Monday, March 09, 2020

Loss of Control in Flight: Cessna 210 Centurion, N81KD; fatal accident occurred November 02, 2018 in Bradley, Clark County, South Dakota

Cabin Area

Accident Site 

John Shoemaker

 Propeller 

Engine 

Attitude Indicator Gyro 

Wreckage Diagram


Accident Flight Track 
Air Traffic Control Information 

Previous Flight Track from FSD to 1D7 with Divert to 8D7 



The National Transportation Safety Board traveled to the scene of this accident.

Additional Participating Entities: 

Federal Aviation Administration / Flight Standards District Office; Rapid City, South Dakota
Textron Aviation; Wichita, Kansas
Continental Motors; Mobile, Alabama

Aviation Accident Factual Report - National Transportation Safety Board:  https://app.ntsb.gov/pdf


Investigation Docket - National Transportation Safety Board: https://dms.ntsb.gov/pubdms

https://registry.faa.gov/N81KD


Location: Bradley, SD
Accident Number: CEN19FA021
Date & Time: 11/02/2018, 1130 CDT
Registration: N81KD
Aircraft: Cessna 210
Aircraft Damage: Destroyed
Defining Event: Loss of control in flight
Injuries: 1 Fatal
Flight Conducted Under: Part 91: General Aviation - Personal 

On November 2, 2018, about 1136 central daylight time, a Cessna T210N airplane, N81KD, was destroyed after impacting terrain near Bradley, South Dakota. The pilot was fatally injured. The airplane was registered to and operated by the pilot as a Title 14 Code of Federal Regulations Part 91 personal flight. Instrument meteorological conditions prevailed at the time of the accident, and no flight plan was filed. The flight departed about 1115 from Clark County Airport (8D7), Clark, South Dakota, and was destined for Sigurd Anderson Airport (1D7), Webster, South Dakota.

According to air traffic control data, the pilot conducted an earlier flight on the morning of the accident. The pilot departed Sioux Falls Regional Airport (FSD), Sioux Falls, South Dakota, with a planned destination of 1D7. Due to poor weather conditions at 1D7, the pilot diverted to 8D7 and landed there about 0940. 8D7 was located about 35 miles southwest of 1D7.

At 1108, while taxiing for takeoff from 8D7, the pilot called a friend to ask about weather conditions at his location, which was closer to 1D7. The pilot's friend told him that "pretty low clouds" existed at his location. During a postaccident interview, the friend reported that he expected the pilot to remain below the clouds and "scud run" from 8D7 to 1D7.

Radar data did not capture the airplane's departure from 8D7, which was consistent with the airplane flying at a low altitude. The airplane reached an altitude of 800 ft above ground level (agl) at 1132 and was midway between 8D7 and 1D7. During the last minute of data, the airplane turned left about 90°, climbed from 1,000 to 2,100 ft agl, and decelerated from a groundspeed of 144 to 106 knots. Radar data ended at 1135:05, and airplane wreckage was located less than one nautical mile from the last radar point.

A witness near the accident site heard what seemed to be the sound of an airplane climbing and descending twice, which was followed by a "loud bang." The airplane impacted terrain in a rural area in a steep nose-down angle, and a postcrash fire ensued.

Pilot Information

Certificate: Private
Age: 47, Male
Airplane Rating(s): Single-engine Land
Seat Occupied: Left
Other Aircraft Rating(s): None
Restraint Used:
Instrument Rating(s): None
Second Pilot Present: No
Instructor Rating(s): None
Toxicology Performed:Yes 
Medical Certification: Class 3 With Waivers/Limitations
Last FAA Medical Exam: 04/12/2018
Occupational Pilot: No
Last Flight Review or Equivalent: 05/22/2018
Flight Time:  (Estimated) 150 hours (Total, all aircraft), 60 hours (Total, this make and model) 

The pilot held a private pilot certificate with a single-engine land rating. On April 12, 2018, the pilot received a special issuance third-class medical certificate (as a result of his obstructive sleep apnea) with a limitation to wear corrective lenses.

