NTSB: Lack of weather update killed Crossfield

In a highly detailed, seven-page final report, NTSB investigators confirm previous stories that lack of current weather information doomed one of America’s most famous and experienced pilots.

Scott Crossfield died in the crash of his Cessna 210 on April 19, 2006, after encountering a level six thunderstorm near Ludville, Georgia, while heading home to Manassas, Virginia, from Alabama.

The Safety Board’s determination of probable cause is an unusual one, blaming both the Atlanta ARTCC controller and Crossfield himself, the former for not offering the vital weather information, the latter for not requesting it.

“The pilot’s failure to obtain updated en route weather information, which resulted in his continued instrument flight into a widespread area of severe convective activity, and the air traffic controller’s failure to provide adverse weather avoidance assistance, as required by Federal Aviation Administration directives, both…led to the airplane’s encounter with a severe thunderstorm and subsequent loss of control,” the NTSB report states.

It goes on to cite 16 FAA directives that were ignored by the air traffic controller, concluding that “the controller’s workload consisted of the accident airplane and one other airplane. Review of sector 38 communications and radar data failed to identify any limitations of radar, excessive traffic, frequency congestions, or workload issues that would have prevented the controller from issuing pertinent weather information to the accident airplane.”

Crossfield was in communication with ATC until his airplane broke up, the report says. His last contact was around 11:09 a.m., when he said, “Atlanta, this is seven niner x-ray. I’d like to deviate south weather.” The controller replied, “Six five seven niner x-ray, roger, we’ll show you deviating south for weather and your mode C indicates one one thousand five hundred.” Crossfield did not respond and about a minute later radar contact was lost when he was at 5,500 feet, 6,000 feet below where he had been flying.

“A plot of the aircraft radar track data indicated that the airplane entered a level 6 (extreme) thunderstorm before the loss of radar contact,” the report says.Crossfield, who was 84, held a commercial ticket with single- and multi-engine and instrument ratings. At the time of the crash he had logged more than 9,000 hours – in such spectacular aircraft as the X-1, XF-92, X-4, X-5, Douglas D-558-I Skystreak, and the Douglas D-558-II Skyrocket, the report acknowledges. On Nov. 20, 1953, he became the first human to fly faster than twice the speed of sound in the Douglas D-558-II Skyrocket. From 1955 to 1960, he was employed by North American Aviation as the chief engineering test pilot during the development and testing of the X-15 rocket plane, in which he either exceeded or came close to Mach 3, depending on whose version you read.

At the time of the accident, the forecast for northern Georgia was for an area of IFR to marginal VFR conditions during the morning hours, with isolated thunderstorms and moderate rain expected after 10 o’clock. Indeed, that was the weather briefing that Crossfield picked up before taking off. The thunderstorms had “a possibility of being severe,” the briefing said.

After Crossfield took off, the National Weather Service Storm Prediction Center described “an ongoing cluster of strong to severe thunderstorms moving into northern Georgia, as a forward-propagating Mesoscale Convective System or squall line,” the NTSB report says. The weather was expected to destabilize further by mid-day because of surface heating, “enhancing the threat of organized severe thunderstorms and supercell thunderstorms.”

It was that advisory that was not passed along to Crossfield, although at the time of the accident, in-flight weather advisories were issued for severe thunderstorms over northern Georgia.

A review of Atlanta ARTCC communications with Crossfield confirmed that he was not provided with any severe weather advisories nor was he advised of the radar-depicted weather displayed on the controller’s radar scope. Crossfield entered the depicted weather while at 11,000 feet, just before asking to deviate south. Radar contact was lost about 30 seconds after he initiated his turn to the south.

According to the report, the controller acknowledged that adverse weather was present “all over” his sector with varying intensities. He stated that northbound departures out of Atlanta were encountering adverse weather and were “picking their way through holes in the weather.” He acknowledged that controllers are required to issue known adverse weather to pilots and stated that his scope depicted adverse weather in the accident airplane’s projected flight path. He said that, even though adverse weather was throughout the area, he did not issue the information to Crossfield because he felt that conditions displayed on his radarscope were unreliable. He stated that pilots have a better idea of where adverse weather is and that he expects them to inform him on what actions they need to take to avoid it. By not issuing weather reports to the pilot, the controller violated several paragraphs in FAA Order 7110.65, “Air Traffic Control,” the NTSB report states, then enumerates those paragraphs.

As a direct result of Crossfield’s death, in October 2006 the NTSB issued Safety Alert SA-11, titled “Thunderstorm Encounters.” It cites four recent fatal accidents involving in-flight encounters with severe weather, including Crossfield’s.

The Safety Alert specifically cites ATC involvement in each of those accidents, but also states that “IFR pilots need to actively maintain awareness of severe weather along their route of flight” and provides suggestions for avoiding involvement in similar accidents.

The Safety Alert can be found at NTSB.gov/Alerts/SA_011.pdf and is well worth reading.

It may be the only good thing to come out of Crossfield’s death.

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