank, a half tank, or a full tank of usable fuel. The gauge must indicate the quantity accurately. The only time the gauge need not be accurate is when the aircraft is sitting on the ground.
If a fuel indicating system does not comply with the regulations, it is defective. Plain and simple.
The relevant part of the aviation regulations is as follows:
§ 23.1337 Powerplant instruments installation.
Fuel quantity indication. There must be a means to indicate to the flightcrew members the quantity of usable fuel in each tank during flight. An indicator calibrated in appropriate units and clearly marked to indicate those units must be used. In addition:  Each fuel quantity indicator must be calibrated to read "zero" during level flight when the quantity of fuel remaining in the tank is equal to the unusable fuel supply. . .
Senator Leahy of Vermont is pushing for a law that would insulate volunteer pilot organizations (such as Angel Flight West) from liability for injury the organization's pilots cause to its passengers. If the bill passes, it means that those injured by the negligence of an organization's pilot would have no recourse against the organization. Rather, the passenger would be limited to seeking compensation against the pilot -- regardless of how minimal the pilot's insurance.
The trouble is that those who decide to fly with a charitable organization usually do so because they are impressed by the organization, not by the pilot. The passengers don't select the pilot who, in some cases, they may not even meet the pilot until arriving at the airport for the flight. They have no way of checking out the pilot's qualifications or competence level. Instead, they trust the organization to do that.
It doesn't seem right for an organization to turn its back on an injured passenger or his family after an accident. Yet, that's what the bill would allow.
The text of the proposed law is as follows:
Liability Protection for Volunteer Pilot Nonprofit Organizations
A volunteer pilot nonprofit organization that flies for public benefit, the staff, mission coordinators, officers, and directors (whether volunteer or otherwise) of such nonprofit organization shall not be liable for harm caused to any person by a volunteer of such nonprofit organization while such volunteer--
(A) is operating an aircraft in furtherance of the purpose of such nonprofit organization;
(B) is properly licensed for the operation of such aircraft; and
(C) has certified to such nonprofit organization that such volunteer has insurance covering the volunteer's operation of such aircraft."
The EMS helicopter was returning to Shenandoah Valley Regional Airport in Virginia, having dropped off a patient in nearby Charlottesville. Reports differ on whether the Cessna was departing the airport or returning to the airport for landing. The Cessna and the helicopter collided. Though the helicopter landed safely, both occupants in the Cessna were killed.
No Control Tower
There’s no control tower at Shenandoah Airport. The primary means of preventing collisions at airports like Shenandoah is called “see and avoid.” That means that pilots are supposed to look out their windows, see other aircraft, and avoid them.
Helicopters and Airplanes Don’t Mix Well
Though the "see and avoid" method may sound primitive, over the years it has worked well, and mid air collisions are relatively rare. But helicopters don’t mix well with airplanes in a "see and avoid" environment. Helicopters tend to fly slower than airplanes and, because they have a small cross section, they are hard for airplanes to spot -- especially when viewed from directly behind.
Because of that, when near an uncontrolled airport, helicopter pilots are supposed to "avoid the flow" of airplane traffic. In other words, as best they can, helicopters are supposed to stay out of the way of airplanes. Sometimes that’s easy enough. For example, if the airplane traffic flies on one side of the airport (see below), the helicopters generally should fly on the other side. Or, the helicopter can fly at an altitude that is lower than the altitude at which the airplanes are flying.
The above diagram depicts a left-hand traffic pattern for fixed-wing (airplane) traffic similar to the pattern used at Shenandoah Airport. Airplanes typically fly the traffic pattern at 1000 feet. To avoid the flow of that traffic, helicopters might fly a right-hand traffic pattern on the other side of the runway, and fly no higher than 500 feet.
One question will be whether the Cessna was operating within the "flow" of fixed wing traffic when the collision occurred and, if so, why the EMS helicopter did not avoid that flow.
Steve Wilson argues that there are safety issues with Cirrus airplanes. First, Wilson feels that the Cirrus is more prone than your typical Beechcraft to crashes in which the pilot loses control of the aircraft while maneuvering. Second, Wilson feels that the Cirrus is more susceptible to crashes involving inadvertent encounters with icing conditions.
Of course, the NTSB chalks up both of these types of accidents to pilot error, not to a fault in theContinue Reading...
The NTSB hasn't yet released its probable cause finding concerning the Pilatus crash at Butte, Montana that killed the pilot and his 13 passengers. But it has just made public its “docket.” The docket sheds some light on what may have been happening in the cockpit in the minutes leading to the crash.
The flight was bound for Bozeman. Suddenly, the pilot diverted to Butte, which was only marginally closer. Though the pilot never explained the reason for the diversion, the docket suggests that theContinue Reading...
We've filed suit against Los Gatos real estate broker Karen Trolan (pictured), her husband Steve Trolan, and their company, Trolan Enterprises, as a result of the September 2009 plane crash that left the Trolans' passenger, 14 year-old Marilyn Mitchell, seriously injured.
The Trolans were headed from Truckee Tahoe airport to San Jose. They needed very little fuel for the short flight. But fuel was a few pennies per gallon cheaper in Truckee than in San Jose. The Trolans decided to fill the tanks of their single-engine Cessna 206 to the tops.
When departing a high altitude airport such as Truckee, that's a very dangerous thing to so. As discussed here, the combination of thin air and a heavy aircraft can dramatically compromise the aircraft's ability to climb. After takeoff, the aircraft will ride briefly on the cushion of air that exists between the plane's wings and the runway, and then crash. And that's exactly what happened.
The NTSB's preliminary report confirmed that the Trolans' tanks were indeed full when they attempted to take off.
The crash was caused by pilot error, plain and simple. Yet, the Trolans have turned their back on Marilyn and her family, leaving them to fend for themselves. The Trolans have yet to pay any of Marilyn's medical bills, which continue to mount.
It’s not uncommon for three or four pilots to share ownership of an aircraft. For years, owning an aircraft as “partners” was the norm. That form of ownership, however, carries with it some liability considerations.
Many pilots seeking to share an airplane now form a limited liability company. They arrange it so that the company, and not the individual pilots, own the aircraft. The pilots own shares in the company only. Because the pilots do not themselves own the aircraft, they avoid some of the liability that comes with aircraft ownership generally and with the partnership relationship in particular.
But here’s where people often get confused: no form of ownership allows the pilot who is flying the aircraft to avoid responsibility for his own negligence. If a pilot error kills or injures someone, that pilot may be held accountable to the victim or his family regardless of whether the aircraft is owned by his partnership or by his limited liability company.
