Accident Case Study: In Too Deep

It is the morning of November 26, 2011 at the Marion Indiana Airport a pilot, his two college-age daughters and the youngest daughter's boyfriend are preparing to depart in a Cirrus SR20, it is Thanksgiving weekend and The plan is to take the oldest daughter back to her college near Chicago's two-page airport then return to her home in Indiana. The 47-year-old private pilot has a total of 207 flight hours. About half of them on this plane. From the second to the third of November. Charlie Delta, which is owned by a local flying club. It is not enabled for instruments. although he apparently received some training, it is not clear how much, his logbook shows a total of three hours of simulated instrument time and 29 hours of real time, but due to problems with the way the time was recorded, this probably exaggerates his true experience at IMC at approximately 8:30.

A.M. the plane is fueled and the pilot departs from Marion VFR in the northwest the flight to Page will last a little over an hour on the day of the

accident

an area of ​​low pressure centered over Wisconsin dominated the regional weather the system had brought IFR and VFR conditions marginal in much of northern Illinois. It is unclear what weather information the pilot received prior to the flight, but at the time of departure the area forecast for Chicago showed marginal VFR ceilings with light rain between 9:00 and 11:00 a.m. m. IFR conditions were Thereafter also the terminal forecast for DuPage was expected to show marginal VFR on arrival broken clouds at 2500 cloudy at 3500 with visibility of six miles 45 minutes after departure; however, that forecast would be revised to show an 800-foot cloudy sky with five-mile visibility and rain. and fog it is not clear if the pilot ever received the updated forecast after the

accident

a CFI in Marion reported that he and the pilot had briefly discussed the weather just before the flight the pilot was aware of IFR conditions in the area but noted DuPage was forecast to be VFR at the time of arrival is now 9:58 AM. m. in the control tower a 2 page airport a call comes in from cirrus 2 to 3 the charlie delta radar shows the plane two miles south of the airport at approximately 1500 AGL in the field, the ceiling is rated at 900 feet 53 charlie delta, what is it? 3 charlie delta hf that is arriving, let me see the visual flight rules.

I was wondering if we can be available to land and then via charlie delta the field is the same IFR. tension 30 seconds later the pilot calls again it may ring university eyes I just check your field I didn't realize I'm going so fast that's nice our Lee Delta IFR say your intentions I'm in IFR we're going to move At this moment I was just checking what it was to that, sit and stay pretty good, so you shouldn't leave, you are available, let's write if you want to get to the page, if possible, that would be wonderful, you have the field in Placer Terrace. our Corning, yeah, you got the field, DuPage Airport in sight, okay, yeah, we just passed, okay, just son, turn right 180 and land 2-0 just as it hits zero zero one five to the right 185, you're right two minutes later, the pilot. he reports that he no longer has the airport in sight and a title is suggested;

However, he seems to be hesitating whether he will land on page three. Charlie Delta says intentions. I think I'm tempted in the closet at the airport for better visibility because I don't want to go in there and get stuck all day three Charlie Delta, do you want to talk to Chicago? They can help with the vectors or you know, I think I'm fine doing it either way, but I was, do you have? a later airport, I mean a report today, three executives from Charlie Delta Chicago, the weather there is a we have visibility of one zero, they are suing at 1500 cloudy, they are VFR right now, they shoot, what is their code, we, Charlie Delta Papa, kilo of whiskey, Roger Papa. with zero, thanks again, three options, are you familiar with the area?

I understood my, what am I trying to say, my training, there are three of them, Charlie Delta Roger, would you like to talk to them to get closer? They can give you titles of justice and help you. I came into Milwaukee a little better than I did. I'm still trying to decide if I want to reject any pages or not. Do you think it's a good idea or not? Tower controller DuPage now seems to realize something is wrong and asks the pilots' flight conditions and qualifications for the IFR flight conducted there are you currently away? right now three medical professionals you are in the clouds are you clearing the clouds?

Actually I'm, I'm, I came out of the clouds right now, let's try another you. I am qualified, I am fire trained by Ania and I let this surround me, I am now more alert to the potential danger of the situation. The controller calls Chicago TRACON and makes arrangements to deliver the airplane to them to help them get to a VFR airport. Three additional to page three, one CSV away or about 10 miles north of less than 2200 using the clouds and need Baxter to come in with us or it looks like Pillaji has a better roof and is not IFR qualified.

Can you just give them headers to catch it? at least Milwaukee Wow, what's going for a walk? If they're showing it, it feels like fifteen hundred and ten because of the visibility. Ok, let me get back to you. I think you're still there. Yeah, you see about 11 miles northwest of. the page in two thousand there I'm not talking to that page tower guide, he says he's not IFR qualified, he's looking to get vectors from Tell Rocky Peak in VFR, well yeah, so I'll just tell the pages that m over T ok ok when the pilot contacted the call tower things were clearly not going well with his attention focused on the immediate problem of flying the aircraft in marginal conditions, he was obviously having trouble staying on top of things, it was the wrong time. being looking for a plan B the fact that he ended up in such a bind says something about his priorities that day clearly the mission of getting his daughter back to school had taken on great importance but his determination not to get caught out by the weather shows that something more was competing for his attention, getting there wasn't enough, he also needed to get home and therein lay the problem, since succeeding in one mission meant failing in the other, we can only speculate on what else may have weighed on the the pilot's mind that day, the wasted effort of a failed flight, the possible embarrassment of delaying plans for later that weekend or maybe just the fact that he was a busy man who didn't want to end up stranded 200 miles away. home, whatever the

case

.

