Primary finding
Probable cause
The pilot's failure to maintain control of the airplane during a missed approach in instrument meteorological conditions.
Investigator assessment
Analysis narrative
While approaching the airport to land in instrument meteorological conditions, the pilot checked in with the local approach controller and informed him that he was south of the airport at 7,000 feet mean sea level (msl). When the airplane was about 33 miles from the airport, the local controller instructed the pilot to turn left 15 degrees to intercept the localizer for the landing runway and descend to 2,000 feet msl. Radar data showed the airplane turn to intercept the localizer but then overshoot the inbound course. The airplane was about 2 miles left (north) of course and continuing north when the local controller advised the pilot that he had flown through the final approach course and was still northbound. The pilot acknowledged the information and requested a vector to turn back to the localizer course. The local controller then instructed the pilot to turn right 70 degrees to re-intercept the inbound course, and the pilot acknowledged the heading. Radar data showed the airplane turn onto the localizer course. When the airplane was 4 miles from the final approach fix, the local controller cleared the approach and instructed the pilot to contact the tower. After the pilot contacted the tower, the tower controller cleared the airplane for landing. After the pilot told the tower controller that the airplane was at 3,000 feet msl, the controller cancelled the landing clearance because the airplane was at too high an altitude to intercept the glideslope and issued missed approach instructions; however, the pilot made no further communications to air traffic control. Radar data subsequently showed the airplane make a tight, right-descending turn to the south while at 1,600 feet msl and 211 knots. The airplane climbed to 1,900 feet msl and then descended. The airplane disappeared from radar when it was headed south-southwest at 1,200 feet msl. Witnesses saw the airplane rapidly descending almost vertically toward the ground. They lost sight of the airplane as it descended below the tree tops and then subsequently heard the it impacting trees and terrain. A postaccident examination of the airplane did not reveal any anomalies with the engine, flight controls, or other airplane systems that would have precluded normal operation. Although postmortem toxicology showed the presence of ethanol, the variability of the amounts found indicate that it was likely from postmortem production and not ingestion.
Source record
Factual narrative
**This report was modified on March 6, 2015. Please see the public docket for this accident to view the original report.**HISTORY OF FLIGHT On January 24, 2013, about 1345 central standard time, a Raytheon Aircraft Company (RAC) A-36 Bonanza, N980SS, impacted trees and terrain in a wooded area near Richwood, Louisiana, while on an instrument approach for landing at the Monroe Regional Airport (KMLU), Monroe, Louisiana. The commercial pilot and three passengers were fatally injured. The airplane was destroyed by the impact forces and a postcrash fire. The airplane was registered to, and operated per Central Flying Service, Inc., under the provisions of 14 Code of Federal Regulations Part 91, as a personal flight. Instrument meteorological conditions prevailed, and an instrument flight rules flight plan was filed and active. The flight originated from Beaumont Municipal Airport (KBMT), Beaumont, Texas, at 1225, and was destined for KMLU. At 1331, the pilot of the airplane checked in with KMLU approach control and reported he was at 7,000 feet msl. Radar track data showed the airplane southwest of the airport on about a 035 degree heading. At 1334:20, with the airplane approximately 37 miles from KMLU, the approach controller directed the pilot to turn left 15 degrees to join the localizer, to track the localizer course inbound, and to descend at the pilot's discretion to 2,000 feet msl. The pilot acknowledged. The airplane was sequenced to follow a King Air descending out of 12,000 feet. Radar showed the airplane at 7,000 feet msl and a groundspeed of 171 knots. At 1338:48, the approach controller requested the pilot to report established on the localizer inbound. The pilot responded that he would report established on the localizer inbound. At 1339:25, the approach controller advised the pilot that it appeared that he had flown through the final approach course and was still northbound. The pilot responded that he was just seeing that and requested a radar vector to return back to the localizer course. The approach controller issued a right turn to a heading of 070 degrees. The pilot acknowledged the heading of 070 degrees. Radar showed the airplane at 5,700 feet msl on a heading of about 025 degrees and a groundspeed of 161 knots. The airplane then turned to the heading of 070 degrees. At 1341:21, the approach controller queried the pilot if he was receiving the localizer signal. The pilot responded, "It's coming." At 1342:26, the approach controller directed the pilot to contact tower, but then corrected himself and asked if the pilot was receiving the localizer. The pilot