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10 Years After Fatal Plane Crash, Family Members Continue To Search For Answers
 
 
December 21, 2015 - At approximately 11:40 PM on Thursday, April 20, 2006, a Cessna U206G aircraft, registration N120HS, crashed while on a precision approach for runway 35 at the Monroe County Airport (BMG), near Bloomington, Indiana killing all five onboard.

The pilot and passengers were identified as students attending Indiana University, the pilot was Georgina Joshi and the passengers were Garth Eppley, Chris Carducci, Robert Samels and Zachary Novak. The five students, best of friends, were accomplished musical performers returning to their graduate program at Indiana University from a rehearsal in Lafayette, Ind.

The parents of these students are searching for answers that caused this plane crash. For five families this year marks the 10th holiday season without loved ones after a tragic 2006 airplane crash without the answers needed for closure.  They have spent the better part of the last decade searching for the truth.
 
“It was the most heartbreaking day of my life when we found out,” said Yatish Joshi, father of Georgina. “To make matters worse, the ensuing investigation by the National Transportation Safety Board (NTSB) did not leave us with peace of mind.”

The NTSB issued its Probable Cause Report more than a year later (445 days), ruling the cause of the crash as ‘pilot error’. The report stated the pilot's continued descent below decision height and not maintaining adequate altitude/clearance from the trees while on approach was the probable cause of the crash. Other factors contributed to the crash included night lighting conditions, and the mist.

Mr. Joshi stated, "The report left many questions unanswered." As a result, Joshi sought out technical experts who performed their own investigation, recreated the accident flight, interviewed witnesses, and performed acoustic testing to determine the accident’s cause. The experts realized that many of the witnesses who heard or saw a plane shortly before the accident were describing a different plane than Georgina’s.
 

 

Joshi and his experts concluded that the Probable Cause Report was flawed and that the more likely cause(s) of the accident included: (a) a second plane flying below FAA radar attempting to land on a perpendicular runway as Georgina was approaching the airport; and (b) flaws in the airport air traffic control system for night landings.

Joshi submitted his evidence to the NTSB in a Petition for Reconsideration asking the NTSB to reexamine its probable cause determination. In its response, the NTSB dismissed this evidence in part because “none of the [911] callers reported hearing more than one airplane during the time surrounding the accident.” The NTSB wrote, "After review of the evidence, the petition for reconsideration of the NTSB’s probable cause in connection with the aircraft accident involving a Cessna 206, N120HS, on April 20, 2006, near Bloomington, Indiana, is denied in its entirety."

In 2008, Joshi petitioned the D.C. Circuit Court for review of the NTSB’s denial of his Petition. In court Joshi argued that the NTSB’s investigation and analysis was fundamentally flawed because they refused to “consider relevant factors”, those factors being what Joshi and his investigators had learned when they conducted their own investigation.

The D.C. Circuit Court dismissed Joshi’s petition for lack of jurisdiction. The court said, in essence it didn't have the jurisdiction to make the NTSB change its report findings and is not subject to judicial review (National Transportation Safety Board accident reports are not subject to judicial review).

Joshi appealed his case before the U.S. Court of Appeals for the District Of Columbia on June 19, 2015 and the court sided with the lower court and dismissed the case. Joshi has now filed his case with the United States Supreme Court. He is asking the court to decide whether the lower courts have the jurisdiction to review the NTSB findings.

After reviewing the NTSB report of the crash, it appears the pilot had some reservations in taking off and flying in bad weather (IFR conditions), had minimum IFR flight hours for flight conditions, appeared to be distracted, did not perform a proper preflight and following air traffic controller instructions during the precision approach. However, if Joshi's findings are correct it will be interesting to see if the court addresses this issue. Below is the NTSB report of the accident and radio communications with the pilot and ATC just prior to the crash.

