Superstition Crash Final report

Z06_Mir said:
I've generally found PHX approach to be some of the most professional and accommodating controllers, as long as a pilot you speak clearly and act like you know what you're doing. I do believe that statistic that 96% of people who ask for a class B clearance get it.
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Yes they are professional and I personally tend to get along well with them, but I am always IFR going into PHX. However, I have noticed that when busy, all too often their answer to an initial VFR call up is 'aircraft calling, remain clear if the class Bravo' and then they go back to working the arrivals. I've even seen the same response to a GA IFR airplane that tried to check in after being handed over by ABQ Center. The VFR aircraft rarely try again. It has gotten a little better in the last few years, but a lot if that us due to many GA airplanes not bothering to try. Kind of a conditioned response.

That said, I still don't think it was a big issue in this crash. Based on the time of day and the route, I'm willing to bet that they would not have bothered to ask for FF and a Class B transition even if PHX was more accommodating.
 
Konaflygirl said:
Thank you, yes this is the toughest life lesson that I have ever had to face. I do agree that complacency....played a role here. I wish to God that Shawn Perry had been at the flight controls that night. I know that Shawn would not have made this mistake. But he was in the back calming our children. If I let my mind go crazy with it, I can feel intense disdain for Russel Hardy...His attitude allowed him to F*ck up. He killed himself, leaving a wife and child behind. He killed my whole family. Every checkride that I have taken the examiner would say "I have to feel that I could put my family with you and they would be safe." Their families all were.....but my family members are all dead.
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My sincere condolences to you Karen. Of all the things I've read on this forum, this is one of the most heartbreaking:sad:
Konaflygirl said:
Nothing could be more painful for me as a mother... than to not only lose all 3 of my children and my former husband, but to lose them doing what I loved most in the world. ~Karen Perry~
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I can't begin to imagine your pain.
 
Henning said:
They didn't, there was no ferry permit for this flight.
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Oops, misunderstood that. They didn't EVEN have a ferry permit. The aircraft was not even "specially" airworthy.
 
Wow. A talking head on TV with a brain and some actual knowledge about flying. Obviously he is overqualified for his job.
 
Henning said:
I don't understand...:confused: What would you like to see the outcome of the airspace review be?
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If you look at the link in the blue bar at the top of her post, it shows that she was answering my question about what "maintain RH" means.
 
Karen, thanks for bringing your insight to the forum.

My ex-wife's uncle crashed into Mount Tamalpais at night, so I've always been very aware of this issue. In addition to the airspace problem that you discussed, I feel that pilot training syllabuses need more explicit coverage of strategies for terrain avoidance on night VFR flights.
 
I've been reluctant to comment in this thread because it seems that once again I'm the outlier in the group. Except for the OP who mentions the airspace restrictions east of PHX bravo in the report, I think I'm the only one who considers the bravo to be one of the factors in the proximate cause of this accident.

Here's my reasoning, flawed though it may be. In finance we have a factor for deciding if a segment of a large business is worth cutting or not. Without belaboring the point too much it comes down to a balancing of the segment margin of the offending dept vs it's cost basis to the overall corp. To take GM for example, the segment margin of the Saturn group was examined and found to be wanting. However, when we excise Saturn from GM as a whole, it results in a gross negative from the corp revenue, even though it was not producing as high as the Cadillac, or GMC segment. Nonetheless, it was producing, and the revenue stream was income that is now lost to GM where buyers may be out shopping for Nissan, or Ford, etc.

If we apply this kind of logic to the accident chain, eventually we get to a question; 'what would have been the result, if the airspace restriction to the immediate west of the mountain weren't there?' One may say that this isn't a valid question, but looking back at even a brief history there was a time when the bravo didn't exist around PHX, and VFR planes were not limited in climb except to the extent of the pilots discretion, and the machinery performance.

If we look at a profile of a plane enroute to some eastern destination from FFZ, and there were no restrictions on climb, it would be not only reasonable, but also prudent to perform the climb continuously from take-off to cruising altitude. Depending on the nature of the equipment, this climb could have been dialed into the VNAV A/P, or it could be done by hand. There would be no restriction sans the PHX bravo for anyone to stop us from climbing. In this case, the factor of having to maintain RH for a long time would not be a negative factor in the accident, but would be a positive factor in avoidance, because as long as the plane was heading north, it was still climbing. If we were also prudent, and requested FF out of FFZ as a VFR flight, we might get traffic notification, and possibly separation from ATC. Which begs the question, if a controller were to advise stop climbing for traffic separation, I might be inclined to report back 'cancel FF, we will handle our own nav, squawking 1200, good day'. Or, I might maintain current altitude, which would put is back in the danger box of potential ground obstruction. With the class B around PHX, this discretion or traffic call is reduced to an absolute limit by the airspace restriction.

