Pilot Debrief

CIRRUS DESIGN CORP SR22 near Glenwood Springs, CO — 2017-09-16

Final reportCEN17FA354
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Date
2017-09-16
Location
Glenwood Springs, CO, USA
Aircraft
CIRRUS DESIGN CORP SR22
Registration
N462SR
Category
Airplane
Highest injury
Fatal
Fatalities
4
Phase of flight
Maneuvering

Probable cause

The non-instrument-rated pilot's inadequate preflight weather planning, his decision to depart into forecast instrument meteorological conditions along the route of flight, and his continued visual flight into instrument meteorological conditions, which resulted in spatial disorientation and a subsequent loss of airplane control.

NTSB narrative

The non-instrument-rated private pilot and three passengers departed on a night cross-county flight over mountainous terrain. Radar track data showed that the airplane traveled mainly on a southwesterly heading directly towards its destination with a series of altitude changes. About 5 minutes before the accident, the airplane turned to the northwest, a deviation off the destination course, and continued northwest for about 12 miles. After the turn, a passenger sent a text message to a family member stating that they were "taking the long way around, lots of weather, keep you posted." Shortly thereafter, the airplane entered a gradual left turn to the southwest, descending from 11,500 ft to 11,300 ft, then climbing back to 11,400 ft. The last recorded radar return was about 1/4 mile south of the accident site, which was located at an elevation of 10,800 ft. Postaccident examination of the airframe and engine showed severe fragmentation of the airplane consistent with a high-energy impact and did not reveal any preimpact anomalies that would have precluded normal operation. The flight was likely operating in instrument meteorological conditions (IMC) at the time of the accident, including light to moderate icing conditions. The airplane likely encountered intermittent IMC beginning about 30 minutes after takeoff, and continued into an area of solid IMC about 3 minutes before the accident occurred. There was no record of the pilot retrieving preflight weather information from an official, access-controlled source, and what weather information, if any, he obtained before or during the flight could not be determined. Based on the weather forecasts and information valid before the airplane departed and while en route, and the equipment available onboard the airplane, there was sufficient weather information available to the pilot before and during the flight to make informed decisions regarding the weather he would likely encounter. The night instrument conditions present at the time of the accident were conducive to the development of spatial disorientation and the circumstances of the accident. The non-instrument-rated pilot's continued flight into IMC, the airplane's descending turn depicted on radar, and the fragmentation of the wreckage due to high-energy impact are all consistent with the known effects of a loss of control due to spatial disorientation. It is likely that, while maneuvering, the pilot experienced spatial disorientation, which resulted in a loss of control and subsequent descent into terrain.

Analysis

Primary failure mode
VFR into IMC
First missed decision gate
Pilot did not obtain weather information before flight despite known weather risks.

NTSB coding

Evidence available

  • ATC audio
  • ADS-B / radar
  • Photos
  • 21 docket documents
View NTSB final reportView NTSB docket

Docket documents21

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