Accident Details
Probable Cause and Findings
The pilot's loss of control due to spatial disorientation while maneuvering in instrument meteorological conditions. Contributing was the pilot's lack of instrument currency and his self-induced pressure to complete the flight.
Aircraft Information
Registered Owner (Historical)
Analysis
HISTORY OF FLIGHTOn November 23, 2017, about 1515 eastern standard time, a Mooney M20, N6894N, was destroyed when it impacted terrain near Starke, Florida. The private pilot was fatally injured. The airplane was privately owned and operated as a Title 14 Code of Federal Regulations (CFR) Part 91 personal flight. Instrument meteorological conditions prevailed at the time and an instrument flight rules (IFR) flight plan was filed for the flight, which originated about 1419 from Ocala International Airport-Jim Taylor Field (OCF), Ocala, Florida, with a destination of Cecil Airport (VQQ), Jacksonville, Florida.
A friend of the pilot reported that she flew to OCF as a passenger with the accident pilot in the accident airplane earlier on the day of the accident. She said that the flight was uneventful until they approached OCF, when the weather became "very turbulent." The pilot mentioned to her that he was trying to maintain altitude as he was preparing for landing. She said that, after they landed, it was "very windy and raining very hard." They went inside the fixed-base-operator (FBO), where the pilot mentioned that he had to get to VQQ for his daughter's birthday and Thanksgiving. She told him that he should "wait it out," and he agreed.
FBO personnel reported that, as the pilot waited for the weather to improve, he asked them to top off the airplane's fuel tanks. They advised the pilot that the weather was very bad and that he should wait for the fuel. The pilot said that he needed the fuel "now" because he was trying to get to his daughter's house for Thanksgiving and requested that the line personnel wipe his fuel caps with a towel and use an umbrella to prevent rainwater from entering the fuel tanks. After about 45 minutes, the pilot said that he was "heading out"; when asked if he found a break in the weather, the pilot laughed and said he was "gonna go for it."
Review of air traffic control radar and voice communication information from the Federal Aviation Administration (FAA) Jacksonville Air Route Traffic Control Center (JAX ARTCC) revealed that, as the pilot departed OCF he was advised to "climb and maintain three thousand." The JAX ARTCC approach controller identified the pilot's airplane, instructed him to proceed direct to VQQ, advise when he had the ATIS, and expect the "ILS to RWY36R." The controller then cleared the airplane direct to "NOLFO" the initial approach fix for the runway 36R instrument landing system (ILS) approach. The pilot asked the controller to spell out the intersection which the controller did, and the controller subsequently informed the pilot "your uh target's going all over the place you having issues." The pilot attributed the airplane's motion as described by the controller as due to wind and further indicated that he was not having any issues.
The JAX ARTCC approach controller asked the pilot if he wanted to try a different altitude, but the pilot declined and responded "…i'm okay."
The airplane was cleared for the ILS approach to runway 36R at 1455:47 and the pilot was instructed to maintain 3,000 ft until reaching NOLFO; however, the pilot read back 2,000 ft and was corrected by the approach controller. At 1459:26, the pilot was instructed to contact the VQQ air traffic control tower (ATCT), which the pilot did not acknowledge until the instruction was repeated by the controller.
At 1501:19, the JAX ARTCC approach controller provided a low altitude alert to the VQQ tower controller. The approach controller noted that the airplane was "going back and forth on the localizer" and asked the VQQ ATCT controller if he was able to see the airplane. The VQQ ATCT controller said he could not see the airplane due to the low ceilings. About 2002, the VQQ tower controller advised the JAX ARTCC controller that the pilot was coming back to JAX ARTCC approach, and the pilot was subsequently provided radar vectors for a second ILS to runway 36R.
While JAX ARTCC approach controller was providing the pilot radar vectors, he noted that the airplane was triggering low altitude alarms. At 1511:02, when the pilot was asked if he was able to climb and turn, the pilot indicated that he could but needed to go out for a long approach. At 1513:02, the controller asked the pilot if he would like to land at Jacksonville International Airport (JAX), Jacksonville, Florida, which was reporting higher ceilings and better visibility. The pilot elected fly to JAX and was provided initial and repeated vectors. The pilot initially acknowledged the heading but did not acknowledge the altitude assignment. Shortly thereafter, at 1515, radar contact with the airplane was lost.
