Fatal Airplane Crash

teetee

New Member
In August of 2000, my cousin who had recently went through a nasty divorce, decided he wanted to continue his passion for flight. He had several hundred hours when he decided to attend a school in California to get his Multi-engine rating.

On October 6, 2000, his plane crashed into the side of the mountain. He was flying with a CFI. Both died in the crash. I have often thought about this crash, even more after I married a pilot. My in-laws had looked up the information and we had discussed it some but not really in-depth. My brother in law had told me that it was ruled as my cousin's fault. I thought that was interesting because of a lawsuit and battle my aunt and uncle had fought to have his name cleared. I had never read the reports but I had the knowledge of what was told to me by his parents and then also what my in-laws had read and discussed with me.

Tonight I was sitting and thinking and I decided that maybe I could finally handle reading what was in the NTSB report. It wasn't easy reading, reading what the plane condition was and that my cousin was in that plane made me sick at times. As I read everything in the report, I had a hard time understanding some of the information with the ATC. My husband is in the process of being hired as an ATC (he is a tentative offer letter). Feeling for both sides (ATC because my husband is going to be one and Pilot because my husband and lots of family are), I really would like to understand what really happened. I would like some input from pilots and ATC if they would on what they think happened, or rather how they would interpret the report.

First, a lot of the lingo is hard to understand. Although I may be married to a pilot and hear pilot talk on a daily basis, I have never received formal training. I have NO clue how to read weather readings and such. I do know that part of this crash was weather related but I couldn't understand it all.

Please tell me if I am understanding this correctly. My cousin was the PIC I believe, but if could have been his CFI, not sure. While flying he was talking to So Cal Tracon (enroute) and then was transfered to POC (tower) when he got to a certain point. He was disoriented from how I read it. A few times he says he has the airport in site then he says he doesn't. Even though he was IFR, the ATC asked if he wanted to move to VFR because of conditions. From what the ATC said he moved to VFR, but when I read I the transcript it sounded like he wanted to stay IFR. Did I get that right?

Where does the the Radar person fall into all of this? From how I understand it there was 3 ATC, the radar, enroute and tower. Is that right? Did the radar stop the warning about airplane elevation from reaching the other ATC's?

My aunt and uncle held a strong conviction that the crash and death was not their son's fault. I think part of it was that they had to hear it wasn't his fault to get closure. They fought the findings that the crash was his fault. About 2 years ago, my aunt was estatic when she got news that the NTSB had changed their findings and blamed the ATC for the crash and not my cousin.

At the end of the report, it stated: "According to 14 CFR Part 91.3, the pilot is responsible for the safety of the flight. This included deciding whether or not to continue the approach or conduct the missed approach procedure when the airplane had reached the missed approach point (MAP). The MAP for the VOR-A approach was the VORTAC. The airplane was approximately 2 1/2 miles north of the VORTAC and the airport.

The IIC released the wreckage to the owner's representative."

From my understanding, the NTSB still places the blame on the pilot. Why would the lawyer and others tell my aunt and uncle that it had been ruled that it was ATC fault and yet the report still reads pilot? Would that finding of it being the ATC fault be in another location?

Here is the full report.

http://www.ntsb.gov/ntsb/brief2.asp?ev_id=20001212X22177&ntsbno=LAX01FA004&akey=1

Here is the summary one:

http://www.ntsb.gov/ntsb/GenPDF.asp?id=LAX01FA004&rpt=fi


Thanks for enduring the long post!
 
NTSB reports are never an easy read... an old friend of mine was killed in a crash about 10 years ago, as a courtesey the NTSB called me prior to the final report, the level of detail they go into is never easy to hear.

ATC was named as a cause in this accident... if you read the briefing report (the one in .PDF format) page three lists findings. Findings 3,4, and 5 list ATC as a cause (C) in the accident along with the PIC, who in this case was the CFI. The way I read the report your cousin is the one person NOT named in the findings.

The CFI was responsible for the safe operaton of the aircraft and ATC was responsible for services. Your cousin was just a student in this whole thing.

I hope this information helps...

Sorry for your loss.
 
I hadn't seen the findings 3,4 and 5. I did know that the ATC had lost their jobs over this. Now that I see more of the ATC side as well as the pilot side, that makes me really say. A really unfortunate situation.

As for the loss, I was not posting this for sympathy. I really was interested in ATC and pilot input on what occurred that night.

I have a question on the radar. The report was really confusing for me with the ATC part. Did the radar guy see the warning but thought the plane had landed so superceded it? Why did the radar warning not reach the other two ATC? I am just starting to try and understand the ATC world. I am hoping as my husband becomes a full CPC he will be able to explain more of that world to me.

