Cessna 402CAir Sunshine, Inc.
Treasure Cay, BF · 2003-07-13·N314AB
What happened
NTSB summary, verbatimThe Safety Board's full report is available at http://www.ntsb.gov/publictn/publictn.htm. The Aircraft Accident Report number is NTSB/AAR-04/03. On July 13, 2003, about 1530 eastern daylight time, a Cessna 402C, N314AB, registered to Tropical International Airlines Inc., and operated by Air Sunshine Inc., as Air Sunshine flight 527, was ditched in the Atlantic Ocean about 7.35 nautical miles west-northwest of Treasure Cay Airport (MYAT), Treasure Cay, Great Abaco Island, Bahamas, after the in-flight failure of the right engine. Two of the nine passengers sustained no injuries, five passengers and the pilot sustained minor injuries, and one adult and one child passenger died after they evacuated the airplane. The airplane sustained substantial damage. The airplane was being operated under the provisions 14 Code of Federal Regulations (CFR) Part 135 as a scheduled international passenger commuter flight from Ft. Lauderdale, Florida, to MYAT. Visual meteorological conditions prevailed for the flight, which operated on a visual flight rules flight plan.
Probable cause
the Board's determinationthe in-flight failure of the right engine and the pilot’s failure to adequately manage the airplane’s performance after the engine failed. The right engine failure resulted from inadequate maintenance that was performed by Air Sunshine’s maintenance personnel during undocumented maintenance. Contributing to the passenger fatalities was the pilot’s failure to provide an emergency briefing after the right engine failed.
Safety recommendations
6 issuedwhat changed because of this accidentThe Safety Board recommends that the Federal Aviation Administration: Issue a flight standards information bulletin to principal operations inspectors of all Part 135 single-pilot operators that carry passengers and operate over water, which familiarizes them with the circumstances of the Air Sunshine flight 527 accident and emphasizes the need for pilots to provide timely emergency briefings. The bulletin should state that these briefings should include, at a minimum, information about the location and operation of the on-board emergency equipment and exits.
TO THE FEDERAL AVIATION ADMINISTRATION: Require all Part 121 and 135 air carriers to obtain any notices of disapproval for flight checks for certificates and ratings for all pilot applicants and evaluate this information before making a hiring decision.
TO THE FEDERAL AVIATION ADMINISTRATION: Conduct a study to determine whether the number of flight checks a pilot can fail should be limited and whether the existing system of providing additional training after a notice of disapproval is adequate for pilots who have failed multiple flight checks. On the basis of the findings of the study, establish a flight check failure limit and modify the recheck training requirements, if necessary.
TO THE FEDERAL AVIATION ADMINISTRATION: Review the procedures used during its oversight of Air Sunshine, including those for the Surveillance and Evaluation Program and Regional Aviation Safety Inspection Program, to determine why the inspections failed to ensure that operational and maintenance issues that existed at the company were corrected. On the basis of the findings of this review, modify Part 135 inspection procedures to ensure that such issues, including maintenance record-keeping and practices, are identified and corrected before accidents occur.
TO THE FEDERAL AVIATION ADMINISTRATION: Develop specific criteria regarding the number of accidents and/or incidents that would cause an increase in oversight of an operator.
TO THE FEDERAL AVIATION ADMINISTRATION: Review and revise the process through which the transfer of a Part 135 air carriers operating certificate from one Flight Standards District Office to another is granted to ensure the adequate oversight of such carriers. Further, ensure that, before granting an operators request to transfer an operating certificate, appropriate geographic oversight is in place at the new office and that the justification for the transfer has been adequately documented and reviewed.
NTSB analysis
from the final reportThe Safety Board's full report is available at http://www.ntsb.gov/publictn/publictn.htm. The Aircraft Accident Report number is NTSB/AAR-04/03. On July 13, 2003, about 1530 eastern daylight time, a Cessna 402C, N314AB, registered to Tropical International Airlines Inc., and operated by Air Sunshine Inc., as Air Sunshine flight 527, was ditched in the Atlantic Ocean about 7.35 nautical miles west-northwest of Treasure Cay Airport (MYAT), Treasure Cay, Great Abaco Island, Bahamas, after the in-flight failure of the right engine. Two of the nine passengers sustained no injuries, five passengers and the pilot sustained minor injuries, and one adult and one child passenger died after they evacuated the airplane. The airplane sustained substantial damage. The airplane was being operated under the provisions 14 Code of Federal Regulations (CFR) Part 135 as a scheduled international passenger commuter flight from Ft. Lauderdale, Florida, to MYAT. Visual meteorological conditions prevailed for the flight, which operated on a visual flight rules flight plan.