Friday, January 27, 2012

Cessna 340A, Flying G Aviation LLC, N340HF: Accident occurred January 27, 2012 in Ocala, Florida

NTSB Identification: ERA12FA161 
14 CFR Part 91: General Aviation
Accident occurred Friday, January 27, 2012 in Ocala, FL
Probable Cause Approval Date: 01/15/2013
Aircraft: CESSNA 340A, registration: N340HF
Injuries: 1 Fatal,1 Serious.

NTSB investigators either traveled in support of this investigation or conducted a significant amount of investigative work without any travel, and used data obtained from various sources to prepare this aircraft accident report.

The pilot entered the left downwind leg of the traffic pattern to land to the north. A surface wind from the west prevailed with gusts to 15 knots. Radar data revealed that the airplane was on final approach, about 1.16 miles from the runway and about 210 feet above the ground. The airplane then crashed in a pasture south of the airport, in a slight left-wing-low attitude, and came to rest upright. The cockpit and cabin were consumed in a postcrash fire. The pilot's wife, who was in the aft cabin and survived the accident, recalled that it was choppy and that they descended quickly. She recalled hearing two distinct warning horns in the cockpit prior to the crash. The airplane was equipped with two aural warning systems in the cockpit: a landing gear warning horn and a stall warning horn. The pilot likely allowed the airspeed to decay while aligning the airplane on final approach and allowed the airplane to descend below a normal glide path. Examination of the wreckage revealed that the landing gear were in transit toward the retracted position at impact, indicating that the pilot was attempting to execute a go-around before the accident. The pilot made no distress calls to air traffic controllers before the crash. The pilot did not possess a current flight review at the time of the accident. Examination of the wreckage, including a test run of both engines, revealed no evidence of a pre-existing mechanical malfunction or failure that would have precluded normal operation of the airplane.

The National Transportation Safety Board determines the probable cause(s) of this accident to be:

The pilot's failure to maintain adequate airspeed and altitude on final approach, resulting in an impact with terrain short of the airport.

HISTORY OF FLIGHT

On January 27, 2012, about 1227 eastern standard time, a Cessna 340A, N340HF, was substantially damaged following a collision with terrain during approach to Ocala International Airport (OCF), Ocala, Florida. The certificated private pilot was fatally injured and one passenger received serious injuries. The airplane was registered to a corporation and was operated by the pilot under the provisions of 14 Code of Federal Regulations Part 91 as a personal flight. Visual meteorological conditions prevailed and an instrument flight rules flight plan was filed. The flight originated from Middle Georgia Regional Airport, Macon, Georgia, about 1117.

An examination of recorded radar data revealed that the pilot entered a left downwind leg on a southerly heading, about 6 miles west of OCF. The airplane was abeam the approach end of runway 36, and about 1,800 feet mean sea level (msl), when a left base turn was initiated. The pilot then initiated a turn to final about 2.5 miles from the runway approach end, at an altitude of about 700 feet msl. The last radar return with an altitude readout other than zero occurred about 1.16 nautical miles south of runway 36, at 1727:27 (HHMM:SS) at an altitude of about 300 feet msl (about 210 feet above the ground).

According to recorded voice transmissions between the accident pilot and Ocala FAA Contract Tower (FCT) personnel, the pilot checked in at 1723:51. The local controller provided the pilot with the current wind information and the pilot reported turning left base at 1724:07. The local controller reported that the airplane was not in sight and issued a landing clearance to the pilot. At 1725:41, the local controlled advised the pilot that he had him in sight. At 1727:52, the local controller stated, "zero hotel foxtrot altitude altitude." No response was received from the pilot, and there were no distress calls received from the pilot.

The pilot's wife was seated in the aft cabin and reported the following after the accident. During the descent for landing at OCF, she recalled the "choppy" and "bumpy" conditions, and the "ground was coming up on them quickly." She recalled hearing two distinct warning horns in the cockpit prior to the crash. She also reported that, during the final phase of the flight, the airplane veered left noticeably two times. Prior to the crash, her husband made no comments regarding any mechanical difficulties with the airplane.

