Primary finding
Probable cause
The pilot's failure to maintain adequate airspeed during the instrument approach, which resulted in an aerodynamic stall and impact with terrain.
Investigator assessment
Analysis narrative
On his first Instrument Landing System (ILS) approach, the pilot initially flew through the localizer course. The pilot then reestablished the airplane on the final approach course, but the airplane’s altitude at the decision height was about 500 feet too high. He executed a missed approach and received radar vectors for another approach. The airplane was flying inbound on the second ILS approach when a witness reported that he saw the airplane about 150 feet above the ground in about a 60-degree nose-low attitude with about an 80-degree right bank angle. The initial ground impact point was about 2,150 feet west of the runway threshold and about 720 feet north (left) of the extended centerline. The cloud tops were about 3,000 feet with light rime or mixed icing. The flap jack screws and flap indicator were found in the 5-degree flap position. The inspection of the airplane revealed no preimpact anomalies to the airframe, engines, or propellers. A radar study performed on the flight indicated that the calibrated airspeed was about 130 knots on the final approach, but subsequently decreased to about 95–100 knots during the 20-second period prior to loss of radar contact. According to the airplane’s flight manual, the wings-level power-off stall speed at the accident aircraft’s weight is about 91 knots. The ILS approach flight profile indicates that 20 degrees of flaps should be used at the glide slope intercept while maintaining 120 knots minimum airspeed. At least 20 degrees of flaps should be maintained until touchdown. The “No Flap” or “5 Degrees Flap Landing” flight profile indicates that the NO FLAP Vref airspeed is 115 knots calibrated airspeed minimum.
Source record
Factual narrative
HISTORY OF FLIGHT On January 18, 2010, at 1405 eastern standard time, a Mitsubishi MU-2B-60, N80HH, was destroyed when it impacted terrain during an instrument approach to runway 07 (5,002 feet by 100 feet, asphalt) at the Lorain County Regional Airport (LPR), Elyria, Ohio. The pilot, the pilot-rated passenger in the right seat, and two passengers seated in the cabin received fatal injuries. The 14 Code of Federal Regulations Part 91 flight departed the Gainesville Regional Airport (GNV), Gainesville, Florida, about 1100, and was en route to LPR. Instrument meteorological conditions prevailed at the time of the accident, and an instrument flight rules (IFR) flight plan was filed. Air Traffic Control (ATC) transcripts indicated that the airplane was approaching LPR on a heading of 325 degrees. At 1335:51, ATC informed the pilot that he could expect radar vectors for the instrument landing system (ILS) Runway 07 approach to LPR. At 1345:53, ATC informed the pilot that he was 4 ½ miles from RAWLS, the final approach fix for the localizer (LOC) Rwy 07 approach, and instructed him to turn right to a heading of 050 degrees, maintain 2,600 feet mean sea level (msl) until established on the localizer. The flight was cleared for the ILS Runway 07 approach. The pilot acknowledged the clearance. Radar track data indicated that the airplane flew through the inbound course of 070 degrees and continued on a 055 degree heading. At 1347:03, ATC instructed the pilot to turn to 090 degrees to intercept the inbound course. The ATC controller also stated, “I didn’t adjust for the wind there.” At 1347:19, ATC instructed the pilot to turn to 100 degrees and asked the pilot if he wanted to continue the approach, or take radar vectors to get reestablished on the inbound course, since he would be intercepting the inbound course near or at RAWLS. The pilot elected to continue the approach. At 1348:27, ATC instructed the pilot to change radio frequency to LPR’s advisory frequency. The pilot acknowledged the frequency change. At 1349:33, the pilot advised ATC that he was executing a missed approach. The radar track data indicated that the airplane’s altitude during the approach was never lower that 1,500 feet msl. The decision height for the ILS Runway 07 approach was 994 feet msl. At 1350:29, ATC instructed the pilot to climb to 2,500 feet msl and turn left to a heading of 280 degrees for radar vectors for the ILS Runway 07 final approach course. The pilot requested that the controller extend the outbound leg to provide more time to get established on the inbound course. The radar track data indicated that the airplane was about 11 miles from the airport before it turned inbound to intercept the inbound localizer course. At 1358:18, ATC instructed that pilot to turn left to 100 degrees, maintain 2,600 feet msl until established on the localizer, and he was cleared for the ILS Runway 7 approach. The pilot acknowledged the