# NTSB CEN09FA603: Cessna 182Q, N96894, Houma, LA, September 24, 2009 - Type: NTSB accident investigation - Classification: Accident · Fatal · Field investigation · Final report - Date: September 24, 2009, 06:08 local (11:08 UTC) - Place: Houma, LA - Coordinates: 29.541666, -90.66333 - Nearby events: https://openairdocs.org/map.md?lat=29.5417&lon=-90.6633&mi=10 - Phase of flight: [Initial climb](https://openairdocs.org/ntsb-phases/350) (OpenAirDocs' grouping) - Defining event: [Initial climb: VFR encounter with IMC](https://openairdocs.org/ntsb-events/401) - Highest injury: Fatal - Injuries: 1 fatal - Status: Completed, report July 1, 2010 - Report: Approved by Office Director - NTSB office: Central Region - Parties: Teledyne Continental Motors, FAA, Cessna - NTSB case key (mKey): 74799 - NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=CEN09FA603 - NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/74799/pdf - NTSB docket: https://data.ntsb.gov/Docket?ProjectID=74799 - Page: https://openairdocs.org/ntsb/CEN09FA603 ## Probable cause The pilot’s decision to take off into instrument meteorological conditions. ## Findings NTSB's coded findings; those marked are part of the probable cause. - [Ceiling/visibility/precip: below VFR minima](https://openairdocs.org/ntsb-findings/03035075): Environmental issues › Conditions/weather/phenomena · Decision related to condition (probable cause); cases with it: [Cessna 182Q, 1 case](https://openairdocs.org/ntsb-findings/03035075/cases.md?model=2072732), [All aircraft, 184 cases](https://openairdocs.org/ntsb-findings/03035075/cases.md) - [Info processing/decision: decision making/judgment](https://openairdocs.org/ntsb-findings/02041520): Personnel issues › Action/decision · Pilot (probable cause); cases with it: [Cessna 182Q, 15 cases](https://openairdocs.org/ntsb-findings/02041520/cases.md?model=2072732), [All aircraft, 3,098 cases](https://openairdocs.org/ntsb-findings/02041520/cases.md) ## Sequence of events The events NTSB coded, in order, by phase of flight. The defining event best describes what happened. - [Initial climb: VFR encounter with IMC](https://openairdocs.org/ntsb-events/401) (defining event); cases with it: [Cessna 182Q, 3 cases](https://openairdocs.org/ntsb-events/401/sequence.md?model=2072732), [All aircraft, 392 cases](https://openairdocs.org/ntsb-events/401/sequence.md) - [Initial climb: Loss of visual reference](https://openairdocs.org/ntsb-events/402); cases with it: [Cessna 182Q, 2 cases](https://openairdocs.org/ntsb-events/402/sequence.md?model=2072732), [All aircraft, 242 cases](https://openairdocs.org/ntsb-events/402/sequence.md) - [Initial climb: Aerodynamic stall/spin](https://openairdocs.org/ntsb-events/241); cases with it: [Cessna 182Q, 5 cases](https://openairdocs.org/ntsb-events/241/sequence.md?model=2072732), [All aircraft, 1,529 cases](https://openairdocs.org/ntsb-events/241/sequence.md) ## Analysis The non-instrument rated commercial pilot requested and received a Special visual flight rules (SVFR) clearance to take off. Weather was below VFR minimums with a reported ceiling of 300 feet and seven miles visibility, and witnesses reported fog in the area. The pilot’s last radio transmission occurred at 0605 and the wreckage was located one mile south of the runway at 1225. No evidence of an airplane malfunction was found during postaccident wreckage examination and airplane wreckage and impact scars were indicative of a loss of airplane control prior to impact. The airplane was not equipped to fly in instrument meteorological conditions (IMC). The pilot's lack of instrument flight certification combined with the poor weather conditions were conducive to spatial disorientation. Toxicology results were positive for ethanol. Postaccident conditions were conducive to post-mortem ethanol production in the pilot. ## Factual narrative HISTORY OF FLIGHT On September 24, 2009, about 0608 central daylight time, a Cessna C-182Q airplane, N96894, impacted terrain while departing from Houma-Terrebonne Airport (HUM), Houma, Louisiana. The non-instrument rated commercial pilot, who was performing duties as a fish spotting pilot for Daybrook Fisheries, Inc., was fatally injured. The business flight was being conducted under the provisions of Title 14 Code of Federal