NTSB Factual Report

HISTORY OF FLIGHT

On November 8, 1994, at 1813 Pacific standard time, N584WA, a Cessna 172N, operated by Kennewick Aircraft, Inc., Kennewick, Washington, impacted trees while maneuvering and was destroyed near Klamath Falls, Oregon. The private pilot was seriously injured and his passenger was fatally injured. Instrument meteorological conditions prevailed and a visual flight rules (VFR) flight plan was filed. The business flight departed Hermiston, Oregon, about 1505 and was destined for the Klamath Falls International Airport. The flight was conducted under 14 CFR 91.

According to the pilot, the purpose of the flight was to visit various sites in the Klamath Falls area and check on packaging machinery that had been previously installed there by his employer. The pilot stated that he arrived at Kennewick on the day of the accident to rent an airplane for the trip to Klamath Falls. After the airplane was "topped off" with fuel, the pilot departed Kennewick and flew about 20 minutes to the Hermiston Airport. He was met by the passenger in Hermiston, who was also working for the same employer.

The pilot stated that he called an FAA Flight Service Station (FSS) and received a weather briefing for his trip to Klamath Falls. According to the pilot, the weather briefer stated that the weather forecast was "favorable" for the flight, and that if he (the pilot) wanted to fly to Klamath Falls, the sooner the better because the evening forecast "didn't look good."

According to a transcript (attached) and voice recording of the pilot's weather briefing provided by the FAA, the pilot requested a "standard briefing" for a VFR flight from Hermiston to Klamath Falls. The briefing began at 1436 and ended at 1440. The FSS briefer advised the pilot of one VFR flight precaution for "turbulence occasional moderate below 16,000 feet." The briefer also stated:

"Klamath Falls has an amended forecast up until [1700] this evening. They're looking for 4,000 [feet above ground level (agl)] scattered, ceilings running 7,000 [feet agl] overcast with gusty winds out of the southeast 8 to 15 knots. They also look for ceilings occasionally down to 3,000 [feet agl] broken with light rain and light snow..."

Following the briefing, the pilot stated: "Okay, sounds like a go then." The FSS briefer responded: "Yeah, it looks okay at this point. You might watch it pretty close on your destination ... with that snow and stuff...."

The pilot then filed a VFR flight plan, briefed the passenger on the flight, ran up the airplane with no problems noted, and departed from Hermiston at 1505. The pilot stated that he climbed to a cruising altitude of 7,500 feet mean sea level (msl) after departure. He flew from Hermiston to the Kimberly Very High Frequency Omni Range (VOR), and then from the Kimberly VOR into the Klamath Falls area. He stated that he observed some "high clouds at 20,000 feet" during the first half of the trip. He stated that he was receiving "flight following" from the Seattle Air Route Traffic Control Center (ARTCC) during the flight.

As he got closer to Klamath Falls, the pilot observed scattered layers of clouds in front of him. He climbed from 7,500 feet up to 8,200 feet to clear the clouds, then went back down to 7,500 feet. He stated that 7,500 feet was "well above the minimum sector altitude" along his route of flight. He stated that he was "VFR on top" and was "getting marginal VFR reports from other pilots" on the radio. He also stated that his ground speed was decreased due to strong headwinds, and he had the controller contact Flight Service and amend his flight plan.

The pilot stated that he noted that he was "in between cloud layers" with "intermittent ground contact." He was also encountering snow showers and it was a dark night. He listened to the Klamath Falls Airport Automated Terminal Information Service (ATIS), and he remembered that ATIS reported 20 knot winds and a 1,300-foot ceiling. He then asked the controller to provide him with vectors to the airport. He stated that the controller gave him "suggestive vectors" toward Klamath Lake. He also stated that he was using the controller "as a big brother" and he rated the controller's performance as "very good." He also remembered setting the VOR to the radial given by the controller to bring him over the lake.

