Colorado

The twin engine airplane was on approach to Steamboat Springs-Bob Adams Airport runway 14 when it departed the approach path to the right. It descended to the ground and crashed onto several houses located southwest of the airport, bursting into flames. The airplane was destroyed and both occupants were killed. The airplane was completing a flight from Longmont-Vance Brand Airport.

The pilot was conducting a solo night cross-country flight in low visibility through mountainous terrain. The pilot was then cleared by an air traffic controller to conduct a RNAV (GPS)-E instrument approach into the destination airport. After passing the final approach fix and before the missed approach point, the pilot, for an unknown reason, executed a left turn, consistent with the missed approach procedure. During the turn toward the holding waypoint, the airplane did not climb. Shortly thereafter, the airplane impacted steep rising terrain The local weather at the time of the accident indicated a cloud ceiling of 1,200 ft above ground level and 1 statute mile visibility, which was below the weather minimums for the approach. Data retrieved from the onboard avionics revealed that although the pilot flew the published route in accordance with the instrument approach procedure, the minimum required altitudes were not adhered to. A review of the ForeFlight weather briefing data indicated that a route weather briefing had been generated by the pilot with the filing of the instrument flight rules (IFR) flight plan. While no weather imagery was reviewed during the period, the pilot had checked METARs for the destination and another nearby airport before departure and viewed the RNAV (GPS)-E approach procedure at the destination airport. A review of the data that was presented to the pilot indicated that visual flight rules conditions prevailed at the destination with light snow in the vicinity at the time it was generated. Based on the preflight weather briefing the pilot obtained, he was likely unaware of the IFR conditions and below minimum weather conditions at the destination until he descended into the area and obtained the current local weather during the flight. It is probable that, based upon the weather and flight track information, as the pilot was on the instrument approach, he became aware of the below minimum weather conditions and elected to initiate the missed approach, as evident by the turn away from the airport similar to the missed approach procedure and the flaps and landing gear being in transition. This investigation was unable to determine why the missed approach procedure was prematurely initiated and why the airplane failed to climb. Additionally, there were no preimpact mechanical malfunctions or anomalies found during a postaccident examination that would have precluded normal operation.

The pilot reported that he performed the “before starting engine” and “starting engine” checklists and everything was normal before taking off in the twin-engine airplane. He performed an engine runup and then started his takeoff roll. The pilot reported that about halfway down the runway the airplane was not accelerating as fast as it should. He attempted to rotate the airplane; however, “the airplane mushed off the runway.” The airplane settled back onto the runway, then exited the departure end of the runway, where it sustained substantial damage to the wings and fuselage. The airplane engine monitor data indicated the airplane’s engines were operating consistent with each other at takeoff power at the time of the accident. Density altitude at the time of the accident was 7,170 ft and according to performance charts, there was adequate runway for takeoff. The reason for the loss of performance could not be determined.

A Cirrus SR22 and a Swearingen AS226TC were approaching to land on parallel runways and being controlled by different controllers on different control tower frequencies. The pilot of the Swearingen was established on an extended final approach for the left runway, while the pilot of the Cirrus was flying a right traffic pattern for the right runway. Data from an on-board recording device showed that the Cirrus’ airspeed on the base leg of the approach was more than 50 kts above the manufacturer’s recommended speed of 90 to 95 kts. As the Cirrus made the right turn from the base leg to the final approach, its flight path carried it through the extended centerline for the assigned runway (right), and into the extended centerline for the left runway where the collision occurred. At the time of the collision, the Cirrus had completed about ½ of the 90° turn from base to final and its trajectory would have taken it even further left of the final approach course for the left runway. The pilot of the Swearingen landed uneventfully; the pilot of the Cirrus deployed the airframe parachute system, and the airplane came to rest upright about 3 nautical miles from the airport. Both airplanes sustained substantial damage to their fuselage. During the approach sequence the controller working the Swearingen did not issue a traffic advisory to the pilot regarding the location of the Cirrus and the potential conflict. The issuance of traffic information during simultaneous parallel runway operations was required by Federal Aviation Administration Order JO 7110.65Y, which details air traffic control procedures and phraseology for use by persons providing air traffic control services. The controller working the Cirrus did issue a traffic advisory to the Cirrus pilot regarding the Swearingen on the parallel approach. Based on the available information, the pilot of the Cirrus utilized a much higher than recommended approach speed which increased the airplane’s radius of turn. The pilot then misjudged the airplane’s flight path, which resulted in the airplane flying through the assigned final approach course and into the path of the parallel runway. The controller did not issue a traffic advisory to the pilot of Swearingen regarding the location of the Cirrus. The two airplanes were on different tower frequencies and had the controller issued an advisory, the pilot of the Swearingen may have been able to identify the conflict and maneuver his airplane to avoid the collision.

