# NTSB DFW08LA166: Beech 99, N99NN, Bowling Green, MO, June 21, 2008 - Type: NTSB accident investigation - Classification: Accident · Fatal · Limited investigation · Final report - Date: June 21, 2008, 17:00 local (22:00 UTC) - Place: Bowling Green, MO - Coordinates: 39.36972, -91.219169 - Nearby events: https://openairdocs.org/map.md?lat=39.3697&lon=-91.2192&mi=10 - Phase of flight: [Enroute](https://openairdocs.org/ntsb-phases/400) (OpenAirDocs' grouping) - Defining event: [Enroute-cruise: Miscellaneous/other](https://openairdocs.org/ntsb-events/900) - Highest injury: Fatal - Injuries: 1 fatal, 12 uninjured - Status: Completed, report September 26, 2008 - Report: Approved by Office Director - Parties: FAA FSDO - NTSB case key (mKey): 68296 - NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=DFW08LA166 - NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/68296/pdf - Page: https://openairdocs.org/ntsb/DFW08LA166 ## Probable cause The parachutist's failure to follow procedures/directives by not waiting to jump until the green jump light was illuminated, resulting in his collision with the airplane's tail. Contributing to the accident was the parachutist's impairment by the use of marijuana prior to performing a parachute jump. ## Findings NTSB's coded findings; those marked are part of the probable cause. - [Communication (personnel): following instructions](https://openairdocs.org/ntsb-findings/02063537): Personnel issues › Task performance · Passenger (probable cause) - [Impairment/incapacitation: illicit drug](https://openairdocs.org/ntsb-findings/02012020): Personnel issues › Physical · Passenger (probable cause) ## Analysis The commercial pilot reported that he was en route to a parachutist jump zone on the first of two planned jumps. Prior to the first jump, before he had slowed the airplane, or illuminated the green jump light, indicating that the parachutists had permission to jump, two of the parachutists prematurely jumped. The first parachutist stated that as soon as he jumped, he realized that the airplane was going faster than normal, and he tucked into a ball, barely missing the horizontal stabilizer. According to the other parachutists still aboard, the second jumper exited, and struck the horizontal stabilizer with his head. He never opened his parachute. All of the other parachutists and the pilot stated that the green jump light was never turned on. Post-accident toxicology testing was consistent with impairment of the fatally injured parachutist by recent marijuana use. ## Factual narrative 'THIS CASE WAS MODIFIED FEBRUARY 24, 2009." On June 21, 2008, at approximately 1700 central daylight time, an in-flight collision occurred involving a twin-engine Beech 99, N99NN, and an exiting parachutist. The parachutist did not deploy his parachute and was fatally injured. The airplane's horizontal stabilizer sustained substantial damage. The airplane was owned and operated by Skydive Factory Incorporated. The local flight originated from Bowling Green Municipal Airport (H19), Bowling Green, Missouri. Visual meteorological conditions prevailed and no flight plan was filed for the Title 14 Code of Federal Regulations Part 91 parachute flight. Initial statements were collected by a responding Federal Aviation Administration inspector. Two parachutists were exiting the airplane at 6,000 feet mean sea level (MSL), and the remaining 10 parachutists planned to exit the airplane at 14,000 feet mean sea level. Two parachutists waited by the open aircraft door as the airplane was inbound for the first drop point. The first parachutist stated that prior to flight he was told by the pilot to "choose [his] spot and exit." Prior to the illumination of the green light, the first parachutist decided to exit the airplane. Once in the slipstream, the first parachutist realized that the airplane was traveling faster than the normal exit airspeed and was able to maneuver away from the aircraft's tail section. Parachutists that remained in the airplane recalled that the second parachutist (the accident parachutist) exited the airplane and arched into an "X" before being struck by the airplane's horizontal stabilizer. The accident parachutist did not deploy his parachute. In a telephone interview with the NTSB, the pilot stated he was climbing to 6,000 feet MSL at 115 knots. The pilot was lining up for the first of two planned drops. The pilot recalled that during the climb to altitude, the door had been opened to cool off the passenger compartment. Since the red light did not operate on the airplane, the pilot stated that he coordinated with the parachutists to announce "door" as the "get ready" command. When the airplane was inbound on a 130 degree heading approximately 0.6-0.75 nautical miles to