EAGLE, CO, USA
N251B
Piper AEROSTAR 601P
The noninstrument-rated pilot filed an IFR flight plan, but did not request nor was given a weather briefing. Shortly after taking off into low instrument meteorological conditions, he reported he was returning to the airport, but did not give a reason why. He never declared an emergency. The last transmission was when the pilot said he had 'the problem resolved,' and was continuing on to his destination. Various witnesses said the engines were 'revvying' and 'unsynchronized,' and that the propellers were being 'cycled.' One witness said brownish-black smoke trailed from the right engine. The airplane struck one ridge, then catapulted approximately 1,000 feet before striking another ridge. There was postimpact fire. Both propellers bore high rotational damage. Disassembly of the engines, propellers, turbochargers, and various components failed to disclose what may have prompted the pilot to want to return to the airport. Internal components of the right engine, however, were black and, according to a Textron Lycoming representative, were indicative of 'an excessively rich mixture.' A psychiatrist had recently treated the pilot for depression, attention deficit and bipolar disorders. The pilot also had a history of alcohol and drug abuse. Postmortem toxicology protocol disclose the presence of Fluoxetine (an antidepressant), Norfluoxetine (its metabolite), and Hydrocodone (the most commonly prescribed opiate).
HISTORY OF FLIGHT On November 17, 1996, at 1505 mountain standard time, a Piper Aerostar 601P, N251B, was destroyed when it collided with terrain while maneuvering near Eagle, Colorado. The private, non-instrument rated pilot and four passengers were fatally injured. Instrument meteorological conditions prevailed, and an instrument flight rules (IFR) flight plan had been filed for the personal flight conducted under Title 14 CFR (Code of Federal Regulations) Part 91. The flight originated from Eagle, Colorado, at 1455. According to the Denver Automated Flight Service Station (AFSS), a man who identified himself as the pilot of N251B telephoned the facility at 1418 and filed an IFR flight plan. He indicated the airplane was "/R" [RNAV (area navigation) and transponder equipped, with altitude encoding capability]. True airspeed was given as 220 knots, and he proposed to depart at 2145Z (1445 mst). Initial cruising altitude was to be 17,000 feet. The route of flight from EGE (Eagle, Colorado), direct RLG (Kremmling, Colorado), direct BJC (Jefferson County Airport, Broomfield, Colorado), direct SNY (Sidney, Nebraska), direct ONL (O'Neill, Nebraska), direct FSD (Sioux Falls, South Dakota), direct FCM (Flying Cloud Airport, Minneapolis, Minnesota). The pilot estimated his time en route would be 3 hours, 15 minutes, and listed 5 hours of fuel on board. [According to Vail/Beaver Creek Jet Center, Inc., the airplane was serviced with 146.7 gallons of 100/130 octane aviation grade fuel on November 17. This filled all tanks to capacity. According to the Piper Aerostar 601P PILOT'S OPERATING HANDBOOK, total fuel capacity is 173.5 gallons, of which 165.5 gallons are useable.] The pilot did not request, nor was he given, a weather briefing. Denver AFSS said they had no record of the pilot receiving a weather briefing prior to or after this contact. The captain and first officer of a corporate jet, who had planned to depart Eagle, off-loaded their passengers because weather conditions were below Part 135 takeoff minimums. They saw the pilot of N251B preparing to depart, and they engaged in a conversation with him. He told the captain he was "confident he was going to be okay because he had his hand held GPS (Global Positioning System) and was from that area and he could tell where he was by feel." The first officer said he tried to discourage the pilot from departing, "but he was committed." As they were returning to their hotel, the corporate jet crew observed the Aerostar fly overhead. The captain said the airplane seemed to be over Interstate Highway 70, westbound, in a right turn and climbing over the mountains. The first officer said the airplane was "apparently attempting to return to the airport." According to the transcript of radio communications, the pilot was cleared to taxi to runway 07 at 1446. At 1448, the pilot was issued his IFR clearance "to the Kremmling Vortac (Very High Frequency Omnidirectional Radio Range-Tactical Air Navigation), no delay expected, via the