It's my opinion, counter to many here that the prior restraint of the class B around PHX played a part in the accident. However, I haven't looked at the vertical profile to see of the pilot stopped climbing, and if so, was the reason he stopped climbing the result of not wanting to request a clearance into the B, or did he consider that getting a clearance into the B for a small corner of the time he was going to fly there more trouble than it's value, or possibly he might have considered that ATC would decline him that small corner of the class B, as he would be considered a nuisance? Without looking at the vertical profile of the flight, this is all rather specious I know, but if the limit was non-arbitrary, and proximate, we should consider that the pilot made decisions based on the fact that the class B did exist, and in it's absence a different profile would have been selected, that would have missed the mountain.

Having said that, this is not the single point of failure, nor is it a weak link in an otherwise strong chain leading to the accident. The fact is, the PHX class B does exist, and pilots have to deal with it, and the vertical navigation is the responsibility of the pilot. But - suppose in a world of 1988, there were no class B, and this plane, with this pilot, and this night flight were begun. Perhaps an instruction to remain on runway heading were given by the FFZ tower for separation. Would this have happened, in the absence of the PXH class B?
 
docmirror said:
I've been reluctant to comment in this thread because it seems that once again I'm the outlier in the group. Except for the OP who mentions the airspace restrictions east of PHX bravo in the report, I think I'm the only one who considers the bravo to be one of the factors in the proximate cause of this accident.

Here's my reasoning, flawed though it may be. In finance we have a factor for deciding if a segment of a large business is worth cutting or not. Without belaboring the point too much it comes down to a balancing of the segment margin of the offending dept vs it's cost basis to the overall corp. To take GM for example, the segment margin of the Saturn group was examined and found to be wanting. However, when we excise Saturn from GM as a whole, it results in a gross negative from the corp revenue, even though it was not producing as high as the Cadillac, or GMC segment. Nonetheless, it was producing, and the revenue stream was income that is now lost to GM where buyers may be out shopping for Nissan, or Ford, etc.

If we apply this kind of logic to the accident chain, eventually we get to a question; 'what would have been the result, if the airspace restriction to the immediate west of the mountain weren't there?' One may say that this isn't a valid question, but looking back at even a brief history there was a time when the bravo didn't exist around PHX, and VFR planes were not limited in climb except to the extent of the pilots discretion, and the machinery performance.

If we look at a profile of a plane enroute to some eastern destination from FFZ, and there were no restrictions on climb, it would be not only reasonable, but also prudent to perform the climb continuously from take-off to cruising altitude. Depending on the nature of the equipment, this climb could have been dialed into the VNAV A/P, or it could be done by hand. There would be no restriction sans the PHX bravo for anyone to stop us from climbing. In this case, the factor of having to maintain RH for a long time would not be a negative factor in the accident, but would be a positive factor in avoidance, because as long as the plane was heading north, it was still climbing. If we were also prudent, and requested FF out of FFZ as a VFR flight, we might get traffic notification, and possibly separation from ATC. Which begs the question, if a controller were to advise stop climbing for traffic separation, I might be inclined to report back 'cancel FF, we will handle our own nav, squawking 1200, good day'. Or, I might maintain current altitude, which would put is back in the danger box of potential ground obstruction. With the class B around PHX, this discretion or traffic call is reduced to an absolute limit by the airspace restriction.

It's my opinion, counter to many here that the prior restraint of the class B around PHX played a part in the accident. However, I haven't looked at the vertical profile to see of the pilot stopped climbing, and if so, was the reason he stopped climbing the result of not wanting to request a clearance into the B, or did he consider that getting a clearance into the B for a small corner of the time he was going to fly there more trouble than it's value, or possibly he might have considered that ATC would decline him that small corner of the class B, as he would be considered a nuisance? Without looking at the vertical profile of the flight, this is all rather specious I know, but if the limit was non-arbitrary, and proximate, we should consider that the pilot made decisions based on the fact that the class B did exist, and in it's absence a different profile would have been selected, that would have missed the mountain.

