General Aviation News

Improperly installed part leads to crash

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The pilot of the experimental amateur-built Minicoupe reported that during the takeoff roll at the airport in Middle River, Maryland, the airplane veered to the left.

As it neared the left edge of the runway, the pilot rotated the airplane in an attempt to become airborne, but the plane aerodynamically stalled three feet above the runway and then hit the runway nose first.

The pilot performed a post-accident inspection of the airplane with the assistance of another pilot, and he discovered that he installed the rudder control horn upside down. The improper installation reversed the rudder control input.

When right rudder input was needed during takeoff to overcome the airplane’s left turning tendency precipitated by the engine and propeller, pushing on the right rudder pedal made the airplane turn left.

The pilot recommended that he verify proper control connections after maintenance.

Probable cause: The pilot’s incorrect installation of the rudder horn and failure to properly inspect the installation, which led to a loss of directional control during takeoff.

NTSB Identification: GAA16CA088

This December 2015 accident report is provided by the National Transportation Safety Board. Published as an educational tool, it is intended to help pilots learn from the misfortunes of others.

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Comments

  1. Complacency is a factor with ‘pro’ mechanics and ”pro’ flight crews..
    Maybe even more than for weekenders in some instances. FWIW a recent CJ accident took off without the checklist required control check. The outcome eas bad. Guess what? The ‘black box’ found only 10 or so of the prior 150 takeoffs were preceded by a control check. The aircraft had been flown by multiple cres prior to the final (fatal) flight. In 2014 a ‘pro’ mechanic misrigged a Malibu at a shop near my hangar. A ‘pro crew’ missed the error and the too perished. The good Dr needs reminded that checklists were instituted in operating rooms because even the ‘best’ can succumb to distractions. At least in the cockpit, ultimate accountability includes the individual the person who made the fatal error. Not so in an operating room.

  2. Recently had a situation where an autopilot had been installed in an Experimental. We were going to fly the first flight so I performed a very careful preflight. Found that the ailerons could jam when full right was applied. Removed the autopilot servo link before the flight. Could have been a really bad had we not done a thorough preflight, which includes flight control check.

  3. It seems we still have people that feel one has to have a government license to know anything, ALL of us unlicensed folks are scum. That high and mighty attitude is so sad.

    • Most EAB aircraft, and even a few certified aircraft, use differential braking to steer the aircraft on the ground. The rudder controls would not perform any function until takeoff is initiated and enough speed has been achieved for effectiveness at which point differential braking can cease. And that is exactly what happened, the rudder became effective and started to drive the aircraft heading opposite the control input. Even if the rudder pedals were used for steering on the ground that would be through connection to the nosewheel and probably not share the same backwards rigging. Incidentally since the pilot was performing maintenance on the aircraft then he would have also been the builder and should have been well aware of the proper control rigging which makes him even more careless because based on that experience he should have known exactly how it should have been reassembled.

  5. Agree with all comments. I think the control check is one of the most challenging items on the checklist because it is hard to believe that controls could be connected backwards (but occasionally it really happens) and over the years it becomes a complacency problem. We look but don’t see. Most POH’s have this item as Controls – FREE and CORRECT as a pre-flight item and again as a pre-takeoff item. The FREE part is easy to check, but verifying the CORRECT part requires looking outside to see the flight control moving in the correct direction. Since this can be difficult on some models with the rudder, another person may be needed on the walk-around. During the walk-around when checking the controls manually, look in the cockpit and note the movement of the control wheel as you move the control surfaces. And trim systems can be reconnected backwards – move the trim wheel full travel in both directions and verify the elevator goes up for nose up trim and the trim tab goes down and vice versa during the pre-fight inspection.

    • I know of a DC-6 having the ailerons hooked up backwards by a profesional airline mechanic crew and being checked and passed by their inspector. On the test flight before putting it back in passenger service, the only thing that saved them was it was done at night in completely smooth air and they immediately recognized the problem and one pilot was assigned to only work the ailerons while the other one worked the elevators and rudder. No way they could check the ailerons as they can’t be seen from the cockpit. Also, I know of a B-47 having the trim motor wired backwards and it caused the crash on takepff that killed all aboard. A good friend was the C.O. of this B-47 maintenance unit in Washington state. Doctors screw up too. In fact, we all do, it’s called being HUMAN.

    • That “non pro” would have been the builder assuming he was following the regulations and had the FAA approval to maintain it. How better qualified can you be to maintain an aircraft then to be its builder? It was carelessness and even “professionals” are guilty of that at times. But then your usual disdain of EAB aircraft drives you to make a frivolous criticism.

  7. To me this is just another example of why a professional mechanic, and not a jake leg professional mechanic but an honest to goodness, 100% in the business mechanic, should be used to maintain airplanes. I view maintaining your own airplane as being akin to performing your own dentistry. Actually probably worse, because mistakes doing your own maintenance can kill you.

    • The pilot of an aircraft is the one responsible for ensuring that it is airworthy. That includes the check list item; ‘ controls free and correct’….that the controls move without restriction, to their control limit, and that they move in the correct direction.
      This is again more ‘Stupid pilot tricks’

    • Well, you’re entitled to your opinion but in this case its mostly irrational hysterics. Certified mechs make their share of mistakes all the way up the ladder of qualifications to include airlines and high perf military aircraft. I’ve seen plenty of them in both areas some of which resulted in accidents. This pilot didn’t just make a mechanical mistake with respect to the installation of the rudder horn but compounded it with his failure to do a simple flight control check prior to takeoff roll the sole purpose of which is to check for freedom of movement and direction of movement. Had he done so he would have completed the quality control check of his work noting it was in error.

      • I’d rather have a professional perform whatever service it is, aircraft mechanics or whatever, as the chance of an error will be much less. I’ll quote the saying about doctors, of which I am one, who treat themselves, as I also see it applying to aircraft mechanics: “The doctor has an idiot for a doctor and a fool for a patient.”

    • Any Professional would be faced with working on an unfamiliar aircraft type and most likely not have any access to the customary maintenance documentation. That is the basis for the FAA granting the builder the approval to also perform the maintenance, they know the aircraft better than anybody else. However when they are careless we see what can be the results.

    • In 1994 I watched a single otter pile in beside the runway (czvl) killing two and leaving a third learning how to tie shoes again. Guess what…all three on board were professional mechanics and pilots who had reassembled the airplane with the ailerons reversed. Last year in Spokane a p46t with the ailerons reversed crashed into the river with two fatalities. There are many more examples…Your statement that pros should work on airplanes is one of ignorance. Btw I have built 2 airplanes and currently own 7 of which only 1 is certified. After the annual on it (I maintain the others) I look it over before flight…I’ve found things not hooked up, latches loose, etc…I even found a flashlight wedged up in the nose gear once. I think your bias towards experimentals and their pilots/mechanics is unfounded

  9. Absolutely use a checklist. What is more, make sure you pay attention to control range and direction. It would seem especially important the first time you fly after doing maintenance on the control system! Maybe the pilot did check but failed to recognize the reversed operation. That point is not clear from the article.

  10. Never have flown an experimental, but I know part of my runup is to check the flight controls; is this different in a homebuilt?

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