CEN23LA028

NTSB accident investigation · Beech E-90 · Slidell, LA · November 7, 2022

Accident · Serious injuriesClass 3 · LimitedFinal report
Date
November 6, 2022, 21:45 local (Nov 7, 2022, 03:45 UTC)
Place
Slidell, LA · wooded terrain
Injuries
1 serious
Damage
Destroyed
Phase of flight
Approach
Aircraft
N809DMBeech E-90
Defining event
Approach-IFR missed approach: Loss of control in flight
Weather
Instrument (IMC) · Night
Status
Completed
Report
Approved by Office Director
Investigation class
Class 3
NTSB office
Central Region
Parties
FAA - FSDO, Textron Aviation
FAA report
20221106013409A
Case key
106256

From the NTSB’s public API. By law, NTSB reports can’t be used as evidence in lawsuits over the accident.

On this page

Probable cause

The pilot’s failure to maintain airplane control during an attempted go-around in low visibility conditions.

Findings · 6

NTSB’s coded findings. Those marked are part of the probable cause; the rest are factors or other findings. Under each, the cases with the same finding.

Attention/monitoringPersonnel issues › Psychological · PilotBeech E-90: 1 caseAll aircraft: 18 casesProbable cause
Use of equip/info: aircraft controlPersonnel issues › Task performance · PilotBeech E-90: 3 casesAll aircraft: 9,295 casesProbable cause
Performance/control parameters: pitch controlAircraft › Aircraft oper/perf/capability · Not attained/maintainedBeech E-90: 1 caseAll aircraft: 526 casesProbable cause
Performance/control parameters: yaw controlAircraft › Aircraft oper/perf/capability · Not attained/maintainedBeech E-90: 1 caseAll aircraft: 149 casesProbable cause
Ceiling/visibility/precip: low visibilityEnvironmental issues › Conditions/weather/phenomena · Effect on operationBeech E-90: 1 caseAll aircraft: 175 casesProbable cause
Object/animal/substance: tree(s)Environmental issues › Physical environment · Contributed to outcomeBeech E-90: 1 caseAll aircraft: 933 cases

Sequence of events

The events NTSB coded, in order, by phase of flight. The defining event is the one that best describes the accident. Under each, the cases with the same event anywhere in their sequence.

Analysis

The pilot flew a visual approach to his home airport but did a go-around due to ground fog. After receiving an instrument flight rules clearance, he flew an RNAV/GPS approach that he also discontinued due to ground fog. After executing a missed approach, the pilot flew another RNAV/GPS approach. The pilot reported that during this last approach he lost visual references and initiated a go-around, during which the airplane impacted trees about 800 ft to the right of the runway. The main wreckage came to rest upright and was consumed by a post-impact fire. The postaccident examination revealed no preimpact anomalies that would have precluded normal operation. The pilot reported that he observed the right engine was slower to accelerate than the left engine during the attempted go-around, and that he was distracted looking at the engine indications. He reported that he did not notice if the airplane yaw to the right and, before he could correct for the altitude loss, the airplane descended into and struck the trees.

Factual narrative

On November 6, 2022, about 2145 central standard time, a Beech E-90, N809DM, was destroyed when it was involved in an accident at Slidell Airport (ASD), Slidell, Louisiana. The pilot sustained serious injuries. The airplane was operated as a Title 14 Code of Federal Regulations Part 91 positioning flight. According to air traffic control information, the airplane departed John C. Tune Airport (JWN), Nashville, Tennessee, and climbed to a cruise altitude of 22,000 ft. The airplane descended to ASD, the pilot’s home airport, and a visual approach was flown that the pilot discontinued due to ground fog. The pilot received an instrument flight rules clearance and flew the RNAV (GPS) RWY 36 approach that he also discontinued due to ground fog. After executing a missed approach, the pilot flew another RNAV (GPS) RWY 36 approach, during which the airplane impacted terrain about 800 ft right of the departure end of Runway 36. The pilot egressed the airplane without assistance. The airplane initially impacted trees with the right wing (see Figure 1). The main wreckage came to rest upright and was consumed by a post-impact fire. The postaccident examination of the airplane revealed no preimpact anomalies that would have precluded normal operation. Figure 1. Wreckage Diagram, Courtesy of Textron Aviation ASD was equipped with an Automated Surface Observation System (ASOS). At 2153, the ADS ASOS observation was wind calm, visibility 5 statute miles in mist, ceiling overcast at 400 ft above ground level (agl), temperature 19°C and dew point 18°C. At 2135, the closest weather reporting station about 12 miles northeast of ASD reported wind calm, visibility 1/4 mile in fog, ceiling overcast at 200 ft agl, temperature 20°C, and dew point temperature 20°C. Several other weather stations in the vicinity reported low ceilings and visibilities, with fog forming over the area. There were no pilot weather reports (PIREPs) within 60 miles of ASD in the national database from 1700 through 2400. The pilot reported that, during the last attempted approach, he initiated a go-around after losing sight of visual references due to ground fog. He observed the right engine was slower to accelerate than the left engine during the go-around, and that he was distracted looking at the engine indications. He reported that he did not notice if the airplane yawed to the right, and before he could correct for the altitude loss, the airplane descended into the trees. Other pilots who flew the airplane reported the right engine’s acceleration was sometimes slower than the left engine. The director of maintenance had performed a timed engine run and found the right engine acceleration time was slower than the left engine, but within the normal range of the maintenance manual.

Aircraft

Registration
N809DM
Reported as
Beech E-90
Category
Airplane
Serial number
LW-334
Built
1980
Airframe hours
7,111
Engines
Pratt & Whitney PT6A-28, 750 horsepower, turbo propPratt & Whitney PT6A-28, 750 horsepower, turbo prop
Damage
Destroyed
Fire
On-Ground
Flight
Positioning · Part 91
Operator
Air Reldan, Inc.
Registered owner
Air Reldan, Inc.
Airworthiness certificate
Standard, Normal
Last inspection
AAIP · September 15, 2022
Departed
JWN · Nashville, TN
Destination
ASD · Slidell, LA
Flight plan
IFR
Airport
ASD · Slidell Airport, runway 36, 5,002 × 100 ft, asphalt
Equipment
Onboard weather, Stall warning system, ADS-B, Angle of attack indicator, Auto-pilot, Electronic flight bag or handheld device

Matched to the registry by N-number and the event date; the registry’s history has gaps, so older matches can be wrong. Compare the reported make and model.

Flight crew

As NTSB recorded them. NTSB leaves out names.

Role
Pilot
Age
64
Injuries
Serious
Certificate
Commercial
Airplane ratings
Single-engine land, Multi-engine land
Instrument ratings
Airplane
Medical
Class 2, With waivers/limitations
Last flight review
September 7, 2022
Seat
Left
Restraint
3-point
Flight hours
4,800 total · 325 in this make and model

Weather

Conditions
Instrument (IMC) · Night
Wind
Calm
Visibility
5 statute miles
Temperature
66 °F, dew point 64 °F
Altimeter
30.11 inHg
Observed at
KASD, 1 nm away

Docket · 8

The files NTSB released with the investigation on April 10, 2024, on NTSB’s docket system: statements, records, photos and specialists’ reports. 23.9 MB in all.

FAA reports on this event · 1

The FAA’s own accident and incident reports, matched to the aircraft by N-number and date.