CEN19FA189

NTSB accident investigation · Beechcraft 58 · Hiawatha, KS · June 28, 2019

Accident · FatalField investigationFinal report
Date
June 28, 2019, 17:15 local (22:15 UTC)
Place
Hiawatha, KS
Injuries
1 fatal
Damage
Destroyed
Phase of flight
Approach
Aircraft
N4614SBeechcraft 58
Defining event
Approach: Loss of control in flight
Weather
Visual (VMC) · Day
Status
Completed · report August 25, 2020
Report
Approved by Office Director
NTSB office
Central Region
Parties
Textron Aviation, Continental Aerospace Technologies, FAA FSDO
FAA report
20190628008309A
Case key
99727

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

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Probable cause

The pilot's loss of control for undetermined reasons.

Findings · 3

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.

Not determinedNot determined › Not determined · Unknown/Not determinedBeech 58: 7 casesAll aircraft: 2,247 casesProbable cause
Performance/control parametersAircraft › Aircraft oper/perf/capability · Not attained/maintainedBeech 58: 4 casesAll aircraft: 1,269 casesProbable cause
Use of equip/info: aircraft controlPersonnel issues › Task performance · PilotBeech 58: 15 casesAll aircraft: 9,295 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 pilot was on a cross-country flight in a twin-engine airplane. A witness, located at the destination airport, reported that the accident airplane approached the airport from the south and then headed northeast, as if to enter the airport traffic pattern. He added that the airplane appeared to climb and then started a left turn. After starting the turn, the airplane flipped inverted, the nose dropped, and the airplane disappeared from view behind terrain. Examination of the wreckage site, located about 1 mile northeast of the airport, revealed that the airplane had impacted terrain on its bottom fuselage, and came to rest upright. A post-crash fire consumed a majority of the cabin and the inboard sections of the wings. The wreckage was confined to one area and all major components were accounted for on site. Though the examination was limited by thermal and impact damage, no pre-impact abnormalities were observed during the airframe or engines examinations that would have precluded normal operations. A review of the pilot's autopsy and medical history did not identify any evidence of an incapacitating event. The airplane's roll to an inverted attitude is consistent with an inflight loss of control event. The ground scars and damage to the airplane are consistent with a probable attempted recovery from the loss of control; however, the reason for the loss of control could not be determined based on the available information.

Factual narrative

On June 28, 2019, about 1715 central daylight time, a Beechcraft BE-58 airplane, N4614S, impacted terrain during an approach to the Hiawatha Municipal Airport (K87), Hiawatha, Kansas. The pilot was fatally injured, and the airplane was destroyed. The airplane was operated as a Title 14 Code of Federal Regulations Part 91 cross-country personal flight. The pilot was not in contact with air traffic control during the cross-country flight from Augusta Municipal Airport (3AU), Augusta, Kansas. Review of radar information revealed that the airplane proceeded in a northeast direction from the origin airport toward K87the destination; however, the flight track stopped about 3/4-mile northeast of K87 and the final minutes of the flight were not captured. A witness reported that the airplane approached the airport from the south and then proceeded north-northeast as if to enter the traffic pattern. He added that the airplane appeared to climb and then started a left turn. Just after starting the turn, the airplane flipped inverted, the nose dropped, and the airplane descended from view behind terrain. The witness saw smoke and called 911. The Frontier Forensics Midwest Morgue of Kansas City, Kansas, under the authority of the Brown County Coroner's Office, conducted an autopsy on the pilot. The cause of death was due to blunt traumatic injuries and severe burns. The Federal Aviation Administration's (FAA) Forensic Sciences Laboratory, Oklahoma City, Oklahoma, conducted toxicological testing. The specimens were not tested for cyanide. The tests were negative for ethanol and tested drugs. The pilot last medical certificate was issued on March 09, 2017, with no limitations. The pilot's second-class medical certificate expired on March 31, 2019, but he had completed the BasicMed flight medical. The pilot's BasicMed course date was April 16, 2019, and the Comprehensive Medical Examination Checklist (CMEC) was completed on April 12, 2019. The airplane wreckage was located in a corn field about 1-mile northeast of K87. The airplane impacted terrain on its bottom fuselage and came to rest upright on a 171° heading. A post-crash fire consumed a majority of the cabin and the inboard section of the wings. The wreckage was confined to one area, and all major components were accounted for on-site. Figure 1: Wreckage Flight control continuity was limited through the center section of the fuselage due to fire damage, however, the connection at each of the respective flight control surfaces was confirmed. The cockpit/instrument panel was impact and fire damaged. The landing gear handle appeared to be in the down/landing gear extended position. A review of the landing gear actuator position corroborated the landing gear was in the down position. The right flap actuator was partially extended, which corresponded to a flap's 15° extended position. The left and right engines remained attached to their respective airframe locations, and both engines had impact and firedamage. The right 3-bladed propeller separated from the engine crankshaft flange and was located underneath the airplane. The left 3-bladed propeller remained attached to the engine; neither propeller was in the feathered position Both engines were rotated by hand, and thumb compression and suction were noted on each cylinder. The valve covers were removed and continuity through the valve train to the accessory section was observed. The left engine's left magneto produced spark at each terminal; the engine's right magneto was fire damaged and would not rotate. The right engine's left magneto produced spark at each terminal. The right magneto was fire damaged and did not produce spark at the terminals; however, spark was observed at the magneto points. Each engine's fuel system, including the fuel manifold, fuel pump, fuel nozzles, and fuel screen were field examined, and no pre-impact abnormalities were noted. The top set of sparkplugs were removed from both engines, and normal combustion and wear signatures were observed. Though the examination was limited by thermal and impact damage, no pre-impact abnormalities were observed during the airframe or engines examinations that would have precluded normal operations.

Aircraft

Registration
N4614S
Reported as
Beechcraft 58
Category
Airplane
Serial number
TH-684
Built
1975
Airframe hours
3,591.8
Engines
Continental IO-520, 285 horsepower, reciprocatingContinental IO-520, 285 horsepower, reciprocating
Damage
Destroyed
Fire
On-Ground
Flight
Personal · Part 91
Airworthiness certificate
Standard, Normal
Last inspection
Annual · August 10, 2018
Departed
3AU · Augusta, KS
Destination
K87 · Hiawatha, KS
Airport
K87 · Hiawatha Municipal Airport, runway 17, 3,400 × 100 ft, grass/turf

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

As NTSB recorded them. NTSB leaves out names.

Role
Pilot
Age
67
Injuries
Fatal
Certificate
Commercial
Airplane ratings
Multi-engine land, Single-engine land
Instrument ratings
Airplane
Medical
BasicMed
Seat
Left
Toxicology
Performed
Flight hours
1,498.4 total · 318.7 in this make and model · 1,351.6 as pilot in command

Weather

Conditions
Visual (VMC) · Day
Wind
200° at 13 knots, gusting 18
Visibility
10 statute miles
Lowest ceiling
None
Temperature
93 °F, dew point 75 °F
Altimeter
29.95 inHg
Observed at
KFNB, 11 nm away

Docket · 10

The files NTSB released with the investigation on August 7, 2020, on NTSB’s docket system: statements, records, photos and specialists’ reports. 16.8 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.