HISTORY OF FLIGHT   (NTSB Identification: CHI06FA117)

On April 20, 2006, about 2345 eastern daylight time, a Cessna U206G, N120HS, piloted by an instrument rated private pilot, was destroyed on impact with trees and terrain while on approach to runway 35 at the Monroe County Airport (BMG), near Bloomington, Indiana. The personal flight was operating under the provisions of 14 Code of Federal Regulations Part 91. Night instrument meteorological conditions prevailed at the time of the accident. An instrument flight rules (IFR) flight plan was on file and was activated. The pilot and four passengers sustained fatal injuries. The flight originated from the Purdue University Airport (LAF), near Lafayette, Indiana, about 2245.

The person representing N120HS contacted the Terre Haute, Indiana federal contract facility automated flight service station (AFSS) to get a weather briefing about 2213. The AFSS briefer at position "PF-3" gave the following brief, in part, to the pilot:

2213:25 PF-3 terre haute flight service

2213:27 N120HS hi i'd like to get a weather briefing

2213:29 PF-3 yes ma'am

2213:30 N120HS um lafayette lima alpha foxtrot and bloomington bravo mike golf and any interesting weather that might be between them

2213:39 PF-3 okay uh what's the aircraft call sign you're using

2213:42 N120HS november one two zero hotel sierra

2213:45 PF-3 and what time are you leaving lafayette

2213:47 N120HS we will probably be leaving in about twenty minutes to half an hour

2213:58 PF-3 okay and is this a v f r flight or i f r

2214:02 N120HS for v f r

2214:03 PF-3 v f r only

2214:05 N120HS *(ho ho) wait i'm sorry go ahead

2214:08 PF-3 is that v f r only

2214:10 N120HS yes yes sir well depending on what the weather's like

2214:13 PF-3 okay well we do have an airmet for i f r for the southern portion of indiana now

0214:18 N120HS okay

0214:19 PF-3 and they're saying that that may continue the rest of the evening into early tomorrow morning and

2214:23 N120HS okay

2214:23 PF-3 looking at the bloomington weather they do have i f r ceilings eight hundred broken right now with visibility eight miles

2214:30 N120HS *(okay)

2214:30 PF-3 so i wouldn't recommend v f r

2214:32 N120HS okay well

2214:33 PF-3 uh

2214:33 N120HS definitely not i'm sorry i got i looked at the *(tafs they) didn't predict that okay can i file an i f r flight plan with you

2214:39 PF-3 sure would you like me to continue with the rest of the weather and and all that

2214:42 N120HS yeah that would that would be great

2214:44 PF-3 okay uh that's the only airmet uh going down that way for you uh looks like a low pressure system we've got uh one in western kentucky tennessee another one's up around the chicago area *(it's a) stationary front running from that one across northern indiana and ohio and then uh high pressure over to our east precip uh nothing really along that route there is some in southeastern indiana but it shouldn't affect your flight at all

2215:08 N120HS *(okay)

2215:08 PF-3 at lafayette uh the winds are two eighty at four ten miles skies clear below twelve thousand sixteen and seven and two nine nine one that's an automated report en route looking at a few clouds at thirteen thousand with niner miles and then again in the bloomington area winds two forty at three eight miles ceiling eight hundred broken seventeen and sixteen and two nine nine four that's also an automated report at bloomington and i don't see any uh pilot reports right now along that route for you the forecast lafayette was saying the rest of the evening a few clouds at six thousand winds three ten at five en route uh calling for *(uh) it looks like three thousand scattered six to ten thousand broken to overcast they were saying occasional showers in central indiana til zero three hundred though there's nothing really showing except for a little northeast of indy and then uh for the bloomington area uh six hundred broken five thousand overcast visibility better than six winds one sixty at four now they were saying within an hour you might see six hundred scattered five in mist around bloomington four hun four thousand broken and winds one fifty at four but the airmet was calling for i f r to continue the rest of the night into early tomorrow

2216:26 N120HS boy am i glad i called you wow

2216:27 PF-3 and

2216:28 N120HS okay

2216:28 PF-3 and then winds aloft uh would you like three and six for those

2216:32 N120HS um just three please

2216:33 PF-3 three thousand you're looking at light and variable winds at three thousand