The pilot stated that he was navigating by reference to his directional gyro, which he "correlated with the magnetic compass," and by the vectors provided to him. He stated that the airplane then encountered a brief updraft, followed by a "big" downdraft which made him feel like he "just stopped." He began to descend at 1,000 feet per minute. He added full power (from 75 percent power) and attempted to arrest the rate of descent. He stated that the engine responded and there were no problems with the airplane. He pulled back on the control yoke, but he "...didn't want to pull back too much" for fear that he may stall the airplane. His stated that his airspeed was about "75 to 80 knots." The rate of descent decreased from 1,000 feet per minute to 500 feet per minute, but he could not stop the descent.

The pilot stated that during the descent, he entered the clouds. He then saw a tree in front of him; the airplane impacted the ground and then "bounced" into the tree.

According to FAA ARTCC transcripts and radar data (attached), the pilot requested and received VFR flight following from the ARTCC controller at 1734. At 1756, the controller asked the pilot "...does it look like you'll be able to get into Klamath Falls VFR alright?" The pilot responded: "It appears to be so sir. [I see] a scattered layer about one thousand two to three hundred." The controller replied: "Roger [because] the airport itself is reporting twelve hundred scattered, two thousand broken, three thousand overcast and five miles with light snow, winds are estimated at one eight zero at one niner."

The pilot then stated "...there's a lot of mountains out here that are kinda obscured and it's my first time in there. Could you set me up on an approach so I can get down below the scattered layer?" The controller then asked the pilot if he was instrument rated, and the pilot responded with "Negative sir." The controller stated that he could not "... give [the pilot] an approach..." but he provided a "best bet" vector of 210 or 220 degrees, and advised the pilot that he could "then go straight in from the northwest."

At 1800, the controller advised the pilot to maintain a heading of 210 degrees and stated: "that'll take you over the lake and I'll bring you in from the lake down to the south right towards the airport, give you a nice area with no mountains in the way." The pilot was at an altitude of 8,300 feet msl at that time and asked the controller for the "minimum enroute altitude" for the area. The controller responded that the "minimum vectoring altitude is ninety-three hundred [feet]..." and "...the highest terrain around there at about seventy-six hundred [feet]." The pilot then responded: "Yeah, I have a chart here. I see it also."

From 1806:46 to 1810:11, the airplane gradually climbed from 8,300 feet msl to 9,100 feet msl. At 1810, the controller asked the pilot if he had "any terrain in sight." The pilot responded with "affirmative." The controller then advised the pilot of his position relative to the airport and stated "if you continue ah the way you're going now you'll come over a lake and head straight down and it's pretty much of a valley going straight in...."

At 1811, the pilot responded with "...I've got intermittent ground contact right now, right now I've lost it." The airplane was at 8,200 feet msl and descending at that time. The controller then advised the pilot that he would "be over the lake at about the Klamath Falls [VOR] three one five radial and you can go inbound from there..." The pilot read back the radial and thanked the controller; this was his last radio communication with ATC. From 1810:11 until 1812:11, the airplane gradually descended from 9,100 feet msl to 7,400 feet at a rate of 850 feet per minute, and continued to turn right along a westerly heading and rising terrain. Radar contact with the airplane was lost at 1813 near the accident site.

The pilot remembered waking up in the aircraft after the accident to the sound of his name being called by the passenger, who was outside the aircraft and in front of it. The passenger was seriously injured and could not move. Both occupants were wearing T-shirts. The pilot stated that he climbed out the airplane and attempted to keep the passenger warm by wrapping aircraft insulation material around his head and hugging him. After a few hours, the passenger expired. The pilot stated that he then climbed back into the airplane. He was in contact with local authorities with a cellular phone until the batteries expired. He was rescued by a helicopter about 22 hours after the accident.

The pilot stated that about 18 inches of snow fell on the airplane from the time of the accident to the time he was rescued.

The pilot was seated in the left front seat during the accident flight. He stated that he was wearing his seat belt and shoulder harness at the time of the accident. The right front seat was occupied by the passenger. The pilot stated that the passenger was wearing his seat belt and shoulder harness during takeoff, but he was not sure if the passenger was wearing them at the time of the accident.

