When everything in the IFR system works as it should, it can be a beautiful thing: Pilots coordinating with controllers to ensure safe, orderly flow of traffic to and from an airport, controllers anticipating a pilot’s needs and granting their every request. Everyone knows their role, and they take pride in doing their jobs with precision and professionalism. But when things aren’t working as they should, it can get ugly.
The ugliness can result from many factors: Thunderstorms sitting over an approach gate; an emergency; a runway closure; too much traffic; too few controllers. Sometimes, though, there’s just too much stress, or a bad attitude, on one side of the transaction. That’s when the other person has to step up and pay extra-close attention to what’s going on. It may be someone has to refuse a request or clearance, or otherwise interrupt the transaction to ensure safety is maintained.
As an example, there’s a tall tower about five miles north of my sea-level home base, rising almost to 1700 feet msl. It’s a controlling obstacle for my descent when arriving from that direction, and local ATC usually won’t clear me any lower than 2700 feet until I’m past it. On a recent IFR arrival, ATC cleared me down to 2000 feet even though I had not yet passed the tower. I suggested 2700 feet would be more appropriate and, after a few seconds, the controller realized the error and issued an appropriate clearance. Thankfully, I knew what to expect.
One moral of this story is that pilots need to be skeptical. While ATC isn’t trying to kill us, controllers often have many competing tasks to perform, and can either forget a detail or put us in a situation where the nice, smooth, relaxed procedure we were planning becomes a hasty, harried and ham-fisted thing of ugly. In such a situation, the smartest thing we can do is to refuse the clearance or request and offer an alternative. Here’s an example of what not to do when ATC gets behind the curve.
Background
On October 3, 2012, at 1116 Central time, a Cirrus SR22 collided with terrain while flying an instrument approach at the Gary/Chicago International Airport (KGYY) in Gary, Ind. The commercial pilot and the passenger were fatally injured; the airplane was destroyed. Instrument conditions prevailed; weather observed some 30 minutes after the accident included variable wind at six knots, visibility of five miles and an overcast ceiling at 900 feet.
The pilot’s first contact with the Chicago Tracon was while in a descent to 4000 feet msl. After receiving vectors and a further descent to 3000 feet, the airplane was cleared for the RNAV/GPS Y approach to Runway 30 at KGYY. The approach clearance came when the aircraft was already inside the final approach fix (FAF) and 1000 feet above the recommended altitude. After the pilot confirmed the approach clearance, radar returns show the airplane descending more or less on-course. About 40 seconds later, a left, descending turn away from the course centerline began.
Investigation
The accident site was about one mile from the approach of the runway. The airplane was fragmented and mostly consumed by fire. Examination of the airframe, engine and propeller did not reveal any anomalies associated with a pre-impact failure or malfunction.
Data from the airplane’s primary flight display (PFD) was recovered and evaluated by the NTSB’s Vehicle Recorder Laboratory. At 1109, the data show the next waypoint parameter switched from KGYY to WASTU, the approach procedure’s FAF. At 1114:32, the next waypoint parameter switched from WASTU to RONOY, a stepdown fix on the approach. The pilot received approach clearance at 1115:09.
At 1115:25, while inside the FAF and still at 3000 feet, the autopilot disconnected. During two periods immediately prior to the autopilot disengaging, a “TRIMMING” indication was received by the PFD. This indicates the autopilot has run the pitch trim for a period in excess of four seconds, which is consistent with the pilot pushing or pulling on the control stick while the autopilot is still connected.
After the autopilot disconnected, the airplane began a descent that reached 5000 fpm, rolling 37 degrees left and pitching down to 14 degrees nose-low. At 1115:50, a roll to the right and a pitch up were initiated. The airplane eventually pitched up to a 15-degree nose-high attitude but continued rolling right, transitioning to more than 85 degrees nose-low and 170 degrees of roll. As the airplane descended below 900 feet agl—i.e., under the overcast—a rapid roll to wings level and a pitch up occurred. Forces recorded during the pitch-up maneuver were in excess of 4.5 Gs. The last data recorded depicted a 48-degree nose-down attitude, with a descent rate of about 7000 fpm.
A flight instructor who flew with the pilot stated he often struggled to maintain instrument proficiency due to an active lifestyle. He also stated the pilot was challenged with accomplishing routine instrument flying tasks, such as changing a radio frequency while conducting an instrument approach.
Regarding the late approach clearance, the air traffic controller handling the flight stated a conflict alert involving two different aircraft drew his attention away from the accident airplane. After resolving the conflict, the controller stated that he was still a little flustered as he returned to provide approach service to the Cirrus and that, if not for the conflict, better services would have been given to the accident airplane.
Probable Cause
The NTSB determined the probable cause(s) of this accident to include: “The pilot’s loss of control during an instrument approach due to spatial disorientation. Contributing to the accident were deficient approach control services and the pilot’s loss of positional awareness.”
In this case, the controller was late with the approach clearance, but the pilot didn’t have to accept it. Requesting a turn away from the final approach course and a vector to re-intercept it outside the FAF would have been the prudent thing to do. When it became obvious to the pilot—if it ever did—that the approach wasn’t going to work, executing the missed approach procedure would have been a good choice, also. In this instance, staying ahead of the airplane is a task at which both the pilot and controller failed. If only one of them had been more aware of the airplane’s position, it’s likely this accident could have been prevented.
