Pilot Debrief

PIPER PA-28-151 near Marana, AZ — 2012-10-15

Final reportWPR13FA010
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Date
2012-10-15
Location
Marana, AZ, USA
Aircraft
PIPER PA-28-151
Registration
N151SV
Category
Airplane
Highest injury
Fatal
Fatalities
1
Phase of flight
Descent

Probable cause

The pilot’s flight in dark night conditions with no visual reference and his subsequent spatial disorientation.

NTSB narrative

During a night cross-country flight, the airplane collided in the unpopulated desert located in between the departure and destination airports. The non-instrument-rated pilot had amassed an estimated 185 hours of total flight experience, of which 7.3 hours were conducted in nighttime conditions. Although the pilot had made this trip twice before, those flights were not conducted in dark night conditions. For the first 30 minutes after departure, radar returns for the flight were uniformly spaced and at uniform altitudes, with the track was consistent with a route of flight toward the destination airport. About 4 minutes before the end of the data, radar returns indicate a period consistent with the airplane making a series of turns with fluctuations in altitude. The maneuvering and altitude variations were inconsistent with the intended route of flight, and along with the pilot's inexperience in night time conditions, he likely experienced the effects of spatial disorientation as the accident occurred in an area devoid of visual references. Ground scar analysis, impact signatures, and wreckage fragmentation patterns disclosed that the airplane impacted terrain in a slightly nose-low attitude with high forward velocity. A review of the pilot's daily work activities revealed that he had not obtained his normal amount of rest before the accident and was likely fatigued; however, the effect the fatigue would have had on his operation of the airplane could not be determined. A postaccident examination of the airframe and engine revealed no evidence of a mechanical malfunction or failure that would have precluded normal operation.

Analysis

Primary failure mode
Human factors
First missed decision gate
Pilot could have chosen to delay flight until daylight conditions improved.

NTSB coding

Evidence available

  • ADS-B / radar
  • 14 docket documents
View NTSB final reportView NTSB docket

Docket documents14

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