The pilot reported that, while conducting a night landing on a runway contaminated with ice and patchy packed snow, the airplane overshot the touchdown zone. The pilot tried to fly the airplane onto the runway to avoid floating. The airplane touched down firm and the pilot applied moderate braking, but the airplane did not decelerate normally. The airplane went off the end of the runway and collided with several Runway End Identifier Lights (REILs) and a tree. The airplane sustained substantial damage to the left and right wings. The pilot reported that he did not feel modulation in the anti-lock braking system (ABS) and felt that might have contributed to the accident. An examination of fault codes from the airplane’s diagnostic storage unit indicated no ABS malfunctions or failures. An airport employee reported that he saw the airplane unusually high on the final approach and during the landing the airplane floated or stayed in ground effect before it touched down beyond the midpoint of the runway. The airplane’s long touchdown was captured by an airport surveillance video, which is included in the report docket.

The student pilot, who was not qualified to operate the airplane, reportedly flew from California to Pennsylvania on a commercial flight the morning of the accident to pick up and fly the accident airplane, which he purchased, to California. The student pilot departed Pennsylvania at 0719 and made several en route stops before arriving at the departure airport at 1949. A witness stated that the airplane’s right engine quit during taxi at the last en route stop and the pilot said he "cut it a little close on fuel." Another witness said that the pilot was “really tired” and planned to fly over the mountains for his return flight. The student pilot was not in communications with air traffic control while en route from the departure airport and did not receive an instrument flight rules clearance to operate the flight in class A airspace as required by Federal Aviation Regulations. The airplane was not equipped with automatic dependent surveillance-broadcast as required for flight in class A airspace. Radar track data indicate the airplane last departed from Fort Collins, Colorado, and maneuvered while climbing to 16,000 ft. The airplane proceeded west/southwest for a little over 40 miles before climbing to about 22,000 ft. The airplane then made several large heading changes and altitude changes between 20,000 ft and 23,000 ft before entering a tight looping turn to the left and losing altitude rapidly before track data was lost. All components of the airplane were distributed along the wreckage path in a manner consistent with a low-angle, high-speed impact with terrain. The airplane was destroyed. A green cylindrical tank consistent in color with an oxygen tank was separated from the airframe and was found along the wreckage path. Portions of pneumatic lines were attached to the tank and exhibited impact damage and separations from impact. Due to accident-related damage, the amount of the tank’s contents prior to the accident are unknown, and the functionality, if any, of the oxygen system is unknown. The reason for the airplane’s impact with terrain could not be determined based on available evidence.

The commercial pilot was relocating the multiengine airplane following the completion of an extensive avionics upgrade, which also included the installation of new fuel flow transducers. As the pilot neared the destination airport, he reported over the common traffic advisory frequency that he had "an engine out [and] smoke in the cockpit." Witnesses observed and airport surveillance video showed fire emanating from the airplane's right wing. As the airplane turned towards the runway, it entered a rightrolling descent and impacted the ground near the airport's perimeter fence. The right propeller was found feathered. Examination of the right engine revealed evidence of a fire aft of the engine-driven fuel pump. The fuel pump was discolored by the fire. The fire sleeves on both the fuel pump inlet and outlet hoses were burned away. The fuel outlet hose from the fuel pump to the flow transducer was found loose. The reason the hose was loose was not determined. It is likely that pressurized fuel sprayed from the fuel pump outlet hose and was ignited by the hot turbocharger, which resulted in the inflight fire.

The commercial pilot of the jet reported that he initially requested that 100 lbs of fuel be added to both fuel tanks. During the subsequent preflight inspection, the pilot decided that more fuel was needed, so he requested that the airplane's fuel tanks be topped off with fuel. However, he did not confirm the fuel levels or check the fuel gauges before takeoff. He departed on the flight and did not check the fuel gauges until about 1 hour after takeoff. He stated that, at that time, the fuel gauges were showing about 900-1,000 lbs of fuel per side, and he realized that the fuel tanks had not been topped off as requested. He reduced engine power to conserve fuel and to increase the airplane's flight endurance while he continued to his destination. When the fuel gauges showed about 400-500 lbs of fuel per side, the low fuel lights for both wing fuel tanks illuminated. The pilot reported to air traffic control that the airplane was low on fuel and diverted the flight to the nearest airport. The pilot reported that the airplane was high and fast on the visual approach for landing. He misjudged the height above the ground and later stated that the airplane "landed very hard." The airplane's left main landing gear and nose gear collapsed and the airplane veered off the runway, resulting in substantial damage to the left wing. The pilot reported no preaccident mechanical malfunctions or failures with the airplane that would have precluded normal operation.