PERSONNEL INFORMATION

The pilot held a private pilot certificate with ratings for airplane single-engine land, airplane multiengine land, and instrument airplane. He reported a total flight experience of 1,005 hours on his latest third-class medical certificate application, dated June 10, 2011.

According to the pilot's logbook that was located in the wreckage, as of January 21, 2012, he recorded about 416 hours in single engine airplanes, about 632 hours in multi-engine airplanes, and about 828 hours as pilot-in-command. His first recorded flight in the accident airplane was on December 19, 2011, and he recorded about 14.2 hours total time in the accident airplane.

The pilot's last recorded Code of Federal Regulations (CFR) part 61.56 flight review occurred on December 28, 2009. The flight included an instrument proficiency check and was conducted in a single-engine Cessna 182. The accident pilot's last flight review in a Cessna 340A occurred on November 3, 2007. The certified flight instructor (CFI) who administered the examinations was interviewed by the NTSB investigator-in-charge following the accident. The CFI reported that he last flew with the accident pilot in 2011. The CFI also owned a Cessna 340A and asked the accident pilot to fly the airplane to Albany, Georgia for him, since the CFI was injured from a recent fall. The CFI reported that the flight from Florida to Albany was uneventful until entering the traffic pattern for landing. The accident pilot lined up on an incorrect runway, and the CFI provided verbal guidance to correct the situation. Once aligned on the correct runway, the accident pilot allowed the airspeed to decay on short final to the point where the CFI responded out loud, "power, power!" The airplane landed hard on the runway, and a hard landing inspection was accomplished after the flight with no damage found.

A friend of the accident pilot, who was also a CFI, provided dual instruction following the pilot's purchase on the accident airplane in December, 2011. The CFI was interviewed by the NTSB investigator-in-charge following the accident. He stated that he did not administer a flight review to the accident pilot. During recent dual instruction, the accident pilot flew precise, smooth approaches and landings. He stated that the accident pilot would have passed a flight review based on how he flew when they were together. The CFI and the accident pilot conversed prior to the flight, and he was aware that the accident pilot needed to be in Ocala by 12 o'clock noon on the day of the accident to meet with a realtor.

The CFR part 61 addresses certification of pilots. The following pertains to flight reviews:

Except as provided in paragraphs (d), (e), and (g) of this section, no person may act as pilot in command of an aircraft unless, since the beginning of the 24th calendar month before the month in which that pilot acts as pilot in command, that person has—
(1) Accomplished a flight review given in an aircraft for which that pilot is rated by an authorized instructor; and
(2) A logbook endorsed from an authorized instructor who gave the review certifying that the person has satisfactorily completed the review.

AIRCRAFT INFORMATION

The airplane was a twin-engine, low wing, retractable gear airplane, serial number 340A0624. It was powered by two Continental TSIO-520 engines with RAM conversions rated at 335 horsepower each.

According to the aircraft maintenance records, the last annual inspection on the airframe and engines was performed on April 18, 2011, at a total aircraft time of 5,057.4 hours.

METEOROLOGICAL INFORMATION

The 1227 surface weather observation for OCF reported wind 260 degrees at 9 knots with gusts to 15 knots, visibility 10 miles or better, few clouds at 2,800 feet, ceiling 3,400 feet overcast, temperature 19 degrees C, dew point 14 degrees C, and altimeter setting 30.00 inches of mercury.

At 1224, the Ocala FAA Control Tower local controller provided with following wind information to the accident pilot, "…wind two seven zero at nine and uh gust one four." The pilot acknowledged the transmission.

WRECKAGE AND IMPACT INFORMATION

The accident site was situated on level ground and was an active livestock pasture. The main wreckage was located about 0.65 nautical miles south-southwest of the approach end of runway 36. The airplane fuselage came to rest on a heading of 120 degrees. Small flecks of white paint and a broken portion of the left wing navigation light were found with the first ground scar along the wreckage path. The straight line distance from the initial impact scar to the main wreckage was about 86 feet and was on a heading of 300 degrees.

