NTSB concludes investigative hearing on deadly Togiak plane crash
The investigative hearing held at the Captain Cook Hotel Thursday is the first of its kind in Alaska since 1989, following the Exxon-Valdez oil spill and the first field hearing the National Transportation Safety Board has held outside of Washington D.C. in 18 years.
The hearing centered around Hageland Aviation Flight 3153. The Cessna 208 was headed to Togiak from Quinhagak on Oct. 2 when it crashed into steep mountainous terrain about 12 miles northwest of Togiak. Both pilots, 43-year-old Homer resident Timothy Cline and 29-year-old Drew Welty of Anchorage died, as well as 49-year-old passenger Louie John from Manokotak.
The NTSB's preliminary report on the wreck said based on tracking data, investigators believe the plane was flying at an altitude of 1,043 feet. An examination of the crash site found that it had struck a 2,300-foot ridgeline before wreckage descended along the slope.
The crash is believed to be one of 36 "Controlled Flight Into Terrain" (CFIT) crashes that have claimed 40 lives in Alaska in the last nine years.
"We also believe that holding the hearing in Alaska will help increase awareness within the Alaskan aviation community of the issues surrounding controlled flight into terrain accidents and flight into instrument meteorological conditions," said board member Earl Weener, ahead of the hearing.
Proceedings began with a room packed to full capacity. After an opening statement from Weener, who served as chairman of the hearing, three panels of witnesses testified. The first focused on controlled flight into terrain avoidance, the second looked into Hageland's operational control and the third topic was safety management and oversight in Alaska flight operations.
A lead Hageland pilot testified saying it's not uncommon for pilots to manually inhibit the plane's Terrain Awareness Warning System (TAWS) in flight. The TAWS is supposed to help pilots avoid CFIT crashes by alerting them if they're too close to terrain, but the sensors are activated below 700 feet, and pilots regularly fly as low as 500 feet. In order to avoid nuisance warnings, a pilot may inhibit the TAWS, but un-inhibiting the system is part of written check lists for both taking off and landing.
According to a panelist representing Honeywell, flight simulations produce an estimate that if the TAWS was activated on flight 3153, the pilot would have had 46 to 36 seconds before impact.
A theme among witness testimony was concern that Alaska lacks the infrastructure needed in many rural areas for pilots to operate according to Instrument Flight Rules, but pilots flying with visual flight rules are forced to fly below the cloud ceiling and can run into trouble quickly with changing weather patterns.
Some panelists praised a changing culture among bush pilots, saying they're more likely now, to turn around in dangerous conditions, instead of taking risks to deliver cargo, but other's believe there is still work to be done.
"It is an attitude of, you know, 'We push the airplane to get where we're going.' I think that's leftover from decades and decades and decades, and we haven't truly gotten to the point where folks understand, the rules are there for a reason, and if we stick to them, we can drive this problem down. But it's gotta be a desire. The procedures are there, these airplanes are beautiful, they're very well maintained, but at the end of the day, if a pilot makes a choice, that's a conscious choice," said Deke Abbott, with the Federal Aviation Administration.
Hageland has participated in a safety program operated by the Medallion Foundation, a non-profit aviation safety group formed in 2001, but the Alaska Air Carrier Association. The carrier has achieved "shield" status.
A panel including representatives from the Medallion Foundation spoke highly of the program, pointing to downward trends of CFIT crashes throughout the state, but wasn't able to provide data attributing the improvement specifically to the Medallion Foundation, apart from several other advances made at the same time.
The NTSB characterized the hearing as a "fact finding mission," saying they were not here to assign blame to anyone. The analysis and discussion regarding the Togiak crash will be reserved for a board meeting in Washington D.C., and the final report and recommendations could be months away.