WPR20CA112

NTSB accident investigation · De Havilland DHC6 · Boulder City, NV · March 6, 2020

Accident · No injuriesData collectionFinal report
Date
March 6, 2020, 11:15 local (18:15 UTC)
Place
Boulder City, NV
Injuries
2 uninjured
Damage
Substantial damage
Phase of flight
Landing
Aircraft
N72GCDe Havilland DHC6
Defining event
Landing-landing roll: Loss of control on ground
Weather
Visual (VMC) · Day
Status
Completed · report August 3, 2020
Report
Approved by Office Director
NTSB office
Western Pacific Region
FAA report
20200306001489A
Case key
101095

From the NTSB’s public API. By law, NTSB reports can’t be used as evidence in lawsuits over the accident.

On this page

Probable cause

The trainee pilot's loss of directional control during landing and his subsequent unintentional control interference with the brakes and/or rudder during the trainer pilot's attempted remedial action, which resulted in a runway excursion and collision with a ditch.

Findings · 6

NTSB’s coded findings. Those marked are part of the probable cause; the rest are factors or other findings. Under each, the cases with the same finding.

Performance/control parameters: directional controlAircraft › Aircraft oper/perf/capability · Not attained/maintainedDehavilland DHC-6-300: 2 casesAll aircraft: 3,958 casesProbable cause
Use of equip/info: aircraft controlPersonnel issues › Task performance · Student/instructed pilotDehavilland DHC-6-300: 4 casesAll aircraft: 9,295 casesProbable cause
Use of equip/info: use of equip/systemPersonnel issues › Task performance · Student/instructed pilotDehavilland DHC-6-300: 1 caseAll aircraft: 1,391 casesProbable cause
Landing gear system: brakeAircraft › Aircraft systems · Unintentional use/operationDehavilland DHC-6-300: 1 caseAll aircraft: 297 casesProbable cause
Flight control system: rudder control systemAircraft › Aircraft systems · Unintentional use/operationDehavilland DHC-6-300: 1 caseAll aircraft: 93 casesProbable cause
Terrain: sloped/uneven terrainEnvironmental issues › Physical environment · Effect on operationDehavilland DHC-6-300: 1 caseAll aircraft: 270 casesProbable cause

Sequence of events

The events NTSB coded, in order, by phase of flight. The defining event is the one that best describes the accident. Under each, the cases with the same event anywhere in their sequence.

Analysis

An operator's pilot was conducting training for a newly hired pilot for a first officer position in the twin-engine airplane. After accomplishing air work, the pilots returned to the airport to practice landings and takeoffs. According to both pilots, the first approach was normal, and the airplane touched down slightly right of the runway centerline. The trainee pilot stated that, after touchdown, the airplane began drifting further right and that he was unable to correct the deviation. The trainer pilot reported that, when directional control became unstable, he told the trainee, "I have the controls." The trainer pilot saw that the trainee pilot released his hands from the engine power levers and the yoke, but the airplane continued to deviate to the right, contrary to his control inputs and his addition of asymmetric power to the engines. The trainer pilot realized that, based on his inputs, the airplane should have returned to the centerline but that it did not and that it was behaving as if the trainee pilot was applying some braking. At that point, the trainer pilot again told the trainee pilot to release the controls, and he used the brakes, which he reported applied and released normally. Subsequently, the airplane exited the right side of the runway and impacted a ditch. The airplane sustained substantial damage to the right wing. The trainer pilot and the operator reported that there were no mechanical failures or malfunctions with the airplane that would have precluded normal operation. The trainer pilot reported that he believed the trainee pilot's feet were either on the brakes or interfered with his brake and/or rudder application attempts. The trainee pilot reported that he could not recall the position of his feet after he relinquished airplane control to the trainer pilot.

Factual narrative

The newly hired pilot was being trained for a First Officer position in the twin-engine airplane by one of the operator's trainer pilots. After accomplishing air work, the flight returned to practice landings and takeoffs. According to both pilots, the first approach was normal, and the airplane made a normal touchdown, just slightly right of the runway centerline. The trainee pilot stated that after touchdown, the airplane began drifting further to the right, and that he was unable to correct that deviation. The trainer pilot reported that when directional control became unstable, he told the trainee "I have the controls". The trainer pilot observed that the trainee released his hands from the engine power levers and the yoke, but the airplane continued to deviate to the right, contrary to his control inputs. He added asymmetric power to the engines to help regain the centerline, without success. The trainer pilot realized that based on his inputs, the airplane should have returned to the centerline but did not, and that the airplane was behaving as if the trainee pilot was applying some braking. At that point, the trainer pilot "clearly shouted a second time" for the trainee to release the controls. The airplane then exited the right side of the runway and collided with a ditch. During that rollout, the trainer pilot used the brakes, which he reported applied and released normally. The trainer pilot reported that it was his opinion that the trainee pilot's feet were either on the brakes or interfered with his brake and/or rudder application attempts. The trainee reported that he could not recall the position of his feet after he relinquished airplane control to the trainer pilot. The airplane sustained substantial damage to the right wing. The pilot reported that there were no mechanical failures or malfunctions with the airplane that would have precluded normal operation.

Aircraft

Registration
N72GC
Reported as
De Havilland DHC6 (300)
Category
Airplane
Serial number
264
Built
1969
Airframe hours
50,964
Engines
turbo propturbo prop
Damage
Substantial damage
Flight
Instructional · Part 91
Operator
Grand Canyon Airlines
Registered owner
Monarch Enterprises Inc
Airworthiness certificate
Standard, Normal
Last inspection
Continuous airworthiness · September 25, 2019
Departed
BVU · Boulder City, NV
Destination
BVU · Boulder City, NV
Flight plan
Company VFR
Airport
BVU · Boulder City, runway 27, 4,803 × 75 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
Flight instructor
Age
55
Injuries
None
Certificate
Airline transport
Airplane ratings
Multi-engine land
Instrument ratings
Airplane
Medical
Class 1, With waivers/limitations
Last flight review
October 22, 2019
Seat
Left
Restraint
4-point
Flight hours
23,500 total · 20,000 in this make and model · 18,500 as pilot in command · 75 in the last 90 days · 28 in the last 30 days · 3 in the last 24 hours
Role
Pilot
Age
52
Injuries
None
Certificates
Private, Commercial
Airplane ratings
Single-engine land, Multi-engine land
Instrument ratings
Airplane
Medical
Class 1, With waivers/limitations
Last flight review
September 26, 2018
Seat
Right
Restraint
4-point
Flight hours
583 total · 4 in this make and model · 539 as pilot in command · 8 in the last 90 days · 6 in the last 30 days · 1 in the last 24 hours

Weather

Conditions
Visual (VMC) · Day
Wind
Variable at 5 knots
Visibility
10 statute miles
Lowest ceiling
None
Temperature
70 °F, dew point 30 °F
Altimeter
30.07 inHg
Observed at
BVU

Docket · 11

The files NTSB released with the investigation on May 19, 2020, on NTSB’s docket system: statements, records, photos and specialists’ reports. 7.8 MB 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.

Other investigations on N72GC · 1

Matched to the same aircraft by N-number and date.