MARCH 23, 2015
SOUTH BEND, INDIANA
A South Bend homeowner who was injured in a March 2013 plane
crash is now suing the estate of former University of Oklahoma quarterback
Steve Davis, three weeks after a government report suggested Davis accidentally
cut the small jet’s power before it went down.
In a new complaint filed in St. Joseph Superior Court, Diana
McKeown alleged that Davis committed negligence by helping to fly the Hawker
Beechcraft model 390 even though he was not trained to pilot the jet.
Davis and the plane’s owner, Wes Caves, both Oklahoma
residents, died in the March 17, 2013, crash. Two passengers, Jim Rodgers and
Chris Evans, were injured in the crash, as was McKeown. Three homes along Iowa
Street near the South Bend International Airport were destroyed or badly
damaged.
According to a report earlier this month by the National
Transportation Safety Board, cockpit voice recordings indicated that Caves was
showing Davis how to pilot the small business jet in the minutes leading up to
the crash. The NTSB classified Davis as a “pilot-rated passenger” who was a
certified pilot but had no logged experience flying the Beechcraft plane.
Davis operated the plane even though he and Caves “knew he
was not competent to do so,” McKeown alleged in her complaint.
“It was established, through the CVR, that he was actually a
part of flying the airplane,” said Michael Demetrio, the Chicago lawyer
representing McKeown.
McKeown added Davis’ estate as a defendant in the already
lengthy suit in a court filing just four days before the March 17 deadline
under the two-year statute of limitations.
Anthony Bertig, a Valparaiso attorney listed as the
representative for Davis’ estate, did not return a call seeking comment Monday.
According to transcripts of cockpit voice recordings, Caves
could be heard coaching Davis on how to achieve the proper speed and altitude
as they were approaching South Bend’s airport before the crash.
Moments before the crash, Caves expressed alarm and said
Davis had moved the throttle too far, causing the engines and electrical power
to shut down. After trying unsuccessfully to restore full power, Caves radioed
an emergency call to air-traffic controllers.
Witnesses saw the jet bounce on a runway several times, with
only its front landing gear extended, and enter a climbing right turn before a
rolling plunge into a neighborhood just southeast of the airport, along Iowa
Street.
The NTSB has yet to release a probable cause for the crash,
however, and Beechcraft still faces allegations that some of plane’s parts were
defective.
In McKeown’s complaint, she alleged the jet did not have an
adequate interlock system and warning system to prevent its operators from
accidentally shutting off the engines.
In a new lawsuit filed last week in U.S. District Court in
Oklahoma, the surviving passengers, Rodgers and Evans, and their wives claimed
that faulty wiring and a defective electrical system prevented Caves from
restarting the engines.
Rodgers, Evans and Beechcraft earlier this month were
dismissed from the ongoing lawsuit in state court in St. Joseph County before
the new case was filed in federal court. Caves’ wife, Regina Caves, named
Beechcraft in a similar suit, also in federal court in Oklahoma.
Mark Kundmueller, an attorney who represented Beechcraft in
South Bend, said he could not comment on pending litigation.
Joel LaCourse, a lawyer for Rodgers and Evans, said the
family did not wish to comment on the case so soon after the anniversary of the
crash.
“We’re right at the early stages, and with respect to the
Evans and the Rodgers, it’s just a very hard time for them,” LaCourse said.
//-------------------------------------//
Wednesday, March 20, 2013
What happens after a plane
crashes into your house?
SOUTH BEND, INDIANA
Investigators are sifting through the
remains of three homes on North Iowa Street for pieces of airplane that may
have been left behind during the recovery of the plane wreckage. What happens
to those homes now?
Kurt Gabrielson's company, Disaster Pro Services, deals with disaster
restoration.
He says it's traumatic when your home is destroyed by a fire, tornado or in
this case, a plane crash.
"It just leaves everybody in chaos; it's a very rough thing to go
through,” said Gabrielson.
Gabrielson says there is no easy road to recovery.
"Everybody's insurance company is different, and your policy could be
different, so until you know that, it's a long process,” said Gabrielson.
That process will be a little longer for these homeowners because the National
Transportation Safety Board is combing through the rubble to make sure they
have every piece of plane wreckage.
"With the plane being down and the federal government being involved with
this now, everything is kind of on hold,” said Gabrielson.
But the NTSB isn't the only obstacle to a quick recovery for these residents.
"When you start getting into whether jet fuel's involved or anything else,
then the EPA's involved too; so you have to have the right people,” said
Gabrielson.
Gabrielson says the right people are in the area, but you have to seek them
out.
"You want to find someone that you can work with that you can trust. If
you don't have that feeling of trust towards the person that's what you need.
And if you don't have that then, that's when you need to keep interviewing,”
said Gabrielson.
Gabrielson says psychologically, it can be difficult not only for the owners of
the damaged homes, but also the residents of the neighborhood.
The visible damage is a reminder of what happened so close to home.
//-------------------------------//
Hawker Beechcraft 390 Premier IA, Digicut Systems, N26DK:
Accident occurred March 17, 2013 in South Bend, Indiana.
NTSB Identification: CEN13FA196
14 CFR Part 91: General Aviation
Accident occurred Sunday, March 17, 2013 in South Bend, IN
Aircraft: HAWKER BEECHCRAFT CORPORATION 390, registration: N26DK
Injuries: 2 Fatal, 3 Serious.
NTSB investigators either traveled in support of this investigation or
conducted a significant amount of investigative work without any travel, and
used data obtained from various sources to prepare this aircraft accident
report.
The following is an INTERIM FACTUAL SUMMARY of this accident investigation. A
final report that includes all pertinent facts, conditions, and circumstances
of the accident will be issued upon completion, along with the Safety Board's
analysis and probable cause of the accident.
