Bar Harbor Airlines Flight 1808 - Investigation

Investigation

In the aftermath of the accident, investigators were hindered by the absence of cockpit voice recorder and flight data recorder information. The Beech 99 was not a large enough plane for the FAA to require their installation. There was also no record of which pilot was to have flown the aircraft. Both pilots had used the radio during the flight instead of the non flying pilot. Examination of radar data from Portland showed that after the plane turned to course 340 to intercept the approach, it flew through the approach and had to correct to get back on course. Investigators noted that this instruction meant the flight crew had to make a 60 degree turn less than one mile from the approach outer marker. Altitude data transmitted by the aircraft transponder showed the plane did not begin its descent along the precision glide slope until it was above it after passing Lewie. This may have caused the flight crew to rush both the descent and the approach. The Captain's altimeter recovered from the wreckage was set to 30.42 InHg, a number transposition from the correct setting 30.24 InHg. With this setting it would have read approximately 180 feet higher than the plane actually was, and close to the 200 feet above ground level minimum descent for the approach. The first officer's altimeter was also set incorrectly at 30.12 InHg causing it to read 120 feet low. The aircraft flew into trees less than one mile from the end of runway 4 and impacted the ground less than 500 feet to the right of the extended runway center line. There were no survivors.

In publishing its report, the National Transportation Safety Board noted that the controller in Portland used "poor judgment" assisting the flight. However, it concluded that the Captain accepted the large course correction and the crew continued flying an unstabilized approach instead of executing a missed approach. As well, the flight crew attempted to stabilize the approach while allowing the plane to fly below the instrument glide slope. The incorrect altimeter settings may have caused this descent to continue below the published decision height. At night in low visibility the crew may have been unaware of their true position. The NTSB recommended a review of controller procedures for outlying airports without ground radar. The 60 degree turn less than one mile from the outer marker would violate approach guidelines for radar assisted arrivals to Portland International Jetport for example. It further recommended aircraft for hire capable of carrying 6 or more passengers be equipped with flight recorders.