the drop point, the pilot reported that he felt an impact on the airplane. The remaining parachutists informed the pilot that a parachutist had struck the airplane. The pilot aborted the flight, performed a controllability check, and landed the airplane. Furthermore, the pilot stated that he had not begun his normal drop procedures, where he decelerates and configures the airplane, notifies air traffic control (ATC) of the parachute drop, awaits an ATC response, and then selects the green light. Additionally, the pilot commented that he does not allow parachutist to exit prior to coordination with ATC and did not expect parachutist to leave the airplane prior to the illumination of the green light.. The pilot reported having flown over 200 jump flights in a Beech 99,and over 100 jump flights in a Cessna 172. The accident parachutist was not wearing a helmet or an automated activation device (AAD), nor were these devices required. On a previous parachute jump, the accident parachutist was observed departing the airplane prior to the illumination of the green light. Another parachutist, who was also an eyewitness to this accident, informed the accident parachutist that he departed the airplane early. The accident parachutist is alleged to have said, "Don't worry about me. I looked out the door and liked what I saw, so I got out." The accident parachutist is reported to have accumulated over 175 parachute jumps. An autopsy was performed by the Boone/Callaway County (Missouri) Medical Examiner approximately 42 hours after the accident. Cause of death was noted as "blunt force injuries of the head, neck, trunk and extremities due to a fall from a great height." The report also notes that "there is hemorrhage beneath the scalp on the right suggesting that some injuries of the right side of the head and face may have occurred prior to the other injuries" with "signs of early decomposition." Forensic toxicology was performed on specimens from the parachutist by the FAA Bioaeronautical Sciences Research Laboratory, Oklahoma City, Oklahoma. The toxicology report noted the following: 0.019 (ug/ml, ug/g) AMPHETAMINE detected in Liver IBUPROFEN detected in Blood 0.0099 (ug/ml, ug/g) TETRAHYDROCANNABINOL (MARIHUANA) detected in Blood 0.079 (ug/ml, ug/g) TETRAHYDROCANNABINOL (MARIHUANA) detected in Kidney 0.0868 (ug/ml, ug/g) TETRAHYDROCANNABINOL (MARIHUANA) detected in Lung 0.0503 (ug/ml, ug/g) TETRAHYDROCANNABINOL CARBOXYLIC ACID (MARIHUANA) detected in Blood 0.0842 (ug/ml, ug/g) TETRAHYDROCANNABINOL CARBOXYLIC ACID (MARIHUANA) detected in Liver 0.0445 (ug/ml, ug/g) TETRAHYDROCANNABINOL CARBOXYLIC ACID (MARIHUANA) detected in Kidney 0.0089 (ug/ml, ug/g) TETRAHYDROCANNABINOL CARBOXYLIC ACID (MARIHUANA) detected in Lung The laboratory noted in response to an inquiry from the NTSB that "the blood was putrefied and unsuitable for amphetamine analysis." ## Sequence of events The events NTSB coded, in order, by phase of flight. The defining event best describes what happened. - [Enroute-cruise: Miscellaneous/other](https://openairdocs.org/ntsb-events/900) (defining event) ## Aircraft - Registration: N99NN (not matched to a registry record) - Reported make and model: Beech 99 - Category: Airplane - Serial number: U-10 - Engines: Pratt & Whitney Canada PT6A-20 550 horsepower turbo prop; Pratt & Whitney Canada PT6A-20 550 horsepower turbo prop - Damage: Substantial damage - Flight: Skydiving, Part 91 - Registered owner: Skydive Factory Inc. - Airworthiness certificate: Standard, Normal - Departed: H19, Bowling Green, MO - Airport: H19, Bowling Green Muni ## Flight crew As NTSB recorded them. NTSB leaves out names. - Pilot; age 58; injuries: none; commercial; airplane ratings: single-engine land, multi-engine land; instrument ratings: airplane; medical: class 2, with waivers/limitations; last flight review July 1, 2006; seat: left; flight hours: 2,700 total, 100 in this make and model, 2,600 as pilot in command ## Weather - Conditions: Visual (VMC), Day - Wind: 250° at 7 knots - Visibility: 10 statute miles - Lowest ceiling: none - Temperature: 72 °F, dew point 59 °F - Altimeter: 30.03 inHg - Observed at: PPQ, 26 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 20080621838919A](https://openairdocs.org/incident/20080621838919A), Jun 21, 2008: Beech B99, Bowling Green, MO, Minor damage, 1 fatal. (-23) Aircraft N99NN was in cruise when two parachute jumpers exited the aircraft prior to the intended exit position. A signaling device (red & Green light)… 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. --- OpenAirDocs.org is an independent research project of [Contrail Labs](https://contraillabs.com/). It is not affiliated with the FAA or the NTSB. Source documents are U.S. government works in the public domain.