HISTORY OF FLIGHT
On March 17, 2013, at 1623 eastern daylight time, a Hawker Beechcraft model 390
(Premier IA) business jet, N26DK, serial number RB-226, collided with three
residential structures following an aborted landing attempt on runway 9R
located at the South Bend Airport (SBN), South Bend, Indiana. The private pilot
and pilot-rated-passenger, who were occupying the cockpit seats, were fatally
injured. An additional two passengers, who were seated in the cabin area, and
one individual on the ground sustained serious injuries. The airplane was
registered to 7700 Enterprises of Montana, LLC, and operated by Digicut Systems
of Tulsa, Oklahoma, under the provisions of 14 Code of Federal Regulations Part
91 while on an instrument flight rules flight plan. Day visual meteorological
conditions prevailed for the business flight that departed the Richard Lloyd
Jones Jr. Airport (RVS), Tulsa, Oklahoma, at 1356 central daylight time.
According to air traffic control (ATC) information, after departing RVS, the
accident flight proceeded toward the intended destination while receiving
normal ATC services. The flight was eventually cleared to a final cruise
altitude of 41,000 feet (FL410). The cockpit voice recorder (CVR) contained
about 31 minutes of cockpit conversation/audio and radio communications. At
1545:31, the beginning of the CVR recording, the pilot was discussing the
airplane's fuel status and how much fuel would be required for the return
flight. The pilot continued to explain and demonstrate various flight
management system functions to the pilot-rated-passenger. At 1546:08, the
pilot-rated-passenger remarked "a lot of stuff to learn." The pilot
continued to explain and demonstrate the features of the flight management
system, the use of his mobile tablet as an electronic flight bag, and the
airplane's various weight limitations.
At 1552:17, the pilot established contact with Chicago Air Route Traffic
Control Center and reported being level at FL410. The controller subsequently
cleared the flight to descend to 24,000 feet (FL240). After receiving the
descent clearance, the pilot and pilot-rated-passenger discussed how to
initiate a descent using the autopilot's vertical speed mode. The pilot
explained how to use airplane pitch and engine power and to maintain a desired
airspeed during the descent. At 1555:22, the pilot stated "we're up more
speed, so we got to get our power back. gettin' ready to start beeping at us.
got to bring it back." At 1555:27, the CVR recorded a sound similar to the
airspeed overspeed warning for 13.5 seconds. At 1555:31, the
pilot-rated-passenger asked the pilot, "just pull it way back?" The
pilot replied, "well, just get it out of the line. and we got to get it
so, that it trends -- there you go -- there you go -- now give it -- it ends,
there you go." The pilot continued to explain how to maintain a desired
airspeed. At 1555:55, the pilot-rated-passenger remarked, "I just hate
chasin' the darn thing." The pilot replied, "huh, how many hours you
got flying this jet?" The pilot-rated-passenger stated, "well, I
know, but I'm just saying it's just, you know, uncomfortable. Creates alarm in
the back -- throttle up, throttle down."
The pilot then explained how to setup a descent while maintaining a specified
airspeed. At 1557:29, the pilot-rated passenger stated, "so, pull
back?" The pilot replied, "little bit. little bit. keep working it
back 'cause that tells you where you're gonna be in six seconds. so, right now,
you're going to be at the line in six seconds, so you want to continue to trend
back. so yeah. so, just take two seventy or something like that." At
1557:53, the pilot told the pilot-rated-passenger to "just keep us out the
red."
At 1558:08, the controller cleared the flight direct to South Bend. After
acknowledging the direct clearance, the pilot told the pilot-rated-passenger
how to program the flight management system to proceed direct to the
destination airport. The pilot then discussed the airplane's indicated
airspeed, ground speed, and how to cross-check the airplane's flight attitude
with the backup cockpit instrumentation. At 1559:24, the Automatic Terminal
Information Service (ATIS) recording is audible over the radio channel. At
1559:42, the pilot-rated-passenger asked the pilot if they needed to engage
engine heat. The pilot replied that they would wait until they get an ice
indication light. At 1600:34, the pilot-rated-passenger asked the pilot
"okay. pull back on the power?"
At 1601:35, the controller cleared the flight to descend and maintain 20,000
feet (FL200). At 1602:13, the pilot discussed the current weather conditions
that he had obtained from the ATIS recording, the expected wind correction
during the approach and landing, the minimum descent altitude during the
instrument approach, and the landing reference speed. At 1603:22, the
controller asked the pilot to expedite a descent to 17,000 feet mean sea level
(msl). At 1603:51, the pilot told the pilot-rated-passenger "watch your
speed" and "very good, very good. great speed management."
At 1605:08, a sound similar to the altitude alert was heard, the pilot
announced "thousand away" and told the passenger-rated-pilot
"okay, now we can come nose back up." At 1605:29, the pilot stated
"let's go to the stop... to the click (detent)... MCT (maximum continuous
thrust)." At 1606:14, the CVR recorded a sound similar to the airspeed
overspeed warning that lasted for 11.4 seconds. At 1606:20, the pilot stated "that's
what a check pilot will do, is he'll give you three things to do... when he
knows you're trending in the wrong direction." At 1606:32, the pilot said
"your throttles."
At 1606:49, the controller cleared the flight to expedite a descent to maintain
11,000 feet msl. After acknowledging the descent clearance, the pilot and
pilot-rated passenger continued to discuss how to maintain airspeed during a
cruise descent. At 1607:23, the controller asked the pilot for a ride report.
The pilot replied that the weather conditions had been "smooth all the
way." At 1607:52, the pilot told the pilot-rated-passenger to maintain 290
knots. The pilot-rated-passenger replied "okay, where is it?" The
pilot responded "two ninety would be more power." At 1608:44, the
controller issued a heading change for traffic sequencing. The pilot then
explained how to promote a waypoint using the flight management system and how
to plan for a descent to the selected waypoint. At 1610:11, the controller
cleared the flight direct the destination airport and to contact South Bend
Approach Control.
At 1610:32, the pilot established communications with South Bend Approach
Control and reported being level at 11,000 feet msl. The approach controller
cleared the flight direct to KNUTE, the outer marker for the instrument landing
system (ILS) runway 9R instrument approach, but to expect a visual approach to
the airport. The pilot then explained how to promote KNUTE as the next active
waypoint within the flight management system, and how to plan for the descent
to the waypoint. At 1611:45, the approach controller cleared the flight to
descend and maintain 10,000 feet msl. At 1613:07, the approach controller
cleared the flight to descend and maintain 3,000 feet msl.