An aircraft owner loans his plane to a friend. The plane crashes and a passenger is injured. It turns out the crash was caused by the negligence of the aircraft's mechanic. Can the crash victim hold the aircraft owner liable for the mechanic’s faulty work?
This question comes up a lot. In fact, it comes up in almost every case where the mechanic doesn't have adequate insurance to cover the passenger's medical expenses.
Ask the owner’s insurance company whether the owner can be held liable, and they will always say “no.” Their argument is that the owner didn’t perform the work and, in fact, without a mechanic's license was legally prohibited from doing so. The owner trusted the mechanic, as the regulations required him to, and so did nothing wrong. According to the owner’s insurance company, the passenger must look to the mechanic for compensation, and not to the owner.
In California, unlike in some other states, an owner of a machine that can seriously injure someone if not properly maintained is responsible to those injured as a result of faulty maintenance. It doesn’t matter that the owner didn't actually perform the faulty maintenance.
Why does this make sense? Because, according to the Supreme Court's opinion in Maloney v. Rath, it is the owner who decides who the mechanic will be.
the owner selects the [mechanic] and is free to insist upon one who is financially responsible and to demand indemnity of him.
In other words, the injured party had no say in what mechanic did the work, or whether the mechanic carried insurance. But the owner who selected him did. So the accident victim can hold the owner financially responsible, and leave it to the owner to try to obtain reimbursement from his mechanic.
The Maloney case didn’t involve airplanes. It involved a car crash caused by improperly maintained brakes. But the reasoning applies to airplanes too. After all, improper aircraft maintenance is just as dangerous as improper car maintenance. Maybe even more so.
The federal aviation regulations make the owner responsible for maintaining the aircraft in airworthy condition. The owner can’t necessarily avoid that responsibility by hiring a good mechanic. Despite what the insurance company says, the owner may still be on the hook. At least in California.
An instrument rating entitles a pilot to legally navigate an aircraft when the weather is bad enough that he can't see outside. A pilot who is not instrument-rated must always stay out of the clouds. If the weather is such that he can't do that, he must stay on the ground.
The training required to obtain an instrument rating is extensive. In most cases, it takes a pilot longer and costs him more to obtain the rating than it did for him to get his pilot's license in the firstContinue Reading...
According to the NTSB, most aviation accidents are caused by pilot error. But aviation lawyers know that as many as half the cases that the NSTB says were the result of "pilot error" simply weren't.
The NTSB does its best to get an accident's probable cause right. The trouble is that, in almost every one of its cases, the NTSB turns to the manufacturer of the aircraft for help in figuring out what happened. In other words, the NSTB asks one of the entities who may have caused the crash for help investigating it. The NTSB calls this method of investigation the "party system." It presents an unavoidable conflict of interest. It's like asking the fox for help in figuring out what happened to the chickens.
More often than not, the "party system" results in the pilot taking the blame, even when the accident may really have been the manufacturer's fault. I've seen this happen dozens of times. I've written about it here and here and here.
NTSB investigators don't disagree. Well, at least one doesn't. From an anonymous email:
[W]e rarely, if ever, can exclude the manufacturers' representatives from access to every part and detail of an investigation. We (NTSB investigators) are open and forthright with these people. Unfortunately, such a candid exchange is rarely a two-way communication...And the process gets pretty cloudy when we send the wreckage, or part, to that manufacturer for teardown and examination. Sure, we're there 'in-charge' of the process...but that's just a formality.
But isn't the NTSB watching everything that the manufacturer is doing?
NTSB investigators 'observing' may be more like a dog watching television when it comes to the latest technology that is known only by those experts who made it in the first place. And it's even worse if an FAA Inspector stands in for the NTSB investigator. Then our 'eyes' may be almost an in-house friend of the manufacturer...
Predictable Probable Cause Findings
So, what do you expect as a result? 'Nothing wrong with our engine! (or accessory) (or special part)'...and that's what goes down in the report...That's the simple reason that 'statistics' cite 80% pilot error...This high rate is simply not accurate, it's far more often a system failure... but the NTSB cannot buck industry when we have to use the 'party system.'
The Cirrus aircraft is loaded with advanced safety features lacking in older "legacy" aircraft. Yet, the Cirrus safety record appears to be no better -- and perhaps even worse -- than that of the legacy fleet. How can this be?
I've written before that "risk homeostasis" may be one factor at work. I suggested here and here that pilots might tend to use the advanced features of the aircraft to fly into more challenging conditions than they otherwise would. While using the features in that fashion might increase the utility of the aircraft, it necessarily undercuts many of the features' safety benefits.
It turns out that that three human factors experts have published a short article (see below) on riskContinue Reading...
I was sitting in my aircraft at the approach end of the runway at San Carlos, waiting to be issued an instrument clearance. A Beech BE65 Queen Air taxied down to the runway and took off ahead of me. Sadly, it crashed 30 seconds later into a lagoon north of the airport, killing the three aboard.
Some questions raised in the various news accounts:
Why was the aircraft headed north on the “Bay Meadows” departure, when its ultimate destination was to the south?
I heard the pilot – or whomever was handling the radios -- tell the ground controller that he was going to fly along the ridge line west of the airport and then to South County airport. TheContinue Reading...
Vice President of Business Administration
Duluth, Minnesota 55811
I own one of your aircraft. There are some nice things about the Cirrus. But a few things, from a safety standpoint, really suck. First, the doors don’t stay closed. Second, too many pilots and passengers are getting killed when pilots try to land the thing. Third, the fuel gauges don’t work.
I read your comments on each of these issues in today’s Duluth News Tribune. Considering that they come from a company that prides itself on “celebrating safety,” I found some of the comments disturbing.
Bill, they pop open. A lot. It’s always a distraction when it happens. If they pop open at a bad time, it can spell real trouble. More on that here.
I read how you flew from one airport to another a few weeks ago with a door that wasn’t shut, andContinue Reading...
The pilot of the Otter that crashed in Alaska on Monday, killing Senator Stevens and three other passengers, encountered some very bad weather. Low ceilings. Fog and rain. Gusty winds.
Rugged terrain only complicated things. Fortunately, the pilot had tons of experience -- tens of thousands of hours. According to the Alaska Dispatch, had any less talented pilot been at the controls, the death toll surely would have been higher.
