ANC19LA046

NTSB accident investigation · Cessna 208B · Lahaina, HI · August 18, 2019

Accident · No injuriesClass 3 · LimitedFinal report
Date
August 18, 2019, 10:37 local (20:37 UTC)
Place
Lahaina, HI
Injuries
10 uninjured
Damage
Substantial damage
Phase of flight
Landing
Aircraft
N879MACessna 208B
Defining event
Landing: Landing area overshoot
Weather
Visual (VMC) · Day
Status
Completed
Report
Approved by Office Director
Investigation class
Class 3
NTSB office
Alaska Regional Office
Parties
Textron Aviation, Transportation Safety Board of Canada, Hatzell Propeller, Pratt & Whitney Canada Corp., FAA
FAA report
20190818017809A
Case key
100077

From the NTSB’s public API. By law, NTSB reports can’t be used as evidence in lawsuits over the accident.

On this page

Probable cause

The pilots’ failure to maintain a proper approach speed and their decision to continue the approach for landing, which resulted in the airplane landing long and a subsequent runway overrun.

Findings · 5

NTSB’s coded findings. Those marked are part of the probable cause; the rest are factors or other findings. Under each, the cases with the same finding.

Use of equip/info: aircraft controlPersonnel issues › Task performance · CopilotCessna 208B: 19 casesAll aircraft: 9,295 casesProbable cause
Performance/control parameters: airspeedAircraft › Aircraft oper/perf/capability · Not attained/maintainedCessna 208B: 5 casesAll aircraft: 1,681 casesProbable cause
Performance/control parameters: landing flareAircraft › Aircraft oper/perf/capability · Not attained/maintainedCessna 208B: 6 casesAll aircraft: 1,285 casesProbable cause
Propeller system: propeller feather/reversingAircraft › Aircraft propeller/rotor · Not specifiedCessna 208B: 2 casesAll aircraft: 26 casesProbable cause

Sequence of events

The events NTSB coded, in order, by phase of flight. The defining event is the one that best describes the accident. Under each, the cases with the same event anywhere in their sequence.

Analysis

The captain reported that, due to the wind conditions at the destination airport, he and the first officer, who was the pilot flying, decided to fly the approach for landing at 95 knots indicated airspeed (KIAS) and use less than full flaps. The captain stated, and onboard data confirmed, that the airplane crossed the threshold of the 3,000 ft-long-runway at 115 KIAS. The airplane touched down about 2,000 ft down the runway at about 96 knots KIAS. Despite the pilots’ application of reverse thrust and full braking, the airplane continued off the end of the runway, where it impacted a fence and trees and came to rest in a ditch, resulting in substantial damage. The pilots and eight passengers egressed the airplane with no injuries. A complete examination of the thrust reverse system was not performed, as the airplane had been disassembled before the examination could take place. However, given the airplane’s touchdown point, there was insufficient runway remaining on which to stop the airplane even if the pilots had utilized a short field landing technique, which required an approach speed of 78 KIAS and full landing flaps. The pilots’ failure to maintain the predetermined approach speed and their decision to continue the approach despite the airplane’s excessive speed resulted in the airplane landing long and a subsequent runway overrun.

