NYC07LA166

NTSB accident investigation · Piper PA-23-160 · Enterprise, AL · July 12, 2007

Accident · Minor injuriesLimited investigationFinal report
Date
July 12, 2007, 15:35 local (20:35 UTC)
Place
Enterprise, AL
Injuries
1 minor, 1 uninjured
Damage
Substantial damage
Phase of flight
Approach
Aircraft
N4043PPiper PA-23-160
Weather
Visual (VMC) · Day
Status
Completed · report May 6, 2009
Report
Approved by Office Director
Parties
FAA/FSDO
FAA report
20070712017239A
Case key
66203

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 designated examiner's improper decision to simulate an engine failure on short final approach, in conjunction with a short-field landing maneuver, and his inadequate remedial action. Contributing to the accident was the private pilot's inadvertent feathering of the left propeller.

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.

UndershootApproach - vfr pattern - final approach
Engine shutdown - simulatedDesignated examiner
1 engine
In-flight planning/decision - improperDesignated examinerCause
Remedial action - inadequateDesignated examinerCause
Wrong propeller feathered - inadvertentPilot in commandFactor
Loss of control - in flightGo-around (vfr)
Aircraft control - not maintainedDesignated examiner
Forced landingDescent - emergency
In flight collision with terrain/waterEmergency landing
Terrain condition - ground

Analysis

A Federal-Aviation-Administration-designated (FAA) pilot examiner was giving a private pilot checkride for the purpose of the private pilot obtaining a commercial pilot certificate with a rating for airplane multi-engine land. Toward the end of the checkride, the private pilot had completed single-engine maneuvers, including a simulated single-engine instrument approach to a full-stop landing. The private pilot believed that the only remaining maneuvers to be completed were a short-field landing and emergency descent. During the final approach for a short-field landing, the examiner simulated a right engine failure. The private pilot feathered the right propeller, but thought that the examiner may have "bumped it out of feather and set it to zero thrust." Shortly thereafter, the private pilot realized that the airplane was not going to reach the runway, and attempted a go-around. When power was increased on both engines, the airplane started to turn left. The private pilot then noticed that the left propeller speed was decreasing. The examiner took control of the airplane, reduced power on both engines, and landed in a grass field. Examination of the airplane did not reveal any preimpact mechanical malfunctions, and the left propeller was observed in the feathered position. Both propeller controls were found mid-range, with the left propeller control trailing the right propeller control by approximately 1 inch. The FAA Commercial Pilot Practical Test Standards contained instructions for the applicant to actually feather a propeller, but it specified that the procedure be done at altitude. All other references pertained to simulating propeller feathering. Further review of the test standards revealed that, "The examiner is expected to use good judgment in the performance of simulated emergency procedures. The use of the safest means for simulation is expected. Consideration must be given to local conditions, both meteorological and topographical, at the time of the test, as well as the applicant's workload, and the condition of the aircraft used."

Factual narrative

On July 12, 2007, about 1535 central daylight time, a Piper PA-23-160, N4043P, was substantially damaged during collision with terrain at Enterprise Municipal Airport (EDN), Enterprise, Alabama. The certificated airline transport pilot (ATP) received minor injuries, and the certificated private pilot was not injured. Visual meteorological conditions prevailed, and no flight plan was filed for the local examination flight conducted under the provisions of 14 Code of Federal Regulations Part 91. The flight originated from EDN about 1445.

According to a Federal Aviation Administration (FAA) inspector, the private pilot was receiving a checkride from the ATP, who was also a designated pilot examiner. The private pilot already held a rating for airplane multiengine land. The purpose of the checkride was for the private pilot to obtain a commercial pilot certificate, with a rating for airplane multiengine land and instrument airplane.

The private pilot reported that after completing maneuvers at altitude, they returned to the airport and he performed a simulated single-engine instrument approach to a full-stop landing. He then taxied back for takeoff, performed a short-field takeoff, and joined the traffic pattern for a short-field landing. The private pilot believed that the only remaining maneuvers to be completed were a short-field landing and emergency descent. During the final approach for a short-field landing, the examiner simulated an engine failure by reducing power on the right engine to zero thrust. The private pilot stated, "After turning final...the examiner gave me an engine failure. I believe he gave me a right engine failure. I completed the emergency procedure, which included identifying the dead engine, verifying and feathering the right engine. I believe he bumped it out of feather and set it to zero thrust, but I really don't know what he did. I only had control of the left engine and had to concentrate on completing my short-field landing."

Moments later, the airplane seemed as if it was not going to reach the runway, and the examiner ordered a go-around. The private pilot increased power on the left engine, partially retracted the flaps, but noticed that the airplane did not respond as it usually did. The airplane started to yaw left and the examiner took control of the airplane. The private pilot then noticed that the left propeller speed was decreasing. The examiner reduced power on both engines to control yaw, and attempted to land the airplane in a grass area off the left side of the runway, in an effort to avoid trees. The airplane then impacted the ground and was substantially damaged.

When asked how the accident could have been prevented, the private pilot wrote, "I don't believe the examiner should have given me an engine failure on short final, especially since we had already completed all the single-engine maneuvers and the short-field landing procedure doesn't include a [single engine] approach. I believe the temperature and [density altitude] contributed to the poor aircraft performance."