An alert notice (ALNOT) was subsequently issued and the airplane was located at 1600 in a field about 18 nautical miles south-southwest of VQQ. PERSONNEL INFORMATIONThe pilot, age 73, held a private pilot certificate with ratings for airplane single-engine land and instrument airplane. He also held an FAA third-class medical certificate, issued July 11, 2016. A review of the pilot's logbook revealed 3,146 total hours of flight experience; the most recent entry was dated September 8, 2017. The pilot had accumulated 400 flight hours in the accident airplane make and model, and 4 hours within the previous 90 days. The pilot recorded a total of 527 actual instrument hours; since January 1, 2016, he had flown 18 actual instrument flight hours, 8 of which were in 2017. A review of the pilot's logbook revealed that he did not meet FAA recency requirements to act as pilot in command under IFR or weather conditions less than the minimums prescribed for visual flight rules. AIRCRAFT INFORMATIONThe single-engine airplane was manufactured in 1968 and was powered by a Lycoming O-360-A1D engine rated at 180 horsepower, equipped with a Hartzell three-bladed, controllable-pitch propeller. The most recent annual inspection was completed on August 1, 2017, at a tachometer time of 2,895.49 hours. At the time of the accident, the tachometer reading was 2,911.22 hours. The Hobbs meter was destroyed during the accident, and the current airframe total times could not be determined. A review of the maintenance logbooks revealed that the last altimeter/pitot-static system and transponder test was performed on June 15, 2015. METEOROLOGICAL INFORMATIONVQQ was located about 18 miles north-northeast of the accident site at an elevation of 80 ft. The recorded VQQ special weather observation at 1511 included wind from 030° at 12 knots, 2 miles visibility in mist, overcast ceiling at 900 ft above ground level (agl), temperature and dew point 17°C, and altimeter setting of 29.87 inches of mercury (inHg).
The closest weather reporting location was Keystone Airpark (42J) Keystone Heights, Florida, located about 8 miles south-southwest of the accident site. The 1515 recorded observation at 42J included wind from 040° at 8 knots, 10 miles visibility or more, broken ceiling at 800 ft agl, overcast ceiling at 1,100 ft agl, temperature and dew point 18°C, and altimeter setting of 29.85 inHg.
Weather Surveillance Radar
The National Weather Service KJAX WSR-88D detected a large area of light to moderate intensity echoes along the airplane's flight track and in the vicinity of the accident site, and indicated that the accident flight was in clouds and precipitation when the flight deviated west and then back to the south. The 1513 base reflectively image showed that the airplane's flight track operated through echoes of 30 to 40 dBZ, moderate intensity echoes and in an area of 15 to 20 dBZ echoes at the time of the accident (See figure 1).
Figure 1. KJAX WSR-88D 0.5° base reflectivity image for 1513 with airplane's flight track of overlaid
Preflight Weather Briefing
The pilot filed IFR flight plans at 0858 and at 1405 with Leidos Flight Service; however, the pilot did not request any weather briefings. There was no record of contact with any other Direct User Access Terminal Service (DUATS) providers or with ForeFlight; therefore, what weather products or advisories the pilot may have familiarized himself with before the flight could not be determined. AIRPORT INFORMATIONThe single-engine airplane was manufactured in 1968 and was powered by a Lycoming O-360-A1D engine rated at 180 horsepower, equipped with a Hartzell three-bladed, controllable-pitch propeller. The most recent annual inspection was completed on August 1, 2017, at a tachometer time of 2,895.49 hours. At the time of the accident, the tachometer reading was 2,911.22 hours. The Hobbs meter was destroyed during the accident, and the current airframe total times could not be determined. A review of the maintenance logbooks revealed that the last altimeter/pitot-static system and transponder test was performed on June 15, 2015. WRECKAGE AND IMPACT INFORMATIONThe wreckage came to rest on a 314° heading about 18 miles from VQQ on the training base of Camp Blanding Military Reservation, Florida. The fuselage was broken into two parts; the cockpit and empennage separated aft of the rear seat at the wing spars. All flight control surfaces were located at the accident site along the debris path.
All flight controls were destroyed and their respective control tubes were impact damaged. Continuity of the flight control tubes could not be established, but the tubes from the yoke mounts to the wing roots were present. Engine and propeller controls were impact damaged and did not reveal useful information. The fuel selector was noted in the left wing tank position and 10 gallons of liquid consistent with aviation fuel was drained from the left wing tank. Flight control tubes in the left wing were attached to the left aileron and the aileron remained attached to the wing surface. The flap remained attached to the wing and the flap control tubes were damaged. The position of the flaps at the time of impact could not be established. The right wing was fragmented along the debris path; its associated flight contr...
Data Source
Data provided by the National Transportation Safety Board (NTSB). For more information on this event, visit the NTSB Records Search website. NTSB# ERA18FA030