After receiving the descent clearance to 3,000 feet msl, the pilot told the
pilot-rated-passenger "let's power back. let's bring it back to uh --
let's trend toward uh two twenty, two ten." The pilot-rated-passenger
acknowledged and the pilot replied "and we'll have to come way out of it
to do that." At 1613:30, the cockpit area microphone recorded a sound
consistent with a decrease in engine speed. The pilot then verbalized a descent
checklist and turned on the seatbelt cabin chime. At 1614:14, the pilot told
the pilot-rated-passenger "we gotta get -- just pull -- just pull the
power out." At 1614:18, the pilot-rated-passenger asked, "just pull
it on down?" The pilot replied, "yeah, let's -- let's get back to two
hundred (knots)." At 1614:21, the cockpit area microphone recorded another
sound consistent with a decrease in engine speed. At 1614:26, the cockpit area
microphone recorded the sound of two clicks. At 1614:27, there was a brief
interruption in electrical power, an autopilot disconnect chime, and two
unidentified tones. According to ATC radar track data, at 1614:28, the final
radar return with an accompanying mode-C altitude return was recorded at 6,700
feet msl. At that time, the flight was located about 18 miles southwest of the
destination airport. At 1614:29, the pilot said "uh-oh" and the pilot-rated-passenger
replied "what?" At 1614:33, the sound similar to the landing gear
warning horn was heard for 3.5 seconds. At 1614:35, the pilot told the
pilot-rated-passenger "you went back behind the stops and we lost
power." (The airplane throttle quadrant had a mechanical stop at the
flight idle power position, which required lifting finger levers, or pull-up
locks, to further retard the throttles into the fuel cut-off position.)
At 1614:43, the pilot said "okay let's see here... boost pumps are on...
okay we are dead stick." At 1614:56, the sound similar to the landing gear
warning horn was heard for 10.9 seconds. At 1615:01, the approach controller
told the pilot to turn five degrees left for runway 9R and to report when he
had the airport in sight. At 1615:02, the cockpit area microphone recorded a
sound similar to an engine starter/generator spooling up; however, according to
a sound spectrum study, engine power was not restored during the attempted
restart. At 1615:08, the pilot told the approach controller, "uh... South
Bend, we have an emergency, two six delta kilo. dead engines, dead stick, no
power." The controller asked if he needed assistance and the pilot replied
"affirm." Between 1615:19 and 1615:27, there was a sustained
electrical power interruption to the CVR. At 1615:30, the controller asked for
the pilot's intentions and the pilot replied "uh, we've lost all power and
we have no hydraulics." At 1615:32, there was the sound similar to an
altitude alert.
At 1615:38, the controller stated that the airport would have emergency
equipment standing-by and asked if the airplane was controllable. At 1615:42,
the pilot replied "ah, barely controllable." The controller told the
pilot that all of the runways were available for landing and issued the current
wind condition. At 1615:53, the pilot told the controller "uh, we have no
navigation. if you could give us a vector please... we have no heading either.
which -- you're gonna have to tell us which way to fly." The controller
replied that the airplane was about 9 miles from the airport, which was at the
12-o'clock position. At 1616:09, the pilot-rated-passenger stated "there's
the airport" and the pilot responded "Where? -- Okay." At
1616:12, the sound similar to the landing gear warning horn was audible until
the end of the CVR recording. At 1616:13, the approach controller told the
pilot to turn left 10 degrees. At 1616:16, the pilot replied "two six
delta, turning left." At 1616:32, the CVR stopped recording while the
airplane was still airborne with both engines still inoperative.
No additional voice communications were received from the accident airplane.
The approach controller continued to transmit radar vectors toward runway 9R
without any response from the accident pilot. At 1618:59, the approach
controller told the accident airplane to go-around because the main landing
gear was not extended. (The tower controller had informed the approach
controller that only the nose landing gear was extended) The accident airplane
was then observed to climb and enter a right traffic pattern for runway 9R. The
airplane made another landing approach to the runway with only the nose landing
gear extended. Several witnesses observed the airplane bounce several times on
the runway before it ultimately entered a climbing right turn. The airplane was
then observed to enter a nose low, rolling descent into a nearby residential
community.
PERSONNEL INFORMATION
--- Pilot ---
According to Federal Aviation Administration (FAA) records, the pilot, age 58,
held a private pilot certificate with single and multi-engine land airplane and
instrument airplane ratings. He was type-rated for the Hawker Beechcraft model
390 (Premier IA) business jet. His last aviation medical examination was
completed on January 22, 2013, when he was issued a third-class medical
certificate. The medical certificate had a limitation that it was not valid for
any certificate classification after January 31, 2014. A search of FAA records
showed no previous accidents, incidents, or enforcement proceedings.
The pilot's flight history was reconstructed using a partially completed pilot
logbook, a spreadsheet flight log, several applications for his FAA pilot
certificates and ratings, and a spreadsheet history of the flights that had
been completed in the accident airplane. The pilot began his primary flight
instruction on January 21, 2011. On April 29, 2011, when he applied for his
private pilot certificate, he reported having 71 hours total time. On February
5, 2012, when he applied for his instrument rating, the pilot reported having
314 hours total time. On February 26, 2012, when he applied for his
multi-engine rating, the pilot reported having 330 hours total time. On May 4,
2012, when he applied for his type-rating in the Hawker Beechcraft model 390,
the pilot reported having 450 hours total time. According to additional flight
documentation, after he had received his type-rating, the pilot accumulated an
additional 163.7 hours in the accident airplane. The pilot's total flight
experience was estimated to be about 613.7 hours, of which at least 171.5 hours
were completed in the same make/model as the accident airplane.
According to training records, from April 29, 2012, through May 4, 2012, the
pilot attended initial type-rating training for the Hawker Beechcraft model 390
airplane at The Jetstream Group, located in Chino, California. The course
consisted of 41 hours of ground training, 8 hours of flight
briefing/debriefing, and 7.8 hours of flight training in the Hawker Beechcraft
model 390 airplane. On May 4, 2012, the pilot obtained his type-rating
following a 2.1-hour oral examination and a 2.0 hour checkride with a FAA
designated pilot examiner.