The fact there were four survivors is testament to [the pilot's] skills. [He] maneuvered that plane like no other mere pilot to save lives.
So is the pilot a hero? No. Not quite.
There's an old saying in aviation: "a superior pilot is one who exercises superior judgment so as to avoid having to exercise his superior skills." In this case, a pilot exercising superior judgment might have turned around before tangling with the worst of the weather. Or, better yet, never left the comfort and safety of the lake lodge in the first place.
The Weather was Bad
When the pilot took off from the lake where the lodge was located, the weather was bad. It was bad at nearby Dillingham airport. It was bad at the river camp that was to be their destination. And it was bad everywhere between.
A pilot who flew the same valley where the crash occurred confirmed to the LA Times that it was bad there too. "It was just awful weather. . .I came through that valley at about 100 feet off the ground with about a mile of visibility."
Now, bad weather doesn't mean a good pilot must stay on the ground. For example, the airport at Dillingham has various instrument approach procedures that will allow planes to land safely in some pretty crappy weather. No undue risk. No sweat.
But this pilot wasn't headed to Dillingham. He was headed to a fishing camp on a nearby river. No instrument approach procedure would guide him through the clouds. If this pilot was going to get there, he’d have to do it without instruments. He’d have to do it by looking out the window. Seat of the pants stuff. All perfectly safe, as long as the weather is good enough for you to see where you are going.
Controlled Flight into Terrain
So what exactly happened? What we know about the accident is consistent with "controlled flight into terrain." Opting out of the instrument flight system, the pilot had to stay under the clouds. He couldn't go through them because once inside, he wouldn't be able to see and might bump into something hard and pointy. So he had to stay in the clear and visually pick his way around the terrain in his path. But as he maneuvered under the low clouds and around the fog, he suddenly came upon a mountain's steep up-slope. He shoved the throttle forward, pulled the nose up and began a climb. But the terrain rose faster than could his aircraft. He bellied onto the rising slope while in full control of a perfectly functioning aircraft.
At least that how it looks.
According to John Bouker, the pilot who found the wreck:
The Otter had plowed into the hill. He bounced up the mountain. He looked like he was in a full-power climb. . the plane appeared mostly intact.
That’s a classic "controlled flight into terrain” scenario.
Poor Decision Making
This morning a pilot who used to fly search and rescue out of Dillingham called me to talk about the crash. He pointed out that the state of Alaska accounts for more than a third of all commuter and air taxi crashes in the entire country. That's right: one state accounts for a third of all the nation's crashes. And more than 80 percent of those crashes are due to poor decision-making.
Alaskans seem to accept aviation tragedies as part of life in the wilderness. My caller suggested that poor decision making seems to be not just tolerated, but sewn into the very fabric of Alaskan aviation community.
The question is not the whether the pilot had the skills to “maneuver” the aircraft around difficult terrain. Or whether he had the experience necessary to pick his way around the obstacles along the route. Or whether he brought the aircraft down with the least impact possible. The question is whether, given the weather, he should have attempted the flight at all.
I can easily imagine that a nice fire was burning in the lodge fireplace when the pilot loaded up his passengers. If ever there was ever a flight that didn't need to be made, it was this one.
Yet it was.
Cirrus N146CK crashed on August 4 at Deer Valley, Airzona. The pilot was killed. Just before the accident, the aircraft's door popped open. We know that because the pilot reported to air traffic control that his door was open and that he needed to return to the airport to close it. Plus, surveillance cameras confirmed that the pilot's door was indeed ajar.
The plane's door popped open? What's with that?
The Cirrus doors are poorly designed. It's that simple. They just don't stay shut in flight.
The plane flies okay after a door pops open. But the distraction can be dangerous, and can lead to a loss of control, as demonstrated by this 2009 Cirrus crash. Following the 2009 accident, JohnContinue Reading...
An FBO is not supposed to rent an aircraft to a pilot who the FBO knows isn't competent to complete the planned flight safely. If it does, and a passenger is hurt or killed by the pilot's mistake, the victim or his family can hold the FBO responsible. That's the law of "negligent entrustment."
A pilot who doesn't hold the proper license or rating to operate the aircraft he is seeking to rent is probably not competent to complete the planned flight safely. But what if the pilot is properly licensed and meets all the FAA's other requirements? If the FBO rents the aircraft to the pilot, can the FBO still be held responsible for what turns out to be the pilot's mistakes?
Sometimes, the answer is yes.
The landmark case is White v. Inbound Aviation. A young pilot had just recently received his private pilot's license. He was comfortable flying the FBO's Piper Archer in which he had been "checked out" by one of the FBO's instructors. The FBO felt the renter was a good pilot. It felt, however, that the pilot should obtain some additional instruction in "mountain flying" before flying to an airport in the mountains nearby. The FBO felt that without the instruction, the pilot might not be able to handle the special challenges presented by "high density altitude" airports.
One day the pilot showed up to rent the Archer. He told the FBO that he wanted to fly two friends to Lake Tahoe airport, an airport in the mountains. The pilot hadn't obtained the mountain-flying instruction, but the FBO rented the aircraft to him anyway.
The pilot landed at Lake Tahoe airport without incident. But he wasn't prepared for the effects of the altitude, heat, and weight of the aircraft on takeoff. When he attempted to depart, he crashed, killing himself as well as his two passengers.
The family of one of the passengers sued the FBO, arguing it should never have rented the plane to the pilot for this particular trip. The jury agreed and held the FBO liable.
The FBO appealed. It argued that the pilot held a license that legally entitled him to fly anywhere he wanted, including mountain airports like Lake Tahoe. That, the FBO argued, should have been the end of the matter. If the pilot was competent in the eyes of the FAA, he should have been deemed competent in the eyes of the court.
The court of appeal disagreed, and affirmed the jury's verdict against the FBO. Though the young pilot may have been a competent pilot generally, that wasn't the issue. The FBO knew that, notwithstanding his license, the pilot wasn't competent for the particular flight he had planned. As the court of appeal noted:
[The issue as plaintiffs framed it] was not whether [the pilot] was competent in general to pilot an aircraft but whether [he] was competent to 'operate the aircraft that he operated on the day he operated it and in the manner in which he operated it under the conditions he experienced ... on July 3rd with three people on board going to Lake Tahoe.'
The FBO knew that, even though he was properly licensed, the pilot was not competent to conduct the particular flight he had planned under the conditions that existed on the day of the accident. The court of appeal ruled that, therefore, the jury properly held the FBO liable for the accident under the law of negligent entrustment.