The pilot started flight training for his private pilot license at the end of March 2018 and completed the training in May 2018; afterward, he purchased the accident airplane. According to his flight instructor, the pilot was "conscientious" and had planned to start instrument flight training soon.

Another friend of the pilot who flew frequently with him described the accident pilot's personality as "gung-ho" and indicated that he was sometimes in a "go-go-go" mode. The pilot's friend (who was also a pilot) thought the accident pilot was "very knowledgeable" operating the accident airplane with the autopilot on but was not as skilled when hand flying the airplane. The pilot's friend reported that, during a flight in September 2018, the accident pilot climbed through a cloud deck with the autopilot on and flew in instrument meteorological conditions even though he did not have an instrument rating.

Aircraft and Owner/Operator Information

Aircraft Make: Cessna
Registration: N81KD
Model/Series: 210 N
Aircraft Category: Airplane
Year of Manufacture: 1981
Amateur Built: No
Airworthiness Certificate: Normal
Serial Number: 210-64484
Landing Gear Type: Retractable - Tricycle
Seats: 6
Date/Type of Last Inspection: 01/30/2018, Annual
Certified Max Gross Wt.: 3803 lbs
Time Since Last Inspection:
Engines: 1 Reciprocating
Airframe Total Time: 3930 Hours as of last inspection
Engine Manufacturer: Continental
ELT: Installed, activated, did not aid in locating accident
Engine Model/Series: TSIO-520 SER
Registered Owner: On file
Rated Power: 310 hp
Operator: On file
Operating Certificate(s) Held: None

The airplane was manufactured in 1981 and was equipped with a Continental TSIO-520-R5A engine, serial number 522181, and a McCauley three-blade metal propeller. The airplane's last annual inspection before the accident was on January 30, 2018.

Meteorological Information and Flight Plan

Conditions at Accident Site: Instrument Conditions
Condition of Light: Day
Observation Facility, Elevation: KATY, 1748 ft msl
Distance from Accident Site: 26 Nautical Miles
Observation Time: 1053 CDT
Direction from Accident Site: 118°
Lowest Cloud Condition:
Visibility:  10 Miles
Lowest Ceiling: Overcast / 600 ft agl
Visibility (RVR):
Wind Speed/Gusts: 6 knots /
Turbulence Type Forecast/Actual: None / None
Wind Direction: 60°
Turbulence Severity Forecast/Actual: N/A / N/A
Altimeter Setting: 29.9 inches Hg
Temperature/Dew Point: 2°C / 2°C
Precipitation and Obscuration: No Obscuration; No Precipitation
Departure Point: Clark, SD (8D7)
Type of Flight Plan Filed: None
Destination: Webster, SD (1D7)
Type of Clearance: None
Departure Time: 1115 CDT
Type of Airspace: Class G 

At 1053, the meteorological aerodrome report from Watertown Regional Airport (ATY), Watertown, South Dakota, located 26 miles southeast of the accident site reported wind from 060° at 6 knots, 10 miles visibility or greater, overcast ceiling at 600 ft agl, temperature 2°C, and dew point 2°C. At the same time, Aberdeen Regional Airport (ABR), located 37 miles northwest of the accident site, reported wind calm, 4 miles visibility, mist, overcast ceiling at 500 ft agl, temperature 5°C, and dew point 4°C.

At 1153, ATY reported wind from 090° at 6 knots, 10 miles visibility or greater, scattered clouds at 600 ft agl, overcast ceiling at 1,900 ft agl, temperature 3°C, and dew point 2°C. At the same time, ABR reported wind calm, 5 miles visibility, mist, overcast ceiling at 500 ft agl, temperature 6°C, and dew point 4°C.