Having said that, this is not the single point of failure, nor is it a weak link in an otherwise strong chain leading to the accident. The fact is, the PHX class B does exist, and pilots have to deal with it, and the vertical navigation is the responsibility of the pilot. But - suppose in a world of 1988, there were no class B, and this plane, with this pilot, and this night flight were begun. Perhaps an instruction to remain on runway heading were given by the FFZ tower for separation. Would this have happened, in the absence of the PXH class B?
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The other question to factor in is "had the TCA/Class B system not been instituted, how many more Cerritos accidents would there have been with even greater loss of life?" Many things to balance in the creation of airspace.
 
docmirror said:
However, I haven't looked at the vertical profile to see of the pilot stopped climbing,
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Can't speak for his specific profile, but from personal experience departing FFZ to the east in a Duchess, you have to either stop or significantly shallow the climb to avoid entering the Bravo. In fact the closest I have ever come to busting airspace was in that exact area (within .1 DME of PXR and less than 100 ft of the Bravo floor).
 
Henning said:
The other question to factor in is "had the TCA/Class B system not been instituted, how many more Cerritos accidents would there have been with even greater loss of life?" Many things to balance in the creation of airspace.
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That is certainly a valid question to ask in the macro-climate of flight ops. However, this question involves a reduction or calculation of probabilities. The first thing I teach in my stats class is that stats are a derivative of some potential or possible outcomes. It can neither guarantee, nor eliminate anomalies. That's why we also call it 'probabilities'. Is it probable that there would be another Cerritos, or San Diego class accident in the absence of class B airspace? I think reasonable people would say that, yes that would increase the probable accident outcomes around major aviation centers.

But in this accident, we are not dealing with an anomaly, or probability. We have a statistical certainty to work with.

I recall clearly the first look that AOPA had back in the 80s when the PSA accident happened in San Diego. It was a narrow decent corridor from over the mountains to the east, and a somewhat wider J shaped corridor leading to the west and curving north. Not surprising, this was the exact path that the San Diego back course appr to KSAN took. There was no carve out for Miramar, there was no very low ceiling over the beach, it was just a corridor for the comm traffic. What we got in the end was horrible, and has been the cause of some consternation for obstructions in the eastern side.

So, it comes down to limiting one kind of traffic for another, more important kind of traffic. I'm not discounting that there needs to be some separation, or more accurately spacial controlled airspace, but many times I don't see the need for the size and scope of the class B around a major urban area, with a lot of GA traffic as well. San Diego is a great example because 99.x% of the comm traffic would have followed the original AOPA plan(back when they had balls) perfectly, without impacting the rest of traffic out of Montgomery, Gillespie or Brown.

<edit: Also, you're talking about absolutes, like removing the class B airspace. I'm not. I think an adjustment to the existing airspace is called for in this particular case, for this particular block of restricted space, and it would improve safety without an undue burden on comm activity to PHX.>
 
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docmirror said:
I recall clearly the first look that AOPA had back in the 80s when the PSA accident happened in San Diego. It was a narrow decent corridor from over the mountains to the east, and a somewhat wider J shaped corridor leading to the west and curving north. Not surprising, this was the exact path that the San Diego back course appr to KSAN took. There was no carve out for Miramar, there was no very low ceiling over the beach, it was just a corridor for the comm traffic. What we got in the end was horrible, and has been the cause of some consternation for obstructions in the eastern side.



So, it comes down to limiting one kind of traffic for another, more important kind of traffic. I'm not discounting that there needs to be some separation, or more accurately spacial controlled airspace, but many times I don't see the need for the size and scope of the class B around a major urban area, with a lot of GA traffic as well. San Diego is a great example because 99.x% of the comm traffic would have followed the original AOPA plan(back when they had balls) perfectly, without impacting the rest of traffic out of Montgomery, Gillespie or Brown.
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Sad thing about that was the airspace design (or lack of it) really had nothing to do with the three failures that caused the 1978 midair.
 
Konaflygirl said:
In my professional opinion, the airspace needs a serious review and I hope the right decisions are made so that pilots have a greater margin of safety flying around the Superstition Mountain. ~Karen Perry~
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So sorry for your loss, I can't imagine what I would do if I lost my kids that way.

As to the airspace issue: Your ex-husbands pilot hit the mountain because he lost situational awareness and didn't realize that he was laterally offset from the 'safe' course. That was problem of planning an execution, not the environment that he was in. The environment is a given, he had to adjust his flightplan to account for it and didn't.
 
weilke said:
laterally offset from the 'safe' course. That was problem of planning an execution, not the environment that he was in. The environment is a given, he had to adjust his flightplan to account for it and didn't.
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And if he was "fly direct" kind of a guy he had KLN 90B aboard (I am not counting whatever hand-held devices there were), knowing there was a safe, direct course between those two airports he could have intercepted the course even he was initially deviated by ATC. But what was required was any concern, awareness about the terrain and it appeared to be none.