Regulations Part 91 without a flight plan, but departed HUM under a special visual flight rules (VFR) clearance. The local flight was originating and instrument meteorological conditions prevailed at the time of the accident. At about 0605 central daylight time, a witness observed the airplane from initial taxi through takeoff to about 100 feet above the ground. The witness stated the airplane appeared to be flying normally. The witness also stated weather at that time was being reported by the automated weather observation system (AWOS) as 300 feet overcast clouds and five miles visibility. Transcripts of communications with the Houma control tower show the pilot requested clearance to takeoff at 0603 without the Automated Terminal Information Service (ATIS) information. The local controller informed the pilot the weather was 300 foot overcast and seven miles visibility. At 0604 the pilot asked “is there any way I can get a special to get up and see what it looks like right south of the field and then if I don’t like it I can come back.” The local controller said that would not be a problem and told the pilot to taxi to Runway 18. At 0604 the pilot told the local controller “…I’m going to go southwest, but initially I’ll just go there to check it out…” The local controller then cleared the pilot out of the airspace to the south and southwest, told him to maintain special visual flight rules, and cleared him for takeoff. The pilot made his last radio communication at 0605:15 when he said “This is going to get thick in about an hour.” The local controller attempted to contact the airplane shortly after that radio call, but the pilot did not answer. Tower personnel were informed of the airplane accident at 1225 by another pilot who spotted the wreckage from the air. No radar data was available for the accident flight. PERSONNEL INFORMATION The pilot, age 61, held a commercial pilot certificate with ratings for airplane single-engine land. He was not instrument rated. His last Federal Aviation Administration (FAA) second-class medical was issued January 20, 2009, with the limitations “Holder shall possess glasses for near/intermediate vision.” The pilot's logbook was not recovered. The NTSB Form 6120.1 completed by the operator indicated the pilot had over 17,000 total hours and over 11,000 hours in this make and type of airplane. The operator did not indicate the pilot had any instrument flight time on the Safety Board Form 6120.1. The pilot indicated 19,949 hours total time and 450 hours during the last six months on hislast FAA medical application issued January 20, 2009. AIRCRAFT INFORMATION The 1979-model Cessna 182Q, serial number 18266891, was a high wing airplane, with a fixed, tricycle landing gear, and was configured for four occupants. The airplane was powered by a direct drive, carbureted, air-cooled, six cylinder engine. The engine was a Teledyne Continental Motors O-470-U engine, serial number 249985-R, rated at 230 horsepower at 2,400 revolutions per minute, and was driving a McCauley two-bladed propeller. The airplane was not equipped to fly in instrument meteorological conditions. The last annual inspection was completed on April 20, 2009. The airframe had accumulated 5,415 tachometer hours and 24,891 total hours at the time of inspection. The airplane had undergone a 100 hour inspection on September 9, 2009, and indicated 6,143 hours on the tachometer. The last entry in the pilot’s fish spotter log indicated 6,152 tachometer hours at the start of the accident flight. The engine had been overhauled by Western Skyways, Inc. on August 1, 2008, and installed in the airplane on August 15, 2008. The engine had accumulated approximately 985 total hours since installation and overhaul at the time of the accident. The last engine annual type inspection was completed on April 20, 2009, at 5,415 tachometer time. The engine underwent a 50 hour inspection on September 23, 2009, at 6,186 tachometer time. METEOROLOGICAL INFORMATION Weather at HUM at 0553 was recorded as wind 030 degrees at seven knots, visibility seven miles, ceiling 300 feet overcast, temperature 26 degrees Celsius, dew point 25 degrees Celsius, and altimeter 30.02. Weather at HUM at 0650 was recorded as wind 030 degrees at seven knots, visibility seven miles, ceiling 