--- Pilot-Rated-Passenger ---
According to FAA records, the pilot-rated-passenger, age 60, held a private
pilot certificate with single and multi-engine land airplane and instrument
airplane ratings. His last aviation medical examination was completed on August
3, 2005, when he was issued a third-class medical certificate with the
limitation for corrective lenses. A search of FAA records showed no previous
accidents, incidents, or enforcement proceedings.
A review of available logbook information indicated that the last recorded
flight was completed on September 28, 2008. At that time, the pilot-rated-passenger
had accumulated 1,877.2 hours total flight experience, of which 1,705.3 hours
were listed as pilot-in-command. He had accumulated 1,576.2 hours in
multi-engine airplanes and 301 hours in single-engine airplanes. He had
accumulated 92.4 hours in actual instrument conditions and 517.6 hours at
night. His last recorded flight review and instrument proficiency check was
completed on September 19, 2006, in a Beech model 60 twin-engine airplane. A
review of available information did not reveal any logged flight experience in
turbine-powered business jets.
According to an affidavit provided by the pilot's son following the accident,
the pilot-rated-passenger was not an employee of the operator, nor was he
employed as a pilot for the accident flight. He was reportedly a friend of the
pilot who shared a common interest in aviation. He reportedly did not have an
official role on the accident flight, and as such, was considered a
pilot-rated-passenger.
AIRCRAFT INFORMATION
The accident airplane was a 2008 Hawker Beechcraft model 390 (Premier IA)
business jet, serial number RB-226. Two Williams International model FJ44-2A
turbofan engines, each capable of producing 2,300 pounds of thrust at takeoff,
powered the airplane. The airplane had a maximum takeoff weight of 12,500
pounds. The airplane was equipped for operation under instrument flight rules
and in known icing conditions.
The accident airplane was issued a standard airworthiness certificate on March
13, 2008. According to FAA documentation, 7700 Enterprises of Montana, LLC,
purchased the airplane on April 18, 2012. The current FAA registration
certificate was issued on May 1, 2012. The airplane was maintained under the
provisions of a FAA-approved manufacturer inspection program. The last inspection
of the airplane was completed on November 4, 2012, at 419 hours total airframe
time. As of the last inspection, both engines also had accumulated 419 hours
since new. The static system, altimeter system, automatic pressure altitude
reporting system, and transponder were last tested on July 7, 2011. A
postaccident review of the maintenance records found no history of unresolved
airworthiness issues. The airplane hour meter indicated 457.5 hours at the
accident site.
The primary flight control systems, except the spoilers, were manually operated
through control cables, push/pull tubes, and mechanical linkages. The spoilers
were electronically controlled and hydraulically actuated. The pitch trim
system, roll trim system, and yaw trim system were electrically operated. The
speed brake was controlled electrically and operated hydraulically. The flaps
were electronically controlled and electrically actuated.
Pitch attitude of the airplane was controlled by the elevators and the variable
incidence horizontal stabilizer. The elevator control system was operated
manually by movement of the cockpit control columns. Roll attitude was
controlled through the ailerons, spoilers and roll trim. The aileron control
system was operated manually by movement of the cockpit control wheels. The
spoiler control system was electrically controlled by movement of the cockpit
control wheels and hydraulically actuated. Yaw control was accomplished by the
rudder and rudder trim tab. The rudder control system was operated manually by moving
the cockpit rudder pedals.
The cockpit engine thrust levers were connected to control cables that extended
aft through the fuselage to the power control arm located on the bottom of each
hydromechanical fuel control unit (HMU). In addition to the mechanical throttle
linkages to the HMUs, each engine had an electronic control unit (ECU) that
interfaced with its respective HMU to provide automatic fuel control throughout
the normal engine operating envelope. The ECUs were part of the Standby Bus
electrical system. Finger levers, or pull-up locks, were installed to prevent
the inadvertent movement of the thrust levers from flight idle into the fuel
cutoff position.
During normal operation, the Standby Bus is powered by the Essential Bus. The
Essential Bus receives electrical power from the main battery and generators
(when online). During engine prestart and engine start, the ECUs are powered by
the main battery until a generator is brought online. The generators are used
as starter motors during normal engine starts and starter-assisted air starts.
As such, following an engine start, a generator is "RESET" by
selecting the associated toggle switch that is located on the electrical
control sub-panel. The momentary "RESET" toggle switch position
reestablishes electrical power from the generator to the Essential Bus system.
During normal engine operation, the ECUs are powered by the generators through
the Essential Bus; however, the ECUs could also be powered by the standby
battery, through the Standby Buss, if the standby battery is selected following
the depletion of the main battery.
In the event of a loss of engine power during flight, an engine can be
restarted in the air by one of two methods: either a windmilling start or a
starter-assisted air start. A windmilling start uses residual engine speed, air
movement against the fan blades, and engine igniters to restart the engine and
regain power. A starter-assisted air start uses electrical power, routed
through the generator/starter motor, to increase the N2 shaft to a speed where
the igniters can restart the engine. Generally, the flight envelope to
accomplish an engine air start is between 130 and 300 knots indicated airspeed
and from sea level to 25,000 feet. At lower airspeeds, a starter-assisted air start
is recommended and uses the normal engine start switch. At higher airspeeds a
windmilling start is recommended and does not use the normal engine start
switch. In contrast to the normal ground start procedure, the air start
procedure requires that the igniter switches be switched to the "ON"
position before attempting any engine air start.
The airplane was equipped with an electrically controlled, hydraulically
actuated, retractable landing gear. If hydraulic or electric power is
unavailable, an alternate procedure is used to extend the landing gear. When
the alternate landing gear extension handle was pulled outward from the stowed
position, the landing gear and door up-lock hooks are released, which allows
the landing gear to free-fall into the down-and-locked position. The use of the
alternate landing gear handle also opens a mechanically actuated recirculation
valve that connects the main landing gear retraction and extension hydraulic
lines to allow a more positive free-fall of the gear. The landing gear release
is sequenced so that the nose gear is released first, followed by the main
landing gear inboard doors, and finally the main landing gear. According to the
airframe manufacturer, the nose landing gear is released from the up-locks when
the alternate extension handle is extended to 2-1/4 inches (+/- 0.25 inch). The
main landing gear inboard doors are released when the alternate extension
handle is extended to 2-3/4 inches (+/- 0.25 inch). Finally, the main landing
gear are released from their respective up-locks when the alternate extension
handle is pulled to 3-1/4 inches (+/- 0.25 inch). The full stroke length of the
alternate extension handle, following a full deployment of the landing gear, is
specified to be a minimum of 4 inches.