An initial examination of the wreckage revealed the following. The cockpit and cabin were extensively burned from a post-impact fire. The landing gear handle was found in the retracted position. The position of the landing gear actuator linkage indicated an "in transit" position and was in close proximity to the up/retracted position. The wing flaps were found extended about 15 degrees. All engine controls were found near the full-forward positions.

Control cable continuity was established from the cockpit controls to the rudder and elevators. The left aileron cables were attached to the bell crank with overload separations noted near the wing root. The right aileron cables were continuous from the wing bell crank to the wing root. The pilot and co-pilot control wheels were linked together by the chain.

The left engine remained attached to the airframe via the engine mounts and thermal damage was evident to the accessory section. The engine-driven fuel pump was removed by investigators and the drive coupling was intact. The pump did not rotate freely by hand. The fuel metering unit/mixture control exhibited thermal damage and both control arms moved freely by hand. The crankshaft rotated by hand when the propeller flange was rotated manually with a hand tool. The turbocharger compressor wheel turned freely by hand and was coupled to the turbine wheel.

The right engine remained attached to the airframe by three of the four mount legs and thermal damage was evident to the accessory section. The engine-driven fuel pump was removed by investigators and the drive coupling was intact. The pump did not rotate freely by hand. The fuel metering unit/mixture control exhibited thermal damage and both control arms moved freely by hand. The crankshaft rotated by hand when the propeller flange was rotated manually with a hand tool. The turbocharger compressor wheel turned freely by hand and was coupled to the turbine wheel.

MEDICAL AND PATHOLOGICAL INFORMATION

A postmortem examination of the pilot was performed at the District 5 Medical Examiner's Office, Leesburg, Florida, on January 28, 2012. The autopsy report noted the cause of death as "Acute carbon monoxide poisoning and thermal injuries due to fire due to airplane crash" and the manner of death was "accident."

Forensic toxicology testing was performed on specimens of the pilot by the Federal Aviation Administration (FAA) Bioaeronautical Sciences Research Laboratory (CAMI), Oklahoma City, Oklahoma. The CAMI toxicology report indicated 31 percent carbon monoxide detected in blood and 1.3 ug/ml of cyanide detected in blood. No ethanol was detected in vitreous fluid. No drugs were detected in the urine.

TESTS AND RESEARCH

The engines were shipped to the Continental Motors, Inc. (CMI) facilities in Mobile, Alabama for further examination. The investigation team reconvened on April 3 through 5 to perform the examinations. After an initial evaluation of overall condition, it was concluded that test runs of the engines would be attempted.

Left Engine

Due to impact and thermal damage, the following items were substituted or repaired prior to the test: fuel manifold valve fittings, the throttle control link rod, the induction system "Y" pipe, and the exhaust system.

The engine was fitted to the test stand and a test club propeller was installed. The engine started normally on the first attempt without hesitation or stumbling in observed RPM. The engine RPM was advanced in steps for warm-up in preparation for full power operation. The engine was advanced to 1,200 RPM, 1,600 RPM , and 2,450 RPM and held for 5 minutes at each RPM setting to stabilize. The engine throttle was then advanced to the full open position and held for an additional 5 minutes to stabilize. Throughout the test phase, the engine accelerated normally without any hesitation, stumbling, or interruption in power and demonstrated the ability to produce rated horsepower. The engine fuel system was not adjusted and was found to be set at a lean condition as compared to CMI specifications.

Right Engine

Due to impact and thermal damage, the following items were substituted or repaired prior to the test: fuel pump fittings, the induction system "Y" pipe, and the engine starter.

The engine was fitted to the test stand and a test club propeller was installed. The engine started normally on the first attempt without hesitation or stumbling in observed RPM. The engine RPM was advanced in steps for warm-up in preparation for full power operation. The engine was advanced to 1,200 RPM, 1,600 RPM, and 2,450 RPM and held for 5 minutes at each RPM setting to stabilize. The engine throttle was then advanced to the full open position and held for an additional 5 minutes to stabilize. Throughout the test phase, the engine accelerated normally without any hesitation, stumbling, or interruption in power and demonstrated the ability to produce rated horsepower.

