ERA24FA036

The non-instrument-rated pilot’s improper inflight decision making and his flight into instrument meteorological conditions, which resulted in spatial disorientation and subsequent loss of airplane control. Contributing to the accident were the pilot’s inadequate preflight weather planning.

The non-instrument-rated private pilot was performing a visual flight rules (VFR) cross-country flight. ADS-B data revealed that when the pilot was about 20 nautical miles (nm) from his intended destination, the airplane began to fly erratically, with several 360° turns and multiple climbs and descents. During this time, the pilot contacted ATC, declared an emergency, and reported that he was “lost in weather.” The controller began to provide the pilot with radar vectors out of the weather and informed the pilot when he began to deviate in altitude or heading, to assist the pilot with maintaining control of the airplane. During these communications, the pilot reported that his vacuum-driven attitude indicator and his electrically driven turn and bank indicator had failed. The pilot reiterated that he couldn’t see anything and reported that he thought he was “upside down.” In the final minutes of flight, the airplane made two tight, left 360° turns with a steep descent in excess of 5,000 ft per minute. The last ADSB data point was about 650 ft from the wreckage location. Before departure, the ground controller at the departure airport reported that the weather conditions were “IFR” and indicated the ceiling was broken clouds at 800 ft above ground level (agl). About 1 minute later, the controller stated there were updated weather conditions, which were few clouds at 800 ft agl, then issued a taxi clearance to the pilot. VFR, marginal VFR (MVFR), and instrument flight rules (IFR) conditions were present along the pilot’s route of flight, with areas of low cloud coverage and low visibility due to rain. The closest weather reporting station to the accident location reported IFR conditions just before the accident with 2 miles visibility, rain and mist, and a broken cloud layer at 1,800 ft agl. A high-resolution atmospheric model for the accident site indicated stratus clouds with bases about 600 ft agl and an overcast cloud layer at 1,000 ft agl with tops near 16,200 ft. Aviation weather forecasts issued near the time of departure depicted general MVFR conditions along the route of flight, and a graphical AIRMET for IFR conditions was active for a portion of the route. There was no record that the pilot received a weather briefing prior to departing on the flight, which would have alerted him to the forecast inclement weather along his planned route of flight. Postaccident examination of the wreckage revealed no evidence of any preimpact anomalies or mechanical failures that would have precluded normal operation. The attitude indicator and the turn and bank indicator were examined; both instruments displayed rotational scoring on their gyroscopes, indicating that the gyroscopes were spinning at the time of impact. However, during a pre-buy inspection performed a few months before the accident, a mechanic determined that the attitude indicator was inoperative. The investigation was unable to determine the nature of the malfunction, but there was no evidence that the attitude indicator had been subsequently repaired or replaced. The detection of carboxy-delta-9-THC in samples of the pilot’s blood indicated that the pilot had used a cannabis product. However, the fact that no delta-9-THC was detected, and that carboxy-delta-9-THC was not detected in liver tissue, indicated that the time between the pilot’s last cannabis use and the accident likely was long enough that he was not experiencing acute psychoactive effects of cannabis at the time of the accident. In summary, it is likely that as the pilot neared the destination airport, the airplane entered a cloud layer, resulting in the pilot losing outside visual reference to his surroundings. As such, the pilot likely became spatially disoriented and subsequently lost control of the airplane.

