Colgan Beech fatal (8/03) final report

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The pilots were employees. As such their families' financial recovery will possibly be limited to worker's compensation. In most States, Worker's Comp is an exclusive remedy.

 

[GateGirl]

I have a lot to say on this. As some of you may or may not know... I was the ops agent. And some of you know more about my involvement than others. Those of you that don't know or cant figure out what i am talking about, but feel you should go ahead and PM me, but Im not going to post it here...

I am kinda upset not to see as much on Raytheon. They did have an imporperly printed manual. I know the mechanics, and they probably could have had better training. But I also know that they were trained. Everyone who knows me knows that I am the type of person who doesnt want to see anyone blamed for anything. Did Colgan have a lot to do with this? Yea... Had that same trim been written up many other times?? Yup. Did Colgan know they had something wrong with the plane?? I dont know. (I have some ideas though)

I spoke to scott maybe an hour before the crash. He came and visited me and ate Wendy's (his usual) and we chatted about his flights earlier that day, and the airport hopping around he had done. When Colgan first called him for the flight he ignored it. Earlier Steve had been in, looking up some flights, he mentioned Colgan had called him for the flight, but that they didnt have a Captain. I told him Scott was on reserve, Scott will always fly. I told him he would probably end up flying. A few hours later, I hear the plane take off. I was out at the front desk and someone said there was an emergency landing comming in and listening for the radio. I went out to stand ont he tarmac, someone said it was a private plane. I had a wierd sinking feeling. On the ramp I stood with a ton of cape air pilots. Looking back I know they knew it was my plane. At the time I had no idea. The trucks suddenly came off the runway, and the cop who had been standing next to me walked away to listen to his radio because it had started going crazy. They all knew it was the Colgan plane. I stood there when someone said the plane had crashed into the ocean. I walked back inside, I was waiting for the times for that flight. The assistant airport manager walked in, with the FAA. I thought I was getting an inspection. He asked me for a passenger list.

Thats my story. Not all of it. There is more... lots more. But thats the majority of it. Im glad to see its comming to an end. The families, both of them, deserve a lot more than what they will ever get. They deserve to have their families at home, the deserve to be able to hug thier loved ones. No amount of money from Colgan, or anyone else, will ever be able to fill that gap left in their hearts. I hope that they get closure from this.

I am saying way more than I need to. Sorry for that. Im tired, and I felt I should add that all in. Colgan isnt an unsafe airline, every airline has problems. Does colgan have more? Maybe. Does colgan have less? Probably not. Every airlne has problems, ever airline has the human factor. You cant completely erase that. Humans make mistakes. Im not trying to rationalize it. Im just telling you what I feel. Im done now, Im tired. Im rambling. Ill read this tomorrow and kick myself. But oh well...

 

[mckpickle]

Very sad story.

You folks may want to keep in mind that everything written on here is written fodder for lawyers.

I was called to testify durring an arbitration for somthing written on the CAL board. I didn't even have anything to do with the situation. If Colganites or lawyers see this there could be........dificulties. FYI

 

[BRA]

Aren't the 1st flight of the day checks all done from memory? I know you could get out the book and look at them....but is anyone taught to do it like that? And you are supposed to preflight the exterior with checklist in hand...what check list??? The pages in the airplane manual? We don't really have a separate checklist like you have for pipers and cessnas? I am confused on this.

 

[TWA Dude]

Don't you think if Colgan was that "unsafe" as some claim the FAA would have shut them down long before now

I wouldn't put so much trust in the FAA. ALL airlines have problems at various times and the FAA usually works with them and things get resolved. The decision to completely ground an airline is usually political. Take the old ValuJet. The horrific crash was as a result of criminal negligence by a subcontractor. I'm not saying there weren't serious problems at ValuJet but the decision to ground the whole airline came from politicians and not the FAA. The FAA is loathe to ground any airlines unless their hand is forced.

Dude

 

[Propblast]

A good call by TWADude. The FAA has a "blood priority". They don't really clamp down until after the fact.

Propblast

 

[Publishers]

negligence

While workmans comp may be involved, I believe that if it ends up that gross negligence was invloved, the pilots can sue and recover damages. If the manual that Raytheon had was improper, they too would be open for legal action as well as the individal maintenance person.

All of these cases are tragic and all are far from simple. You can play the "what if" games until you are blue in the face. As most of us know, there is rarely one single factor in an accident, they are usually the result when a bunch of factors come together in a single moment.

