Pilot Debrief

CESSNA 182 near Statesboro, GA — 2021-12-08

Final reportERA22FA083
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Date
2021-12-08
Location
Statesboro, GA, USA
Airport
TBR
Aircraft
CESSNA 182
Registration
N5776B
Category
Airplane
Highest injury
Fatal
Fatalities
1
Phase of flight
Initial climb

Probable cause

The pilot’s decision to initiate a visual flight rules flight into dark night instrument meteorological conditions, which resulted in spatial disorientation and subsequent loss of control shortly after takeoff.

NTSB narrative

The instrument-rated commercial pilot had conducted a cross-country flight to the airport arriving in the afternoon and, after attending a meeting, was returning to her home airport on a night visual flight rules (VFR) cross-country flight. Before the return flight, the pilot discussed with a family member her knowledge of a low cloud layer and her intention to stay low for the first 10 to 15 miles of the flight. At the time of departure, dark night conditions prevailed, and the airport was reporting an overcast cloud ceiling at 600 ft above ground level (agl). Review of automatic dependent surveillance-broadcast (ADS-B) data found that the airplane became airborne before the midpoint of the runway and turned right toward the destination airport. It then climbed to about 1,000 ft mean sea level (msl), which was about 800 ft agl, before entering a left turn about 2 miles south of the airport. The airplane continued in a left 360° tightening turn where a maximum altitude of about 1,800 ft msl was reached, which was subsequently followed by a rapid descent. Before the left 360° turn, the airplane likely entered the low cloud layer and never exited the clouds until a few seconds before it impacted with terrain. Multiple witnesses reported that the airplane’s engine noise was loud and continuous until impact. Examination of the wreckage revealed no evidence of preimpact mechanical malfunctions or failures with the airplane. Evaluation of the wreckage indicated that the airplane impacted terrain in a left turning descent at high speed. Based upon ADS-B, meteorological, and astronomical data, the pilot initiated a VFR flight into known dark night instrument meteorological conditions, which would have prevented reliable control of the airplane using external visual cues. The circling and rapidly ascending and descending flight track was consistent with a pilot who was experiencing spatial disorientation, which resulted in a loss of control in flight and a high speed impact with terrain. The pilot’s instrument and night currency could not be determined. The pilot’s toxicology report was positive for ethanol and quetiapine. Given that the ethanol was identified at a low level in muscle and that none was found in liver tissue, it is likely that the identified ethanol is from sources other than ingestion and unlikely that any effects from it contributed to the circumstances of the crash. Attempts were made to identify the underlying reason for the pilot’s use of quetiapine; however, the investigation was unable to do so. While the drug itself may cause neuropsychiatric effects, at the low levels likely present at the time of the event, it was unlikely to impair judgment. However, whether an underlying medical condition might have influenced the pilot’s decision-making could not be determined from the available information.

Analysis

Primary failure mode
VFR into IMC
First missed decision gate
Pilot could have delayed takeoff due to low cloud conditions.

NTSB coding

Evidence available

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

Docket documents14

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