When Cory Lidle's widow sued Cirrus Design, it caused a bit of an uproar in the aviation community. Her suit alleges that it was a defect in the aircraft's flight controls that caused the Cirrus SR-20 to slam into a Manhattan hi-rise. That claim led many to call the suit frivolous. After all, the NTSB determined the accident was caused by pilot error, plain and simple. Right?
Cirrus asked the federal judge who is hearing the case to toss it out as being based on "junk science." Cirrus argued that under legal precedent known as Daubert v. Merrell Dow Pharmaceuticals, the judge must act as a "gatekeeper." That means she must review the expertContinue Reading...
Many airports in the western United States are located at altitude. In the thin air, a departing aircraft's propeller and wings are less aerodynamically efficient. And without a turbocharger, the aircraft's engine won't be able to produce full power. All of that hurts the aircraft's ability to climb. Unless the aircraft is handled properly, after lifting off the runway it may travel for a distanceContinue Reading...
A passenger injured in an aircraft accident can't sue the aircraft manufacturer if the part that caused the crash is older than 18 years. Any such suit would be barred by the General Aviation Revitalization Act, or GARA.
What if the accident was caused by a mistake in one of the aircraft's manuals rather than a defect in the aircraft itself? If the manual is older than 18 years, does GARA protect the manufacturer from liability for its error?
It depends. The manufacturer is off the hook if the manual is properly considered a "part" of the aircraft. Some manuals are. Some aren't.
A flight manual (sometimes called a "pilot's operating handbook" or "flight handbook") is properly considered "part" of the aircraft, and so GARA protects the manufacturer. For example, in Caldwell v. Enstrom Helicopters, the pilot's family blamed a helicopter crash on the flight manual's failure to say that the last two gallons of fuel in the helicopter were unusable. As a result, the pilot believed he had sufficient fuel but in fact did not. He crashed just minutes from his destination.
The Caldwell court said that manufacturers are required by regulation to provide a flight manual when it delivers the aircraft to the customer. The manual must be carried in the aircraft at all times thereafter. Therefore, the manual was properly considered to be an aircraft "part." Because the manual at issue was more than 18 years old, GARA applied to protect the manufacturer from liability for any errors.
But the situation is different when the manual is a maintenance manual. A manufacturer can sell an aircraft without providing to the buyer a maintenance manual. Thus maintenance manuals, unlike flight manuals, are not a "part " of the aircraft, and GARA doesn't apply. At least according to Rogers v. Bell Helicopters Textron, a case decided earlier this month by a California appellate court.
In Rogers, the pilot claimed the accident resulted from faulty instructions in a maintenance manual for balancing the helicopter's tail rotor. The court ruled that, despite the fact that the manual was more than 18 years, GARA didn't apply and so the pilot was entitled to sue.
Unlike a flight manual that is unique to the aircraft, used by the pilot, and necessary to operate the aircraft, a maintenance manual applies to different aircraft models, is used by the mechanic, and only for troubleshooting and repairing the aircraft.
According to Rogers,, GARA won't protect a manufacturer from liability for mistakes in its maintenance manuals, regardless of how old the manuals are.
The plaintiff in Rogers was represented by Louis Franecke of San Rafael.
The General Aviation Revitalization Act immunizes aircraft manufacturers from liability for defects in their products once those products turn 18 years old. GARA was enacted in 1994. Back then, more than half the general aviation fleet was older than 18 years.
In other words, in 1994, the manufacturers were allowed to "walk away" from the majority of the fleet they had produced, as well as any defects that they had built into them. But once relieved of that financial responsibility, the manufacturers were supposed to spring into action and start cranking out new aircraft at more affordable prices.
True, anyone injured by a defect in an older aircraft would be left without a legal remedy against the manufacturer that caused the injury. But GARA proponents argued that the flood of new piston aircraft would lead to the older aircraft being removed from service. In short order, GARA proponents argued, the average age of the aircraft in the fleet would drop and manufacturers wouldContinue Reading...
A Philadelphia jury has determined that a defective carburetor caused the 1999 crash of single-engine aircraft that killed four and injured one. The aircraft, a Piper Cherokee Six, was manufactured in 1968. The jury’s verdict included $25 million for compensatory damages and $64 million as punitive damages against the engine manufacturer Avco Lycoming, a division of Textron.
Since the Aircraft was Older than 18 Years, Why Didn’t the General Aviation Revitalization Act Protect Lycoming from Liability?
There are a number of exceptions to the General Aviation Revitalization Act (known as GARA). In particular, GARA doesn’t apply when the manufacturer, in obtaining FAA certification of its part, conceals from the FAA information about defects in the part's design. The jury in this case determined that Lycoming did just that. Thus, GARA was no defense.
The NTSB Determined the Cause of the Crash was Pilot Error. Its Report Didn’t Say Anything About a Defective Carburetor. Why Wasn’t the Jury Bound by the NTSB’s Findings?
The NTSB’s accident reports almost always favor the manufacturers. That’s because the NTSB relies on the manufacturer for help in determining the cause of the crash it is investigating. The NTSB calls this method of investigation the “party system.”
Of course, asking the manufacturer for help in figuring out if there was a defect in its engine is much like asking the fox for help in determining what happened to the chickens. There’s a built-in conflict of interest. The NTSB is aware of the conflict, but continues using the party system anyway.
Here, after consulting with Lycoming’s experts, the NTSB decided not even to examine the carburetor. Since the NTSB never tore down this critical component, it’s no surprise that the NTSB did not discover any problems with it.
Fortunately for the victims’ families, the NTSB’s conclusions are by regulation inadmissible in court.
Why Did the Jury Award Punitive Damages?
A jury cannot award punitive damages simply because the defendant was negligent, or justContinue Reading...
The NTSB has released its preliminary report of the off-airport landing of Lancair IV-P N9JE at Hilton Head. The accident killed a jogger but left the plane’s two occupants uninjured. According to the preliminary report,
Further examination of the airplane revealed that the propeller assembly separated from the crankshaft flange and was missing.
In other words, the crankshaft failed.
One wouldn’t expect a crankshaft to break absent some sort of defect. If that proves to be the case, could the manufacturer of the crankshaft be held liable to the jogger’s family?
The aircraft was built from a kit and was thus "experimental." The engine, however, was not. Rather, according to FAA records, it appears that the engine was an FAA-certified, turbocharged piston engine manufactured by Teledyne Continental Motors, a company that has had its share of lawsuits related to its engines coming apart in flight.