 

[climbhappy]

am i hearing that the visual check done by the captain to move by the electric trim and verify trim wheel movement was not done. second, in the misrigging of it , what would have happened when the captain overrode the fo trim ?

in my recent groundschool, we watched the valujet disaster and saw the test done by the fed with respect to these oxy gens.

it was horrifying. they never had a chance. neither did this crew.

actually, if the aircraft was returned to service improperly without a maintenance flight, then the merits of a huge wrongful death suit get stronger and stronger. if the policies and procedures of colgan management didn't allow for this anomoly to be detected, they'll pay dearly.

 

[chperplt]

am i hearing that the visual check done by the captain to move by the electric trim and verify trim wheel movement was not done. second, in the misrigging of it , what would have happened when the captain overrode the fo trim ?

You are correct.. Neither the Captain nor the FO performed the first flight of the day check on the trim wheel.

When the captain overrode the FO trim wheel, the same thing would have happened that did happen. They commanded a nose up action but inturn, the elevator went nose down. The trim wheel spun in the correct position relative to the trim request. The cable was backwards and commanded the opposite action.

 

[79%N1]

When the captain overrode the FO trim wheel, the same thing would have happened that did happen. They commanded a nose up action but inturn, the elevator went nose down. The trim wheel spun in the correct position relative to the trim request. The cable was backwards and commanded the opposite action.

Thats messed up, man! Scarry thought how little control we may have over what we trust others to ensure is working properly!

 

[WileE]

You know what would have happened?

If they had done a test flight? The pilots would have died on the test flight instead of the ferry flight. Test flights at these companies involve taking off, flying a pattern and if you don't crash, its a successful test. If you crash, I guess they didn't do the tail right.

 

[chperplt]

You know what would have happened? If they had done a test flight? The pilots would have died on the test flight instead of the ferry flight. Test flights at these companies involve taking off, flying a pattern and if you don't crash, its a successful test. If you crash, I guess they didn't do the tail right.

You're missing the bigger picture my friend. IF the crew was doing a test flight, they would have been told what the problem with the airplane was. They then would have had the foresight to perform a functional check on the elevator and it's trim components.

Secondly, IF the company would have brought qualified people in to fix the aircraft properly rather than send the aircraft out to be fixed, the accident would never had occurred.

 

[Publishers]

Questions

As evidenced from above, you would not acutually had to find the problem by flying at all.

It was known what was worked on and a test on the ground would have shown the problem.

Usually a mechanic is given a card to perform a certain maintenance function. It is then often someone else who is responsible for seeing that the work was done and checked for proper function.

The above should hold true no matter who, the company or a contractor, performs the maintenance.

As a pilot, it is always good to see what your aircraft did last. We do not really know whether or not this crew knew that the aircraft had come out of maintenance. The fact that they did not do the first flight check list is indicative that maybe they took this flight more casually than normal as there would be no passengers.

If there is one thing that I have learned over the last 30 years in aviation is that many good people have serious and sometimes fatal accidents. Other times, those that surely should have been killed through their actions end up coming out all right.

 

[chperplt]

As a pilot, it is always good to see what your aircraft did last. We do not really know whether or not this crew knew that the aircraft had come out of maintenance. The fact that they did not do the first flight check list is indicative that maybe they took this flight more casually than normal as there would be no passengers Emphasis added.

How much 121 time do you have? My guess by your profile is zero.

We as pilots in a 121 operation don't have a clue (generally) what heavy maintenance was done on an airplane. Each airplane has two sets of books. One is stored somewhere other than the airplane, and the one in the airplane. The airplane maintenance log will generally only show work done as a result of a pilot write-up.

Yes, we know that this crew knew the aircraft came out of maintenance. What we don't know if what they were told was done to the aircraft. We also know that dispatch told them the airplane was going to ALB to pick up a revenue trip. We know this because that is what the company told the pilot group after the accident. It was shortly after the fact that the truth came out.

The aircraft came out of a maintenance base which is a pilot base as well. Aircraft overnight in the maintenance hanger. It's common practice to pick an airplane up from maintenance.

Are you trying to tell me that you find fault with the crew, because maybe the took the flight more casually than normal? Am I reading that wrong?

 

[DH106]

Not a criticism, but a heads-up to current 1900D drivers:

Our 1900D manual had a specific preflight procedure for checking/preflighting the elevator trim tab, Nearly none of the pilots I flew with were familiar with the procedure (the company wasn't even training it), so I always took the time to show it to my FO's.

I recall that you had to set the trim to a certain setting... then, you'd go outside, and look at the elevator --- the trim tab trailing edge should be lined up with the elevator trailing edge, at the specified trim setting. If the two trailing edges weren't lined up, it was a sign of mis-rigging.

I believe it was a Raytheon-published procedure, put out around 1999 (?).

Current 1900D drivers: check your manuals about this, and correct me if I'm wrong?