400 feet overcast, temperature 26 degrees Celsius, dew point 25 degrees Celsius, and altimeter 30.02. A witness described fog at the airport at the time of departure. Another witness, who was about one mile from the impact site, described heavy fog in the area when he left for work at 0550. No evidence was found indicating the pilot had obtained a weather briefing. FLIGHT RECORDERS A Garmin GPS 496 unit and a JPI engine monitor were removed from the wreckage and sent to the Safety Board recorders laboratory for data download. The data recovered from the Garmin GPS 496 unit was not readable. Historical data recovered from the JPI engine monitor ended on September 21, 2009. WRECKAGE AND IMPACT INFORMATION The accident site was located 1.05 miles south of the departure end of Runway 18 and two tenths of a mile west of the extended runway centerline. Examination of the airplane wreckage and accident site indicated the airplane impacted trees and terrain in about a 35-degree left bank and 30 degrees nose low. The wreckage was contained in about a 150-foot diameter circle. All control surfaces were located in the wreckage and flight control continuity was verified from the cockpit to each aileron, elevator and rudder control surfaces.Damage to the cockpit area prevented examination of flight controls and their associated flight control connections. The engine was rotated by hand and compression was verified at each cylinder. The propeller was separated from the engine and found buried in the impact crater. Both propeller blades were bent rearward from the spinner at a 45 to 60 degree angle. The leading edge of Blade A was scratched and nicked, showed chord wise scratches, and about six inches of the outboard tip was bent forward. The leading edge of Blade B was scratched. Both magnetos produced spark at all six leads. No evidence of catastrophic engine failure was found. MEDICAL AND PATHOLOGICAL INFORMATION The Terrebonne Parish Coroner’s Office, Houma, Louisiana, performed an autopsy on the pilot on September 25, 2009. The cause of death was attributed to multiple blunt trauma due to an aircraft accident. The FAA, Toxicology Accident Research Laboratory, located in Oklahoma City, Oklahoma, conducted toxicological testing on the pilot. Blood was not available for testing. Testing for carbon monoxide and Cyanide was not performed. The pilot tested positive for the following volatiles: - 40 (mg/dL, mg/hg) Ethanol detected in kidney - 32 (mg/dL, mg/hg) Ethanol detected in muscle - 24 (mg/dL, mg/hg) Ethanol detected in lung - 20 (mg/dL, mg/hg) Ethanol detected in spleen - 13 (mg/dL, mg/hg) Ethanol detected in brain - 11 (mg/dL, mg/hg) Ethanol detected in liver - 1 (mg/dL, mg/hg) N-Butanol detected in muscle - 1 (mg/dL, mg/hg) N-Propanol detected in spleen The pilot was reported to have been recovered to the morgue at 1703. Outside air temperatures were as high as 89 degrees Fahrenheit on the day of the accident. The drug Alfuzosin was detected in the pilot’s liver and kidney. The pilot reported on his last FAA medical application that he took 10 Mg of Uroxatral daily. ADDITIONAL INFORMATION The following exerts were taken from Federal Aviation Circular AC-60-4A, Pilot’s Spatial Disorientation. Paragraph 3.a. “The attitude of an aircraft is generally determined by reference to the natural horizon or other visual references with the surface. If neither horizon nor surface references exist, the attitude of an aircraft must be determined by artificial means from the flight instruments. Sight, supported by other senses allows the pilot to maintain orientation, however, during periods of low visibility, the supporting senses sometimes conflict with what is seen. When this happens, a pilot is particularly vulnerable to disorientation. The degree of disorientation may vary considerably with individual pilots. Spatial disorientation to a pilot means simply the inability to tell which way is up.” Paragraph 3.d. “…The disoriented pilot may place the aircraft in a dangerous attitude.” Paragraph 3.e. “…Therefore, the use of flight instruments is essential to maintain proper attitude when encountering any of the elements which may result in spatial disorientation.” Paragraph 4 “RECOMMENDEDACTION, 4.1. “Before you fly with less than 3 miles visibility, obtain training and maintain proficiency in aircraft control by reference to instruments. 