The General Aviation Revitalization Act, or GARA, protects aircraft engine manufacturers from liability for defective engine parts older than 18 years.
We don’t know how old the engine was in this case. However, the Lancair builder had reportedly taken the engine from a Piper Malibu. Piper stopped using the Teledyne Continental TSIO-520 engine in its Malibus due to reliability problems. In 1988, it switched and began installing Avco Lycoming engines instead. Thus, if it turns out that the engine was an original equipment Malibu engine, then it had to be at least 20 years old -- 2 years beyond GARA's age limit.
So is Teledyne Continental Motors off the hook, regardless of whether the jogger's family can prove that the engine was defective?
There is one important but little-known exception to GARA. Regardless of the defective part's age, GARA doesn’t protect its manufacturer from lawsuits brought by the families of those killed on the ground.
That's the number one question I've been asked about this accident. Not "why did the accident happen," but "why didn't the pilot use the parachute?"
As I note here, most Cirrus pilots would say that the parachute should be deployed in the event of engine failure, unless there is a long, paved runway beneath the aircraft such that a safe on-airport landing is assured. But that doesn't mean that, if there is no airport within range, a pilot who opts to glide to a field rather than pull the chute is negligent.
Pulling the parachute has serious risks. The aircraft's rate of descent under the parachute is high. Ground impact forces are severe. Cirrus warns that the decision to deploy the parachute shouldContinue Reading...
A Cirrus SR-22, N224GS, crashed yesterday in Washington state. The pilot was killed. The passenger was critically injured. The aircraft departed Concord, California (CCR) in good weather, bound for home. It crashed in Morton, 60 miles from its destination, which was presumably Renton (RNT).
The accident appears to have been the result of engine failure:
Facts suggesting that the engine failed because it ran out of gas:
Only modifications that carry a Supplemental Type Certificate may be legally installed on an aircraft. The Supplemental Type Certificate guarantees that the FAA has thoroughly tested and reviewed the modification. And it's the Supplemental Type Certificate that insures that the modification is safe and compatible with the particular model aircraft on which it’s being installed. Right?
Maybe not. Owners really shouldn't place too much stock in an STC. Or so says one former NTSB accident investigator. The investigator, now retired, explained to me that most owners might be surprised by how little work the FAA does before issuing an STC. Sure, the STC process is a huge paperwork shuffle for the modification's manufacturer. But it's little more than that. The process seldom entails any real independent engineering cross-check on the FAA's part.
"Give me an example", I asked. "OK,' he said. "Let's talk tip tanks."
A popular modification for many models of Cessna single-engine aircraft are wingtip extensions thatContinue Reading...
Most general aviation aircraft manufactured today come with "glass cockpits." Instead of being equipped with mechanical gauges and indicators, they are equipped with computer screens. The screens integrate and display all sorts of useful flight information. The information displayed may include satellite weather, synthetic vision, infrared vision, terrain awareness information, trafficContinue Reading...
The NTSB released its preliminary report on the Pine Mountain Lake crash. As usual, the preliminary report contains no conclusions concerning the cause of the crash. For that, we'll have to wait up to 4 years. The preliminary report does, however, hint that the NTSB's investigation will focus on whether the pilot pressed on into weather beyond what the regulations allowed.
The full text of the report is here. Some excerpts:
Instrument night meteorological conditions prevailed at the accident site, and no flight plan had been filed.
Instrument weather conditions are those that require a pilot to fly by reference to his instruments rather than by looking out the window. To fly in instrument conditions, a pilot must be instrument-rated, his plane must be properly equipped, and he must have a clearance from air traffic control. He is not necessarily required to file a flight plan. For example, instead of filing a flight plan, theContinue Reading...
Lisa Krieger of the San Jose Mercury News writes on a variety of issues related to this crash:
Related posts: Tesla Crash: NTSB Probable Cause Investigation
The runway at Pine Mountain Lake is oriented east-west, and is surrounded by rugged terrain. In poor weather, pilots are permitted to execute instrument approaches to the airport. The approach procedures guide pilots as they descend through the clouds to the runway. The procedures, flown properly, will place the pilot in a position to land straight ahead without having to maneuver. When the pilot pops out of the clouds after flying the instrument approach to Pine Mountain Lake, his view out of the windshield should be something like this:
The procedure the pilot must follow when approaching from the east is set forth below. A pilot may descend in the clouds no lower than 770 feet above the runway. To descend further, the pilot mustContinue Reading...
The initial investigation was conducted by local law enforcement in conjunction with the FAA. Now the National Transportation Safety Board will take over.
The NTSB’s job will be to examine the wreckage and attempt to determine if the crash was caused by a defective aircraft part, negligent maintenance, or pilot error. The NTSB concedes, however, that it lacks the manpower, the technical expertise, and the funding to do that job properly on its own. Therefore, as a matter of long-standing policy, it will seek engineering assistance from the companies that manufactured the aircraft components in question. In this case, the NTSB will recruit the help of Cessna Aircraft, which manufactured the aircraft involved in the accident, Cessna N5225J, and Teledyne Continental Motors, which manufactured each of the aircraft’s two 260 horsepower engines. The NTSB will exclude members of the victims’ families and their technical representatives from the investigation, feeling that they have nothing to offer. (Sad but true.)
Of course, the NTSB’s practice of asking the manufacturers for help – a practice it calls “the party system” -- presents a conflict of interest. After all, the manufacturers themselves might be the ones responsible for the accident. Some say that the NTSB’s party system is akin to asking the suspects for help in solving a crime. Nonetheless, the conflict – discussed further here – is ingrained in all NTSB investigations.
It’s no surprise that most NTSB final reports often favor the manufacturers who have “assisted” the NTSB investigators in their work. But perhaps it doesn't make any difference because, by federal regulation, the NTSB’s probable cause findings are not binding on anyone. The families are free to conduct their own investigation, and in the event of a lawsuit, the NTSB’s conclusions are given no deference whatever. In fact, in the event of litigation, the NTSB conclusions are not even admissible. Aviation attorneys who conduct their own independent investigations find that the NTSB’s conclusions are wrong about 50% of the time.
In one recent example, a Teledyne Continental engine similar to those installed on N5225J quitContinue Reading...
One might think that a twin-engine aircraft is safer than a single-engine aircraft. After all, if one engine fails, you still have the other to bring you home safely. That's the whole point of the second engine, right?
