FTW95FA402

NTSB accident investigation · Piper PA-24B-260 · Westcliffe, CO · September 25, 1995

Accident · FatalField investigationFinal report
Date
September 24, 1995, 19:13 local (Sep 25, 1995, 01:13 UTC)
Place
Westcliffe, CO
Injuries
5 fatal
Damage
Destroyed
Phase of flight
Enroute
Aircraft
N9121PPiper PA-24B-260
Weather
Instrument (IMC) · Dusk
Status
Completed · report February 27, 1996
Report
Approved by Office Director
FAA report
19950924029999A
Case key
19253

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

VFR flight by the pilot into instrument meteorological conditions (IMC), and his failure to maintain sufficient altitude or clearance from mountainous terrain. Factors relating to the accident were: the light conditions at dusk, the adverse weather conditions, and the pilot's lack of recent instrument experience.

Sequence of events

NTSB’s coding before 2008: each occurrence and phase of flight, and the causes and factors under it. The codes are defined in NTSB’s coding manual.

In flight encounter with weatherCruise
Light condition - duskFactor
Terrain condition - high terrainFactor
Weather condition - low ceilingFactor
Weather condition - fogFactor
Weather condition - snowFactor
Vfr flight into imc - continuedPilot in commandCause
Lack of recent instrument timePilot in commandFactor
In flight collision with terrain/waterCruise
Terrain condition - mountainous/hilly
Altitude/clearance - not maintainedPilot in commandCause

Analysis

When the pilot contacted the reno, Nevada, flight service station, he declined a standard briefing, but requested a route forecast between las vegas, Nevada, and Colorado springs, Colorado. He was advised of an AIRMET for mountain obscurement, occasional moderate rime icing in clouds and precipitation between 8,000 and 17,000 feet east of the Continental divide. Also, he was advised of IFR conditions from pueblo north to denver. The pilot filed a VFR flight plan and departed. Witnesses near the accident site said they heard a low flying airplane and the sounds of impact. Impact occurred at dusk, near the top of a ridge. No preimpact mechanical problem was found. Weather was described as 100' to 200' visibility, freezing temperature, fog, and intermittent light snow. Although the pilot was instrument rated, his logbook contained no recorded instrument flight time, either simulated or actual, in the last 13 years. Five people were aboard the airplane, although it was equipped with only four seats. Autopsy protocol disclosed the pilot had 'patchy fibrosis compatible with previous cardiac ischemia' and 'significant arteriosclerosis.' Toxicological protocol disclosed the presence of thiazides, a diuretic used in heart medication.

Factual narrative

History of flight

On September 24, 1995, at 1913 mountain daylight time (MDT), a Piper PA-24B-260, N9121P, was destroyed when it collided with terrain near Westcliffe, Colorado. The commercial pilot and four passengers were fatally injured. The personal flight, being conducted under 14 CFR Part 91, originated at Las Vegas, Nevada, on September 24, 1995, at 1515 Pacific daylight time (PDT). Instrument meteorological conditions prevailed at the time, and a VFR (visual flight rules) flight plan was filed.

The occupants flew to Las Vegas on September 22, and were returning to Colorado Springs, Colorado, when the accident occurred. The following is based on Federal Aviation Administration documents. On the morning of September 22, at 0913 PDT, a person who identified himself as the pilot of N9121P contacted the Reno Flight Service Station (FSS). He declined a standard briefing but requested a route forecast between Las Vegas and Colorado Springs for the time period of 1400. According to the taped recorded conversation, he was advised of an AIRMET (airman meteorology) for occasional moderate rime icing in clouds and precipitation between 8,000 and 17,000 feet; occasional mountain obscurement in clouds and precipitation, and IFR conditions from Pueblo north to Denver. The briefer told the pilot that VFR flight was not recommended in these areas. The forecast for Colorado Springs throughout the afternoon up until 2100 MDT was for scattered clouds at 1,000 feet and a 2,000-foot overcast, with winds from 090 degrees at 8 knots and gusts to 15 knots, and occasional 1,000 foot overcast conditions and 5 miles visibility in light rain.

Later that afternoon, at 1430 PDT, a person who identified himself as the pilot of N9121P contacted the Reno FSS and filed a VFR flight plan. He indicated he would depart Las Vegas at 1600 PDT and fly direct to Colorado Springs at 11,500 feet (MSL). He indicated the flight would take 4 hours to complete, and that he had 6 hours of fuel on board. When asked by the briefer, the pilot said he was aware of the AIRMET in effect for southern Nevada, Arizona, and Colorado.