2216:37 N120HS okay great

2216:38 PF-3 and notams uh lafayette r c o one two two three five is out of service

2216:44 PF-3 and uh it says the class d surface area and uh tower only available through zero one hundred daily down at Bloomington uh showing tower and class d surface area available through zero one thirty daily and three five pilot controlled lighting is out of service at bloomington indiana and otherwise en route i don't see anything else en route for you notam d wise as far as t f rs no unpublished t f rs along that route at this time

2217:15 N120HS *(great)

2217:15 PF-3 *(we'd) appreciate uh pilot reports flight watch is shut down for the evening but any any flight service frequencies along the route for you would you like to go ahead and file then

2217:24 N120HS yes sir

2217:25 PF-3 okay i'm ready to copy

2217:26 N120HS (unintelligible) november one two zero hotel sierra it's a cessna two oh six slash alpha airspeed a hundred and a hundred and thirty knots flying at three
thousand feet departing lafayette lima alpha foxtrot lafayette direct bloomington indiana bravo mike golf five on board three hours of fuel the aircraft is based in south bend pilots name ... and aircraft is red white and blue

2218:12 PF-3 (unintelligible) uh what's your time en route from lafayette to bloomington

2218:15 N120HS time on route forty minutes

2218:19 PF-3 and you say you're leaving in just a few minutes i put that out for zero two thirty that's on the half hour

2218:23 N120HS *(perfect)

The transcript of the weather briefing showed that the pilot did not give an alternate airport to the briefer when the flight plan was filed. The briefer did not ask for an alternate airport and was not required to ask for one.

About 2319, the pilot checked on with the Air Route Traffic Control Center controller working the Shelbyville, Indiana, sector (SHB R). The transcript of their transmissions, in part, stated:

2319:57 N120HS indy center november one two zero hotel sierra is with you at five thousand

2320:01 SHB R november one two zero hotel sierra indianapolis center roger how do you
hear center

2320:04 N120HS ah loud and clear

2320:05 SHB R okay and ah what type of approach are you going to shoot into bloomington this morning or this evening

2320:11 N120HS we'd like to go for a runway three five six ah i l s

2320:14 SHB R i l s three five okay you can expect that ah one two zero hotel sierra do you have the ah asos weather

2320:19 N120HS yes sir

2320:20 SHB R all right

2323:11 SHB R cessna one two zero hotel sierra you're one two miles north of bloomington cross bloomington at or above two thousand six hundred cleared for the i l s runway three five approach report procedure turn inbound

2323:23 N120HS oh any way we can have vectors to the---ah final course

2323:26 SHB R not a problem at all ma'am what's your heading

2323:30 N120HS one seven zero

2323:32 SHB R okay turn ah right heading of ah one nine zero it'll be a vector for a left down wind entry for i l s three five straight in

2323:39 N120HS one niner zero for a---right down wind entry ah for three five zero hotel sierra

2323:43 SHB R yes ma'am and maintain five thousand

2323:46 N120HS maintain five thousand

2328:35 SHB R cessna one two zero hotel turn left heading one eight zero

2328:39 N120HS left heading one eight zero

...

2333:03 SHB R cessna one two zero hotel sierra descend at pilot's discretion maintain four thousand

2333:08 N120HS descend and maintain four thousand for zero hotel sierra

2333:13 SHB R i am going to take you about two miles outside of claye if that's okay with you ma'am

2333: 18 N120HS that's great

2333:50 SHB R cessna one two zero hotel sierra turn left heading zero eight zero

2333:53 N120HS left heading zero eight zero

2334:36 SHB R cessna one two zero hotel sierra three and a half miles south of claye turn left heading zero two zero maintain two thousand six hundred until established on the localizer you're cleared straight in i l s runway three five approach

2334:48 N120HS turn left heading zero two zero---cleared for the approach maintain twenty six hundred til ah established zero hotel sierra

