Pilot Debrief

BEECH E 90 near Ruidoso, NM — 2017-06-14

Final reportCEN17FA227
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Date
2017-06-14
Location
Ruidoso, NM, USA
Airport
SRR
Aircraft
BEECH E 90
Registration
N48TA
Category
Airplane
Highest injury
Fatal
Fatalities
2
Phase of flight
Initial climb

Probable cause

The pilot's failure to maintain clearance from terrain after takeoff during dark night conditions.

NTSB narrative

The commercial pilot had filed an instrument flight rules flight plan and was departing in dark night visual meteorological conditions on a cross-country personal flight. A witness at the departure airport stated that during takeoff, the airplane sounded and looked normal. The witness said that the airplane lifted off about halfway down runway 24, and there was "plenty" of runway remaining for the airplane to land. The witness lost sight of the airplane and did not see the accident because the airport hangars blocked her view. The wreckage was located about 2,400 ft southeast of the departure end of runway 24. Examination of the accident site indicated that the airplane impacted in a nose-down attitude with a left bank of about 20°. A left turn during departure was consistent with the airport's published instrument departure procedures for obstacle avoidance, which required an immediate climbing left turn while proceeding to a navigational beacon located about 7 miles east-northeast of the airport. Examination of the wreckage did not reveal any evidence of preimpact mechanical malfunctions that would have precluded normal operation. The pilot had reportedly been awake for about 15 hours and was conducting the departure about the time he normally went to sleep and, therefore, may have been fatigued about the time of the event; however, given the available evidence, it was impossible to determine the role of fatigue in this event. Although the circumstances of the accident are consistent with spatial disorientation, there was insufficient evidence to determine whether it may have played a role in the sequence of events.

Analysis

Primary failure mode
Controlled flight into terrain
First missed decision gate
Pilot could have delayed takeoff due to dark night conditions.

NTSB coding

Evidence available

  • Photos
  • 11 docket documents
View NTSB final reportView NTSB docket

Docket documents11

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