A Pilot's Perspective.

     By Barry Meek. 

December 2013     

 After the Crash, Who Do You Blame?

     In August of 2007, a doctor along with his fiancée, were severely injured when their light twin, a Cessna 337, crashed near Atlanta, Georgia.  His legs were crushed, and both occupants suffered third degree burns to 40% of their bodies.  The woman was the PIC that evening.  She was a commercial pilot and worked as a co-pilot for American Airlines. The doctor owned the Skymaster.


      The couple had just departed a regional airport en-route to Ohio, when after about ten minutes in the air, the rear engine stopped producing power.  The pilot spent a certain amount of time attempting to resolve the situation, then decided to return to the airport for landing.  However, they crashed in a field a few miles short. 

      Both occupants survived the impact and the ensuing fire although their recoveries  would never be complete.  They were left with scars and injuries consistent with severe burns.  Predictably, they went to litigation to obtain some type of compensation from anyone who could be blamed and held responsible for the accident.  The main target was the aircraft maintenance organization.  When the dust cleared from the court case five years later in 2011, the AMO was hit with damages of 11.5 million dollars!

            During the trial the plaintiffs claimed that the maintenance shop never undertook repairs or overhaul of the rear engine that were necessary to keep it airworthy. They sited a misdiagnosis of power loss in the rear engine, and the failure to have an appropriate inspector investigate all work that its mechanics were performing. The plaintiffs also claimed that the shop knew the front engine was long overdue for overhaul, but it was never recommended. They argued that the failure to overhaul the engine caused diminished power during an in-flight emergency precisely when full power was needed.

          The maintenance organizations defense focused on the turbocharger wastegate, and once a new one was installed, the problem had been resolved.  They also pointed to the pilot’s post-accident statement which confirmed the resolution of that condition.  Further statements by the pilot confirmed that she had not applied full power to the front engine or retracted the rear-engine cowl flaps. There were a number of issues during the trial that remain in dispute, and the maintenance organization has appealed the verdict.  At this time, over two years later, I cannot find any further details of that appeal, so the focus of this article will remain on the original proceedings.

      The NTSB investigation revealed facts pertinent to the crash and attached the probable cause as pilot error.  It found that the pilot rejected the idea of landing at a smaller airport which was at one point as close as six miles from their position.  Instead, the pilot elected to shut down the rear engine and go back to their departure airport, which was considerably further.  The front engine was maintaining power, although it was kept at the top of the green arc and not redlined as the emergency procedures allow.

        It also states, “The examinations of both engines, including the accessories, revealed extensive thermal damage. Of those items that could be examined, including the internal engine parts, there was no evidence of any anomaly to either engine that would have precluded normal operation prior to the accident.”

       The "Single-Engine Maximum Rate-of-Climb Data Chart" found in the owner’s manual indicated that the airplane, at maximum gross weight and at 5,000 ft msl, should have been able to climb about 290 feet per minute with the ambient temperature conditions that existed at the time. Notes attached to the chart stated that the operating engine must be running at 37 inches of manifold pressure, at 2,800 rpm, and that the inoperative propeller had to be feathered to obtain the results listed in the chart. The "Single Engine Service Ceiling Chart" in the owner’s manual was also predicated on the use of 37 inches of manifold pressure and 2,800 rpm.

        The jury in this trial quite possibly didn’t understand many of the technical details of operating an aircraft, responsibilities of the pilot in command, nor the principals of pilot decision making and basic airmanship. Their decision was based on the lawyers’ arguments for both sides.  The plaintiffs lawyer obviously prevailed.  Furthermore, the NTSB review and findings are inadmissible in court.  The law regarding this states:  “No part of [the board’s accident report, which contains the board’s determinations, including the probable cause of an accident] may be admitted as evidence or used in any suit or action for damages growing out of any matter mentioned in such reports.”

          So what about the pilots responsibility?  The jury assessed her and the owner (her fiancé) twenty percent of the blame for the accident.  This case, like countless others in aviation, is not likely understood nor agreed with by pilots and mechanics.  Without having sat through this trial, nor seen the actual transcription, which I’d not have understood anyway, it’s only second-guessing to discuss the outcome.  But, I’ll do it anyway.  Along with the freedom to own and fly an airplane, comes responsibility to maintain and service it.  There is a lot of basic common sense required when flying too.  In my mind, it would be total nonsense to over fly a suitable airport while operating with a crippled engine.  There is a little button on a GPS that says “closest” to help in a simple decision like that.  The pilot also needs to be totally familiar with the operators’ manual, enough to know the emergency procedures for that aircraft.  According to the NTSB finding in this case, the pilot didn’t know or disregarded what was spelled out in that section of the POH. 

           The system we have to decide responsibility in cases like this is extremely difficult to understand.  One reason is the fact that in the U.S., and in Canada, the TSB findings are not admitted in any courtroom or suit for damages.  Although there are good reasons for this, which I understand and generally agree with, common sense and personal responsibility are thrown out like dirty bathwater.  A maintenance shop can advise an owner, and make recommendations on the upkeep of an aircraft.  But the owner is ultimately responsible.  It boils down to leading a horse to water. 

            I will continue to check up on the appeal that is underway, and in some future article I hope to write more on the case.  Something that involves such a huge award is worth watching. 

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