If one of the twin engines fails in cruise flight, maybe that's true. But if it quits right after takeoff, the twin can be extremely difficult to handle. When the aircraft's landing gear is down, its flaps set, and its airspeed just above the minimum flying speed, the asymetric thrust generated by the operating engine can flip the aircraft onto its back and out of control. A "Vmc roll", as it is called, isContinue Reading...
Cirrus aircraft are now available with "flight into known icing" (FIKI) capability. That's a great feature. I've written before, however, that Cirrus is asking for trouble with its marketing. Cirrus sells the feature as one that both enhances safety and increases the aircraft's utility. But Cirrus can't have it both ways. If a pilot uses the FIKI capability by, for example, flying in conditions that would otherwise keep him on the ground, he necessarily undermines that feature's safety benefits. I discuss why Cirrus' marketing is a problem here.
Steve Wilson, who is an air safety investigator (among other things), now slams Cirrus' marketing even harder. According to Wilson, some aspects of Cirrus' marketing encourage pilots to use the FIKI capability to take risks that are simply foolish.
Some say that Wilson's criticisms should be discounted because he sells Cessna aircraft and Cessna competes with Cirrus. But Wilson isn't criticizing Cirrus' product, just its marketing. It seems hard to argue with him.
Updated February 12:
A Cirrus SR-20 single engine aircraft collided with a Pawnee tow plane that was pulling a glider. The Cirrus reportedly ran into the Pawnee's tow line. The Pawnee crashed and the pilot was killed. The occupants of the Cirrus were also killed. The glider pilot, however, recognized the impending collision, released his aircraft from the tow line, and landed without injury to himself or his twoContinue Reading...
The FAA has instituted new rules designed to keep sightseeing helicopters from colliding with airplanes that are transitioning the Hudson River Corridor near the Statue of Liberty. The San Francisco Daily Journal, California's largest legal newspaper, published this column on how the new rules came to pass, and why they aren't enough.
The NTSB's preliminary report on the crash contains little more than what was in the news accounts. The report does, however, offer one bit of new information. The helicopter impacted on a magnetic heading of 230 degrees. That heading is not in line with the route from Reno to Susanville. While that might ultimately prove to be important, little can be made of that information without a careful examination of the layout of the terrain near the accident site and the roadway that the pilot might have been using to aid in his navigation.
Though the information in the NTSB's official report is sparse, an NTSB spokesman did offer his expanded comments to Mary Pat Flaherty, a reporter for the Washington Post who has been following the poor EMS safety record during the past months. The NTSB's Ted Lopatkiewicz told Flaherty that the Mountain Lifeflight helicopter didn't have certain important safety equipment. Lopatkiewicz was referring to the helicopter's lack of an autopilot, a ground proximity warning system, night vision goggles (discussed in this post), and other equipment necessary to navigate in poor weather.
But in this case the pilot was flying in good weather. He did not collide with the ground because he could not see it. Rather, as discussed here, it appears that the pilot crashed because of some type of mechanical problem with the helicopter. It's unlikely the helicopter's lack of advanced equipment played any role in the accident at all.
Aircraft engine manufacturers recommend that owners overhaul their engines when they accumulate a certain amount of operating time, usually between 1200 and 2400 hours depending on the engine's make and model. For example, Teledyne Continental Motors suggests that owners overhaul its IO-550 model engine at 2000 hours. Textron Lycoming suggests that owners overhaul its O-235 engine, like the one pictured, at 2400 hours.
Overhauls are expensive. Some can cost $40,000 or more. An increasing number of owners opt to run their engines 200, 400 or more hours past the manufacturer's recommended "time between overhauls," or TBO. Once past TBO, they may take extra precautions by, for example, regularly sending out engine oil samples for spectrographic analysis, checking the engine’s compression, and looking inside certain parts of the engine with a boroscope to insure that things look good. They feel the manufacturer's TBO recommendations are somewhat arbitrary. By running their engines past TBO they are squeezing more life out of them, and that just makes good economic sense.
The FAA does not require private owners to comply with the manufacturer’s stated TBO interval. The manufacturer's TBO is therefore advisory only. As long as a properly certified mechanic hasContinue Reading...
Burdett v. Teledyne Continental Motors involved the forced landing of a Beech Bonanza after the Teledyne Continental IO-550 engine installed in the aircraft came apart in cruise flight. The passenger was severely injured.
The National Transportation Safety Board blamed the engine failure on the mechanic who last worked on the engine, and cleared the engine manufacturer, Teledyne Continental, from any liability.
We suspected that the NTSB's determination had been influenced by Teledyne's engineers, who the NTSB had allowed to assist in the investigation, despite the obvious conflict of interest that presented. We thus conducted our own, independant investigation. We concluded that, contrary to the NTSB's findings, Teledyne Continental was to blame. After a six-week trial, the jury agreed.
At its annual convention in San Francisco, the California Trial Lawyers Association, known as the Consumer Attorneys of California, honored aviation accident attorney Mike Danko as a Trial Lawyer of the Year finalist for 2009 in recognition of our work in the Burdett case. The Trial Lawyers Association showed this video presentation during the ceremony.
An A-Star AS350B air ambulance helicopter crashed November 14 at Doyle, California, killing the three crew members on board. According to an article in the Reno Gazette Journal, the pilot made a distress call before the crash. That indicates that the pilot was likely experiencing a mechanical emergency. The photographs accompanying the article show that the wreckage was spread over a fairly large area. That indicates that the pilot lost control of the helicopter well before he was able to attempt an emergency landing.
Under the circumstances, the NTSB will be looking at the helicopter'sContinue Reading...
This past April, the NTSB called upon the FAA to ground the entire fleet of Zodiac aircraft because their wings tend to fall off in mid-flight. As it turns out, a defect in the Zodiac's design induces an aerodynamic phenomenon known as flutter. Flutter can destroy a wing or other control surface in a matter of seconds. This well-known, dangerous, but rare condition is shown occurring in the tail surfaces of other aircraft types here and here.
When the NTSB's issued its "urgent recommendation," a total of ten people had already been killed in Zodiacs due to flutter-induced failures. Back then, the NTSB was under heavy fire for sitting on a long list of NTSB recommendations pertaining to a number of different aviation industry sectors while lives were being lost. Because of that, I figured that this was one recommendation the FAA would act on, and fast.
The FAA will see Zodiac's manufacturer as an easy target and move against it -- if for no other reason than to quiet its critics.
I was wrong. The FAA refused to ground the aircraft. Even I was surprised.