METEOROLOGICAL INFORMATION
At 1620, the SBN automated surface observing system reported: wind 120 degrees
at 13 knots, gusting 17 knots; a clear sky; 10 mile surface visibility;
temperature 2 degrees Celsius; dew point -8 degrees Celsius; and an altimeter
setting of 30.14 inches of mercury.
COMMUNICATIONS
The accident flight was on an activated instrument flight rules (IFR) flight
plan. A review of available ATC information indicated that the accident flight
had received normal air traffic control services and handling. A transcript of
the voice communications recorded between the accident flight and South Bend
Approach Control are included with the docket materials associated with the
investigation.
AIRPORT INFORMATION
The South Bend Airport (SBN), a public airport located approximately 3 miles
northwest of South Bend, Indiana, was owned and operated by the St. Joseph
County Airport Authority. The airport was a certificated airport under 14 CFR
Part 139 and had on-airport fire and rescue services. The airport field
elevation was 799 feet msl. The airport had three runways: runway 9R/27L (8,414
feet by 150 feet, asphalt/grooved); runway 18/36 (7,100 feet by 150 feet,
asphalt/grooved); and runway 9L/27R (4,300 feet by 75 feet, asphalt).
FLIGHT RECORDERS
Although not required, the airplane was equipped with an L-3/Fairchild model
FA2100-1010 CVR, serial number 446023. The CVR recording contained about 31
minutes of digital audio, which was stored in solid-state memory modules. The
CVR was not damaged during the accident and the audio information was extracted
from the recorder normally. The recording consisted of four channels of audio
information, ranging from good to excellent quality. The recording began at
1545:31 with the airplane established in cruise flight at 41,000 feet (FL410),
and the recording stopped about 1616:32 while the airplane was maneuvering
toward the destination airport with both engines inoperative. A transcript of
the CVR audio information is included with the docket materials associated with
the investigation. The airplane was not equipped with a flight data recorder,
nor was it required to be so equipped.
WRECKAGE AND IMPACT INFORMATION
The airplane collided with three residential structures during the final impact
sequence. A majority of the wreckage was found within one of the structures.
There was a noticeable odor of Jet-A fuel at the accident site and the South
Bend Fire Department reported that fuel had pooled in the basement of the
house. The airplane wreckage was recovered from the house and transported to
the South Bend Airport to facilitate a more detailed examination. A
postaccident examination of the runway 9R revealed areas of abrasion damage to
the grooved asphalt surface. The observed damage was consistent with the
accident airplane coming in contact with the runway surface during the accident
flight.
--- Fuselage ---
The radome had separated from the radome bulkhead, which had separated from the
fuselage. The nose baggage and avionics sections had separated forward of the
forward pressure bulkhead and the nose wheel well structure had buckled. The
cabin area exhibited impact damage; however, portions remained intact from the
forward pressure bulkhead to the aft pressure bulkhead. A section of the right
cabin sidewall, from the emergency escape hatch opening forward to
approximately the right side galley area, had been cut open by first responders
to extract the occupants. The aft fuselage had separated from the cabin portion
at the aft pressure bulkhead, but remained attached by flight control cables
and other conduits. Both engines remained attached to the aft fuselage. The
main entry door remained attached at both hinge locations and was found open
with the latches in the closed position. The main entry door latching mechanism
was actuated and operated as designed. Examination of the fuselage revealed no
evidence of an in-flight or post-impact fire. The VHF communications No. 1
antenna had separated from the lower fuselage, and exhibited gouges and scoring
of the lower leading edge that were consistent with contact with the runway
surface.
--- Wings ---
The wing assembly had separated from the airframe at all mounting points. The
left wing exhibited deformation consistent with impact forces, but remained
intact with all flight control surfaces attached. The right wing exhibited
deformation consistent with impact forces and had separated in several
locations. The inboard portion of the right wing exhibited minor damage when
compared to the outboard wing. The outboard portion of the right wing, outboard
of the inboard flap, exhibited impact damage, deformation, and had separated
into several pieces. The outboard portion of the right wing, from the aileron
outboard, had separated as one piece, with the exception of the composite wing
tip assembly. The composite wing tip assembly had separated from the outboard
end of the wing and was found amongst the main wreckage. The lower skin of the
outboard portion of right wing and the lower skin of the composite wing tip
exhibited gouging/scoring that was consistent with contact with the runway
surface. The marks made by the gouging/scoring were approximately parallel with
the chord of the wing and were aligned with the longitudinal axis of the
fuselage. Additional abrasion damage was observed on the lower aft portion of
all right wing flap tracks and the aft portion of the wing center keel
structure. The trailing edge of the right aileron also exhibited abrasion
damage. The wing flaps were observed in the retracted position and the measurement
of the individual flap actuators corresponded with fully retracted flap
positions. The aileron flight control system displayed multiple separations
throughout the circuit; however, all observed separations exhibited features
consistent with an overstress failure.
--- Stabilizers ---
The horizontal stabilizer remained attached to the rear fuselage and revealed
limited impact damage. The elevators remained attached to the horizontal
stabilizer at all hinges. The outboard portion of the right elevator, including
the balance weight, had separated from the remaining right elevator. The right
and left elevator trim tab surfaces remained attached to their respective
elevators at their hinges. The rudder remained attached to the vertical
stabilizer and the hinges exhibited no apparent damage. The rudder trim tab
remained attached to the rudder at the hinges and did not appear to be damaged.
The rudder trim tab surface was visually aligned (faired) with the trailing
edge of the rudder. Flight control continuity for the elevator and rudder
displayed multiple separations; however, all observed separations exhibited
features consistent with an overstress failure.