ADDITIONAL INFORMATION

The airplane was equipped with two aural warning systems, a landing gear warning horn and a stall warning horn.

According to the Cessna 340A Information Manual, the landing gear warning horn was controlled by the throttles and the wing flap position. The horn would sound intermittently if either throttle was retarded below about 15 inches of manifold pressure with the landing gear retracted or if the wing flaps were lowered past the 15 degree position with the landing gear in any position except extended and locked.

The stall warning horn would sound 5 to 10 knots above the stall in all flight configurations.




A Cessna 340A piloted by P.Allen Golson (inset) crashes near Ocala International Airport, Friday, Jan. 27, 2012




The head of Macon's Coliseum Health System died Friday when the small plane he was piloting crashed near Ocala, Fla.

The hospital system confirmed in a news release that P. Allen Golson died in the crash. His wife Carol was aboard and suffered non life-threatening injuries. She was taken to a hospital.

The plane, a twin-engine Cessna 340A, crashed in a pasture just south of Ocala International Airport. The 340A seats six.

Golson recently announced he was leaving Coliseum for a CEO job with Ocala Health System. Both systems are owned by HCA.

The Golsons lived in Forsyth.

Investigators say Golson's last contact with the airport control tower was at 12:26 p.m. when he reported he was coming in for a landing. The plane crashed right afterward.

National Weather Service records say skies were mostly cloudy in Ocala at the time of the crash.

The plane departed Middle Georgia Regional Airport at 10:30 a.m., according to flightaware.com.

According to the Federal Aviation Administration website, the plane is registered to Flying G Aviation LLC in Wilmington, Del.

The Ocala Star-Banner reported on ocala.com that workers at nearby businesses rushed to the crash site and managed to pull Carol Golson out of the wreckage but could not rescue her husband because of heavy smoke. At least one rescuer suffered smoke inhalation. The fire department said it arrived four minutes after receiving an emergency call.

PHOTOS: From ocala.com

The Coliseum's news release quotes Michael Joyce, president of HCA's North Florida Division, as saying  "This is tragic news for our HCA family, and it will take time and the support of each other to deal with this loss.

"Allen was a true friend and a great leader who enjoyed life and dedicated himself to his work. He will be deeply missed."

Golson led the Coliseum system for the past seven years and had been a hospital administrator for more than 30, Coliseum said.

According to the news release: He served for nine years as CEO of Palmyra Medical Centers in Albany. He had been with HCA since 1986 serving in various administrative roles.

Golson graduated with his Bachelor of Science in HealthCare Management in 1981 from the University of Alabama, and has a Master of Business Administration at the Southeastern Institute of Technology in Huntsville, Alabama.

He was a Fellow in the American College of HealthCare, on the Board of Trustees of the Georgia Hospital Association (GHA), and had been a Rotarian for more than 20 years.

Marion County sheriff Ed Dean issued this release:

The Sheriff's Office responded to the area of SW 60th Avenue and 38th Street in Ocala around 12:30 p.m. on Friday, January 27 after a small plane crashed into a pasture. The Cessna 340 Alpha model plane was headed for the Ocala International Airport but crashed just south of its destination. The passenger, Carol Golson, 55, was pulled from the plane by citizens that witnessed the crash. Carol was taken to an area hospital with non-life threatening injuries. The pilot, Paul Allen Golson, 55, did not survive the crash.

The last contact Mr. Golson made with the air tower was at 12:26 p.m. to report he was coming in for a landing. Investigators estimate the crash occurred immediately following this contact. The cause of the crash is now being investigated by the Federal Aviation Administration (FAA) and the National Transportation and Safety Board (NTSB).


===============

OCALA — A small plane crashed midday Friday in an open field near the Ocala International Airport. The pilot — P. Allen Golson, the recently named CEO of Ocala Health System — was killed, and his wife was injured.

Golson, 55, was from Macon, Ga., where he had been CEO of Coliseum Health System for seven years.