The closest National Weather Service Weather Surveillance Radar-1988 Doppler to the accident site was at ABR. The radar imagery indicated no precipitation targets above the accident site about the time of the accident. AIRMETs Sierra and Zulu were valid for the accident site at the accident time and during the previous flight on the morning of the accident (FSD to 8D7). The AIRMETs, which were issued at 0345 and 0945, indicated that instrument flight rules conditions existed due to mist and fog.

The pilot did not request a weather briefing through the Federal Aviation Administration (FAA) flight service contractor, and a search of archived ForeFlight information found no evidence indicating that the pilot requested or reviewed any of the company's weather information. The available evidence did not indicate if the pilot checked or received weather information from another source before or during the accident flight. 

Wreckage and Impact Information

Crew Injuries: 1 Fatal
Aircraft Damage: Destroyed
Passenger Injuries: N/A
Aircraft Fire: On-Ground
Ground Injuries: N/A
Aircraft Explosion: None
Total Injuries: 1 Fatal
Latitude, Longitude: 45.108611, -97.694444 

The airplane impacted terrain in a nose-down, left-wing-low attitude, and a postimpact fire consumed the cabin. The wreckage path extended about 270 ft on an easterly heading, and soot was observed on multiple pieces of the wreckage debris.

The engine was inverted near the impact crater. The six cylinders, which remained attached to the crankcase with varying degrees of impact damage, were inspected with a lighted borescope and no preimpact anomalies were noted. The crankshaft propeller flange was fractured from the crankshaft and remained attached to the propeller hub.

The propeller separated from the engine, and all three blades exhibited leading edge gouges and chordwise scratches. One blade was broken out of the hub and was bent aft from the root to the tip. The other two blades remained in the hub and exhibited S-shaped bending.

The fuel pump was disassembled; the shear shaft was intact, and no preimpact anomalies were noted. The magnetos had separated due to impact and could not be functionally tested. The fuel screen had no obstructions.

Control cable continuity was established for the aileron, rudder, elevator, and elevator trim. The instrument panel was fragmented and destroyed by postimpact fire. The pilot-side attitude indicator gyro rotor showed evidence of rotational scoring. The postaccident examinations of the airframe and engine revealed no evidence of mechanical malfunctions or failures that would have precluded normal operation. 

Medical And Pathological Information

The Sanford Health Pathology Clinic, Sioux Falls, South Dakota, performed an autopsy on the pilot. His cause of death was multiple blunt force injuries. Toxicology testing performed at the FAA Forensic Sciences Laboratory was negative for drugs and ethanol.

6 comments:

  1. Should be a requirement for all new pilots to watch ALL of the AOPA accident safety videos. This is unreal.

    ReplyDelete
    Replies
    1. The reports describe a person who fully rejected the protocols he had been required to learn for the PPL. Additional videos and examples that will help a conscientious pilot grow would be blown off by someone who behaves this way. You can bet that his buddy on the 20 November autopilot climb through IMC said something to him about it, but just 12 days later he crashed doing the same profile. Rules are for others, until Physics kicks in...

      Delete
  2. He had no business being in that model a/c.

    ReplyDelete
  3. At the bottom of the first paragraph I stopped reading and thought "let me guess - low time pilot with recently purchased airplane, not instrument rated etc...". Condolences to those he left behind - this certainly didn't have to happen.

    ReplyDelete
  4. It was supposed to be a 15 minute scud run, so no need to follow the rules, autopilot can fly the plane if needed like it did in IMC last time, don't need IFR training, and hey it is a big wide open prairie out there, right?

    Sad outcome for pilot's loved ones and friends, but at least there was not a full load of passengers and/or a burning house with ground injured victims to go with it that time.

    ReplyDelete
  5. I just don't get it. It seems that this type of accident will never go away...same thing over and over. To all you superman pilots out there, get it together! Ya'll aren't any more special than anyone else...the laws of physics apply to us all. When you climb into the cockpit, leave the ego behind!

    ReplyDelete