2336:15 SHB R cessna one two zero hotel sierra see you joining up on the localizer now radar service is terminated change to advisory tower frequency of one two eight point zero two is approved---and i'll need you to cancel---with ah terre haute tower on that frequency one two eight point zero two they monitor that frequency and they'll
relay for ya

2336:35 N120HS radar service terminated and cancel with terre haute on one two eight point zero two thanks (unintelligible) zero hotel sierra

2336:40 SHB R and you can change to that frequency now you have a good night

2336:43 N120HS thanks

A Continuous Data Recording (CDR) airplane radar track data file was obtained from the Federal Aviation Administration (FAA) in reference to the accident flight. The airplane's radar returns along with their respective altitudes and times were plotted. The plotted data was consistent with an airplane that was being vectored for an instrument landing system (ILS) approach to runway (rwy) 35. The plot showed the airplane at about 5,000 feet on a downwind. At 2334:30, the return showed the airplane was about 4,500 feet on base about ten miles from the approach end of runway 35. The airplane's return at 2337 was right of and approaching the outer marker CLAYE at an altitude of 3,300 feet. About 2337, the pilot made an advisory radio call on the Hulman Approach control frequency for BMG (128.025) that the flight was six miles south of BMG and inbound for runway 35. The last plotted return showed the airplane at 2,000 feet at 2338:34 about two and a half miles from the approach end of runway 35. About 2343, the controller from the Terre Haute International Airport-Hulman Field air traffic control tower, near Terre Haute, Indiana, who was working the approach frequency, advised the flight that the BMG common traffic advisory frequency (CTAF) was 120.77 and the flight responded with "Thank you sir." No further communication was recorded with the accident flight. That plotted chart is appended to the docket material associated with this case.

About 2345, the Monroe County Sheriff responded to telephone calls of a possible airplane crash. About 0400, the wreckage was located in a wooded area about one-half mile from the approach end of runway 35. Witnesses in the area stated that they were awakened by a low flying aircraft. A witness said that the airplane noise was like a roar. Another described it as an engine acceleration. A thud was heard and no more engine sounds were heard.


PERSONNEL INFORMATION

The pilot held a private pilot certificate with single-engine land, multiengine land, and instrument airplane ratings. The airplane operator reported that the pilot had completed a flight review or equivalent on July 3, 2005. It was further reported that the pilot had accumulated 379.1 hours of total flight time, 24.5 hours of actual instrument time, 51.1 hours of simulated instrument time, 30.4 hours of total flight time in the previous 90 days, 18.0 hours of total flight time in the previous 30 days, and 1.8 hours of total flight time in the previous 24 hours. She held a FAA third-class medical certificate issued on August 19, 2003, with a limitation for corrective lenses.


AIRCRAFT INFORMATION

N120HS, a Cessna U206G, Stationair 6, serial number U20604728, was a six-place, single engine, high-wing, all-metal airplane of semimonocoque construction. The wings were externally braced and each wing contained a standard integral 46-gallon fuel tank. The airplane was powered by a six-cylinder, horizontally opposed, air cooled, fuel injected, marked as a Continental IO-520-F (17) engine, with serial number 812264-R. The engine was rated at 300 horsepower for five minutes and 285 horsepower continuously. Maintenance records showed that the airplane's propeller was a three-bladed McCauley D3A34C404B model, hub serial number 785309. The airplane was issued a standard airworthiness certificate and was certified for normal category operations.

Maintenance records show that the last annual inspection was performed on June 7, 2005, and that the airplane had accumulated 2,125.7 hours at the time of that inspection. An entry in the records showed that the static system was inspected in accordance with Part 91.411 and 91.413 requirements on May 19, 2005.

The airplane was equipped with a J.P. Instruments Engine Data Management (EDM) 700 system. According to manufacturer's data, the EDM will monitor up to twenty-four critical parameters in your engine, four times a second, with a linearized thermocouple accuracy of better than 0.1 percent or 2 degrees F, has a user selectable index rate, fast response probes, non-volatile long term memory, records and stores data up to 30 hours, and has post-flight data retrieval capabilities.