Marion County Sheriff's Office spokeswoman Jenifer Lowe said Carol Golson, also 55, was taken to West Marion Community Hospital for treatment of non-life-threatening injuries. The hospital is part of Ocala Health System.

The Golsons were the only people aboard the twin-engine Cessna 340.

The website www.flightaware.com indicates the plane left the Middle Georgia Regional Airport in Macon at 10:30 a.m. Friday for a flight expected to last one hour and 10 minutes, with a destination of Ocala International Airport.

The plane crashed in a field south of Southwest 38th Street, which is just south of the airport.

Lowe said Golson's last contact with the airport tower was at 12:26 p.m. There was no indication of distress.

According to sheriff's officials, the plane was headed east and turning north to make its approach for landing "when something obviously went wrong."

Jo and Judy Ciufo, visiting from Canada, were driving on Southwest 38th Street, bound for Beall's on State Road 200. They saw a small passenger plane coming from the south that looked like it was about to cross 38th Street, heading toward the airport.

Then the pilot abruptly turned west and the plane plowed into the ground. Jo Ciufo said it looked like the pilot turned because he knew he was going down and didn't want to hit buildings.

"I never saw anything like this before," Judy Ciufo said.

Airport director Matthew Grow said it's premature to speculate on a cause of the crash. As of 3:42 p.m., the crash site had been turned over to the National Transportation Safety Board and Federal Aviation Administration.
•••

Michael Osbourne, 28, of Beverly Hills, works at FirePrograms across from the crash site. He ran to the scene, was overcome by smoke, and then was taken to a local hospital for treatment of smoke inhalation.
Other rescuers also were evaluated for smoke inhalation.

Workers from OxyLife Respiratory Services LLC, 6405 SW 38th St., heard a loud "boom" and then grabbed fire extinguishers and ran to the burning plane.

The workers said they managed to get the woman out of the wreckage but couldn't get to the man because of the heavy smoke.

Some of the workers used the fire extinguishers to fight the blaze. Others began to pull luggage from the plane.

Ocala Fire Rescue Battalion Chief Brian Stoothoff said his agency received a call at 12:30 p.m. from the airport tower. He said personnel were on scene at 12:34 p.m. with the Aircraft Rescue Fire Fighting truck, which is specially equipped for such emergencies.

On scene were officials with Ocala Fire Rescue, the Ocala Police Department, the Marion County Sheriff's Office and the Medical Examiner's Office. Ocala Mayor Kent Guinn was there, as well, conferring with police Chief Greg Graham.
•••

According to the FAA website, the plane is registered to Flying G Aviation LLC in Wilmington, Del.

The Flight Aware website indicates that the plane, tail No. N340HF, flew on Jan. 19 from Macon to Ocala in a trip covering one hour and 11 minutes. It returned from Ocala to Macon on Jan. 21 in one hour and 14 minutes. It was not clear if Golson was the pilot on those flights.

"He's very well respected and has been flying for many, many years," said Henry Lowe, president of Lowe Aviation Co.

Golson's plane was based with the company, which operates at the Middle Georgia Regional Airport.

"It's a real tragedy. He was a great guy," Lowe said.

Also saddened were Golson's colleagues at HCA.

"This is tragic news for our HCA family, and it will take time and the support of each other to deal with this loss," said Michael Joyce, president of HCA's North Florida Division, which includes Coliseum Health System.

"Allen was a true friend and a great leader who enjoyed life and dedicated himself to his work. He will be deeply missed," said Joyce, whose remarks were provided by Ocala Health.

Golson had more than 30 years of experience in public and private hospital administration. Before taking his post in Macon, he spent nine years as CEO of Palmyra Medical Centers in Albany, Ga.

Golson earned a bachelor's degree in health care management in 1981 from the University of Alabama and an MBA from the Southeastern Institute of Technology in Huntsville, Ala.

Ocala Health includes Ocala Regional Medical Center, West Marion Community Hospital, and outpatient facilities including Family Care Specialists and Advanced Imaging Centers.

Golson's appointment as new CEO was announced earlier this month. The leadership transition was set to be complete on Feb. 20.

Source:  http://www.ocala.com

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