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The deadly Pilatus PC-12 crash in 2022 was found to be due to the pilot's inadequate preflight planning and inflight monitoring of the of the plane's flight parameters, as well as his failure to regain control of the plane after it entered into an inadvertent aerodynamic stall. The NSTB final report indicates that his spatial disorientation following the stall contributed to the crash, which killed eight people.
On Feb. 13, 2022 the PC-12 (N79NX) left Pitt-Greenville Airport (PGV) in Greenville, North Carolina and landed at Hyde County Airport (7W6) in Engelhard, North Carolina. The NTSB reported that before leaving on the accident flight, the pilot and student pilot-rated passenger attempted to enter a flight plan into the plane's integrated flight management system but did not, with the pilot stating "We'll get to it later." The pilot departed and climbed into instrument meteorological conditions without an instrument flight rules flight plan. After he entered IMC he contacted air traffic control and asked for visual flight rules following services and an IFR clearance to the destination airport.
The NTSB said that from shortly after the plane leveled after takeoff through the final seconds of the flight, the pilot was attempting to program, delete, reprogram and activate a flight plan into the flight management system, recorded on the cockpit voice recorder. After departing for Michael J. Smith Field Airport (MRH), the pilot also attempted to navigate around the restricted airspace the plane flew into. Based on the CVR audio from the final 10 minutes of the flight, the pilot was unsure of how to spell the fix he was supposed to be navigating to begin the instrument approach at the destination airport. The pilot began expressing more frustration and confusion while still attempting to program the integrated flight management system.
"I have - I have [got to] get a fricken flight plan in this thing," the pilot said.
As the pilot was fixating on the programming, the plate's pitch attitude increased to 10 degrees nose up, while the airspeed decayed down to 109 knots. Due to the pilot's inattention to the decay, the stall warning system activated and the autopilot disconnected. The plane began to climb and turn to the right and then the left before entering a steep descending right turn that continued until the plane hit the ocean. The pilot was given stall warnings, stick shaker activations, autopilot disconnect warnings and terrain avoidance warning system alerts. The plane crashed into the ocean about three miles from the coast. Post-crash examination of the wreckage did not reveal evidence of any mechanical failures or malfunctions of the airframe or engine that may have precluded normal operation.
The NTSB said the instrument meteorological conditions in the area at the time were conducive to the development of spatial disorientation. Spatial disorientation occurs when a pilot loses their sense of orientation and awareness of their position and motion to the earth's surface The plane's erratic flight track in the last two minutes, which resulted in a final rapidly descending right turn, was consistent with the known effects of spatial disorientation. When pilots experience spatial disorientation, it can lead to the loss of situational awareness, delayed reaction time, panic and loss of control. The report indicates that the inadequate flight planning and subsequent distraction while unsuccessfully attempting to program the flight management system resulted in a failure to monitor plane speed, leading to the activation of stall protection and warning systems as the plane entered an aerodynamic stall. The sudden deactivation of the autopilot combined with the pilot's inattention to the plane's flight attitude and speed likely surprised the pilot and he ultimately failed to regain control of the plane following the aerodynamic stall, likely due to spatial disorientation.RELATED STORY:5 tips for pilots to recognize and overcome spatial disorientation
The report notes that the pilot had a history of mantle cell lymphoma that was in remission and his maintenance treatment with a rituximab infusion was more than 60 days before the accident. The pilot also had a history of back pain and received steroid injections and nonsteroidal anti-inflammatory drugs. He self-reported taking oxycodone for pain management but it is unknown how frequently this medication was used or if he had taken the medication the day of the crash. Oxycodone use can result in fatigue or dizziness and could interfere with reaction time but based on CVR data, it could not be determined if the pilot had these side effects. A few weeks before the crash the pilot reported having COVID-19 and received a 5-day treatment course of hydroxychloroquine and ivermectin. Some of these cause impairing side effects but enough time had elapsed that no adverse effects would be expected. The NTSB could not determine whether mantle cell lymphoma, back pain and the recent COVID-19 and medications used to treat these conditions had contributed to the crash.ADS-B Data from final moments of flight
In the final minutes before the crash, the pilot was heard making comments like "What are we doin'" and "It'll navigate" before the stall alert sounded eight times and the airspeed decayed to 83 knots. The controller tried contacting the pilot to inquire about the plane's altitude but there was no response. Radar contact with the plan was lost one minute later and an ALNOT was issued by ATC over 20 minutes later. The plane crash killed all eight on board. Killed in the crash were the 67-year-old pilot Ernest Rawls, 28-year-old Jeffrey Rawls, 42-year-old Stephanie Fulcher, 15-year-old Johnathan McInnis, 45-year-old Douglas Parks, 15-year-old Noah Styron, 15-year-old Michael Shepherd and 16-year-old Jacob Taylor. WITN reported the names of the victims and said the group was returning from a duck hunting trip in Hyde County. WITN reported that one year ago, five families of the victims settled wrongful death lawsuits for $15 million against the owner of the plane and the companies that employed Rawls.