published IFR departure procedure. Climb and maintain one four thousand (feet), and expect your filed altitude (at) one zero minutes after departure. Squawk zero six two seven. Contact Denver (air route traffic control) center (on frequency) one two eight point six five leaving one zero thousand feet." The pilot was cleared for takeoff at 1453. The tower controller said that as the airplane was making its takeoff roll, he glanced down at his weather monitor and noted the meteorology report. It is included in this report under "Meteorological Information." At 1458, the pilot called the control tower and said he was "coming back in for runway two five." The controller said he would turn the strobe and runway lights up to full brightness. When he had done so, the controller asked the pilot if he had the airport in sight. He said he did not. At 1459, the controller asked the pilot if he "needed any assistance." The pilot said no, and he never declared an emergency. The controller asked the pilot for his position. The pilot replied, "Well, we're currently over the east end of the field. I think we're getting the problem resolved. Hang on a minute." At 1501 the pilot reported, "Five One Bravo's okay, we've got the problem resolved. Thanks." At 1505 the controller asked the pilot for his position. There was no reply to this or subsequent radio transmissions. There were several witnesses who reported seeing or hearing a multiengine airplane, but only six submitted written statements. Witness 1 was at the west end of town when he heard a small twin engine aircraft. He said the engines "sounded good." The airplane was about 200 feet high, flying in an easterly direction, then it turned and headed west just (south) of the town. A few minutes later the airplane returned, heading east. The witness said he heard "the props being cycled...I thought he was icing up." The witness said the airplane then came back, heading west, then it turned north: "All the time he was cycling the props. I knew he was icing and trying to sling the ice off." Witness 2 said she heard a twin engine airplane flying eastbound and the engines were "working (laboring) hard, trying to turn south." The sounds eventually diminished towards the west. Witness 3, a supervisor with the Eagle County Sheriff's Office, heard "a very loud, sputtering engine roar," then she saw a small twin engine airplane come over condominium rooftops from the south. She said the right engine was trailing a steady stream of brownish-black smoke. The airplane "banked sharply west, dropping in altitude," then "it sharply turned south" towards Brush Creek. While she was in one of the condominiums, she heard the airplane pass overhead again. When she went outside, the airplane was making a third pass about 500 feet. This time she did not see smoke and the engine "seemed to be running smoother, but weak sounding." The airplane turned west, then south. The last time she saw the airplane, it was flying in an easterly direction about 1,000 feet, and it "sounded weak." Witness 4, located southeast of town, heard "the unsynchronized sound of airplane engines revving up and down." He said the airplane was headed in an easterly direction about 1,000 feet. Soon, it came back heading west. Shortly thereafter, it came back heading east again. The engines were "still not sounding good. He last saw the airplane heading in a southwesterly direction, "the engines sounded better" and the airplane "was still very low." Witness 5 was in her home just east of the airport when she heard a departing airplane traveling east. There was "a loud pop, bang" that rattled the windows, then she heard "a high pitched whining noise for about a minute, then seemed to sound normal." About 5 minutes later she heard the airplane return, heading west. She said it sounded like the airplane circled her house, then headed east. Witness 6, a pilot, was standing outside his home in Vail, about 35 miles west of Eagle. He heard (but did not see) a low flying airplane. He said the engines "sounded good." The weather was "very bad...it was snowing moderately," the ceiling "was no more than about 500-400 feet agl (above ground level)," and "the clouds seemed to engulf us." According to the Eagle County Sheriff's report (96-8447), an off duty deputy reported seeing "a twin engine aircraft flying (eastbound) at about 500 feet. It sounded like it was having engine problems." He said the engine(s) were "revving very high" and then