Kaunakakai Airport
Aircraft Accident/Incident Report

Kaunakakai, Hawaii 96748
Wednesday, May 10, 2000 20:31 HST

NTSB Narrative Summary Released at Completion of Accident

The airplane collided with mountainous terrain after the flight crew terminated the instrument approach and proceeded visually at night. The flight crew failed to brief or review the instrument approach procedure prior to takeoff and exhibited various cognitive task deficiencies during the approach. These cognitive task deficiencies included selection of the wrong frequency for pilot controlled lighting, concluding that the airport was obscured by clouds despite weather information to the contrary, stating inaccurate information regarding instrument approach headings and descent altitudes, and descending below appropriate altitudes during the approach. This resulted in the crew's lack of awareness regarding terrain in the approach path. Pilots approaching a runway over a dark featureless terrain may experience an illusion that the airplane is at a higher altitude that it actually is. In response to this illusion, referred to as the featureless terrain illusion or black hole phenomenon, a pilot may fly a lower than normal approach potentially compromising terrain clearance requirements. The dark visual scene on the approach path and the absence of a visual glideslope indicator were conducive to producing a false perception that the airplane was at a higher altitude. A ground proximity warning device may have alerted the crew prior to impact. However, the amount of advanced warning that may have been provided by such a device was not determined. Although the flight crew's performance was consistent with fatigue-related impairment, based on available information, the Safety Board staff was unable to determine to what extent the cognitive task deficiencies exhibited by the flight crew were attributable to fatigue and decreased alertness.

NTSB Probable Cause Narrative

Inadequate crew coordination led to the captain's decision to discontinue the instrument approach procedure and initiate a maneuvering descent solely by visual references at night in an area of mountainous terrain. The crew failed to review the instrument approach procedure and the copilot failed to provide accurate information regarding terrain clearance and let down procedures during the instrument approach.

Event Information

Type of Event Accident
Event Date 5/10/2000
Event Day of the Week Wednesday
Time of Event 2031
Event Time Zone Hawaii Standard Time
Event City KAUNAKAKAI
Event State HAWAII
Event Country --
Zipcode of the event site 96748
Event Date Year 2000
Event Date Month 5
MidAir Collision Indicator No
On Ground Collision occurred ? No
Event Location Latitude 210738N
Event Location Longitude 1570859W
Event Location Airport KAUNAKAKAI
Event Location Nearest Airport ID MKK
Indicates whether the acc/inc occurred off or on an airport Off Airport/Airstrip
Distance from airport in statute miles 3.3
Degrees magnetic from airport 232
Airport Elevation 454
Weather Briefing Completeness Unknown
Investigator's weather source Weather Observation Facility
Time of the weather observation 1954 Hawaii Standard Time
Direction of event from weather observation facility (degrees) 52
Weather Observation Facility ID PHMK
Elevation of weather observation facility 454
Distance of event from weather observation facility (units?) 3
Time Zone of the weather observation HST
Lighting Conditions Night
Lowest Ceiling Height --
Lowest Non-Ceiling Height --
Sky/Lowest/Cloud Conditions Clear
Sky Condition for Lowest Ceiling None
Visibility Runway Visual Range (Feet) 0
Visibility Runway Visual Value (Statute Miles) 0
Visibility (Statute Miles) 10
Air Temperature at event time (in degrees celsius) 23
Dew Point at event time (in degress fahrenheit) 18
Wind Direction (degrees magnetic) 60
Variable Wind Indicator Wind direction could be determined
Wind Speed (knots) 8
Wind Velocity Indicator --
Wind Gust Indicator Not Gusting
Wind Gust (knots) --
Altimeter Setting at event time (in. Hg) --
Density Altitude (feet) --
Intensity of Precipitation --
METAR weather report --
Event Highest Injury Fatal
On Ground, Fatal Injuries 0
On Ground, Minor Injuries 0
On Ground, Serious Injuries 0
Injury Total Fatal 6
Injury Total Minor --
Injury Total None --
Injury Total Serious --
Injury Total All 6
Investigating Agency NTSB
NTSB Docket Number (internal use) 12078
NTSB Notification Source FAA
NTSB Notification Date May 11 2000 12:00AM
NTSB Notification Time 130
Fiche Number and/or location -used to find docket information DMS
Date of most recent change to record Dec 18 2002 11:28AM
User who most recently changed record NTSB\GIUV
Basic weather conditions Visual Meteorological Cond
FAA District Office --

Aircraft Involved

Aircraft #1

Aircraft Registration Number N241H
NTSB Number LAX00FA191
Missing Aircraft Indicator N
Federal Aviation Reg. Part Part 91: General Aviation
Type of Flight Plan filed IFR
Flight plan Was Activated? Yes
Damage Destroyed
Aircraft Fire Ground
Aircraft Explosion Ground
Aircraft Manufacturer's Full Name Rockwell
Aircraft Model NA-265-65
Aircraft Series Identifier NA 265-65
Aircraft Serial Number 464-5
Certified Max Gross Weight 24000
Aircraft Category Airplane
Aircraft Registration Class U.S. Registered/U.S. Soil
Aircraft is a homebuilt? No
Flight Crew Seats --
Cabin Crew Seats --
Passenger Seats --
Total number of seats on the aircraft 10
Number of Engines 2
Fixed gear or retractable gear Retractable
Aircraft, Type of Last Inspection Continuous Airworthiness
Date of Last Inspection Apr 1 2001 12:00AM
Airframe hours since last inspection 6
Airframe Hours 7934
ELT Installed No
ELT Activated No
ELT Aided Location of Event Site No
ELT Type --
Aircraft Owner Name PRICE AIRCRAFT COMPANY, LLC
Aircraft Owner Street Address 11906 HANGAR CT
Aircraft Owner City BROOMFIELD
Aircraft Owner State CO
Aircraft Owner Country USA
Aircraft Owner Zipcode 80021
Operator is an individual? No
Operator Name --
Operator Same as Owner? Yes
Operator Is Doing Business As --
Operator Address Same as Owner? Yes
Operator Street Address --
Operator City --
Operator State --
Operator Country --
Operator Zip code --
Operator Code --
Owner has at least one certificate None
Other Operator of large aircraft? --
Certified for Part 133 or 137 Operation --
Operator Certificate Number --
Indicates whether an air carrier operation was scheduled or not --
Indicates Domestic or International Flight --
Operator carrying Pax/Cargo/Mail --
Type of Flying (Per_Bus / Primary) Executive/Corporate
Second Pilot on Board Yes
Departure Point Same as Event No
Departure Airport Code OGG
Departure City MAUI
Departure State HI
Departure Country USA
Departure Time 2008
Departure Time Zone HST
Destination Same as Local Flt crash at destination city
Destination Airport Code MKK
Destination City KAUNAKAKAI
Destination State HI
Destination Country --
Specific Phase of Flight --
Report sent to ICAO? --
Evacuation occurred No
Date of most recent change to record Jun 26 2002 11:04AM
User who most recently changed record COOS
Since inspection or accident Last Inspection
Event Location Runway Number and Location 05
Runway Length 4494
Runway Width 100
Sight Seeing flight No
Air Medical Flight No
Medical Flight --