LAX03LA083

NTSB accident investigation · Beech 76 · Truckee, CA · January 17, 2003

Accident · No injuriesLimited investigationFinal report
Date
January 17, 2003, 10:30 local (18:30 UTC)
Place
Truckee, CA
Injuries
2 uninjured
Damage
Substantial damage
Phase of flight
Takeoff
Aircraft
N5400MBeech 76
Weather
Visual (VMC) · Day
Status
Completed · report December 28, 2004
Report
Approved by Office Director
Parties
Federal Aviation Administration
FAA report
20030117001399A
Case key
56447

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

failure of the CFI to ensure that the pilot under instruction adequately understood the engine out procedure during the preflight planning phase of the flight; failure of the pilot under instruction to obtain/maintain directional control; and the inadequate supervision and delayed remedial action of the CFI during the engine out procedure. The pilot under instruction's misunderstanding of the engine out procedure was a factor in the accident.

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.

Loss of control - on ground/waterTakeoff - roll/run
Engine shutdown - intentionalPilot in command(cfi)
1 engine
Preflight planning/preparation - not understoodDual studentCause
Procedures/directives - not understoodDual studentFactor
Directional control - not obtained/maintainedDual studentCause
Supervision - inadequatePilot in command(cfi)Cause
Remedial action - delayedPilot in command(cfi)Cause
On ground/water encounter with terrain/waterTakeoff - roll/run
Terrain condition - snowbank

Analysis

The airplane veered off the runway and struck a snow bank off the left side of the pavement. The CFI briefed on an engine out procedure prior to takeoff and told the student he was going to fail the left engine. However, the pilot under instruction (PUI) did not fully understand the procedure. He believed that the engine failure would happen when they were in the air and not on the ground. During the takeoff roll, the CFI simulated the engine out by pulling the left mixture. However, the PUI did not pull the throttles to idle as briefed. He was surprised when the airplane started to veer to the left during the takeoff roll. He fixated on the rudder controls, and did not reduce engine power on the right engine. Both pilots stated that there were no mechanical anomalies with the airplane.

Factual narrative

On January 17, 2003, at 1030 Pacific standard time, a Beech 76, N5400M, collided with a snow bank during takeoff from the Tahoe-Truckee Airport (TRK), Truckee, California. The Palo Alto Flying Club was operating the rental airplane under the provisions of 14 CFR Part 91. The airplane sustained substantial damage. The certified flight instructor (CFI) and the private pilot under instruction PUI) were not injured. The cross-country instructional flight departed the Palo Alto Airport of Santa Clara County (PAO), Palo Alto, California, at 0845, en route to TRK. Visual meteorological conditions prevailed, and no flight plan had been filed.

On February 5, 2003 the incident was upgraded to an accident after verification that the airplane had been substantially damaged.

According to the CFI, the purpose of the flight was to practice maneuvers. At TRK he briefed the PUI on the procedures for a simulated engine failure on takeoff, which included recovery procedures. The PUI aligned the airplane with the runway centerline. The PUI engaged the brakes, added partial power, and then full power. The PUI released the brakes, and the CFI leaned the left mixture to idle cut off. The CFI stated that the airplane yawed to the left, and the PUI "failed to pull the throttles to idle." The airplane collided with the snow bank. The CFI reported that prior to colliding with the snow bank, the right mixture was to idle cut off.

According to the PUI, they had conducted engine out procedures on the training flight from PAO. After landing the CFI suggested that, since the runway was 7,000 feet long, it would be a good airport to practice engine out procedures during the takeoff roll. There would be plenty of room to stop. The PUI stated that the CFI explained the "procedure of reducing power, using rudder to control direction, and stated that he would fail the left engine."

The PUI indicated that his understanding was that the "failure" would occur after they "were underway" in the air. He was surprised when the airplane veered to the left immediately after he started to add power. He was too slow in "reducing power, [and] fixated on rudder control."

Both pilots reported that there were no mechanical anomalies with the airplane.

Aircraft

Registration
N5400M
Reported as
Beech 76
Category
Airplane
Serial number
ME-30
Airframe hours
690
Engine
Lycoming O-360, 180 horsepower, reciprocating
Damage
Substantial damage
Flight
Instructional · Part 91
Operator
Palo Alto Flying Club
Registered owner
Jerry Hoffman
Airworthiness certificate
Standard, Normal
Last inspection
Annual · September 1, 2002 · 45 hours before
Departed
PAO · Palo Alto, CA
Destination
TRK · Truckee, CA
Airport
TRK · Truckee-Tahoe, runway 28, 7,000 × 100 ft, asphalt

Flight crew · 2

As NTSB recorded them. NTSB leaves out names.

Role
Flight instructor
Age
40
Injuries
None
Certificates
Flight instructor, Commercial
Airplane ratings
Multi-engine land, Single-engine land
Instrument ratings
Airplane
Medical
Class 2, Valid Medical--no waivers/lim.
Last flight review
February 1, 2002
Seat
Right
Flight hours
1,775 total · 75 in this make and model · 1,555 as pilot in command · 95 in the last 90 days · 30 in the last 30 days
Role
Student pilot
Age
59
Injuries
None
Certificate
Private
Airplane ratings
Single-engine land
Instrument ratings
Airplane
Medical
Class 2, Valid Medical--w/ waivers/lim
Last flight review
January 17, 2001
Seat
Left
Flight hours
710 total · 9 in this make and model · 632 as pilot in command · 15 in the last 90 days · 9 in the last 30 days · 2 in the last 24 hours

Weather

Conditions
Visual (VMC) · Day
Wind
Calm
Visibility
10 statute miles
Lowest ceiling
30,000 ft broken
Temperature
37 °F, dew point 28 °F
Altimeter
30.45 inHg
Observed at
RNO, 20 nm away

Docket · 2

The files NTSB released with the investigation on November 5, 2004, on NTSB’s docket system: statements, records, photos and specialists’ reports. 706 KB 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.