replied that he was established on the localizer and was "going over to tower." The approach controller responded that the airplane was four miles from the SABAR final approach fix, cleared for the ILS runway 4, and to contact tower on frequency 118.9 MHz. The pilot acknowledged that he was cleared for the approach and was switching to the tower frequency. At 1344:18, the pilot checked in with KMLU tower for the ILS approach to runway 4. The tower local controller issued a landing clearance for runway 4. The pilot acknowledged that he was cleared to land runway 4 and that he was "curious that he was not going to be able to get down." The tower asked the pilot if he was going to be able to make the descent. The pilot responded that he was at 3,000 feet and it was as much as he could descend at the moment. The local tower controller advised the pilot to expect to receive vectors around for another ILS approach as there was another aircraft on the approach behind the airplane. The pilot did not respond. At 1344:49, radar showed the airplane on a heading of 042 degrees, at 3,100 feet msl, and a groundspeed of 183 knots At 1345:22, the tower local controller cancelled the airplane's landing clearance and directed the pilot to fly runway heading and maintain 2,000 feet. The pilot did not respond. Radar showed the airplane in a tight right, descending turn at 1,600 feet, and a groundspeed of 210 knots. Radar contact with the airplane was lost at 1345:36. At the time radar contact was lost, the airplane was at 1,200 feet and headed south-southwest away from the airport. At 1345:32, the tower local controller asked the pilot if he was still on the localizer. The pilot did not respond. The tower local controller made several radio calls to the airplane without response. At 1346:09, the tower local controller transmitted to the airplane that radar contact was lost four miles south of the Monroe airport and queried the pilot if he was on the tower frequency. There were no further transmissions between the tower and the airplane. A witness whose home was on the approach path to the airport heard the airplane go over his house. He went outside to see if he could see it, but didn't because the weather was overcast skies. He said he did hear the engine sound change as if the pilot reduced power and then put it back in again. Several witnesses near the accident site saw the airplane come out of the clouds descending almost vertically toward the ground at a high rate of speed. They lost sight of the airplane as it descended below the tree tops. They then heard sounds of the airplane impacting the trees and terrain. PERSONNEL INFORMATION The pilot, age 31, held a commercial pilot certificate for airplane single-engine land, multi-engine land, instrument airplane. He also held certificates as a flight instructor for airplane single-engine land and instrument airplane, and ground instructor, instrument. The pilot held a first class airman medical certificate issued May 13, 2008, with no limitations. The pilot was hired by Central Flying Service, Inc. on April 16, 2012. According to information reported by the company to the FAA, as of July 25, 2012, the pilot had 470 total flying hours. The company also reported that the pilot successfully completed company check rides on July 27, 2012, to be able to instruct in the company's airplanes. According to information obtained by the FAA, the pilot had less than 10 hours in the accident airplane. AIRCRAFT INFORMATION The six seat, low-wing, retractable landing gear airplane, serial number E-3152 was put in service on February 22, 1998. It was powered by a Continental Motors, Incorporated, IO-550B-45B, 300 horsepower engine and equipped with a McCauley, part number D3A32C409-C, three-bladed constant speed propeller. A review of the airplane's maintenance records showed it underwent an annual inspection on January 9, 2013. The total airframe time at the annual inspection was 2,823.2 hours. According to the operator, the airplane flew about 10 hours after the annual inspection was performed, making the total time on the airframe at the time of the accident 2,833.2 hours. The airplane's engine, serial number 834715R, was installed on August 27, 2007. The total time on the engine since major overhaul was 872.6 hours. The propeller, serial number 971813, had a total time of 2,823.2 hours. It's time since major overhaul was 1,222.3 hours. METEOROLOGICAL INFORMATION At 1253, the recorded weather at KMLU was wind 060 degrees at 8 knots, visibility 1-1/2 statute miles in mist, sky condition overcast at 400 feet, temperature 13 degrees Celsius (C), dew point 11 degrees C, and altimeter 30.27 inches of Mercury. At 1353, the recorded weather was wind 050 degrees at 12 knots, visibility 2 statute miles in mist, sky condition overcast at 700 feet, temperature 12 degrees C, dew point 9 degrees C, and altimeter 30.26 inches of Mercury. AERODROME AND GROUND FACILITIES Monroe Regional Airport, elevation 79 feet msl, is located about 4 miles east of the city of Monroe, Louisiana, at geographic coordinates: 32-degrees, 31 minutes north latitude, and 092-degrees, 02 minutes west longitude. The airport has three runways; runway 4-22, runway 14-32, and runway 18-36. Runway 4-22 is the longest at 7,