clearance. At 1901:12, ATC instructed the pilot to change to the advisory frequency. The pilot acknowledged the frequency change. Radar track data indicated that the airplane’s altitude increased to about 3,000 feet msl when it turned inbound and intercepted the localizer. The altitude was about 2,200 feet msl when it crossed RAWLS (The altitude at RAWLS is depicted as 2,263 feet msl). The airplane continued inbound and the altitude continued to decrease. The radar track data indicated that the airplane was about 1 mile from runway 07 when the altitude was about 1,300 feet msl (about 506 feet above ground level (agl)). The last radar return indicated that the airplane’s altitude was about 1,000 feet msl. The radar track data indicated that the airplane’s heading started to go left of the centerline when it was about 1,400 feet msl, and it continued to “drift” left until the last radar return. The last radar return was about 0.19 miles (about 1,000 feet) left of centerline. The linear distance from the last recorded radar return to the initial impact point was about 750 feet. A witness, who was waiting at the airport for the airplane to arrive, reported that he heard the radio transmission on the Unicom frequency and was looking to the west to observe the airplane as it landed. He reported that he saw the airplane as it descended out of the clouds. He stated that it was in a nose low attitude, rolling to the right into a steep right turn (initially he thought it might have been a left turn) with the wings at almost a 90 degree position relative to the ground. He stated that the airplane was “definitely out of control” when he saw it. A “huge cloud of snow” was created by the subsequent impact and when it cleared, he observed the airplane wreckage at the west end of the airport property. He stated that it happened very fast - “in the blink of an eye.” He reported that the airplane’s landing light was not turned on. Another witness reported that he heard the airplane as it was approaching his house near the airport. He stated that he looked out a window and saw the airplane about 150 feet above the ground. Using an airplane model to describe the airplane’s flight profile, he indicated that he observed the airplane in about a 60 degree nose low attitude with about an 80 degree angle of bank to the right. PERSONNEL INFORMATION The 30-year-old pilot held an airline transport pilot (ATP) certificate for single-engine land airplanes, multi-engine land airplanes, and helicopters. He was also a certified flight instructor with single-engine airplane, multi-engine airplane, and helicopter ratings; and he was an instrument instructor in airplanes and helicopters. The pilot's latest first class medical certificate was issued on November 29, 2007. The pilot’s flight logbook was not obtained during the course of the investigation. On April 15, 2009, the pilot had reported on an aircraft insurance form that as of 4/15/2009 he had a total of 2,010 flight hours. He had 1,285 multi-engine flight hours with 1,250 hours flown in the MU-2 make and model. He had 231 flight hours in helicopters. He recorded 290 hours of flight in actual instrument conditions. He flew 180 hours in the MU-2 within the preceding 12 months, and had flown 30 hours of instrument flying within the preceding 12 months. The pilot’s training records were obtained from the SimCom Training Center located in Orlando, Florida. The training records indicated that the pilot obtained his initial MU-2 simulator training in October of 2002. Records indicated that the pilot returned to SimCom for recurrent MU-2 simulator training on a yearly basis. On January 28, 2009, the pilot attended the SimCom Training Center and received a certificate signifying that he had satisfactorily completed a Special Federal Aviation Regulation (SFAR) 108 compliant MU-2 Recurrent course for the MU-2B-60 model. The pilot was scheduled to return to SimCom for recurrent MU-2 simulator training on January 25 – 27, 2010. The owner of the airplane reported that the pilot was a competent pilot and was qualified to fly the MU-2 single pilot. The owner and the accident pilot routinely flew together, and they would switch pilot and copilot responsibilities. He stated that they routinely flew in instrument conditions and had often flown IFR approaches in actual instrument conditions. He stated that the accident pilot was a good instrument pilot and that there were no issues with his flying or his technique. The pilot had worked for the owner of the airplane for about 13 years. The pilot rated passenger held a private pilot certificate with a single-engine land rating. His flight logbook was not obtained during the course of the investigation. During his third class medical examination on October 10, 2008, the pilot reported that his total flight time was 190 hours. The airplane owner reported tha