ERA13LA012

NTSB accident investigation · Cirrus Design SR22 · Birmingham, AL · October 6, 2012

Accident · Serious injuriesLimited investigationFinal report
Date
October 6, 2012, 12:17 local (17:17 UTC)
Place
Birmingham, AL
Injuries
1 serious, 1 minor
Damage
Substantial damage
Phase of flight
Approach
Aircraft
N80KWCirrus Design SR22
Defining event
Approach-IFR missed approach: Loss of control in flight
Weather
Instrument (IMC) · Day
Status
Completed · report April 25, 2013
Report
Approved by Office Director
NTSB office
Eastern Region Aviation
Parties
FAA/FSDO, Avidyne Corp, Cirrus Aircraft
FAA report
20121006022639A
Case key
85272

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

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Probable cause

The pilot's failure to maintain airplane control during a missed approach in instrument meteorological conditions. Contributing to the accident was the pilot's overreliance on the autopilot system and his inability to hand-fly the airplane once the autopilot was disconnected.

Findings · 5

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.

Action: lack of actionPersonnel issues › Action/decision · PilotCirrus Design SR22: 11 casesAll aircraft: 792 casesProbable cause
Performance/control parameters: altitudeAircraft › Aircraft oper/perf/capability · Not attained/maintainedCirrus Design SR22: 10 casesAll aircraft: 1,310 casesProbable cause
Performance/control parameters: directional controlAircraft › Aircraft oper/perf/capability · Not attained/maintainedCirrus Design SR22: 35 casesAll aircraft: 3,958 casesProbable cause
Use of equip/info: use of automationPersonnel issues › Task performance · PilotCirrus Design SR22: 2 casesAll aircraft: 17 casesProbable cause
Auto flight system: autopilot systemAircraft › Aircraft systems · Incorrect use/operationCirrus Design SR22: 2 casesAll aircraft: 28 casesProbable cause

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 airplane was in instrument meteorological conditions, and the pilot intended to fly an instrument landing system approach. Review of non-volatile memory data revealed that the autopilot approach mode was armed as the airplane intercepted the localizer course and was descending toward 2,600 feet mean sea level (msl). At that time, the autopilot was selected to vertical speed (VS) mode with the altitude armed rather than selected to the altitude mode, which is one of the criteria for automatically arming the glideslope (GS) mode later in the approach. About 1 minute later, the autopilot automatically cancelled the VS mode and switched to altitude mode as the airplane reached 2,600 feet msl. However, at that time the airplane was above the glideslope by 53 percent needle deflection. The autopilot will not automatically arm the GS mode unless, in addition to the altitude mode being selected, the airplane is more than 10 percent needle deflection below the glideslope. As a result, the airplane remained above the glideslope until the autopilot was disconnected about 1 minute later. The pilot then attempted to hand-fly a missed approach; however, he was unable to maintain the heading or altitude assigned by air traffic control. He subsequently lost control of the airplane during a turn and elected to deploy the airplane's parachute system. The airplane came to rest in a vacant lot.