Thanks for that answers!
 
I have a question on the radar. The report was really confusing for me with the ATC part. Did the radar guy see the warning but thought the plane had landed so superceded it? Why did the radar warning not reach the other two ATC?

ATC radar is highly digitized for air traffic use... to track an aircraft the data block and functionality (MSAW, conflict alert, etc.) is derived by a computer. From the report the radar controller was told by the tower that that the pilot went VFR... at that point the radar controller "dropped" track on the aircraft meaning that the computer stopped tracking the target. By doing this MSAW and other functionality are no longer available.

From the report it appears that the tower controller had the MSAW warning on the dbrite radar... a small radar screen that generally hangs from the ceiling in the tower cab. I don't think dbrite is certified to radar seperate A/C ... I'm not a tower controller so I am not sure.
 
So are there Radars in each location? I knew that Enroute and Tower were seperate but do they have a third place that is for Radar or was the Radar person with the Enroute person?
 
So are there Radars in each location? I knew that Enroute and Tower were seperate but do they have a third place that is for Radar or was the Radar person with the Enroute person?

In centers we have radar called DSR, it's a composite radar that is highly digitized. By composite it means it uses more then one radar site to create a radar mosaic on the display. Due to the numerous radars we have to use 5 mile lateral separation.

TRACONS, which are approach controls, use single site radar, meaning they use a single radar feed, there radar is not as digitized as DSR, they have more of a "raw" radar display, due to the single site they use 3 mile lateral separation. TRACONS provide more localized radar services in terminal areas, they underlay center airspace.

Most towers have radar called Digital Brite Radar (D'Brite). I have never worked at a tower so my knowledge about it is limited ... my understanding is that tower controllers use it for sequencing, traffic calls, and general traffic info.

In the NTSB report it notes that a TRACON was providing radar services to the aircraft at the time of the accident.
 
Interesting, thanks.

So I have an ATC question. Do all ATCers that are Enroute/Tracon work on radars (So the room is full of a ton of radars) or is it one main one that each person has a section of it? The entire time you are working you are working Radars while talking with traffic?
 
ATC radar is highly digitized for air traffic use... to track an aircraft the data block and functionality (MSAW, conflict alert, etc.) is derived by a computer. From the report the radar controller was told by the tower that that the pilot went VFR... at that point the radar controller "dropped" track on the aircraft meaning that the computer stopped tracking the target. By doing this MSAW and other functionality are no longer available.

From the report it appears that the tower controller had the MSAW warning on the dbrite radar... a small radar screen that generally hangs from the ceiling in the tower cab. I don't think dbrite is certified to radar seperate A/C ... I'm not a tower controller so I am not sure.

I'm guessing POC is class D airspace and the tower controller is not authorized to use the Brite for radar services. Just my .02 here but I don't think the pilot intended on cancelling IFR and the minute he lost sight of the airport the tower controller should have called radar, asked for a climbout (heading and alt.) and shipped the plane back to approach. Plus, as the report states the tower controller told the approach controller, "I don't know what to do with him" and he allowed him to cancel his IFR flight plan with 2 miles of vis. Unfortunately it sounds like a lack of experience on the tower guys parts.

HD
 
Interesting, thanks.

So I have an ATC question. Do all ATCers that are Enroute/Tracon work on radars (So the room is full of a ton of radars) or is it one main one that each person has a section of it? The entire time you are working you are working Radars while talking with traffic?
The room is full of radar screens to be accurate.

It works the same in the US as in Canada as far as I know and each TRACON/Area control centre has a bank of radar sources that they use, when a controller sits into a sector/position they are assigned a certain portion of airspace, their radar screen displays all of the information from the radar sites inside their facilities control. There is a computer which takes all of the information from various radar sites and computes it to display aircraft in a single more accurate position. We have the ability to select a radar site stand alone, but there rarely is any purpose for this.

So to answer your question in brief:

Multiple controllers/screens all of which access the same radar information which is fed into a computer and displayed on each controllers screen.
 
From my understanding of POC (Brackett Tower), the (D'Bright) is a localize feed from SoCal TRACON radar services and it has a minute or so delay. Thusly it is not used for seperation, but for advisories and giving the Local Controller a generalize area to attempt visual contact with the aircraft. POC sits in the foothills between San Dimas and La Verne and is immedately east of Lake Puddingstone, very hilly terrian. If my memory serves me, the missed appoach procedure for 26L is to make a climbing turn to the south, I normally turn 180 and climb to 3,500 but I am also only flying VFR, so for IFR it may be different. It honestly sounds like the instructor got disoriented in the clouds and flew north far to long. This would not be the first time this has happened, will not be the last.

I am deeply sorry for you loss.
 
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