The examiner reported that he simulated an engine failure of the right engine. The private pilot correctly identified the failed engine and feathered the right propeller. Subsequently, the examiner set the right engine to zero thrust. The private pilot remarked that the airplane was not going to reach the runway, and executed a go-around. The examiner further stated, "We both pushed all levers forward in an attempt to go-around. The aircraft began to turn left and he was unable to stop the turn. The left engine had to be running as he had selected gear-up for the go-around and the gear did retract. When it was evident that we would not be able to safely go-around, both of us pulled the power levers to idle to prevent a roll in the aircraft and further turn to the left as we were approaching a tree line."

Examination of the accident site and wreckage, by an FAA inspector, revealed that the airplane had come to rest 150 feet left of the runway. The left wing was separated from its mounting location, and the left engine propeller was observed in the feathered position. The right engine propeller blades were bent aft and the right wing was wrinkled in multiple places. Both horizontal stabilizers were wrinkled, and the rest of the airplane displayed varying degrees of damage.

Examination of the cockpit revealed that both throttle levers were full forward. The propeller control levers were in the mid-range position, with the left propeller control trailing the right propeller control by approximately 1 inch. The left propeller control moved freely from stop to stop, with corresponding movement noted on the left propeller governor. The mixture control levers were near idle cutoff. Both fuel selectors were in their respective main fuel tank position, and all four fuel tanks contained fuel.

The pilot examiner held an airline transport pilot certificate, with numerous ratings, including airplane multiengine land. He reported a total flight experience of 16,602 flight hours, with 8,357 hours in multiengine airplanes, and 237 hours in the same make and model as the accident airplane. His most recent FAA first-class medical certificate was issued on June 18, 2007.

The private pilot held a private pilot certificate, with multiple ratings, including airplane multiengine land. He reported a total flight experience of 1,463 hours, with 98.7 hours in multiengine airplanes, and 17.3 hours in the same make and model as the accident airplane. His most recent FAA first-class medical certificate was issued on May 22, 2007.

The airplane was manufactured in 1958. The airplane's most recent annual inspection was completed on August 21, 2006. At the time of the inspection, the airplane had accrued 8,494 total hours of operation.

A weather observation taken 20 minutes after the accident, at Cairns Army Airfield (OZR), Ozark, Alabama, located approximately 9 nautical miles east of the accident site, included: winds from 310 degrees at 6 knots, visibility 10 miles, scattered clouds at 4,500 feet, temperature 91 degrees Fahrenheit, dew point 72 degrees Fahrenheit, and an altimeter setting of 29.99 inches of mercury.

Review of the FAA Commercial Pilot Practical Test Standards revealed, "During simulated engine failures on multiengine practical tests, the examiner shall set zero thrust after the applicant has simulated feathering the propeller. The examiner shall require the applicant to demonstrate at least one landing with a simulated feathered propeller with the engine set to zero thrust." The test standards contained instructions for the applicant to actually feather a propeller, but it specified that the procedure be done at altitude. All other references pertained to simulating propeller feathering.

Further review of the tests standards revealed, "The examiner is expected to use good judgment in the performance of simulated emergency procedures. The use of the safest means for simulation is expected. Consideration must be given to local conditions, both meteorological and topographical, at the time of the test, as well as the applicant's workload, and the condition of the aircraft used. If the procedure being evaluated would jeopardize safety, it is expected that the applicant will simulate that portion of the maneuver."

Aircraft

Registration
N4043P
Reported as
Piper PA-23-160
Category
Airplane
Serial number
23-1520
Airframe hours
8,494
Engines
Lycoming O-320-B, 160 horsepower, reciprocatingLycoming O-320-B, 160 horsepower, reciprocating
Damage
Substantial damage
Flight
Instructional · Part 91
Operator
Quinton Jenkins
Registered owner
Double Bridges Aviation LLC
Airworthiness certificate
Standard, Normal
Last inspection
Annual · August 21, 2006
Departed
EDN · Enterprise, AL
Destination
EDN · Enterprise, AL
Airport
EDN · Enterprise Municipal Airport, runway 05, 5,100 × 100 ft, asphalt

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
42
Injuries
None
Certificates
Private, Commercial
Airplane ratings
Multi-engine land, Single-engine land
Instrument ratings
Airplane, Helicopter
Medical
Class 1, Without waivers/limitations
Seat
Left
Flight hours
1,463 total · 17 in this make and model · 1,008 as pilot in command · 50 in the last 90 days · 50 in the last 30 days · 3 in the last 24 hours
Role
Check pilot
Injuries
Minor
Certificate
Flight instructor
Airplane ratings
Single-engine land, Single-engine sea, Multi-engine land
Instrument ratings
Helicopter, Airplane
Medical
Class 1, Unknown
Seat
Right
Flight hours
16,602 total · 237 in this make and model

Weather

Conditions
Visual (VMC) · Day
Wind
310° at 6 knots
Visibility
10 statute miles
Lowest ceiling
25,000 ft broken
Temperature
91 °F, dew point 72 °F
Altimeter
29.98 inHg
Observed at
OZR, 9 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.