would "sputter." The airplane made "a high banking turn" to the north and lost altitude as it turned. Shortly thereafter, the airplane reappeared from the west, traveling east, approximately 1,000 feet and "it appeared there were no problems." At 1508, another off duty sheriff's deputy reported seeing an airplane go behind a ridge in the Bellyache area and did not reappear. The tower controller called Denver Air Route Traffic Control Center (ARTCC) and was advised the pilot had made no contact with that facility. After trying unsuccessfully to contact N251B, the tower controller notified the Eagle County Sheriff's Office at 1515 of a possible downed airplane. Emergency locator transmitter (ELT) signals were received and the Civil Air Patrol (CAP), assisted by the Eagle County Sheriff's Office and the Air National Guard (ANG), launched a ground and aerial search. The wreckage was located early the following morning by an ANG helicopter at a location of 39 degrees, 38 minutes, 93.6 seconds north latitude and 106 degrees, 45 minutes, 71.3 seconds west longitude. PERSONNEL INFORMATION The pilot's flight logbook was retrieved from Altitudes, Inc., a flight training facility at Centennial Airport in Englewood, Colorado, where the pilot had left it on November 7. According to the logbook, the pilot started taking flying lessons on September 30, 1995, in a Cessna 172 at Eagle, Colorado. On November 15, he began flying a Beech F33A, and he purchased it soon thereafter. The pilot took his recommendation ride on November 25 in the Beech F33A, and successfully passed his private pilot check ride on December 5, flying the Cessna 172. When the pilot received his private pilot's license, he had logged the following flight times: single engine, 105.8; Cessna 172, 71.0; Beech F33A, 34.8; cross country, 34.2; day, 92.0; night, 13.8; simulated instruments, 0.6; dual received, 49.2; pilot in command, 56.6; total flight time, 105.8. After the pilot obtained his private pilot's license, he flew the Beech F33A almost exclusively. On January 25 and 26, 1996, he took two lessons for a multiengine rating, flying a Piper PA-23-235 with Altitudes, Inc. Later that day, the 26th, he flew a Beech B55 for the first time. The following day, he took his multiengine recommendation ride, followed by the multiengine check ride, in the Beech B55. One month elapsed between the time the pilot obtained his private pilot's license and when he received his multiengine rating. During that time period --- December 5, 1995 to January 27, 1996 --- the pilot flew 189.4 hours and logged the following total flight times: single engine, 288.5; multiengine, 6.7; Cessna 172, 71.0; Beech F33A, 217.5; Piper PA-23-235, 2.9; Beech 55, 3.8; cross country, 177.8; day, 239.3; night, 55.9; simulated instruments, 2.6; dual, 85.6; pilot in command, 246.0; total flight time, 295.2. About the time he obtained his multiengine rating, the pilot traded his Beech F33A for the Beech 55 and flew it almost exclusively. Between entries made on October 6 and November 4, there was a complete blank page. As of November 6, 1996 (the last entry in the logbook), the pilot had accumulated the following flight times: single engine, 321.4; multiengine, 441.1; Cessna 172, 72.9; Beech F33A, 246.4; Piper PA-23-235, 2.9; Beech 55, 440.4; Piper PA-28R-201T, 2.1; Enstrom 280, 3.5; cross country, 592.3; day, 560.7; night, 196.1; simulated instrument, 8.1; AST-300, 4.6; actual instruments, 32.3; dual, 126.2; pilot in command, 713.3; total flight time, 765.0. According to the president of Altitudes, Inc. (the company that trained the pilot for his multiengine rating), the pilot came into his office on November 4 and said he wanted to purchase a Piper Aerostar, but his insurance company required that he have an instrument rating. He was told the company would be happy to enroll him in the instrument pilot training course. The pilot said that was not what he wanted, but that he had sufficient instrument hours to be recommended for the check ride. After examining his logbook, the company determined that, aside from the 2.6 hours of simulated instruments recorded, the pilot had logged 32.3 hours of actual instruments. None of actual instrument time had been signed by a certified instrument flight instructor nor had it been entered into the "dual received" column. All of it had been logged as "pilot in command" time. The president said the pilot told him his instructor had "probably forgotten" to sign the