METEOROLOGICAL INFORMATION

At 2340, the recorded weather at BMG was: Wind 230 degrees at 5 knots; visibility 1 statute mile; present weather mist; sky condition overcast 100 feet; temperature 17 degrees C; dew point 16 degrees C; altimeter 29.94 inches of mercury.


AIDS TO NAVIGATION

There were eight non-precision instrument approaches and one precision approach available at the airport. The published inbound course for BMG's ILS RWY 35 approach was 354 degrees magnetic, with the published decision height (DH) of 1,045 feet msl. The crossing altitude for the final approach fix (CLAYE) was 2,533 feet msl. The distance between CLAYE and the missed approach point was 5.1 nautical miles (nm). The airport elevation was 846 feet msl. The published weather minimums for the ILS RWY 35 approach were a 200-foot ceiling and one-half mile visibility for category A, B, C, and D aircraft. On April 21, 2006 the FAA conducted a post aircraft accident technical inspection and found the ILS system was operating normally.


AIRPORT INFORMATION

BMG had two asphalt-surfaced runways, 17/35 and 6/24. Runway 17/35 was 6,500 feet long and 150 feet wide. Runway 35 was equipped with a medium intensity approach lighting system with runway alignment indicator lights (MALSR) and high intensity runway lights (HIRL). Runways 6,17, and 24 were equipped with visual approach slope indicators (VASI) located on the left side of their respective runways. The airport was serviced by an Air Traffic Control tower. The tower was attended from 0630 - 2130 local. After hour local traffic communications were accomplished via the published airport CTAF 120.775 megahertz (MHz). The tower did not record the CTAF transmissions made after hours. Indianapolis Approach provided approach/departure control services for the airport. The pilot controlled lighting function of the approach lights was not operative. The approach lights were turned on before the tower was closed.


WRECKAGE AND IMPACT INFORMATION

The airplane came to rest inverted on an approximate 180 degree magnetic heading. Broken and linearly separated tree branches were observed. A tree on a 230 degree magnetic heading from the wreckage and about 6 feet from the wreckage contained embedded aluminum colored metal consistent with the nose wheel rim. The engine was found about three feet below the surface. The propeller hub remained attached to the engine crankshaft propeller flange. The propeller blades separated from their hub. One blade exhibited forward bending and leading edge deformation. All of the blades exhibited chordwise abrasion. The wings were detached from the fuselage. The outboard section of the left wing had separated from the inboard section. The rudder was detached from the empennage and its control cables remained attached.

An on-scene examination of the wreckage was conducted. Flight control cables were traced. All breaks in cables were consistent with overload. Flight control continuity was established from the cabin area to all flight control surfaces. The engine's control cables were traced from the cabin to the engine and engine control continuity was established. A blue liquid consistent with 100 low lead aviation gasoline was observed in the left tank.

The wreckage was relocated for a detailed examination and wreckage layout. The right engine driven vacuum pump was separated from the accessory case. The pump's drive coupler was not recovered. The right vacuum pump was rotated by hand and an inspection revealed that its rotor and vanes were intact. The left pump was attached to the accessory case. The pump was crushed and an inspection revealed its rotor was fragmented. The sparkplugs were removed and no anomalies were detected. The engine was rotated by hand and a thumb compression was observed at all cylinders. The right magneto was crushed, deformed, and did not produce any spark when rotated by hand. The left magneto produced spark at all leads when rotated by hand. The engine driven fuel pump's coupler was intact. A blue liquid consistent with 100 low lead aviation gasoline was found in the fuel line from the engine driven fuel pump to the manifold valve. The attitude indicator and horizontal situation indicator rotors exhibited rotational scoring. The rotor housings exhibited witness marks consistent with contact with their rotors. The altimeter's Kollsman window indicated 29.91. The airplane's engine monitor was crushed. The on-scene investigation did not reveal any pre-impact anomalies.


