NYC02LA002

NTSB accident investigation · Beech C-45H · Hudson, NH · October 2, 2001

Accident · Minor injuriesLimited investigationFinal report
Date
October 2, 2001, 13:10 local (17:10 UTC)
Place
Hudson, NH
Injuries
3 minor
Damage
Substantial damage
Phase of flight
Enroute
Aircraft
N8393HBeech C-45H
Weather
Visual (VMC) · Day
Status
Completed · report November 28, 2001
Report
Approved by Office Director
Parties
Federal Aviation Administration
FAA report
20011002026189A
Case key
53555

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/owner's failure to properly identify the inoperative engine prior to feathering the wrong propeller, and his lack of familiarity with the required corrective procedures. A factor was the initial engine failure.

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 engine power(total) - mech failure/malfClimb - to cruise
1 engine - failure,totalFactor
Wrong propeller feathered - not identifiedPilot in commandCause
Lack of familiarity with aircraftPilot in commandCause
Forced landingDescent - emergency
In flight collision with terrain/waterEmergency descent/landing

Analysis

The Twin Beech (C-45H) departed on a local training flight with the pilot/owner in the left seat and a flight instructor in the right seat to conduct a flight review. Shortly after departure, the left engine started to shake, then it seized. While the flight instructor reached for the emergency checklist, the pilot/owner inadvertently feathered the good engine. The flight instructor took control of the airplane and performed a forced landing. The feathering buttons were only accessible to the pilot/owner, who had never unfeathered an engine in flight, was not familiar with the procedures necessary to restart the engine, and was subsequently unable to assist in unfeathering the engine for a restart. He had 55 hours in make and model, with none in the preceding 90 days.

Factual narrative

On October 2, 2001, about 1310 eastern daylight time, a Beech C-45H, N8393H, was substantially damaged during a forced landing in Hudson, New Hampshire. The certificated commercial pilot, flight instructor, and passenger received minor injuries. Visual meteorological conditions prevailed for the instructional flight. No flight plan had been filed for the flight conducted under 14 CFR Part 91.

The purpose of the flight was to conduct a flight review for the airplane owner, who occupied the left seat. A flight instructor occupied the right seat. According to a written statement from the pilot:

"...the flight was normal up until approximately 2,000 feet on climb out. At that time, the left engine started to shake. Shortly after, the left engine failed, [and] the left propeller came to a complete stop."

"[The flight instructor]...added power to the right engine, and vocalized that he would get the engine failure checklist. At this time, I was manipulating the controls. While he reached down to obtain the checklist located on the floor between us, I depressed the [right] engine feather button, [and] the right engine subsequently feathered. In the confusion, without confirmation from [the flight instructor]...I depressed the wrong feather button and feathered the wrong engine."

"[The flight instructor]...vocalized and took command of the aircraft. [The flight instructor]...instructed me to start the right engine. Two attempts at restart were unsuccessful. It was necessary for me to conduct the restart procedure due to the fact that the starter controls are located on the left side, not accessible to him."

"We were losing altitude rapidly; there were not many suitable landing areas. [The flight instructor]...located a golf driving range approximately 300 yards long. He successfully made an emergency landing into this area."

According to a written statement from the flight instructor:

"We departed Nashua airport and headed southeast, leveling off at pattern altitude approx 3 or 4 miles away, then started a slow climb, at approx 2,000 feet MSL, the left engine started to shake and shortly after the engine failed. I added power to the right engine and told...[the pilot] I would get the engine failure checklist. [The pilot]...was still flying the airplane. I reached down to get the checklist on the floor between us. After opening it to the proper section, I realized the airspeed was still decreasing. Then I found out,[the pilot]...had feathered the wrong engine, and didn't tell me. I told [the pilot]...I was taking command of the aircraft. He was badly shaking when I asked him to restart the right engine. We were losing altitude rapidly and [I] had to focus on flying the airplane. I found a golf driving range and made a successful emergency landing."

In a follow up telephone interview, the pilot was asked why the engine was not restarted. He said the feathering button needed to be held down, but he was not familiar with the engine restart procedures and said he had never conducted an inflight restart. In addition, he said that after he had feathered the wrong engine, he "just froze."

In a follow-up telephone interview, the flight instructor reported that during the landing, the right engine and firewall separated from the wing. When asked why the good engine was not unfeathered, and restarted, he replied that the feathering buttons for both propellers were located on the top of the left side glare shield in front of the pilot. Unfeathering the propeller required the appropriate feather button to be held in a depressed position until the propeller came out of feather and started rotating, and then, the feather button had to be pulled out to stop the propeller from going back into feather again. He reported that after the left engine lost power, and the right engine was feathered, he had to devote his full attention to the flying the airplane and picking a landing area.

According to the pilots involved, the airplane owner's flight experience was 3,877 hours, with 872 hours in multi-engine airplanes, and 55 hours in make and model. The pilot had flown 10 hours in the preceding 90 days, with none in make and model. The flight experience of the flight instructor was in excess of 20,000 hours, with 16,000 hours in multi-engine airplanes, and 500 hour in make and model. He had flown 230 hours in the preceding 90 days, with 30 hours in make and model.

Aircraft

Registration
N8393H
Reported as
Beech C-45H
Category
Airplane
Serial number
AF 854
Airframe hours
5,420
Engine
P&W R-985, 450 horsepower, reciprocating
Damage
Substantial damage
Flight
Instructional · Part 91
Registered owner
Frank Hammerbacher
Airworthiness certificate
Standard, Normal
Last inspection
Annual · September 6, 2001
Departed
ASH · Nashua, NH
Destination
ASH · Hudson, NH
Airport
ASH · Boire Field

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 · 2

As NTSB recorded them. NTSB leaves out names.

Role
Pilot
Age
67
Injuries
Minor
Certificate
Commercial
Airplane ratings
Single-engine sea, Multi-engine land, Single-engine land
Instrument ratings
Airplane
Medical
Class 2, Valid Medical--w/ waivers/lim
Last flight review
August 1, 1999
Seat
Left
Flight hours
3,877 total · 55 in this make and model · 3,000 as pilot in command · 10 in the last 90 days
Role
Flight instructor
Age
53
Injuries
Minor
Certificates
Airline transport, Commercial
Airplane ratings
Multi-engine land, Single-engine land, Single-engine sea
Instrument ratings
Airplane
Medical
Class 1, Valid Medical--w/ waivers/lim
Last flight review
August 2, 2001
Seat
Right
Flight hours
20,000 total · 500 in this make and model · 17,000 as pilot in command · 230 in the last 90 days · 67 in the last 30 days

Weather

Conditions
Visual (VMC) · Day
Wind
350° at 7 knots
Visibility
25 statute miles
Lowest ceiling
None
Temperature
73 °F, dew point 52 °F
Altimeter
29.86 inHg
Observed at
ASH, 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.