entries, and that he would obtain the proper endorsements. Meanwhile, the company gave the pilot two evaluation checks in an AST 300 flight simulator. The instructor said the pilot "needed a lot of work." The pilot received a rental checkout in the Piper PA-28R-201T on November 6, then asked if he could rent the airplane and fly to Eagle that evening. The president refused, telling the pilot the company did not allow single engine flight across the mountains at night. The president pointed out that darkness was approaching and it was becoming quite windy. "If it was windy down here, imagine what it would be like over the mountains," the president told investigators. The president's refusal angered the pilot. The next day, the pilot was given a third simulator check. He left and never returned, leaving his logbook at Altitudes, Inc. According to the Federal Aviation Administration (FAA) and corroborated by his logbook, the pilot was not instrument rated. The pilot purchased the Beech F33A, Beech 55, and Piper Aerostar 601P from a United Air Lines captain. The captain said he brokered used airplanes on the side. The captain said he flew with the pilot in the Aerostar on November 6 for about one hour. Upon returning to Centennial Airport, the pilot said he wanted to trade his Beech 55 for the Piper Aerostar. He gave him his personal check for $50,000 to cover the difference in price, and said he wanted to take immediate delivery. The captain refused, telling him it "just wasn't good business" to release the airplane until the check had cleared the bank. He also pointed out that the pilot had not obtained insurance on the airplane. The captain said his refusal to surrender the airplane also angered the pilot. On November 10, the captain flew the Aerostar to Eagle where he met the pilot, and they flew to Grand Junction, Colorado. The pilot removed personal belongings from the Beech 55, then they departed for Minneapolis (Flying Cloud Airport), Minnesota. En route, the pilot suggested that they land at Rapid City and the captain could visit his mother. The pilot would then continue to Minneapolis. Asked if he felt comfortable with the airplane, the pilot said he was. The captain disembarked at Rapid City but instead of spending the night with his mother, he returned to Denver. The next day, he received a telephone call from the pilot who told him his trip to Minneapolis had been uneventful and that he planned to fly the Aerostar every day. The pilot said his GPS receiver had become inoperative, and asked that the captain send him via overnight mail his hand-held GPS receiver. The captain complied. That was the last contact the captain had with the pilot. An attempt was made to estimate the pilot's Aerostar flight time. Using fuel receipts obtained at Eagle and Grand Junction, Colorado; Sioux Falls, South Dakota, and Eden Prairie, Minnesota; assuming fuel consumption rates of 32 gallons per hour (gph) maximum and 28 gph minimum, and adding those flights the captain made with the pilot, it was estimated the pilot had flown N251B a minimum of 13.3 hours and a maximum of 20.6 hours. AIRCRAFT INFORMATION The airplane maintenance records were recovered from the aft baggage compartment. According to these documents, the airplane underwent an annual inspection on April 25, 1996. At that time, the tachometer registered 1,715 hours and the Hobbs meter registered 1,473 hours. The engines, fuel control units, and magnetos were overhauled on this same date. Overhauled turbochargers were installed. Each engine is equipped with two turbochargers. The left turbocharger on the right engine had recorded 0 hours since overhaul, and the right turbocharger on the right engine had recorded 186 hours since overhaul. The left propeller was overhauled on July 8, and the right propeller was overhauled on July 1, 1993. Both propellers received 100-hour inspections when the airplane underwent the annual inspection. All Airworthiness Directives had been accomplished. Other than a heated pitot tube, the airplane was not de-ice/anti-ice equipped. METEOROLOGICAL INFORMATION Weather observed and recorded as N251B began
The pilot initiating flight into known adverse weather conditions without proper certification. Factors were the meteorological conditions that existed --- low ceiling, low visibility, and falling snow --- and his use of contraindicated drugs.
Source: NTSB Aviation Accident Database
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