4.2. When flying at night or in reduced visibility, use your flight instruments, in conjunction with visual references. 4.6. Do not attempt visual flight rule flight when there is a possibility of getting trapped in deteriorating weather. 4.7. Rely on instrument indications unless the natural horizon or surface reference is clearly visible. ## Aircraft - Registration: [N96894](https://openairdocs.org/deregistered/N96894-2015-08-26), registration cancelled 2015-08-26, S/N 18266891, built 1979 (OpenAirDocs) - Reported make and model: CESSNA 182Q - Registry model: [Cessna 182Q](https://openairdocs.org/model/cessna-182q) (registry code 2072732) (OpenAirDocs) - Registry engine: [Continental O-470 series](https://openairdocs.org/engine/continental-o-470-series) (registry code 17026, reciprocating) (OpenAirDocs) - Category: Airplane - Serial number: 18266891 - Airframe hours: 25876 - Engines: CONT MOTOR O-470 SERIES 230 horsepower reciprocating - Damage: Destroyed - Flight: Aerial observation, Part 91 - Operator: Daybrook Fisheries - Registered owner: Westbank Corp - Airworthiness certificate: Standard, Normal - Last inspection: 100 hour, September 9, 2009, 115 hours before - Departed: HUM, Houma, LA - Destination: HUM, Houma, LA - Flight plan: Unknown - Airport: HUM, Houma Terrebonne Airport, runway 18, 6,508 × 150 ft, concrete ## Flight crew As NTSB recorded them. NTSB leaves out names. - Pilot; age 61; injuries: fatal; commercial; airplane ratings: single-engine sea, single-engine land; seat: left; flight hours: 19,949 total, 11,000 in this make and model ## Weather - Conditions: Instrument (IMC), Day - Wind: 30° at 7 knots - Visibility: 7 statute miles - Lowest ceiling: 300 ft overcast - Temperature: 79 °F, dew point 77 °F - Altimeter: 30.02 inHg - Observed at: HUM, 2 nm away ## FAA reports on this event (1) The FAA's own accident and incident reports, matched to the aircraft by N-number and date (OpenAirDocs). - [Accident 20090924020089A](https://openairdocs.org/incident/20090924020089A), Sep 24, 2009: Cessna 182Q, Houma, LA, Destroyed, 1 fatal. N96894 called the Houma, LA. Tower for taxi instructions, the tower instructed N96894 to taxi to runway 18 and advised the pilot the airport was IFR with and… ## Docket (6 files) The files NTSB released with the investigation on March 15, 2010, on NTSB's docket system: https://data.ntsb.gov/Docket?ProjectID=74799. 2.2 MB in all. - Pilot/Operator Aircraft Accident Report, NTSB Form 6120.1 (item 1, .PDF, 416 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40326298&FileExtension=.PDF&FileName=Pilot%2FOperator%20Aircraft%20Accident%20Report,%20NTSB%20Form%206120.1-Redacted.PDF - Witness Statement (item 2, .PDF, 29 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40326299&FileExtension=.PDF&FileName=Witness%20Statement-Redacted.PDF - Maps or Charts of Accident Area, Wreckage Diagrams (item 3, .PDF, 99 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40326300&FileExtension=.PDF&FileName=Maps%20or%20Charts%20of%20Accident%20Area,%20Wreckage%20Diagrams-Master.PDF - Transcript of Radio Communications (item 4, .PDF, 135 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40326302&FileExtension=.PDF&FileName=Transcript%20of%20Radio%20Communications-Redacted.PDF - Statement of Party Representatives to NTSB Investigation (item 5, .PDF, 1.4 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40326309&FileExtension=.PDF&FileName=Statement%20of%20Party%20Representatives%20to%20NTSB%20Investigation-Redacted.PDF - Release of Aircraft Wreckage, NTSB Form 6120.15 (item 6, .PDF, 53 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40326310&FileExtension=.PDF&FileName=Release%20of%20Aircraft%20Wreckage,%20NTSB%20Form%206120.15-Redacted.PDF From the NTSB's public API. Aircraft are matched to registry aircraft by N-number and event date, checked against the reported serial number, make and model; the registry's history has gaps, so older matches can be wrong. Compare the reported make and model. --- OpenAirDocs.org is an independent research project of [Contrail Labs](https://contraillabs.com/). It is not affiliated with the FAA or the NTSB. Source documents are U.S. government works in the public domain.