Investigation Summary
The accident flight was an on-demand charter carrying 17 passengers from Atlantic City to Wilkes-Barre. Before the first leg of the day from Farmingdale to Atlantic City, the crew ordered 90 gallons of fuel. However, they failed to specify that this amount should be added to both the left and right tanks. Consequently, only 90 gallons (600 pounds) were added in total, rather than the 180 gallons (1,200 pounds) the crew likely intended. The pilots recorded 2,400 pounds of fuel on their manifest, while the actual amount was approximately 1,600 pounds. During the approach to Wilkes-Barre, the crew executed a missed approach due to low visibility. During the second approach, the right engine failed due to fuel exhaustion. Shortly after, the left engine began to fail due to fuel starvation. Although the crew briefly reported regaining the left engine, both engines ultimately stopped. The aircraft impacted trees and terrain at a steep angle and extreme bank, approximately 11 miles south of the airport.
Final Conclusions
The National Transportation Safety Board (NTSB) determined the probable cause was the flight crew's failure to ensure an adequate fuel supply, leading to fuel exhaustion in the right engine and starvation in the left engine. Contributing factors included the crew's failure to monitor the fuel state and their failure to maintain directional control after the initial engine stoppage. The final report (NTSB/AAB-02-05) was published on August 29, 2002.
Photographic Evidence (1)
Video Analysis
No video analysis linked for this case file yet.
Airframe & Maintenance
Crew Experience
Captain
Age 34. Pilot monitoring on the accident leg. Also a full-time pilot for Atlantic Coast Airlines.
First Officer
Age 38. Pilot flying on the accident leg. Joined Executive Airlines in November 1998.
Systems & Failure Modes
Fuel Annunciator System
Low fuel quantity lights are designed to warn the crew of critical fuel levels; investigators noted these can be easily overlooked in high-workload environments.
Cockpit Voice Recorder (CVR)
The CVR failed to record the flight because it was not receiving power, a condition that existed prior to the accident.
Garrett TPE331-10UGR Engines
The turboprop engines ceased operation sequentially as the fuel supply was exhausted from the tanks.
Interesting Facts
- 01The aircraft was 800 pounds short of the fuel amount recorded on the load manifest.
- 02The cockpit voice recorder (CVR) was inoperative due to an improper power configuration.
- 03The aircraft was not equipped with a flight data recorder (FDR), nor was it required to be.
- 04The crew likely ignored or overlooked low fuel quantity annunciator lights.
- 05The crash site was located approximately 11 miles south of the destination airport.
Safety Actions & Advisories
Fueling Procedure Clarification
The NTSB recommended that the FAA require all Part 135 and Part 121 operators to establish standardized procedures for ordering fuel, specifically requiring that orders be made in writing and specify the amount to be added to each individual tank to prevent miscommunication.
CVR Maintenance and Testing
Following the discovery that the CVR was inoperative due to an improper power configuration, the NTSB reiterated the need for operators to perform more rigorous functional tests of cockpit voice recorders to ensure they are receiving power and recording correctly.
Known Controversies & Unanswered Questions
Airline Challenge to NTSB Findings
Reference ↗Executive Airlines CEO Michael Peragine publicly challenged the NTSB's final report, claiming the investigation dismissed other potential factors and focused too narrowly on fuel exhaustion. The airline also faced a $32 million settlement in 2003 following lawsuits from victims' families.
Location
ACCIDENT SITE · Coordinates taken from the official investigation report.