--- Landing Gear ---
The nose landing gear had separated from the airframe trunnion. The nose
landing gear drag brace had separated from the nose landing gear assembly and
the airframe supporting structure. The down lock actuator and down lock
"pawl" assembly had separated from the drag brace assembly. The nose
wheel and tire remained attached to the nose landing gear assembly. The nose
wheel exhibited signs of impact damage to a portion of the bead area. The nose
landing gear doors had separated from the airframe and were found amongst the
main wreckage. The nose landing gear actuator had separated from the airframe
in two pieces. The piston portion of the actuator remained attached to the nose
landing gear assembly.
The left main landing gear assembly remained intact and attached to the left
wing trunnion. The gear was found in the wheel well; however, the uplock was
not engaged to the main landing gear uplock roller. The left main landing gear
actuator remained attached to the main landing gear assembly and to the wing
supporting structure. The actuator was found in the retracted position;
however, multiple separations of hydraulic lines and impact damage prevented a
determination of the landing gear position by the measurement of the landing
gear actuator. The left outboard gear door remained attached to the wing
structure and the left main landing gear assembly. The left inboard gear door
had separated from the wing and was found in several pieces amongst the main
wreckage. The left inboard gear door actuator remained attached to the wing.
About 90-percent of the inboard gear door was recovered and reconstructed. The
paint on the exterior portions of the door appeared to be eroded, consistent
with contact with the runway surface while in the closed position.
The right main landing gear assembly remained intact and attached to the wing
structure. The right wing had separated between the main landing gear trunnion
fitting and the main landing gear actuator wing attach fitting. The main
landing gear actuator remained attached to the main landing gear assembly and
the wing attach fitting. The right main landing gear actuator was partially
extended; the actuator was in neither the fully retracted nor the
down-and-locked position. Multiple separations of hydraulic lines and impact
damage prevented a determination of the landing gear position by measurement of
the landing gear actuator. The right main landing gear outboard door had
separated from the wing and was not recovered during the investigation. About
60-percent of the right inboard gear door was recovered and reconstructed. The
reconstructed portion of the door exhibited exterior paint erosion that was
consistent with door being abraded in the closed position. Additionally, there
was evidence that the left tire had pressed against the interior of the door
when the exterior abrasion had occurred. The inboard gear door actuator
remained attached the wing.
--- Cockpit Switch and Lever Positions ---
Both engine power levers were in the normal takeoff position. Both levers were
bent right and forward approximately 45-degrees. The power levers moved
smoothly from the normal takeoff position to the flight idle detent. There was
a positive indication at the normal takeoff and flight idle stops. The finger
levers, which allow the power levers to be moved aft of the flight idle detent
into fuel cut-off, could not be activated/pulled because of damage to both the
power levers and the finger levers.
The flap handle was in the 20-degree detent position. Although the flap handle
was bent, it could be moved between each flap position detent. A positive
detent was noted at each flap position.
The lift dump switch was in the "Unlock" position. The lift dump
handle was in the retracted position.
The speed brake was in the "RETRACT" position.
The landing gear position handle located in the cockpit was observed in the
"UP" position. The cockpit landing gear circuit breaker was in the
closed (not pulled) position. The landing gear alternate extension handle was
found partially extended about 1-1/2 inches and was bent toward the instrument
panel.
The battery toggle switch was in the "Standby" position.
Both generator toggle switches were in the "ON" position.
Both avionics switches were in the "ON" position.
The left fuel boost switch was in the "ON" position.
The position of the right fuel boost switch could not be determined due to
impact damage.
The fuel transfer switch was in the "OFF" position.
Both engine ECU switches were in the "ON" position.
Both engine ignition switches were in the "ARM" position.
Engine synchronization was in the "OFF" position.
--- Engines ---
A postaccident examination of the left engine, serial number 105363, revealed
evidence of leading edge foreign object damage to the N1 (Spool) Fan,
consistent with the ingestion of debris during the impact sequence. Although
damaged, the N1 Fan could still be rotated by hand. Thrust lever cable
continuity from the center pedestal to the engine could not be verified due to
the severity of the airframe damage. However, on the engine, the power control
cables were continuous from the engine pylon to the power control arm located
at the base of the HMU. The fuel control throttle lever was observed in the
maximum power position. The Low Pressure (LP) Trip Lever cable exhibited no
visible damage, and the fuel cutoff mechanism had not been activated. All three
engine magnetic chip collectors were inspected and were free of metallic chips
and/or debris. The powerplant examination revealed evidence that the left
engine was operating at the time of impact.
A postaccident examination of the right engine, serial number 105364, revealed
evidence of attic insulation, pieces of home roofing shingles, pieces of wood,
and other unidentified debris within the engine cowling and bypass duct.
However, the N1 fan did not reveal visible evidence of leading edge foreign
object damage that would be expected from the ingestion of debris in
conjunction with engine operation. Thrust lever cable continuity from the
center pedestal to the engine could not be verified due to the severity of the
airframe damage. However, on the engine, the power control cables were
continuous from the engine pylon to the power control arm at the base of the
HMU. The fuel control throttle lever was observed in the maximum power
position. The LP Trip Lever cable was found bent and damaged, and the LP Trip
Lever fuel cutoff mechanism had been activated. (The LP Shaft Trip Sensor is
activated when the LP turbine is forced in the aft direction against the trip
lever. Typical scenarios of when a trip sensor would be activated include a LP
Shaft separation or when the engine is exposed to significant impact loading.)
All three engine magnetic chip collectors were inspected and were free of
metallic chips and/or debris. The powerplant examination did not reveal any
evidence that the right engine was operating at the time of impact.
MEDICAL AND PATHOLOGICAL INFORMATION
On March 18, 2013, autopsies were performed on the pilot and
pilot-rated-passenger at the St. Joseph Regional Medical Center, located in
Mishawka, Indiana. The cause of death for both individuals was attributed to
blunt-force injuries sustained during the accident. The FAA's Civil Aerospace
Medical Institute (CAMI) located in Oklahoma City, Oklahoma, performed
toxicology tests on samples obtained during each autopsy.
