DCA90MA005

NTSB accident investigation · De Havilland DHC-6-300 · Halawa,Molokai, HI · October 29, 1989

Accident · FatalClass 1 · MajorFinal report
Date
October 28, 1989, 18:37 local (Oct 29, 1989, 04:37 UTC)
Place
Halawa,Molokai, HI
Injuries
20 fatal
Damage
Destroyed
Phase of flight
Enroute
Aircraft
N707PVDe Havilland DHC-6-300
Weather
Instrument (IMC) · Night/dark
Status
Completed · report July 29, 1992
Report
Board-adopted at Board Meeting
Investigation class
Class 1
NTSB office
Major Investigations Division
Safety recommendations
Yes
FAA report
19891028043379A
Case key
15930

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 airplane's controlled flight into terrain as a result of the decision of the captain to continue flight under visual flight rules at night into instrument meteorological conditions (IMC), which obscured rising mountainous terrain. Contributing to the accident was: the inadequate supervision of personnel, training, and operations by aloha islandair management and insufficient oversight of aloha islandair by the federal aviation administration particularily during a period of rapid operational expansion. (Ref: NTSB/AAR-90/05)

Sequence of events

NTSB’s coding before 2008: each occurrence and phase of flight, and the causes and factors under it. The codes are defined in NTSB’s coding manual.

In flight encounter with weatherCruise
Light condition - dark nightFactor
Weather condition - cloudsFactor
Weather condition - low ceilingFactor
Weather condition - fogFactor
Vfr flight into imc - continuedPilot in commandCause
Inadequate trainingCompany/operator managementFactor
Inadequate surveillance of operationCompany/operator mgmtFactor
Inadequate surveillance of operationFaa(organization)Factor
In flight collision with terrain/waterCruise
Terrain condition - mountainous/hillyFactor

Analysis

De havilland DHC-6, N707PV (aloha islandair flt 1712), collided with mountainous/hilly terrain near halawa bay, HI, while en route on a scheduled passenger flt at night from maui to molokai, HI. Impact occurred at an elevation of about 500 ft, shortly after the acft had descended over water, then crossed the shoreline. There was evidence that the captain had made a navigational error & mistakenly believed that he was circumnavigating the northern portion of mokokai island. The acft crashed while on a heading that was parallel with the island's northern shoreline. Low clouds obscured the mtn tops in the area of the acdnt. There was also evidence of inadequate supervision of psnl, training & opns by aloha islandair management & insufficient oversight of aloha islandair by the FAA during a period of aloha islandair's rapid opnl expansion.

Aircraft

Registration
N707PV
Reported as
De Havilland DHC-6-300
Category
Airplane
Serial number
400
Airframe hours
19,875
Engine
P&W PT6A-27, 620 horsepower, turbo prop
Damage
Destroyed
Fire
On-Ground
Flight
Part 135
Registered owner
Aloha Islandair
Airworthiness certificate
Standard, Normal
Last inspection
100 hour · October 19, 1989 · 59 hours before
Departed
OGG · Maui, HI
Destination
MKK · Molokai, HI
Flight plan
Company VFR

Flight crew

As NTSB recorded them. NTSB leaves out names.

Role
Pilot
Age
30
Certificates
Airline transport, Flight instructor
Airplane ratings
Multi-engine land, Single-engine land
Instrument ratings
Airplane
Medical
Class 1, Valid Medical--no waivers/lim.
Seat
Left
Toxicology
Performed
Flight hours
3,542 total · 1,668 in this make and model · 1,811 as pilot in command · 259 in the last 90 days · 67 in the last 30 days · 4 in the last 24 hours

Weather

Conditions
Instrument (IMC) · Night/dark
Wind
50° at 11 knots
Temperature
77 °F, dew point 70 °F
Altimeter
29.00 inHg

FAA reports on this event · 1

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