The Alarming Backstory Of A Fatal Hawaii King Air Crash
The pilot failed initial check rides and was said to fly aggressively at low level. And those are the least shocking parts of this story.
Note: This analysis is of an NTSB Preliminary Accident Report. Any conclusions on the probable cause or causes of the accident will be addressed when the Safety Board's final report is released.
When it happened in June of 2019, TV news aired sensational claims about a fatal accident of a skydiving plane in Hawaii that killed 11 people. Based on the NTSB report, with its roughly 500-page docket, I learned that the news reports had more than a little basis in fact.
June 21, 2019, on the North Shore of Oahu, was beautiful---about 74° Fahrenheit, VFR, light winds. Dillingham Airfield sits right on the Pacific Ocean, well known for amazing glider flying conditions and less-well-known as a filming location for the TV show "Lost."
The sun was getting ready to set. A Beechcraft King Air twin-turboprop took off with one pilot and 10 passengers on a Part 105 commercial parachute jump flight. Almost immediately, it banked to the left and rolled fast, crashing into the ground less than 700 feet from the departure end of the runway. Barely made it to the airport fence. Inverted. Forty-two degrees nose-down. There was a post-impact fire, and all 11 occupants died.
Some accidents are so sudden, so violent, that wearing a parachute while sitting next to a big opening won't help you. It was the deadliest civil aircraft accident in the United States since 2011.
The NTSB hasn't yet issued a probable cause. We won't speculate on that here. It recovered no cockpit voice recorder or flight data recorder but conducted many careful analyses and interviews. Parachute jumpers take a lot of photos and videos, and it just so happened that some of their images came in handy in the NTSB's quest to better understand previous incidents to inform their investigation into this accident.
Pilot
The pilot information section starts off well. A roommate reported he, "did not drink, smoke or do drugs, and led a very clean lifestyle!She stated that he was always in bed by 2100-2130." On the day of the accident, witnesses said he appeared happy. The 42-year-old had been flying for two years, with about 1,100 total hours, around 200 of those as PIC in King Airs.
There are some oddities in his logbook, like PIC time in a King Air while still a student pilot. We don't know many details here, as the NTSB couldn't get that information from sources close to the pilot. Eventually, subpoenas were issued, but an experienced NTSB investigator once told me that by the time a sheriff has to go get a witness, interview answers are often variations of, "I don't remember."
FAA databases reveal that the pilot failed his initial private pilot practical test, which, on its own, is no big deal. We all have bad days or bad instructors. But our pilot also failed his first instrument airplane practical test and his commercial multi-engine practical test. Not a good history, but we can all move on.
While some jumpers interviewed said the pilot flew consistently and predictably, others said the opposite---that he hadn't seemed to internalize all the conventions required of a working commercial pilot. One skydiver wrote that the pilot would, "sometimes take off at an extremely steep angle and aggressive climb right after leaving the runway. This was presumably done for fun to create a high-gravity environment momentary intentionally. I talked to the pilot and asked he consider not flying the aircraft in that manner while I am onboard as it could cause a high AoA stall, which would be unrecoverable that close to the ground."
The witness wasn't alone. According to the preliminary report, "One former Oahu Parachute Center pilot stated that the accident pilot would bank hard and pitch up aggressively on departures, and he had seen him do that as a ’thrill ride' for the passengers. He said the pilot would also do negative-G dives for the ’weightless' effect for fun, but he heard some jumpers would complain. He said the accident pilot told him he had done barrel rolls in the accident airplane but not with passengers. When asked if the accident pilot had ever received acrobatic training, he said no. When he talked to the accident pilot about doing these maneuvers and putting excessive stress on the airplane, the pilot's response was always that the passengers seemed to like it and did not complain to him."
Another concerning detail from the preliminary report is a witness' claim that when confronted about his unorthodox flying, the "pilot's response was always that the passengers seemed to like it." Which misses the point. Passengers don't get to weigh in on safety procedures. They don't like being told they can't carry home the gifts they bought or the fish they caught (due to weight and balance) or that they're not landing where they paid to go (due to weather minimums). Balancing safety needs against passenger wants is fundamental to the real job we do as professional pilots, and safety wins that one every time, or at least it should.
Some passengers do get it. One rode on the jump flight before the crash. This skydiver was working at Dillingham Airfield and wrote to the NTSB, "I have witnessed this pilot taking off aggressively banking low to the ground many times. I feared the worst, and it happened. I hope you find out why."
Training
There were also serious concerns about the pilot's training. The NTSB report states, "According to former Oahu Parachute Center pilots, there was no training curriculum for Oahu Parachute Center King Air pilots and no company training or procedures manuals." It continues that, "Training consisted of doing a couple of jump runs, hand them the keys and that was it. There was no formalized training since there was no money to take the airplane out of service for training flights, and they primarily trained by viewing the King Air Academy videos on YouTube and not hands-on training."
Another former Oahu Parachute Center King Air pilot stated that, "the training at Oahu Parachute Center ’was a joke.'" He said his training was minimal, and, when completed, his instructor hopped out of the airplane and told him "not to get uncoordinated." There were no procedures given to him to follow, and there was no training on how to fly the airplane.
Unaddressed Structural Damage To The Airplane?
There were serious concerns about the health of the accident airplane, a 1967 Beech Model 65-A90 King Air powered by two Pratt & Whitney PT6A engines. The King Air is a safe, popular workhorse of a plane. But this one was old, and some recent history is incomplete. Work over the previous few months hadn't been recorded in the aircraft logbooks. No logbook entries were found documenting engine compressor washes required due to flying in a salty atmosphere. The mechanic had both his Airframe and Powerplant and his Inspection Authorization FAA certificates revoked in 2005 due to falsification of records on two aircraft. He was later allowed to be reexamined, and new certificates were issued in 2015 and 2017.
According to one pilot who trained multiple other pilots in the accident airplane, "the accident airplane would not fly true straight and level, and always wanted to bank to the left. It required full maximum aileron trim to keep it straight and level." The pilot said the aircraft owner was aware of the issue and told him, "it had something to do with the left wing being bent."
Sound like hyperbole? Actually, this wasn't the first time the board had seen N256TA; the plane had been involved in a dramatic incident in 2016, again flying skydivers. In this case, a pilot poorly recovered from an inadvertent spin, allowing excess airspeed and G-loads that caused the overstress separation of the right horizontal stabilizer. There's an amazing air-to-air photographic record by a skydiver who exited the damaged aircraft. [Below] are NTSB graphics from the video that's on YouTube https://www.youtube.com/watch?v=Qi83pFqAxOc. Somehow the pilot brought the plane in for a safe landing. No one was injured.
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