Of course, it was just a matter of time. On November 6, another Zodiac crashed in Arkansas. It looks like another flutter-induced failure. That brings the death toll to 11. On November 13, the NTSB issued an official "I told you so."
The Safety Board's urgent recommendation to the FAA was to "prohibit further flight of the Zodiac CH-601XL, both special light sport aircraft and experimental, until such time that the FAA determines that the CH-601XL has adequate protection from flutter." The FAA replied in July that they lacked "adequate justification to take immediate certificate action to ground the entire fleet."
The NTSB's unstated question: Just how many deaths are required before the FAA finds "adequate justification" to act?
The families of the victims of the Zodiac crash near Oakdale, California, have filed suit against the aircraft's maker, Zenith Aircraft, alleging that the Zodiac's design is defective. The Zodiac is the two-seat aircraft whose wings tend to break off in flight due to a design-induced aerodynamic phenomenon known as flutter. That appears to be exactly what happened in the Oakdale crash. The design has caused at least 10 deaths so far.
According to the Modesto Bee, Zenith Aircraft is blaming the pilot and passenger for getting into the airplane it designed.
Zenith Aircraft said the crash was caused by the "negligence" of [the pilot and his passenger]. The company said both had "full appreciation" of the risks involved.
As discussed here, months ago the NTSB called upon the FAA to ground all Zodiacs. The FAA, however, has yet to do so. Unfortunately, the NTSB has no power to ground an aircraft on its own. It doesn't matter how bad the design of the aircraft is; only the FAA can ground a fleet.
The FAA refuses to act, and Zenith Aircraft won't accept responsibility for the fatal flaws in its aircraft's design. Lawsuits brought by aviation accident lawyers like the families' lawyers in this case seem to be the only way to prevent others from being killed in the Zodiac.
Maintenance manuals tell the mechanic when to perform an inspection or service, and how to perform it. Many mechanics believe that the regulations require them to follow the book exactly. But in an excellent column on this murky subject, mechanic and aviation author Mike Busch sums up the regulatory requirements nicely:
The manufacturer's “how-to” instructions are compulsory, but the manufacturer’s “when-to” instructions are not.
Let's say, for example, that the manual requires the aircraft’s spark plugs to be removed and regapped every 100 hours. If a mechanic decides to service the aircraft’s spark plugs, he must do it exactly as instructed in the aircraft manual. The regulations, however, do not require the mechanic to follow the manufacturer's instructions at all concerning when or how often to service the plugs, regardless of how much time the engine has accumulated. As Busch explains:
No manufacturer can mandate any maintenance requirement on a part 91 aircraft owner; only the FAA can do so.
There is another part of the story, however, that Busch's column doesn't address. The FAA regulations are bare minimum requirements only. If an accident occurs because the mechanic failed to comply with the manufacturer’s recommendations, questions can arise as to whether the mechanic was negligent – that is, not reasonably careful -- and thus liable to those injured as a result. A jury may conclude that, though the regulations didn't require him to, a reasonably careful mechanic would have followed the manufacturer's recommendations anyway. After all, does a reasonably careful mechanic believe he knows better than the manufacturer?
The NTSB has now given us further reason to question whether it deserves the confidence we place in it. On Friday, the NTSB came out with a block-buster press release condemning the Teterboro air traffic controller who had cleared the Piper airplane for takeoff. According to the NTSB's report, the Teterboro controller could see on his radar screen that the Piper pilot was on a possible collision course with the Liberty Tours helicopter. In fact, according to the NTSB, the controller could see the conflict before the Piper pilot switched off from the Teterboro controller’s frequency. Yet, according to the NTSB, the controller failed to warn the Piper pilot.
At 1152:20 the Teterboro controller instructed the pilot to contact Newark on a frequency of 127.85. . . At that time there were several aircraft detected by radar in the area immediately ahead of the airplane, including the accident helicopter, all of which were potential traffic conflicts for the airplane. The Teterboro tower controller, who was engaged in a phone call at the time, did not advise the pilot of the potential traffic conflicts.
That was wrong. True, the controller was on the phone when he should not have been. But the helicopter did not appear on the controller’s radar screen until after the Piper pilot was supposed to have switched to a new frequency. Of course, by then it was too late for the controller to advise the pilot of anything. In other words, it appears that there was nothing the controller could have done -- whether he was on the phone or not.
Over the weekend, the air traffic controllers’ union privately asked the NTSB to correct its error. The NTSB refused. So today the union issued its own press release setting the record straight. The press release claims that the NTSB's account, which implies that the controller should have prevented the accident, is "outright false" and "misleading." Worse, it charges that the NTSB knows it, but refuses to correct its error.
This afternoon, after the controllers' union went to the press, the NTSB finally conceded that it was, in fact, wrong. It thus issued a new press release, explaining that the controller could not have seen the helicopter after all.
The accident helicopter was not visible on the Teterboro controller's radar scope at 1152:20 [when the controller instructed the Piper to change frequencies]; it did appear on radar 7 seconds later - at approximately 400 feet.
The NTSB offered no apology for its error. Nor did it offer an explanation. Rather, despite that the union was right, and the NTSB was wrong, the NTSB’s only reaction was to kick the union off the investigation.
The NTSB’s blunder was a whopper. It laid blame for the accident where it does not appear to belong. The NTSB's only interest is supposed to be in getting the facts right. If that’s so, why did it not correct its error when the union asked it to? Why did it require the union to force the issue?
Compared to pilots in other countries, pilots in the US have extraordinary freedom. Of course, to keep commercial airliners safe from collisions, pilots of small aircraft are excluded from certain airspace near major airports unless they have first obtained a clearance from air traffic controllers. If a pilot obtains the necessary clearance, controllers will dictate the pilot's path and use radar to monitor the pilot's every move.
But that still leaves many places where pilots are permitted to fly without being supervised or controlled in any way. One such area, appropriately enough, is near the Statue of Liberty. As long as the pilot stays below 1100 feet -- outside the airspace used by airliners -- the pilot doesn't need a clearance, doesn't need to have filed a flight plan, and doesn't need to communicate with any tower or other air traffic control facility. The pilot is totally on his own.
Many non-pilots are surprised to learn that the method used to prevent collisions in such uncontrolled areas is called "see and avoid." The pilot is supposed to look out his window, "see" the other aircraft, and "avoid" them. Pilots talk about having to "keep their head on a swivel" when flying in uncontrolled airspace. Though this method of collision avoidance may sound primitive, over the years it has worked well.