Karen - thanks for visiting this forum and we are all deeply sorry for your unimaginable loss.
 
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Anyone who has questions about this accident...please ask me....the mother of the kids who died, the former wife of the pilot who died (who was not flying that night) and a pilot myself..airline and CFII/MEI.
Karen Perry
 
He wasnt flying he was in the back of the airplane with our kids
 
Very sorry for your loss Karen. Welcome to POA and thank you for participating in our forum.

When I first learned of this accident I wondered why the airplane had not been equipped with TAWS. Reading the accident report I see why.

The airplane was not equipped with a terrain awareness and warning system (TAWS). Six years earlier, the accident airplane seating configuration was changed to reduce passenger seat provisions from six to five by removing a seat belt from the aft divan, which was originally configured with seat belts for three people. This modification rendered the airplane exempt from the TAWS requirement; however, this modification was not approved by the FAA or documented via a supplemental type certificate or FAA Form 337 (Major Repair and Modification). Per the requirements of 14 Code of Federal Regulations 91.223, TAWS is not required for airplanes with fewer than six passenger seats. In this accident, onboard TAWS equipment could have provided a timely alert to help the pilot avoid the mountain.
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Everskyward said:
Very sorry for your loss Karen. Welcome to POA and thank you for participating in our forum.

When I first learned of this accident I wondered why the airplane had not been equipped with TAWS. Reading the accident report I see why.
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Yeah, I read that as well and wondered how much trouble the IAs who had since signed off the annuals got in. The sad thing is, this whole accident revolves around, "pilots are cheap".:(
 
Henning said:
Yeah, I read that as well and wondered how much trouble the IAs who had since signed off the annuals got in. The sad thing is, this whole accident revolves around, "pilots are cheap".:(
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The implication from the report is that the owner of the aircraft at the time of the TAWS mandate forged a page of the maintenance manual and provided it to the maintenance shop that made the log entryafter rrmoval of the belt. Whether every maintenance provider who signed subsequent inspections should be liable for this deception is debatable.
 
Henning said:
Yeah, I read that as well and wondered how much trouble the IAs who had since signed off the annuals got in. The sad thing is, this whole accident revolves around, "pilots are cheap".:(
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I wouldn't say that the "whole" accident revolves around that. As with so many accidents, there were many links in the accident chain, and breaking any of those links could have prevented the accident.
 
weilke said:
The implication from the report is that the owner of the aircraft at the time of the TAWS mandate forged a page of the maintenance manual and provided it to the maintenance shop that made the log entryafter rrmoval of the belt. Whether every maintenance provider who signed subsequent inspections should be liable for this deception is debatable.
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Where was the STC and 337 they should have verified?
 
Palmpilot said:
I wouldn't say that the "whole" accident revolves around that. As with so many accidents, there were many links in the accident chain, and breaking any of those links could have prevented the accident.
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Yep, but the central link is being cheap. TAWS could have prevented it and so could SVT.
 
Fearless Tower said:
Would TAWS have prevented it? They flew straight into a completely vertical rock face.
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TAWS is required FLTA (forward looking terrain avoidance) by the TSO.

http://rgl.faa.gov/Regulatory_and_Guidance_Library/rgTSO.nsf/0/cc60d6b4c807869586256dc700717e5f/$FILE/C151b.pdf
 
Henning said:
TAWS is required FLTA (forward looking terrain avoidance) by the TSO.



http://rgl.faa.gov/Regulatory_and_Guidance_Library/rgTSO.nsf/0/cc60d6b4c807869586256dc700717e5f/$FILE/C151b.pdf
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How does it work?
 
Fearless Tower said:
How does it work?
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There is a good explanation in the FAA Advanced Avionics Handbook page 5-8.

http://www.faa.gov/regulations_poli...advanced_avionics_handbook/media/aah_ch05.pdf

A terrain awareness and warning system (TAWS) offers you all of the features of a terrain display along with a sophisticated warning system that alerts you to potential threats posed by surrounding terrain. A terrain awareness and warning system uses the aircraft’s GPS navigation signal and altimetry systems to compare the position and trajectory of the aircraft against a more detailed terrain and obstacle database. This database attempts to detail every obstruction that could pose a threat to an aircraft in flight.