At 1520 PDT, the pilot contacted Reno FSS and advised he had departed Las Vegas at 1515 PDT and asked that his flight plan be activated. The briefer reminded the pilot of the current AIRMET, adding that there was "some weather in the Rockies" and suggested he get an update. The pilot acknowledged the advisory.

The pilot contacted the Denver Automated Flight Service Station (AFSS) at 1814 MDT and reported he was over the Dove Creek, Utah, VORTAC at 11,500 and that it had been "smooth all the way." He requested and was given the current Colorado Springs and Pueblo weather observations, and was advised of the AIRMET that was still in effect. The pilot replied, "...it looks broken up in front of us. We'll let you know later on."

Several residents near the accident site heard a low-flying airplane and the sounds of impact. One witness (who is a private pilot) said the weather "was very bad (100 to 200 feet) visibility, (the temperature was)close to freezing with heavy moisture and intermittent light snow." Another witness said it was "very foggy." The wreckage was located on September 25 at 0100 MDT.

Crew information

The second of two logbooks was located and examined. The first entry was April 22, 1982, and the last entry was September 12, 1995. During this period, there was a gap from August 20, 1984, to September 3, 1992, when no flights were recorded. The pilot was checked out in the Piper PA-24-250 and PA-24-260 on January 23 and 16, 1993. Although the pilot was instrument rated, there were no entries in the logbook to indicate he had logged instrument flying time, either simulated or actual, since 1982.

Aircraft information

The Piper PA-24-260 is certificated for six seats. The fifth and sixth seats are installed or removed via snaps on the backs of the cushions with a minimal aft change in the center of gravity. According to the operator, he asked the pilot before he departed Colorado Springs if he wanted the fifth and sixth seats installed. The pilot declined the offer.

Wreckage and impact information

Wreckage was distributed for 300 feet on a magnetic heading of 110 degrees. The left outboard wing panel, its leading edge dented and containing pieces of bark, was found against a tree at the beginning of the wreckage path. Next to the tree was a crater with a disturbed area at its edge. Small pieces of debris continued up and over a small hill. All aircraft seats were ejected. The inverted empennage was wrapped around the fuselage

The engine remained attached to the firewall. The propeller separated from the engine but both blades remained attached to the hub, as did the crankshaft flange. Both blades bore leading edge gouges and 90 degree chordwise scratching on the cambered surfaces. One blade was bent forward in an "S" fashion. The other blade was bent aft at midspan.

Medical and pathological information

An autopsy was performed on the pilot by Dr. Robert S. Stewart at the St. Mary-Corwin Regional Medical Center in Pueblo, Colorado. According to the report, there was "patchy fibrosis compatible with previous cardiac ischemia, such as a healed myocardial infarction. A short segment of coronary artery was located and showed significant arteriosclerosis, but no areas of total occlusion. There was no evidence of acute myocardial damage." Toxicological protocol, conducted by FAA's Civil Aeromedical Institute (CAMI) in Oklahoma City, Oklahoma, detected thiazides, a diuretic used in heart medication.

Additional information

The wreckage was released to the owner's representative on September 26, 1995.

Aircraft

Registration
N9121P
Reported as
Piper PA-24B-260
Category
Airplane
Serial number
24-4600
Airframe hours
7,111
Engine
Lycoming IO-540-D4A5, 260 horsepower, reciprocating
Damage
Destroyed
Flight
Personal · Part 91
Registered owner
Falcon Rentals
Airworthiness certificate
Standard, Normal
Last inspection
Annual · June 24, 1995 · 98 hours before
Departed
VGT · Las Vegas, NV
Destination
COS · Colorado Sprgs, CO
Flight plan
VFR

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
66
Certificate
Commercial
Airplane ratings
Single-engine land
Instrument ratings
Airplane
Medical
Class 3, Valid Medical--w/ waivers/lim
Seat
Left
Toxicology
Performed
Flight hours
2,102 total · 84 in this make and model · 6 in the last 90 days · 3 in the last 30 days

Weather

Conditions
Instrument (IMC) · Dusk
Wind
170° at 6 knots
Temperature
52 °F, dew point 37 °F
Altimeter
30.00 inHg
Observed at
PUB, 33 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.