There is one problem. Helicopters and airplanes don't mix well in a "see and avoid" environment. Helicopters fly slower than airplanes. And because they have a small cross section, they are hard to spot -- especially when viewed from directly behind. That puts them at risk of being rear-ended. It doesn't help matters that helicopters tend to manuever in a fashion that most airplane pilots find to be unpredictable.
Because of all that, helicopter pilots are supposed to "avoid the flow" of airplane traffic. In other words, as best they can, they are supposed to stay out of the way. Unfortunately, when both a helicopter and airplane are headed to the same spot, or are both looking at the same feature on the ground, that can be difficult to do.
We don't know what factors combined to result in the midair over the Hudson. But the NTSB has long recognized that when it comes to uncontrolled airspace, helicopters -- especially tour helicopters -- don't mix well with airplanes.
The G36 Bonanza's closest competitor is probably the Cirrus SR22. Would the outcome of this accident have been different had the Beechcraft been equipped with a ballistic parachute system, like the system installed in the Cirrus, depicted here? Probably not. For the Cirrus' ballistic parachute to work, the plane needs at least 400 feet of altitude. Although we don't know how high N618MW climbed before its engine quit, it's unlikely it reached 400 feet. That's an altitude the aircraft probably wouldn't have achieved until well after crossing the end of the runway. As this illustration shows, the Bonanza never made it that far.
The NTSB has now released its Preliminary Report. The report can be found here. There's no new information in the report, and certainly nothing that causes us to rethink the analysis we wrote about here.
As usual, the NTSB report contains no conclusion concerning the cause of the crash. For that, we have to wait until the NTSB issues its Probable Cause report. Some news sources, such as the one here, are reporting that the probable cause report will be issued in the next 6 to 9 months. That's doubtful. Except in the simplest of cases, it takes the NTSB at least 18 months to issue its probable cause report. Sometimes, it can take as long as four years.
Bonanza N618MW, a Beechcraft like the one pictured below, was doing "touch & goes" at Jack Northrop field in Hawthorne. "Touch and goes" are practice landings where the pilot does not stop on the runway. Instead, after the wheels touch down, the pilot advances the throttle, takes off again, and then circles around for another landing. Everything appeared to be fine until, on one ofContinue Reading...
Special rules protect careless health care providers in California. The rules, collectively known as MICRA, were designed to make it harder for medical malpractice victims to sue the doctors who injure them. For example,
But what do the MICRA rules have to do with helicopter crash cases?
In March 2008, a California court of appeal ruled that the medical malpractice rules apply to the claims of a someone injured in an ambulance. In that case, called Cannister v Emergency Ambulance Service, the court ruled that a negligent ambulance company that injures a patient en route to the hospital was entitled to all the protections of MICRA, because the ambulance company was properly considered a “health care provider.” The ruling extended the umbrella of MICRA's protection from doctors to ambulance drivers, at least when those drivers are licensed as EMT’s.
An EMS air ambulance company will undoubtedly argue that Cannister -- regardless of how unfair -- applies not just to road-bound ambulances, but to air ambulances as well. The aviation lawyer must keep the MICRA rules in mind in handling EMS helicopter accidents in California, and he should be familiar with the strategies that medical malpractice lawyers use to minimize MICRA's unfair impact on his clients.
The pilot's original destination was Bozeman, Montana. But the pilot amended his flight plan and diverted to Butte. The pilot did not tell air traffic control why he was diverting. About 25 minutes later, as the aircraft approached for landing at Butte, it went out of control and crashed.
Some possible explanations for diverting include:Continue Reading...
The General Rule
Mechanics are required by regulation to follow the instructions set forth in the manufacturer's maintenance manuals when working on an aircraft. The mechanic is not allowed to deviate from the instructions covering the work he undertakes. If he does deviate, and someone is injured as a result, the mechanic is liable.
Sometimes, a manufacturer learns of a problem with the way its product is performing in the field.Continue Reading...
Cory Lidle's wife and Tyler Stanger's family are suing Cirrus Design, alleging that a problem with the plane's flight controls caused Lidle and Stanger's plane to crash into a Manhattan hi-rise.
Miles O'Brien, a former CNN correspondent, calls the lawsuit frivolous, because the NTSB concluded the cause was pilot error. According to O'Brien, "in our litigious society, the facts don't matter for much."Continue Reading...
The Cirrus is a “new generation” aircraft loaded with safety features. For example, if a pilot flying after dark gets too close to a ridge line, the Cirrus' on-board Terrain Awareness Warning System generates a voice urging him to “Pull Up! Pull Up!” The plane’s wings secrete fluid that helps prevent them from icing up in poor weather. The cockpit has airbags, and its seats protect the passengers in a crash by absorbing 26 times the force of gravity. The Cirrus is the only aircraft of its kind that comes with a rocket propelled parachute that can shoot out of the back of the plane in an emergency. Partly as a result of all its safety features, the Cirrus has become the most popular general aviation aircraft, with sales surpassing long-time industry leaders Cessna, Beechcraft, and Piper.
Critics, however, say that the aircraft has a lousy safety record, with a fatal accident rate significantly higher than the “old style” Cessnas and Beechcrafts. They say that the Cirrus, made mostly of fiberglass rather than the traditional aluminum, is not crashworthy. Not only does theContinue Reading...
The General Aviation Revitalization Act, known as “GARA,” immunizes general aviation manufacturers from lawsuits for defectively designed or manufactured aircraft that are more than 18 years old. Regardless of how serious the defect, if the aircraft is more than 18 years old, an injured victim cannot sue its manufacturer.
There are exceptions. An injured party can sue the manufacturer regardless of the defective aircraft's age if:
Today the NTSB issued an "urgent" safety recommendation, asking the FAA to immediately ground all Zodiac CH-601XL aircraft. The reason: their wings tend to fall off. So far, six have broken up in flight, causing 10 fatalities. The NTSB suspects that the design of the aircraft induces "flutter"-- an aerodynamic phenomenon that can destroy an aircraft in seconds. This short NASA video depicts flutter nearly destroying the tail on a Piper Twin Comanche.
Will the FAA act on this recommendation or, like it has with regard to so many other NTSB recommendations, simply ignore it? I'm betting that this is one the FAA will act on. As I've noted before, the FAA has been under increasing fire for sitting on NTSB recommendations while lives are lost. The FAA will see Zodiac's manufacturer as an easy target and move against it -- if for no other reason than to quiet its critics.