Factual narrative

On October 6, 2012, at 1217 central daylight time, a Cirrus SR22, N80KW, operated by a private individual, was substantially damaged during impact with terrain, after deployment of the Cirrus Airplane Parachute System (CAPS), following a loss of control during a missed approach at Birmingham International Airport (BHM), Birmingham, Alabama. The private pilot incurred minor injuries and the passenger was seriously injured. The personal flight was conducted under the provisions of 14 Code of Federal Regulations Part 91. Instrument meteorological conditions prevailed and an instrument flight rules flight plan was filed for the flight that departed Charles B Wheeler Downtown Airport (MKC), Kansas City, Missouri; destined for BHM. The pilot stated that while on the instrument landing system approach to runway 6 at BHM, he reported missed approach at 2,000 feet mean sea level (msl) to the BHM air traffic control tower. The tower controller instructed the pilot to fly the runway heading; however, the pilot reported to the controller that he was unable due to weather. The tower controller then instructed the pilot to fly a heading of 180 degrees and climb to 4,000 feet. The pilot acknowledged the instruction and during the turn, lost control of the airplane. He then observed the altimeter indicating a descent through 1,700 feet and elected to deploy the CAPS. The airplane subsequently descended via parachute and came to rest in a commercial parking lot, about 2 miles south of BHM. Review of Federal Aviation Administration (FAA) recorded radio communications between N80KW and BHM tower revealed that after the pilot declared a missed approach, the tower controller instructed the pilot to fly runway heading and climb to 4,000 feet. The pilot replied "Okay, I'm way off of runway heading…" and did not make any mention of not being able to turn due to weather. The controller then instructed the pilot twice to climb to 4,000 feet and make a left turn to 360 degrees as the airplane was approaching an antenna to the south. After a third query, the pilot replied that he was "going, trying to get around." About 20 seconds later, the pilot reported that he was "going down." Examination of the airplane by an FAA inspector revealed substantial damage to the fuselage and a puncture of the left wing near the left main landing gear. The airplane was equipped with an Avidyne primary flight display (PFD), which was forwarded to the NTSB Vehicle Recorder Laboratory, Washington, DC. The unit contained non-volatile memory, which was successfully downloaded. Review of the data revealed that the autopilot was engaged shortly after takeoff and remained on until 1215. At 1213, the autopilot approach mode was armed as the airplane was descending to 2,600 feet msl and had intercepted the localizer course. The autopilot was selected to vertical speed (VS) mode with the altitude armed, rather than the altitude mode. At 1214, the VS mode was automatically cancelled (and the autopilotautomatically switched to altitude mode) as the airplane reached 2,600 feet; however, at that time the airplane was above the glideslope (GS) by 53 percent needle deflection. The airplane remained above the GS until the autopilot was disconnected at 1215 and the CAPS was deployed about 1217. According a representative from the PFD manufacturer, the autopilot would automatically arm the GS mode, provided seven criteria were met. Two of the seven criteria were altitude mode engaged and airplane no more than 10 percent needle deflection below GS (airplane above GS). Review of the data did not reveal any preimpact mechanical malfunctions with the airplane, nor did the pilot report any. The pilot reported a total flight experience of 1,944.7 hours; of which, 1,450 hours were in the same make and model as the accident airplane. He reported 17 and 75 total hours of actual and simulated instrument experience, respectively. The recorded weather at BHM, at 1153, included an overcast ceiling at 700 feet above ground level (1,350 msl).

Aircraft

Registration
N80KW
Reported as
Cirrus Design SR22
Category
Airplane
Serial number
1879
Airframe hours
1,612
Engine
Cont Motor IO-550-N, 310 horsepower, reciprocating
Damage
Substantial damage
Flight
Personal · Part 91
Operator
Billy Sprague
Registered owner
Two Flyers Llc
Airworthiness certificate
Standard, Normal
Last inspection
Annual · March 20, 2012 · 112 hours before
Departed
MKC · Kansas City, MO
Destination
BHM · Birmingham, AL
Flight plan
IFR
Airport
BHM · Birmingham International, runway 06, 11,998 × 150 ft, asphalt

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
60
Injuries
None
Certificate
Private
Airplane ratings
Single-engine land
Instrument ratings
Airplane
Medical
Class 3, Without waivers/limitations
Last flight review
September 23, 2011
Seat
Left
Flight hours
1,948 total · 1,450 in this make and model · 45 in the last 90 days · 24 in the last 30 days · 0 in the last 24 hours

Weather

Conditions
Instrument (IMC) · Day
Wind
330° at 9 knots
Visibility
10 statute miles
Lowest ceiling
700 ft overcast
Temperature
64 °F, dew point 61 °F
Altimeter
30.07 inHg
Observed at
BHM, 2 nm away

Docket · 9

The files NTSB released with the investigation on March 15, 2013, on NTSB’s docket system: statements, records, photos and specialists’ reports. 4.4 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.