MEDICAL AND PATHOLOGICAL INFORMATION

An autopsy was performed on the pilot by the Monroe County Coroner's Office on April 22, 2006. The FAA Civil Aeromedical Institute prepared a Final Forensic Toxicology Accident Report. The report was negative for the tests performed.


TESTS AND RESEARCH

The engine monitor was examined at its manufacturer. The unit and its circuit board were crushed. The data memory chip was removed from its circuit board and installed on a serviceable circuit board. The accident flight's data was downloaded. The downloaded data was graphed. The end of the graph showed a reduction in fuel flow consistent with a descent followed by an increase in fuel flow consistent with a full power setting and the data stopped at that point. The graph of the engine monitor's data is appended to the docket material associated with this investigation.


ADDITIONAL DATA/INFORMATION

Federal Aviation Regulation Part 91.169 IFR flight plan: information required, in part, stated:

(a) Information required. Unless otherwise authorized by ATC, each person filing an IFR flight plan shall include in it the following information:
(1) Information required under Sec. 91.153(a).
(2) An alternate airport, except as provided in paragraph (b) of this section.
(b) Exceptions to applicability of paragraph (a)(2) of this section.
Paragraph (a)(2) of this section does not apply if part 97 of this chapter prescribes a standard instrument approach procedure for the first airport of intended landing and, for at least 1 hour before and 1 hour after the estimated time of arrival, the weather reports or forecasts, or any combination of them indicate--
(1) The ceiling will be at least 2,000 feet above the airport elevation; and
(2) The visibility will be at least 3 statute miles.
(c) IFR alternate airport weather minimums. Unless otherwise authorized by the Administrator, no person may include an alternate airport in an IFR flight plan unless current weather forecasts indicate that, at the estimated time of arrival at the alternate airport, the ceiling and visibility at that airport will be at or above the following alternate airport weather minimums:
(1) If an instrument approach procedure has been published in part 97 of this chapter for that airport, the alternate airport minimums specified in that procedure or, if none are so specified, the following minimums:
(i) Precision approach procedure: Ceiling 600 feet and visibility 2 statute miles.
(ii) Nonprecision approach procedure: Ceiling 800 feet and visibility 2 statute miles.
(2) If no instrument approach procedure has been published in part 97 of this chapter for that airport, the ceiling and visibility minimums are those allowing descent from the MEA, approach, and landing under basic VFR.

The operator's safety recommendation, in part stated:

Even if a tower is closed, as it was in this case, there should be an automatic recording of all pilot transmissions on the common frequency. Such a recording would make available vital information in the case of a fatal accident [for example] did the pilot make a distress call? Does the pilot's voice indicate that they are under duress? Was it the pilot's intention to do a missed approach? Was there anything that may have interfered with the pilot's conduct of the flight? Did the pilot make any announcement indicating what problem they were facing? Was there any other aircraft in the immediate vicinity? The parties to the investigation included the FAA, Cessna Aircraft Company, and Teledyne Continental Motors.

Joshi states despite the numerous attempts to locate the pilot of this other plane the families’ search continues. The family's of these students are "appealing to the pilot of the second plane to come forward and help us discover what happened that evening,” said Joshi. “During this time of the year, please look into your heart and help the families of those who were lost uncover the truth. Your insights will help to put our hearts and minds to rest, and hopefully prevent similar accidents in the future.”

Earlier this year, Joshi, a prominent business and community leader in South Bend, Ind., founded the movement Safe Skies For All (SSFA). SSFA’s mission is to improve procedures in the investigations of general aviation accidents and to encourage the NTSB, the government agency responsible for these investigations to be accountable for the thoroughness of its investigations, leading to accurate findings, and to ensure recommendations are made so that safety is continually improved.

“The five friends will live on through their amazing accomplishments and the change we hope to effect,” continued Joshi. “Through this movement, we want to ensure other families never have to endure a similar tragedy.”

 
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