Factual narrative

On August 18, 2019, about 1037 Hawaii-Aleutian standard time, a Cessna 208B-EX airplane, N879MA, sustained substantial damage when it was involved in an accident near Lahaina, Hawaii. The eight passengers and two pilots were not injured. The airplane was operated by Mokulele Airlines as a Title 14 Code of Federal Regulations Part 135 scheduled passenger flight. The captain reported that the accident occurred while landing during the second flight of the day. The first officer was the pilot flying, and the captain was the pilot monitoring. He and the first officer briefed the approach and chose to fly a speed of 95 knots with an approach flap setting due to the wind conditions. The captain noted that the airplane’s speed on final approach was 115 knots and that the airplane touched down "a little longer than normal." After touchdown, the first officer applied reverse thrust (beta range). He added that, "something didn't feel right" and that the airplane was not decelerating. The captain took control of the airplane and applied the thrust lever to full reverse, but the airplane did not slow down; he applied brakes, but the tires skipped with the brakes locked and had limited effect. The airplane exited the runway, impacted the airport boundary fence, trees, and a ditch, and sustained substantial damage to the left aileron. The first officer reported that, during the approach, the airplane was "a little fast" and floated longer down the runway than normal. He was not sure of the exact touchdown point but noted that he did not hear any loud noise typically associated with the application of reverse thrust. The captain then took the flight controls and applied full reverse thrust with no change or deceleration. The captain then applied full brakes, but the airplane exited the runway. All crew and passengers evacuated through the main door without further incident. One of the passengers, who was also a pilot for the company, reported that, before departure, he observed and heard the reverse thrust operation of the airplane function properly. He added that, during the landing, the airplane touched down about halfway down the runway. He was not able to confirm that the pilots were applying reverse thrust during the landing roll; however, he did feel the brakes being applied. He noted that he did not hear or smell the brakes being locked up and that, after the accident, no tire skid marks were present on the runway or in the grass near where the airplane exited the runway. A review of the Garmin 1000 data indicated that the airplane crossed over the runway numbers at an indicated airspeed of about 115 knots (kts) and landed about 2,000 ft down the 3,000-ft-long runway. The touchdown was registered at approximately 1037:49, with the indicated airspeed of about 96 knots and a ground speed of about 89 knots, as shown in the following figure. Figure: Approximate touchdown of the airplane at JHM According to the pilots operating handbook (POH), the airplane’sestimated landing ground roll distance using a short field landing technique was about 1,070 ft; however, this assumed full flap extension and an approach speed of 78 knots indicated airspeed. The airplane was reported to have an airframe total time of 8,820.5 hrs at the time of the accident. Review of maintenance records revealed that, the month before the accident, the propeller control lever was adjusted because the propeller could not be brought to the feather stop. The propeller received a 100-hour inspection about 56 flight hours before the accident. Examination revealed that the propeller and gearcase section had been displaced from the engine and came to rest on the ground in front of the airplane. Proper rigging of the propeller controls could not be confirmed, as the airplane was dismantled before the examination could take place.

Aircraft

Registration
N879MA
Reported as
Cessna 208B
Category
Airplane
Serial number
208B5019
Built
2013
Airframe hours
8,820.5
Engine
Pratt & Whitney Canada PT6A-140, 867 horsepower, turbo prop
Damage
Substantial damage
Flight
Part 135
Operator
Mokulele Airlines, doing business as Mokulele Airlines
Registered owner
Mokulele Flight Service Inc
Airworthiness certificate
Standard, Normal
Departed
HNL · Honolulu, HI
Destination
JHM · Kapalua, HI
Flight plan
IFR
Airport
JHM · Kapalua, runway 02, 3,000 × 100 ft, asphalt
Equipment
Stall warning system, Auto-pilot, Electronic flight bag or handheld device

Matched to the registry by N-number and the event date; the registry’s history has gaps, so older matches can be wrong. Compare the reported make and model.

Flight crew · 2

As NTSB recorded them. NTSB leaves out names.

Role
Pilot
Age
64
Injuries
None
Certificates
Commercial, Airline transport
Airplane ratings
Single-engine land, Multi-engine land
Instrument ratings
Airplane
Medical
Class 2, With waivers/limitations
Last flight review
March 28, 2019
Seat
Left
Restraint
5-point
Flight hours
9,374 total · 1,288 in this make and model · 7,045 as pilot in command · 212 in the last 90 days · 66 in the last 30 days
Role
Co-pilot
Age
29
Injuries
None
Certificate
Commercial
Airplane ratings
Single-engine land
Instrument ratings
Airplane
Medical
Class 1, With waivers/limitations
Last flight review
April 18, 2019
Seat
Right
Restraint
5-point
Flight hours
566 total · 294 in this make and model · 184 as pilot in command · 252 in the last 90 days · 89 in the last 30 days · 7 in the last 24 hours

Weather

Conditions
Visual (VMC) · Day
Wind
50° at 12 knots
Visibility
10 statute miles
Temperature
88 °F, dew point 64 °F
Altimeter
30.01 inHg
Observed at
PHJH, 1 nm away

Docket · 15

The files NTSB released with the investigation on November 4, 2021, on NTSB’s docket system: statements, records, photos and specialists’ reports. 8.0 MB in all.

FAA reports on this event · 1

The FAA’s own accident and incident reports, matched to the aircraft by N-number and date.