Aviation Accident Summaries

Aviation Accident Summary WPR20LA101

Needles, CA, USA

Aircraft #1

N123CE

CESSNA 210

Analysis

The pilot departed on a cross-country flight with a self-induced pressure to return home in dark night conditions, despite a lack of recent experience flying at night. After departing on the first leg of his flight, he lost his geographic orientation after he failed to configure his navigation equipment before departure. As a result, he landed and refueled at an airport 150 nm south of his perceived location. The pilot then departed toward the south and performed a series of climbs and descents, eventually flying into Mexico airspace. He subsequently completed another series of climbs and descents in the 30 minutes that he flew over Mexico airspace before he reentered US airspace. Approximately 1 hour later, and nearly 4 hours into the flight, the engine lost all power. The pilot immediately switched fuel tanks and engaged the high boost pump, which restarted the engine. About 15 minutes later the engine lost all power again. The pilot made a forced landing in dirt, and the airplane nosed over and came to rest inverted. Examination of the airplane did not reveal any mechanical anomalies. Performance computations showed that the engine would have burned about 40 gallons of fuel during the accident flight. The fuel tanks were not breached, and the fuel lines and connections did not indicate a fuel leak. Further, there were no indications that fuel had been expelled from the tanks at the accident site. The pilot’s fuel management practice was to switch fuel tanks when they were half empty, which would have resulted in fuel starvation should he have omitted this task item only once during the accident flight. This oversight may have occurred during the accident flight as the pilot was distracted trying to configure his navigation device to establish his geographic position and return home. While the airplane had sufficient fuel onboard at the time of the power loss to continue the flight, the investigation was unable to establish how much fuel was in each wing or why the engine lost power due to a lack of available evidence.

Factual Information

On March 4, 2020, about 2030 Pacific standard time (PST), a Cessna 210L airplane, N123CE, was substantially damaged when it was involved in an accident near Needles, California. The pilot received minor injuries. The airplane was operated as a Title 14 Code of Federal Regulations Part 91 personal flight. According to the pilot, he flew the accident airplane from Henderson, Nevada, to St. George, Utah, where a passenger deplaned. He departed St. George promptly in the late afternoon because he wanted to return to Henderson before night as he had not flown in nighttime conditions in nearly 1 year. The pilot had not configured his navigation as he assumed that he would return home before dark. After takeoff, the pilot observed that his fuel level was insufficient for the trip. He stated that he landed in Mesquite, Nevada, for fuel; however, a fuel receipt and automatic dependent surveillance-broadcast (ADS-B) data showed that he obtained 77 gallons of fuel at Parker, Arizona. According to the pilot, shortly after his departure at 1653 into night conditions, he decided to fly south to avoid breaching Las Vegas Class B airspace. Mesquite, Nevada, is located about 30 nm northwest of Las Vegas Class B airspace, and Parker, Arizona, is located about 100 nm southeast of Las Vegas Class B airspace. The pilot stated that he spent most of the approximate 4-hour long accident flight attempting to configure his GPS. According to the pilot, once the airplane reached a town near the Mexican border, he turned to the north. According to ADS-B data, after departure, the airplane slowly climbed to about 8,300 ft mean sea level (msl) on a southern heading. Approximately 40 minutes into the flight, the airplane made an abrupt right turn and descended rapidly to about 700 ft msl as it overflew a small town. Data indicated that the airplane turned to the south over the town and started a normal climb. During this time, the airplane made a series of left turns and passed over the Mexican border twice before it established a southwest heading at an altitude of about 11,000 ft msl. At 1824 the airplane flew back into Mexico and made another series of turns at various westerly headings as it descended to about 6,500 ft msl. The airplane turned to a northern heading and crossed over the Mexican border back into the United States about 1908. The airplane circled El Centro, California, for about 20 minutes at various altitudes before it climbed to about 10,000 ft msl and established a straight course on a northeasterly heading. At 2053 mst, the airplane descended to about 6,000 ft msl, at which point the airplane started another climb and made a series of large S-turn maneuvers. According to the pilot, as the airplane neared Needles, California, it experienced a total loss of engine power. The fuel selector was on the left fuel tank, which indicated 100 lbs (16 gallons) of fuel remaining on the fuel gauge. He rotated the selector to the right tank, which indicated 150 lbs (25 gallons), activated the high fuel boost pump setting and within about 15 seconds the engine restarted. The engine subsequently lost all power about 15 minutes later. At 2123 mst, and an altitude of about 8,900 ft msl the airplane turned back to a northeasterly heading and about 2 minutes later it turned east and began a descent. The ADS-B track terminated at 2129 mst/2029 pst and showed the airplane on an easterly heading at 3,625 ft msl, 2 nm west of the accident site. During the pilot’s subsequent forced landing attempt, the nose landing gear dug into dirt and the airplane nosed over and came to rest inverted. The pilot stated that he was under a self-induced pressure to return home at the time of the accident and should have departed the following day in daylight conditions. The pilot did not file a flight plan for the accident flight, nor was he in contact with air traffic control. Photographs from the accident site showed substantial damage to the vertical stabilizer. A BLM ranger, who responded 16 hours after the accident took place, reported that he did not smell fuel near the aircraft. He did not activate the airplane’s power source to observe the reported fuel tank quantities, nor did he observe the actual fuel tank quantities. Recovery personnel attempted to drain the fuel tanks when they arrived on-scene about 5 days after the accident but did not observe any fuel. Figure 1: ADSB data of accident flight Review of the aircraft logbooks showed that a mechanic had replaced a cracked fuel return hose between the engine and firewall about 6 flight hours prior to the accident. A wreckage examination was performed by a Federal Aviation Administration (FAA) inspector. Mechanical continuity of the crankshaft and valvetrain to the accessory section was confirmed when the propeller was rotated by hand. Thumb compression and suction were achieved for each cylinder and each top spark plug exhibited a blue spark while the propeller was rotated. The spark plug electrodes all displayed normal wear. The fuel selector valve indicated that the left tank was selected. According to the FAA inspector, all of the fuel lines were secure, and the fuel tanks were intact. Additionally, he did not observe any hydraulic fracturing of the wings or fuel staining anywhere on the airplane to indicate a breach or a fuel leak. No pre-impact anomalies that would have contributed to a loss of engine power were noted. The airplane’s fuel consumption was computed using the airplane’s Pilot Operating Handbook, and inflight information retrieved from the ADS-B data. Performance was calculated with a starting fuel quantity of 90 gallons of fuel (the full fuel capacity of the airplane) and an enroute power setting of 2,500 rpm; both values were provided by the accident pilot. Additionally, he stated that his body weight at the time was 150 lbs. Based on this information, the airplane’s weight was 3,000 lbs at the time of departure, which was 800 lbs under its gross takeoff weight. The performance computations showed that the airplane would have burned about 40 gallons of fuel during the accident flight. According to the pilot, his fuel management practice is to switch fuel tanks once the selected fuel tank is half empty.

Probable Cause and Findings

A loss of engine power for undetermined reasons due to a lack of available evidence.

 

Source: NTSB Aviation Accident Database

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