The end result was a pilot struggling with indecision, apparently seeking advice from ATC but not taking the kind of action that would indicate he understood the true severity of the situation. It is now 10:08 a.m. m. and DuPage tower has told the pilot to contact Chicago TRACON who is waiting to hear from you the plane is now heading northwest below Class B airspace after five minutes with no word from the pilot the new controller attempts to lift it 2 November 3 3 charlie delta to chicago broach 53 charlie delta we are, we are heading out of your area and you will get better visibility and delta charlie number 2 to 3, okay, you will continue heading west with VFR.

Roger, November 2nd and 3rd, just Charlie Charlie Delta, just FYI, the executive shows a cloudy sky at 1,500 feet. while Keegan is cloudy at 1400, you have the page and I'm looking at Rockford right now for you and Rockford at 700 feet over the limit at this point, there is no indication that the pilot is having trouble controlling the airplane, although His somewhat confusing interactions with a controller indicate that he is under considerable stress. I painted where we wanted to go, but it looked like it was less than 900 feet or a thousand feet away. Yes, the page is currently showing cloudy at 900 feet.

Roger, if that's the

case

, I think I'll just go to the page, the page is IFR. I understand, but I apologize. I think José had repeated if he knew where the closest was to see a barn and November 2nd to 3rd, Charlie Delta, the closest one I'm showing is executive and like I said, it's shown cloudy a 1500 foot Roger that will have executive sports. Could you remind me of your call letters Papa whiskey kilo Roger Papa whiskey kilo number seven seven whiskey and raise and maintain two thousand four hundred Roger 2,450 we are in 2000 number seven seven with the affirmative two thousand four hundred for me please you are a bar spread and I think that did anyone else reread the two thousand four hundred that was four seven seven with him just two to three Charlie Delta November 3 Charlie Delta just want to make sure the health tube restriction wasn't for you Roger 2400 and keep negative two to three Charlie Delta that altitude was not for you sir maintain VFR a few minutes later the pilot tells the approach controller that he has changed his mind landing at Pojoaque Cirrus two to three Charlie Delta executive ATIS information Victor is up to date and let me know when you can navigate direct and what do you like to follow the flight at this point I don't want to mess with the weather I'm going out and I don't want to get stuck here there are two or three Charlie Delta, okay, so you're not, you're no longer on the bill to the executive.

I know we have sailed outside your airspace. Yes, two or three Charlie Delta frequency changes were approved. The project may not help them at the time of this last exchange, the pilot has turned left to the west, possibly to continue searching for a VFR field, possibly in preparation to return home, a minute later another turn begins , this time to the right. becomes a downward spiral that continues until radar contact is lost approximately 900 feet on the ground, witnesses report hearing what sounds like a plane doing aerobatics. Seconds later, the doomed Cirrus emerges from the bottom of the clouds at a 70-degree angle as onlookers watch helplessly.

He plummets to the ground and disintegrates, instantly killing the pilot and his three passengers. Hey, remember that two or three Charlie Deltas, can you, uh, can you make fun, find someone to talk to him and call me real quick? It's important that Charlie took out a guy. de Pays uses heavy problems and a new executive is fine, no, he decided to go for his account the last time we saw me was about five north of Lake in the Hills heading north. I missed his radar. I was at about 1,800 feet when the Cirrus crashed two by three.

Charlie Delta is a tragic but sadly typical example of the type of accident that kills more pilots than storms, icing and all other weather phenomena combined in one way, although the accident is not at all typical, what is different is not It is not the immediate cause or spatial and meteorological disorientation, but the fact that the pilot in his conversations with ATC so clearly articulated a mentality that contributes to too many airplane accidents they say it takes two to tango in the training materials we read about the insidious qualities of low ceilings and poor visibility and the ways in which they can attract a VFR pilot only gets into worse and worse conditions and, in doing so, makes escape difficult or impossible, but in reality, of course, we As pilots, we are almost always complicit in our own trap, there is somewhere we need to be, there is something we want to do, there are some worried about disappointing us. friends or family about failure in the task we have set for ourselves with such thoughts we tie ourselves to a course of action and it is only at the end when the horizon suddenly tilts and the mind cannot understand what the eyes say If we understand true gravity of the situation, there is no single solution to the problem.

Clearly part of the answer is a degree of respect for one's own limitations as a pilot and a corresponding respect for the unpredictability of the weather. The presence of mind to take a step. Recognizing a deteriorating situation and taking action is another, and perhaps a more honest recognition of how much is at stake is part of the answer to the fact that in this case the price of failure was lives, but it was also years of pain for those who left. behind the nightmares of those who saw it happen and the doubts of those who will always wonder if they could have done more and no mission is worth any of that.