The pilot's toxicological test results were negative for carbon monoxide and
ethanol. Losartan, an FAA-accepted high blood pressure medication, was detected
in urine and blood samples. The pilot had reported the use of this medication
on his most recent FAA medical certificate application.
The pilot-rated-passenger's toxicological test results were negative for carbon
monoxide, ethanol, and all drugs and medications.
TESTS AND RESEARCH
--- Sound Spectrum Study ---
A study was performed to evaluate the sound spectrum of audio recorded by the cockpit
area microphone after the loss of engine power at 1614:27. The CVR audio was
compared with audio recorded during ground testing of an exemplar Hawker
Beechcraft model 390 (Premier IA). The sound spectrum study indicated that, at
1615:02, the pilot engaged a starter motor in attempt to restart one of the
engines. The study further established that the electrical noise from the
engine igniters was not present at any point during the CVR recording,
including the attempted engine air start. (The air start procedure required
that the igniter switches be switched to the "ON" position before
attempting any engine air start) A review of the remaining CVR audio did not
reveal any evidence of another attempt to restart an engine.
--- Surveillance Video Study ---
There were several surveillance videos of the accident airplane during the two
landing attempts, and the final descent and impact. A study of airport
surveillance footage was completed to determine an average ground speed of the
airplane during the second landing attempt. The study determined that the
airplane's average ground speed was 127 knots (+/- 4 knots) during the 3.75
seconds of camera footage of the second landing attempt. Additional information
concerning the surveillance videos can be found with the docket materials
associated with this investigation.
--- Mobile Device Examinations ---
Several mobile devices were recovered from the wreckage and sent to the
National Transportation Safety Board (NTSB) Vehicle Recorder Laboratory for
examination.
The pilot's tablet mobile device contained several aviation related
applications; however, none of the applications contained flight track data for
the accident flight. One application, ForeFlight, depicted the planned
route-of-flight for the accident flight. Additionally, the ForeFlight
application also contained 160 file-and-brief entries for previous flights.
Another application, LogTen Pro, contained a partial flight history log.
The pilot's mobile phone was reviewed and no information pertinent to the
investigation was recovered.
The pilot-rated-passenger's mobile phone contained a text message, dated March
13, 2013, concerning a previous flight that he had in the accident airplane
with the pilot. No additional information was recovered that was pertinent to
the investigation.
Another passenger's mobile phone contained multiple out-going text messages
with timestamps between 13:45 and 13:53 central daylight time. These text
messages noted that the accident flight was about to takeoff and provided the
expected time en route to South Bend. At 1505 eastern daylight time, a
multi-media text message was sent with a photograph from inside the airplane
cabin looking toward the cockpit. At 1612, another photo was taken from inside
the cabin looking outside through a cabin window. No additional information was
recovered that was pertinent to the investigation.
ADDITIONAL DATA/INFORMATION
One of the surviving passengers was interviewed by two NTSB Human Performance
and Survival Factors investigators. The passenger reported that he loaded his
luggage and computer gear on the airplane between 1330 and 1345 central
daylight time. After loading, he and the other passenger boarded the airplane
and waited for the pilots. Around 1350, the pilot and pilot-rated-passenger
boarded the airplane. The passengers were not provided a safety briefing. He
stated that the takeoff and cruise portion of the flight appeared to be normal;
however, while the airplane was on approach to the runway he noticed instrument
panel was not illuminated like it had been earlier in the flight. Specifically,
he recalled that the cockpit instrument panel appeared to be unpowered. He saw
that the pilot was manually flying the airplane. The pilot-rated-passenger
turned around and announced that they should prepare for landing.
The passenger
stated that he became concerned when the airplane flew past the terminal and
control tower and had not touched down. He noted that he felt like the airplane
was "coming in hot." The airplane then banked right and climbed away
from the runway. The passenger heard the pilot tell the pilot-rated-passenger
that they were "down to one engine." The airplane continued in the
traffic pattern back to the runway. The passenger stated that the cockpit
instrument panel still appeared to be unpowered during the second landing
attempt; however, he did recall seeing flashing red and yellow cockpit lights.
The passenger believed that during the second landing attempt the airplane had
a slower groundspeed when compared to the first landing attempt. He noted that
the airplane bounced off the runway several times before it entered a nose-high
attitude and rolled to the right. He remembered seeing rooftops of homes before
he blacked-out. His next memory was after the accident, as first responders
attempted to gain access to the cabin.
==================
Jim Rodgers can smile, even though he can’t speak normally. He is good-humored
and desperately wants to get better, his attorney says.
But the former Tulsa, Okla., firefighter and survivor of a South Bend plane
crash is bedridden. He can’t walk or take care of his own bodily functions. His
ability to communicate is limited.
He has a serious brain injury from the crash.
“It’s still highly unlikely he will make a serious recovery and be
independent,” Rodgers’ attorney Fred Stoops said.
And the medical bills after the March 17 crash into a South Bend neighborhood
are mounting fast.
The Oklahoma City, Okla., attorney has filed a lawsuit in South Bend on behalf
of Rodgers and his wife Sheryl. Chris Evans, Rodgers’ son-in-law who also
survived the crash, and his wife Jill are named as plaintiffs as well.
The suit, filed in April against the plane manufacturer and the company that
owned it, alleges that parts of the jet, a Hawker Beechcraft model 390, were
defective, which caused the fatal and destructive plane crash.
A pilot and owner of the jet, Wes Caves, along with a co-pilot, Steve Davis,
died after the jet spiraled out of the air into three homes on Iowa Street.
The crash followed an unsuccessful landing attempt at the nearby South Bend
Regional Airport. The jet destroyed three homes, but the residents survived.
St. Joseph Superior Court Judge David Chapleau has allowed two of the
homeowners whose residences were leveled, Diana McKeown and Patricia Kobalski,
to join the lawsuit.
In the months after the filing of the claim, the case has grown into a massive
stack of papers that detail the financial repercussions the crash left in its
wake.
Filings from McKeown and Kobalski and their insurance companies ask for
monetary reimbursement for the destruction of their homes.
Rodgers’ and Evans’ cite physical injury, emotional distress, loss of normal
life, medical expenses, lost earnings and the ability to continue earning
income in their quest for monetary relief.
