# NTSB CHI91FA140: Cessna P210, N65M, Kansas City, MO, April 25, 1991

- Type: NTSB accident investigation
- Classification: Accident · Fatal · Field investigation · Final report
- Date: April 25, 1991, 16:25 local (21:25 UTC)
- Place: Kansas City, MO
- Coordinates: 38.990886, -94.54013 (estimated)
- Nearby events: https://openairdocs.org/map.md?lat=38.9909&lon=-94.5401&mi=10
- Phase of flight: [Standing](https://openairdocs.org/ntsb-phases/150) (OpenAirDocs' grouping)
- Highest injury: Fatal
- Injuries: 1 fatal
- Status: Completed, report March 31, 1993
- Report: Approved by Office Director
- NTSB case key (mKey): 14900
- NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=CHI91FA140
- NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/14900/pdf
- Page: https://openairdocs.org/ntsb/CHI91FA140

## Probable cause

THE PILOT IN COMMAND'S INTENTIONAL FLIGHT WITH KNOWN MECHANICAL DEFICIENCIES IN THE AIRCRAFT WHICH RESULTED IN A FIRE & FORCED LANDING IN UNSUITABLE TERRAIN. A FACTOR CONTRIBUTING TO THE ACCIDENT WAS IMPROPER MAINTENANCE TO THE TURBOCHARGER WASTE GATE BY OTHER MAINTENANCE PERSONNEL.

## Sequence of events

In NTSB's coding before 2008 (https://www.ntsb.gov/GILS/Documents/codman.pdf).

- Airframe/component/system failure/malfunction, standing - pre-flight
  - exhaust system,wastegate - failure,partial
  - maintenance,replacement - improper, other maintenance personnel (contributing factor)
- Fire, cruise
  - exhaust system,wastegate - failure,total
  - operation with known deficiencies in equipment - intentional, pilot in command (cause)
- Forced landing, descent - emergency
- In flight collision with terrain/water, maneuvering - turn to landing area (emergency)
  - object - pole
  - unsuitable terrain or takeoff/landing/taxi area - encountered, pilot in command
  - terrain condition - open field

## Analysis

THE AIRCRAFT HAD BEEN PREVIOUSLY OPERATED WITH THE TURBOCHARGER INOPERATIVE.  WHEN THE PILOT SUSPECTED ANOTHER TURBOCHARGER PROBLEM HE INTENTIONALLY INITIATED A FLIGHT FOR THE PURPOSE OF HAVING MAINTENANCE DONE ON THE AIRCRAFT. AN IN FLIGHT FIRE ENSUED WHICH LOCALIZED IN THE WASTE GATE AREA.  WHEN THE PILOT BECAME AWARE OF THE FIRE HE ATTEMPTED AN EMERGENCY LANDING IN UNSUITABLE TERRAIN.  SUBSEQUENT INVESTIGATION REVEALED THAT TWO BOLTS WERE MISSING FROM THE WASTE GATE TO THE EXHAUST PIPE CONNECTION WHERE A FRACTURE OCCURED.  HOT EXHAUST GASES IMPINGED ON THE NOSE WHEEL WELL WHERE FIRE PENETRATED THE WHEEL WELL AND EVENTUALLY BECAME FED BY PRESSURIZED HYDRAULIC FLUID.

## Aircraft

- Registration: [N65M](https://openairdocs.org/deregistered/N65M-1991-10-03), registration cancelled 1991-10-03, S/N P21000687 (OpenAirDocs)
- Reported make and model: CESSNA P210
- Registry model: [Cessna P210N](https://openairdocs.org/model/cessna-p210n) (registry code 2073454) (OpenAirDocs)
- Category: Airplane
- Serial number: 2106687
- Engines: CONTINENTAL TSIO-520-P 310 horsepower reciprocating
- Damage: Destroyed
- Fire: In-Flight
- Flight: Personal, Part 91
- Operator: Cavu, Inc.
- Registered owner: Cavu, Inc.
- Departed: MKC, MO
- Destination: BUM, BUTLER, MO

## Flight crew

As NTSB recorded them. NTSB leaves out names.

- Pilot; age 57; private; airplane ratings: single-engine land; instrument ratings: airplane; medical: class 3, valid medical--w/ waivers/lim; toxicology performed; flight hours: 2,443 total

## Weather

- Conditions: Visual (VMC), Day
- Wind: 110° at 10 knots
- Visibility: 7 statute miles
- Lowest ceiling: 2,200 ft overcast
- Temperature: -0 °F, dew point -0 °F
- Observed at: MKC, 6 nm away

## FAA reports on this event (1)

The FAA's own accident and incident reports, matched to the aircraft by N-number and date (OpenAirDocs).

- [Accident 19910425012519A](https://openairdocs.org/incident/19910425012519A), Apr 25, 1991: Cessna P210N, Kansas City, MO, Destroyed, 1 fatal. Fire in flight. Crash landed and burned. Turbocharger exhaust pipe came off. Pilot aware loss of power prior flight

From the NTSB's public API. Aircraft are matched to registry aircraft by N-number and event date, checked against the reported serial number, make and model; the registry's history has gaps, so older matches can be wrong. Compare the reported make and model.

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