The accident occurred during the hours of darkness at 42 degrees, 25.32 minutes North and 121 degrees, 41.33 minutes West. It was located about 19 miles north of the Klamath Falls International Airport at an elevation of 7,200 feet msl.

PERSONNEL INFORMATION

The pilot, age 35, is a certificated private pilot with a rating for single engine land airplanes. According to FAA records, the pilot was issued an FAA Third Class Medical Certificate on March 9, 1993, with the limitation that he must wear corrective lenses. The pilot reported that he had accumulated a total of 430 hours of flight time, including 182 hours in type, 65 hours at night, and no instrument time.

METEOROLOGICAL INFORMATION

The Klamath Falls International Airport ATIS reported the following weather conditions 18 minutes prior to the accident: Sky condition 1,200 feet agl (5,292 feet msl) scattered; estimated ceiling 2,000 feet agl (6,092 feet msl) broken, 3,000 feet agl (7,092 feet msl) overcast; visibility 7 miles with light snow. The airport is located 16 nautical miles south of the accident site at an elevation of 4,092 feet msl.

The reported estimated wind conditions at the airport were 160 degrees at 16 knots with peak gusts of 22 knots; the ridge line located near the accident site is oriented along a magnetic bearing of about 130 degrees. The accident site was found on the leeward side of the ridge line about 3,000 feet above the elevation of the airport.

Dark night conditions prevailed at the time of the accident.

WRECKAGE AND IMPACT INFORMATION

The airplane wreckage was examined by the Safety Board at a storage facility in Redmond, Oregon, on November 29, 1995, after it had been removed from the accident site. Efforts of the investigative team to examine the wreckage at the accident site were not successful due to the failure of ground rescue personnel to relocate the site. Observations of the accident site were forwarded to the Safety Board by the wreckage recovery team who later found the wreckage on November 15, 1995.

According to the wreckage recovery team, the outboard half of the right wing was found near a broken tree. The remainder of the wreckage was found about 200 feet southwest of the right wing section along downsloping terrain. A ground scar was found about halfway between the right wing section and the remainder of the wreckage.

An examination of the wreckage by the Safety Board did not reveal any evidence of pre-impact mechanical deficiencies.

The right wing was separated into two halves and exhibited leading edge crush damage.

The electrically-driven flap actuator mechanism was examined; none of the threads from the mechanism's jackscrew were exposed. According to engineering data from the Cessna Aircraft Company, the lack of exposed threads indicates that the flaps were in the fully retracted position.

An examination of the instrument panel after the wreckage was recovered revealed the following indications: Attitude indicator read 20 degrees nose-up attitude and 30 degrees right bank; the directional gyro read 225 degrees; the vertical speed indicator read 300 feet per minute climb; the No. 1 VOR omnibearing selector was selected to 312 degrees and the needle was full left; the throttle control was in the full power position.

The right front seat and associated restraint system was examined. The seat was intact, but was separated from the mounting rails. The aft roller claws of the seat were deformed. No evidence was found to indicate that the lap belt had been engaged at impact. The flat metal attachment (male end) was not recovered.

The engine, a Lycoming model O-360-A4M, and propeller were examined. No preimpact mechanical deficiencies were found. The two-blade Sensenich metal propeller was examined. One blade was bent aft slightly at its mid-span. Light chordwise scratches were noted on the leading edge of the outboard portion of the blade. The other blade exhibited evidence of chordwise scratching, "S" bending, and its tip had been sheared off.

ADDITIONAL INFORMATION

The aircraft wreckage was released to the Specialty Aircraft Company, Redmond, Oregon, on November 29, 1994.

NTSB Probable Cause

THE VFR PILOT'S ATTEMPT TO CONTINUE THE FLIGHT INTO INSTRUMENT METEOROLOGICAL CONDITIONS, AND HIS FAILURE TO MAINTAIN ALTITUDE/CLEARANCE WITH THE MOUNTAINOUS TERRAIN BELOW HIM. CONTRIBUTING TO THE ACCIDENT WAS A DOWNDRAFT.