According to FAA airman records, the pilot held a private pilot certificate with a rating for airplane single-engine land. He did not hold an instrument rating. The pilot’s paper logbook contained records of flights between September 1, 2020, and February 25, 2023. None of the pilot’s logged flight time was in the accident airplane. He had logged a total of 2.2 simulated instrument hours and 1 hour in actual instrument conditions. The most recent logged instrument hours were on January 30, 2021. According to FAA records, the pilot purchased the airplane on October 31, 2023. A review of the airplane’s maintenance records revealed that the most recent annual inspection was completed on October 28, 2022, at an airframe total time of 3,554.1 hours. A mechanic performed a pre-buy inspection on May 11, 2023, and found several discrepancies, including that the attitude indicator had failed. There were no logbook entries indicating the attitude indicator had been repaired or replaced before the accident. An autopsy of the pilot’s remains was conducted by the Office of the Medical Examiner District Eight, Gainesville, Florida. According to the autopsy report, the cause of death was multiple blunt traumatic injuries, and the manner of death was accident. Toxicology testing performed by the FAA Forensic Sciences Laboratory on the pilot detected carboxy-delta-9-tetrahydrocannabinol (carboxy-delta-9-THC) in cavity blood and did not detect carboxy-delta-9-THC in liver tissue. Carboxy-delta-9-THC is a non-psychoactive metabolite of delta-9-tetrahydrocannabinol (delta-9-THC). Delta-9-THC (which was not detected in this case) is the primary psychoactive chemical in cannabis, including marijuana, hashish, and other cannabis products. Cannabis may be inhaled or ingested recreationally by users seeking mind-altering effects. It may also be used to treat symptoms of various medical conditions. Psychoactive effects of cannabis vary depending on the user, dose, and route of administration, and may impair motor coordination, reaction time, decision-making, problem solving, and vigilance. Carboxy-delta-9-THC may be detected in blood days or weeks after the last cannabis use, well beyond the duration of acute psychoactive effects of delta-9-THC. Marijuana is a federal Schedule I controlled substance, and the FAA considers its use by pilots unacceptable, regardless of state laws. On November 14, 2023, about 1409 eastern standard time, a Piper PA-28-180, N7806W, was destroyed when it was involved in an accident near Micanopy, Florida. The pilot was fatally injured. The airplane was operated as a Title 14 Code of Federal Regulations Part 91 personal flight. According to air traffic control (ATC) communication records, before departure, the ground controller at Kissimmee Gateway Airport (ISM), Orlando, Florida, reported that the weather conditions were “IFR” and indicated that the broken cloud ceiling was at 800 ft agl. About 1 minute later, the controller stated there were updated weather conditions, which were few clouds at 800 ft agl, then issued a taxi clearance to the pilot. According to ADS-B flight track data, the airplane departed ISM about 1245. ADS-B data revealed that after departure, the airplane flew on a northerly track until the airplane was about 20 nm south of the pilot’s destination. The airplane initially climbed to an altitude of 3,500 ft mean sea level (msl) and flew at altitudes between 2,900 and 3,500 ft msl until about 1314, when it descended to 2,000 ft msl. About 1322, the airplane descended further to 800 ft msl. About 1331, a brief turn toward the east was observed, followed by a left turn back to a northerly track. Subsequently, the airplane performed several erratic 360° turns and numerous climbs and descents to a maximum altitude of 6,900 ft msl and a minimum altitude of 500 ft msl, between 1335 and the last data point at 1409. The data ended after the airplane made two tight, left 360° turns while in a steep descent in excess of 5,000 ft per minute. The main wreckage was located about 650 ft northeast of the final ADS-B data point. Review of air traffic control communications revealed that during the erratic maneuvering, the pilot called "mayday" and stated he "was lost in weather." During this period, ATC attempted to provide the pilot with radar vectors toward an area with better weather and also suggested control inputs when the ADS-B data showed he was flying off course or beginning a descent or climb. During the conversation, the pilot reported multiple times that multiple instruments had failed, specifically the vacuum-driven attitude indicator and the electrically-driven turn and bank indicator. The pilot also reported that he "mistakenly flew into weather,” "it's completely white,” and he could not see anything outside. At one point, the pilot reported to ATC that he thought he was “upside down.” The airplane came to rest in a heavily wooded area, in a 4-ft-deep crater at an elevation of 100 ft msl. It struck several trees before impacting sandy terrain. All major components of the airplane were located in the vicinity of the main wreckage. The fuselage was fragmented and the cabin was crushed forward. Flight control continuity was established from the cabin to all flight control surfaces through multiple cuts made by first responders and separations consistent with tensile overload failure. The right wing was separated from the fuselage at the wing root. The forward section of the right wing was crushed aft. The outboard 4 ft of the right wing was separated from the inboard section and located along the debris path. The left wing was fragmented. The inboard section of the left wing was crushed aft. The empennage was separated from the fuselage. The stabilator remained attached to the empennage. The trim tab remained attached to the stabilator. The vertical stabilizer and rudder were separated and located in the vicinity of the main wreckage. All airframe damage was consistent with impact forces rather than in-flight separation. Examination of the attitude indicator revealed rotational scoring on the gyroscope and the gyroscope housing. Examination of the electric turn and bank indicator revealed vertical scoring on the gyroscope. The compass was separated from the instrument panel. During examination, the compass float moved when the instrument was manipulated. The engine remained attached to the forward section of the fuselage through all engine mounts. The crankshaft could not be rotated by hand. The propeller flange was bent from impact but remained attached to the crankshaft. The rocker arms showed no anomalies. The cylinders were examined with a lighted borescope; sand and oil were present in the cylinders, but no other anomalies were observed. The magnetos produced spark on all towers. All spark plugs were removed except the No. 2 bottom spark plug, which was damaged from impact. The spark plugs were massive electrode type; all were light gray and exhibited worn out–normal wear when compared to the Champion Check-A-Plug Chart. The carburetor bowl did not contain fuel; however, the carburetor floats exhibited hydraulic deformation, consistent with the presence of fuel at the time of impact. The oil filter was free of metallic debris. The oil suction screen was unobstructed. The rotor and vanes of the vacuum pump were intact, and the drive splines were also intact. The airplane was equipped with a two-blade, fixed-pitch propeller. Tip tearing, chordwise scratching, and S-bending were observed on the propeller, consistent with the engine producing power at the time of impact. Furthermore, a branch, about 2 inches in diameter, that was cut at a 45° angle, was located in the vicinity of the main wreckage. According to an NTSB weather study, the closest weather reporting station to the accident site was Gainesville Regional Airport (GNV), Gainesville, Florida. A special weather observation at 1412