The commercial pilot and the pilot-rated passenger were flying the biplane to a fly-in gathering in another state. Witnesses saw the airplane flying over a frozen lake at a low altitude and low airspeed. One witness saw the airplane "listing" left and right before it entered a left turn, and he lost sight of it. Other witnesses saw the airplane turn left and nose-dive into the ground. A postimpact fire consumed most of the airplane. Damage to the wreckage indicated that the airplane impacted the ground in a nose down attitude. The examination did not reveal evidence of any preimpact anomalies with the airframe, engine, or the control system of the airplane. A witness reported that, at the time of the accident, the wind was from the south about 30 miles per hour. However, a burnt area extending east from the airplane's impact point indicated the wind was from the west. Additionally, although wind information from nearby weather stations varied in direction and intensity. One station, about 14 miles west-northwest of the accident site reported calm wind., However, another station, located about 11 miles south of the accident site, recorded wind from the west at 11 knots with gusts to 27 knots about the time of the accident and wind from the west at 33 knots with gusts to 48 knots about an hour after the accident. Further, the forecast for the accident area called for wind gusts to 40 knots from the west-northwest. Therefore, it is likely that strong gusty west winds prevailed in the accident area at the time of the accident. Although some witnesses speculated that the pilot may have been attempting to land the airplane on the frozen lake, the airplane was not equipped to land on ice, and the reason the pilot was maneuvering at a low altitude in strong gusty winds could not be determined. Based on the witness observations and the damage to the wreckage, it is likely that the pilot allowed the airspeed to decrease to a point where the critical angle of attack was exceeded, and the airplane entered an aerodynamic stall/spin. Although the pilot was known to have heart disease, it is unlikely that his medical condition contributed to the accident. The witness observations indicate that the pilot was actively flying the airplane before the loss of control. Toxicology testing showed the presence of chlorpheniramine in the pilot's blood at a level that was likely in the therapeutic range. Chlorpheniramine is a sedating antihistamine available in a number of over the counter products, and it carries the warning, "May impair mental and/or physical ability required for the performance of potentially hazardous tasks (e.g., driving, operating heavy machinery)." Because of its sedating effect, chlorpheniramine may slow psychomotor functioning and cause drowsiness. It has also been shown in a driving simulator (after a single dose) to suppress visual-spatial cognition and visual-motor coordinating functions when compared to placebo. Such functions would have been necessary for the pilot to maintain control of the airplane while maneuvering close to the ground in the strong gusty wind conditions. Therefore, it is likely that the pilot's ability to safely operate the plane was impaired by the effects of chlorpheniramine.

The pilots were conducting an international chartered flight in the small, twin-engine jet with five passengers onboard. Since the weather at the destination was marginal, the flight crew had discussed an alternate airport in case weather conditions required a missed approach at their destination. As the airplane neared the non-towered destination airport, the flight crew received updated weather information, which indicated that conditions had improved. Upon contacting the center controller, the crew was asked if they had the weather and NOTAMS for the destination airport. The crew reported that they received the current weather information, but did not state if they had NOTAM information. The controller responded by giving the flight a heading for the descent and sequence into the airport. The controller did not provide NOTAM information to the pilots. About 2 minutes later, airport personnel entered a NOTAM via computer closing the runway, effective immediately, for snow removal. Although the NOTAM was electronically routed to the controller, the controller's system was not designed to automatically alert the controller of a new NOTAM; the controller needed to select a display screen on the equipment that contained the information. At the time of the accident, the controller's workload was considered heavy. About 8 minutes after the runway closure NOTAM was issued, the controller cleared the airplane for the approach. The flight crew then canceled their instrument flight plan with the airport in sight, but did not subsequently transmit on or monitor the airport's common traffic advisory frequency, which was reportedly being monitored by airport personnel and the snow removal equipment operator. The airplane landed on the runway and collided with a snow removal vehicle about halfway down the runway. The flight crew reported they did not see the snow removal equipment. The accident scenario is consistent with the controllers not recognizing new NOTAM information in a timely manner due to equipment limitations, and the pilots not transmitting or monitoring the common traffic advisory frequency. Additionally, the accident identifies a potential problem for flight crews when information critical to inflight decision-making changes while en route, and problems when controller workload interferes with information monitoring and dissemination.