Casualties unknown

Engine failure due to excessive magneto drop and improper mixture setting (N5838U)

West Palm Beach, FL, US

On September 28, 1991, a Piper PA-28-140 (registration N5838U) operated by Steven Mccaughey was involved in an aviation accident near West Palm Beach, FL. Investigators recorded the probable cause as: The pilot's failure to place the mixture control to full rich prior to takeoff after leaning it to correct an excessive magneto drop, which resulted in a gradual loss of engine power. This summary draws on records from the U.S. National Transportation Safety Board (NTSB) historical archive.

Sourcesthe U.S. National Transportation Safety Board (NTSB) historical archivePrimary reportUpdated 2026-06-19Data APIEditorial standards

The pilot experienced an excessive magneto drop during the engine run-up and leaned the mixture to correct it, but never returned the control to full rich before takeoff. The engine gradually lost power after departure.

What happened

During the pre-flight inspection, the pilot noted an excessive magneto drop while running up the engine. To address this condition, he adjusted the mixture control to a leaner setting. However, there is no record of the pilot returning the mixture control to the full rich position prior to initiating the takeoff roll.

After becoming airborne, the engine performance began to degrade gradually. The power loss continued until the engine eventually quit completely. With no power available, the pilot was forced to execute an emergency landing in unsuitable terrain. During this forced landing, the aircraft struck a tree and subsequently hit a building.

The investigation

The investigation focused on the pilot's actions during the pre-flight phase and the subsequent flight. Key findings included:

  • The pilot admitted to leaning the mixture to correct an excessive magneto drop.
  • The pilot did not state that he placed the mixture control to full rich before takeoff.
  • The engine lost power gradually after takeoff, indicating a fuel delivery issue rather than an immediate mechanical failure.

Findings

The primary factor leading to the accident was the improper management of the engine mixture. By leaning the mixture to correct a magneto drop and failing to reset it to full rich, the engine received an insufficient fuel-air ratio for takeoff power. This resulted in a gradual loss of power that left the pilot with no options other than a forced landing.

Safety message

Pilots must ensure that all pre-flight checks are completed correctly. If adjustments are made to correct engine irregularities, such as magneto drop, the controls must be returned to their proper settings before flight operations begin.

Probable cause

The pilot's failure to place the mixture control to full rich prior to takeoff after leaning it to correct an excessive magneto drop, which resulted in a gradual loss of engine power.

Frequently asked questions

What happened in the 28 Sept 1991 Piper PA-28-140 accident near West Palm Beach, FL?

The pilot experienced an excessive magneto drop during the engine run-up and leaned the mixture to correct it, but never returned the control to full rich before takeoff. The engine gradually lost power after departure.

What aircraft was involved and where did it happen?

The accident on 28 Sept 1991 involved a Piper PA-28-140, registration N5838U, operated by Steven Mccaughey, at West Palm Beach, FL.

What was the probable cause of the accident?

The pilot's failure to place the mixture control to full rich prior to takeoff after leaning it to correct an excessive magneto drop, which resulted in a gradual loss of engine power.

Investigation report by the U.S. National Transportation Safety Board (NTSB) historical archive. Original record: https://carol.ntsb.gov/event/20001212X18141. This page is a structured re-presentation; facts and quotes are in the National Transportation Safety Board (NTSB), United States.