A TAWS A system provides indications for the following potentially hazardous situations:
1. Excessive rate of descent
2. Excessive closure rate to terrain
3. Altitude loss after takeoff
4. Negative climb rate
5. Flight into terrain when not in landing configuration
6. Excessive downward deviation from glideslope
7. Premature descent
8. Terrain along future portions of the intended flight route

A TAWS B system provides indications of imminent contact with the ground in three potentially hazardous situations:
1. Excessive rate of descent
2. Excessive closure rate to terrain (per Advisory Circular (AC) 23-18, to 500 feet above terrain)
3. Negative climb rate or altitude loss after takeoff
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Even if you don't have terrain displayed in the MFD it will still give you a warning. Since the information is predictive and derived from a database I'm sure it would have given a warning regardless of whether or not the face of the rock was vertical.
 
These days TAWS even give advanced warning about some tall man-made objects like antennas, highly vertical objects I must say. :)
 
Henning said:
Yep, but the central link is being cheap. TAWS could have prevented it and so could SVT.
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You have absolutely no interpersonal or social skills whatsoever...do you?

But we've all known that for quite sometime...

Just show some respect and give it a rest in this case, please.
 
This aircraft was purchased to be operated as a lead-in aircraft on a forest service contract. Even if it had come with 7 paper-seats and a TAWS, the operator could have executed a 337 to remove the seat and pulled out the TAWS in order to make the aircraft suitable for its intended purpose. Just like the ferry permit, the absence of TAWS is nothing but a paperwork issue. They didn't go through the correct paperwork to remove the system, the issue was not the absence of the system itself.

They would hit the same mountain in anything from a 172 to a 747.
 
Given the drawn-out controversy and warnings concerning the Airspace change before the accident, I can't believe the FAA didn't compromise and install a solar-powered obstruction beacon on the top of the peak. That thing, only a few seconds out of Class B going East or West, poses a real hazard. Imagine coming into Bravo from the East, at 230kts, and having an un-marked mountain peak jutting up 100ft just a couple of seconds before the Bravo threshold.
 
CT4ME said:
Given the drawn-out controversy and warnings concerning the Airspace change before the accident, I can't believe the FAA didn't compromise and install a solar-powered obstruction beacon on the top of the peak.
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???? :confused:

How many mountains in the US have a beacon to mark their peak ? The Superstitions is a federal wilderness area, installing a beacon is going to require an act of congress god.
 
weilke said:
They would hit the same mountain in anything from a 172 to a 747.
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But if the airplane had TAWS they would have gotten a warning. Sure, they could have ignored the warning and flown into the mountain but that is a different issue. Personally I think the absence of TAWS was a big factor even though I understand why it was not installed.
 
This isn't any mountain, it's a mountain that juts up (into) just seconds outside of Class B. It's not the mountain's fault. But when the FAA put the Class B right next to it (and below it), they made it special. Had the floor been raised 1-2,000 feet. There would be no problem, day-or-night, either direction. BTW, I've read that the special lower approach route has never been used.
 
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CT4ME said:
This isn't any mountain, it's a mountain that juts up (into) just seconds outside of Class B. It's not the mountain's fault.
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For all I know, this mountain has been there for a while, it certainly pre-dates the formation of the FAA.

In 2007 two CAP pilots flew into a rock-face on Mt Potosi near Las Vegas right where the magenta line intersects with the rocks. Same setup, they remained under the class B shelf and once they started climbing didn't have enough performance to clear the top of the mountain. Do you think Mt Potosi needs a beacon too ? How about Hayford Peak ?
 
CT4ME said:
Imagine coming into Bravo from the East, at 230kts, and having an un-marked mountain peak jutting up 100ft just a couple of seconds before the Bravo threshold.
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Yes, I can imagine that but fail to see significance of this "couple seconds". Perhaps it is even to pilot's advantage because presumably by now having received clearance to enter B he/she would be under positive radar control receiving terrain advisories. The mountain clearly presents problem only to those who insist on squeezing between B and the mountain top.
 
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olasek said:
The mountain clearly presents problem only to those who insist on squeezing between B and the mountain top.
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Or those who request and are denied, delayed entry. Or those who consider that asking to use a small part of the class B would frustrate the controller and they would take it out on the next GA plane.

The peaks have been there for centuries, the class B for only a handful of years. But for the extended class B, would the plane have continued the climb from FFZ? I don't know, but due to the artifact that is this ring of the class B, it is surely a question the NTSB ought to be interested in(if they are in fact interested in SAFETY).
 
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