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Aftermath: First, Fly the Airplane

A pilot loses focus on what matters most.

Just after noon on a June day in 2012, a Pilatus PC-12 took off from Fort Pierce, in the middle of Florida’s Atlantic coast, bound for Junction City, Kansas. The pilot, his wife and their four young children were aboard, returning from a vacation in the Bahamas. Less than a minute later, the pilot engaged the autopilot and asked the Miami Center controller the identifier for Lakeland, the first fix along his route.

The first controller handed the flight off to a second, who cleared the airplane to climb to FL 230 and advised of an area of heavy rain ahead and slightly to the right. The pilot acknowledged and then, after a delay of several seconds, asked, “Do we have a vector to go around it? Is it … do we need to circumnavigate the weather?”

The controller replied, “If you need deviations, deviations north of course are approved, when able direct Lakeland.”

The pilot, evidently uncertain how to respond, simply said, “Affirmative.”

The controller subsequently amended the clearance to deviations south rather than north of the cell, asked the pilot to expedite through 14,000, and handed him off to another Miami Center controller. It was now 12:21.

At 12:32 the Pilatus was approaching FL 260 when the Center controlled advised the pilot of a large area of precip, some of it extreme, ahead of him. “Take a look at it and let me know which way you want to deviate. I’m thinking you might want to go to the right of course until you get north of it.”

The pilot agreed and said he would turn right about 30 degrees to a heading of 320. The controller concurred, clearing the pilot to deviate right of course as needed and to proceed direct Seminole when he could. The pilot acknowledged, and that was the last transmission Miami Center received from the Pilatus. It disappeared from radar moments later.

On the ground, a man looked up and saw a falling aircraft. He ran into his house to get a camera and recorded 30 seconds of video of the Pilatus coming straight down in a slow flat spin, its nose rising and falling, until it disappeared behind trees.

There were no survivors.

Outer panels of both wings had separated in flight, and the horizontal stabilizer — the PC-12 has a T-tail — had torn away from the fin. By reconstructing the flight path from radar returns, National Transportation Safety Board investigators were able to ascertain that when the breakup occurred at around 15,000 feet the airplane had reached a true speed of almost 340 knots in a steeply banked spiral dive.

A PC-12 does not have a flight data recorder, but electronic devices monitor and record the performance of certain systems. From them it could be inferred that the airplane had been in a 25-degree right bank at 109 kias when, for reasons that could not be determined, the autopilot disengaged, illuminating an amber warning light on the annunciator panel and sounding a warning tone.

You would have expected the pilot, at this point, to mutter a curse, complete his turn to the new heading, level the wings and then turn his attention to the autopilot. But that is not what happened. Apparently he did nothing. Possibly his attention was diverted to his family and he did not see the warning light or hear the tone. The angle of bank increased to 50 degrees and the airplane began to lose altitude. Thirteen seconds after the autopilot disengaged, the pilot, apparently now aware of the disconnect but not of the airplane’s flight condition, pressed the auto­pilot test button. This initiated a two-second internal self-test procedure, which the autopilot passed. But the pilot apparently still did nothing to recover from the spiral, although G forces must have been increasing in the airplane. At about 338 ktas, 110 kias above the maneuvering speed (not 175 knots over it; the NTSB report confuses indicated and true speeds), he “likely applied either abrupt or full aft elevator control input, resulting in overstress fracture of both wings in a positive direction.”

How can we account for such an egregious failure of basic airmanship?

The pilot, 45, had a private certificate, an instrument rating and 755 hours, 38 of them in his PC-12. He had been flying for 18 years and had worked his way up from a Grumman Yankee through a B36TC Bonanza, which he sold in 2010. He had just acquired the Pilatus, attended a four-day training course and arranged for several days of additional supervised practice in the airplane before departing for the Bahamas with his family.

Between selling the Bonanza and buying the PC-12, he had not logged any flight time. He had logged 28 hours of actual instruments between 1997, when he got the instrument rating, and the end of 2004. After that, until he bought the Pilatus, he logged no actual instrument time at all. In the month before the accident, however, he logged four hours of actual instruments and 11 instrument approaches, so he was at least as current as many other active instrument pilots.

It is tempting, given the pilot’s relatively meager turbine experience and the unprofessional quality of his radio communications, to file this one away under “Thurman Munson syndrome” — the pattern, named after the New York Yankees’ catcher who crashed his Citation while practicing landings on a clear day, of a person whose wealth allows him to purchase equipment out of proportion to his skills. But that would be to ignore other instances of pilots who have made seemingly inexplicable mistakes. One example that jumps to mind, because it too began with an unexpected auto­pilot disengagement, is that of the pilot flying Air France 447. Whatever you may think of his actions at that moment, his qualifications, training and currency were not in question.

Neither were those of this pilot. Though he was rusty and a novice in the 6,000-pound turboprop, in PC-12 school he practiced and demonstrated satisfactory competence in, among other things, instrument flying, high-altitude procedures, unusual attitude recovery, recovery from autopilot malfunctions, and autopilot in-flight testing. He took his flying seriously, and although he was of a wealthy and socially prominent family and had plenty of other irons in the fire, he spoke of wanting to fly professionally.

The NTSB determined that the probable cause of the accident was the pilot’s “failure to maintain control of the airplane,” which it attributed to his “lack of experience in high-performance, turbo-propeller airplanes and in IMC.”

As probable-cause findings go, this one seems weakly reasoned. The fact that this was a high-performance turbo-propeller airplane had nothing to do with the pilot’s failure to keep it upright. An autopilot can malfunction in any airplane, and you either take over the controls and hand-fly or you don’t. The NTSB, evidently satisfied to perceive the pilot as a feckless dunce, does not address at all what distractions in the airplane — there were four children aboard, after all — could have interfered with his normal patterns of attention. The NTSB also seems to ignore its own statement that the plane broke up because the pilot overcontrolled it. It is possible to recover, even from a 340-knot spiral, if you roll the wings level while trimming nose-down to relieve G forces. But that may take more presence of mind than a relatively low-time pilot is likely to possess.

Everyone knows that when something unexpected happens aloft the first rule is: Fly the airplane. The pilot of the Pilatus knew it. If his accident had befallen someone else, he would have read the NTSB’s account of it with the same incredulity as we feel now. But something happened that kept him from doing what he should have done. We need to use a little imagination to try to understand what that can have been; otherwise, as a PC-12 instructor said to me, the loss of six lives will have been entirely in vain.

This article is based on the NTSB’s report of the accident and is intended to bring the issues raised to our readers’ attention. It is not intended to judge or to reach any definitive conclusions about the ability or capacity of any person, living or dead, or any aircraft or accessory.

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