NTSB Identification: NYC99LA151.
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Accident occurred Thursday, July 01, 1999 in HYANNIS, MA
Probable Cause Approval Date: 08/31/2000
Aircraft: Learjet 60, registration: N219FX
Injuries: 4 Uninjured.
NTSB investigators may not have traveled in support of this investigation and used data provided by various sources to prepare this aircraft accident report.
The pilot in command (PIC) and first officer (FO) were on a return flight. While being vectored for the Runway 24 ILS approach, as the flaps were selected to 20 degrees and the landing gear was extended, the crew noted that the left and right amber HYDR PRESS lights began to illuminate. When the lights began to flash with more regularity, the crew discussed whether to continue or divert to another airport. The captain decided to proceed to the destination airport, with a 5,425-foot runway. After touchdown, the captain applied normal braking, but the brakes did not respond. Additionally, the crew attempted to use the reverse thrusters, which also did not respond. The captain then attempted to apply emergency braking, but the emergency brake lever would not move. The captain then requested the FO to apply emergency braking. The captain then declared he was aborting the landing, immediately after which, the FO successfully engaged the emergency brakes. The airplane proceeded off the departure end of the wet runway, struck a localizer antenna, and came to rest in a fence. Examination of the airplane revealed that the left main landing gear actuator extend hose leaked hydraulic fluid and was not torqued to specifications. According to a work item sheet, a corrective action was entered on the sheet on June 14, 'Replaced main gear actuator extend pressure hoses. Replaced uplock main gear hoses with new [Teflon] hoses.' The Airplane Flight Manual (AFM) stated that in the event of a hydraulic pressure loss, 'With no flaps, no spoilers, no thrust reversers, and no anti-skid, the landing distance will be greatly increased.' Multiply the Actual Landing Distance for Anti-Skid ON shown in Section V by a factor of 3.' The calculated landing distance, uncorrected, was 3,690 feet. The factor of three required an 11,000-foot runway. No abnormal or emergency quick reference checklists were found in the cockpit, and there was no mention of abnormal or emergency procedures in the cockpit voice recorder (CVR) transcript. An AFM, which contained an abnormal checklist and procedures section, was found in a side pocket next to the captain. Examination of company personnel files revealed that the captain had been issued an 'Employee Warning Notice,' in August 1998, for failure to follow instructions and rudeness to employees or customers. The notice also stated that numerous FO's reported that the pilot was rude and discourteous when he addressed them, and that he was not promoting good cockpit resource management (CRM). The captain had not received company CRM training. The airplane was part of a fractional ownership program and was operated under 14 CFR Part 91.
The National Transportation Safety Board determines the probable cause(s) of this accident to be: The flightcrew's inadequate coordination and their failure to utilize checklists. Also causal was the captain's improper decision to continue the approach to a runway with insufficient length. A factor in the accident was the improper maintenance. Full narrative available
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