“They are facing an unbelievable hardship,” Stoops said.
Evans is in better physical shape than Rodgers and faced orthopedic injuries.
Rodgers was a firefighter when he was injured, but, Stoops said, his health
insurance plan did not cover injuries sustained when working other jobs.
He and Evans flew in the plane that day because they were employees of Caves,
who was traveling to the area from Oklahoma for business.
Stoops said Rodgers’ family is able to pay for some of his medical care but not
all of it.
“They are totally mortgaging their future in hopes that at some point, they can
get it back,” Stoops said.
Named as defendants in the case are the Beechcraft Corp., Hawker Beechcraft
Inc., Digicut Sales LLC, 7700 Enterprises of Montana LLC and 7700 Enterprises
LLC, as well as unnamed manufacturers.
Robert Konopa, who is representing the Beechcraft Corp., declined to comment,
saying it is his policy not to discuss pending litigation.
Other attorneys involved in the case did not return phone messages left today.
Caves owned Digicut Sales, which owned the jet.
The lawsuit cites “improper manufacture and dangerous stability, handling,
stall and spin characteristics” as factors that caused the crash.
“The landing gear, GPS navigation systems and other flight-essential systems
subsequently failed to function properly,” the complaint says.
It argues that the manufacturer and company that maintained the plane allowed a
defective craft to fly.
The defendants have denied these claims in answers to the complaint.
Stoops said the parties in the suit are waiting for the final report from the
National Transportation Safety Board, which is delaying the progression of the
lawsuit.
NTSB has released a preliminary report detailing the radio traffic dispatched
before the crash, but it has not released a final report that determines a
cause.
“We've lost all power, and we have no hydraulics," the pilot radioed
minutes before the crash, according to the NTSB report.
He radios that the plane is barely controllable.
Stoops said Evans recalls the crash and the events leading up to the crash.
Evans told him the problem was mechanical.
But the plaintiffs don’t have access to the jet parts that could prove or
disprove that while NTSB is conducting the investigation.
Neither Evans nor his attorney will specifically relate what happened during
the crash, as that is a key part of their case, Stoops said.
Meanwhile, as the survivors trudge through what will likely be a long
litigation process, South Bend firefighters offered some comfort for Rodgers as
he fights to recover.
Two local firefighters traveled to Tulsa this week to visit Rodgers, a fellow
fireman, and gave him a helmet with insignias of both Notre Dame and Oklahoma
University.
Members of the fire department signed the helmet.
Davis, one of the pilots who died, was a quarterback for the Sooners from 1972
to 1976.
“It was such an unbelievably classy thing they did,” Stoops said.
Story and Comments/Reaction: http://www.southbendtribune.com
http://registry.faa.gov/N26DK
NTSB Identification: CEN13FA196
14 CFR Part 91: General Aviation
Accident occurred Sunday, March 17, 2013 in South Bend, IN
Aircraft: Hawker Beechcraft Corporation 390, registration: N26DK
Injuries: 2 Fatal,3 Serious.
This is preliminary information, subject to change, and may contain errors. Any
errors in this report will be corrected when the final report has been
completed. NTSB investigators either traveled in support of this investigation
or conducted a significant amount of investigative work without any travel, and
used data obtained from various sources to prepare this aircraft accident
report.
On March 17, 2013, at 1623 eastern daylight time, a Hawker Beechcraft model 390
(Premier IA) business jet, N26DK, serial number RB-226, collided with three residential
structures and terrain following an aborted landing attempt on runway 9R
located at the South Bend Regional Airport (KSBN), South Bend, Indiana. The
private pilot and pilot-rated-passenger occupying the cockpit seats were
fatally injured. An additional two passengers and one individual on the ground
sustained serious injuries. The airplane was registered to 7700 Enterprises of
Montana, LLC and operated by Digicut Systems of Tulsa, Oklahoma, under the
provisions of 14 Code of Federal Regulations Part 91 while on an instrument
flight plan. Day visual meteorological conditions prevailed for the business
flight that departed Richard Lloyd Jones Jr. Airport (KRVS), Tulsa, Oklahoma,
at 1358 central daylight time.
According to preliminary air traffic control information, at 1610:31, the
accident pilot established radio communications with South Bend Approach
Control while at 11,000 feet mean sea level (msl). The air traffic controller
cleared the flight direct to KNUTE intersection and told the pilot to expect a
visual approach to runway 9R. At 1611:44, the flight was cleared to descend to
10,000 feet msl. At 1613:06, the flight was cleared to 3,000 feet msl. At
1615:00, the approach controller told the pilot to make a 5-degree left turn to
align with runway 9R and asked the pilot to report when he had the airport in
sight. At 1615:07, the pilot declared an emergency because of a lack of engine
power, reporting that they were "dead stick" and without any power.
About 23 seconds later, at 1615:30, the pilot transmitted "we've lost all
power, and we have no hydraulics." When the controller asked if the
airplane remained controllable, the pilot replied "ah, barely
controllable." The controller advised that all runways at KSBN were
available for landing and issued the current winds, which were 130-degrees at
10 knots. At 1615:22, the pilot transmitted that the airplane’s navigational
systems were inoperative and requested a radar vector toward the airport. The
controller replied that the airport was 9 miles directly ahead of the
airplane’s current position. At 1616:12, the controller told the pilot to turn
10-degrees left to intersect runway 9R. At 1616:15, the pilot replied
"26DK, turning left." No additional voice communications were
received from the accident airplane. The approach controller continued to
transmit radar vectors toward runway 9R without any response from the accident
pilot. At 1618:58, the approach controller told the accident airplane to
go-around because the main landing gear was not extended. (The tower controller
had informed the approach controller that only the nose landing gear was
extended) The accident airplane was then observed to climb and enter a right
traffic pattern for runway 9R. The airplane made another landing approach to
runway 9R with only the nose landing gear extended. Several witnesses observed
the airplane bounce several times on the runway before it ultimately entered a
climbing right turn. The airplane was then observed to enter a nose low descent
into a nearby residential community.
Source: http://www.kathrynsreport.com
