View Full Version : ATC Vectors IFR Flight Into California Mountain
Larry Dighera
June 3rd 16, 09:44 PM
The Air Traffic Controller issued the flight a heading of 030 (toward the
mountains), evident in this video
<http://www.cbs8.com/story/32010167/air-traffic-controllers-desperately-tired-to-save-san-diego-pilot-before-crash>.
But that vector appears to have been omitted from the NTSB report.  
At this point, it looks like ATC made an error to me.
--------------------------
You can see where the 030 sent the flight on maps on this page:
http://www.kathrynsreport.com/2016/05/cessna-r182-skylane-rg-san-diego.html
SAN DIEGO (CBS 8) - Newly released recordings reveal that Dr. Thomas Bruff, the
pilot killed in a small plane crash in the Los Angeles National Forest Sunday,
lost contact with air traffic controllers moments before the crash.
The Cessna R182 Skylane RG was flying from Montgomery Field in San Diego to
Santa Monica when it crashed into Brown Mountain. The last radar contact was
around 8:30 a.m.
The audio recordings reveal the urgency in air traffic controllers' voices as
they tried to communicate with Dr. Bruff because he was flying too low. Their
efforts to get him to a higher elevation were met with silence.
According to the audio recordings, Dr. Bruff was in constant contact with air
traffic controllers as he made his way from Montgomery Field in San Diego to
Santa Monica.
As he flew over Los Angeles, the 57-year-old pilot went silent.
Air traffic controllers repeatedly tried to reach him to warn him about his low
altitude. All contact was lost with Dr. Bruff about six miles North of the Rose
Bowl.
------------------
Video and ATC audio here:
http://www.cbs8.com/story/32010167/air-traffic-controllers-desperately-tired-to-save-san-diego-pilot-before-crash
----------------------
http://ntsb.gov/_layouts/ntsb.aviation/brief.aspx?ev_id=20160516X04030&key=1&queryId=c918a7b1-395c-4876-8c75-05a97e45d6ce&pgno=2&pgsize=200
NTSB Identification: WPR16FA111
14 CFR Part 91: General Aviation
Accident occurred Sunday, May 15, 2016 in Altadena, CA
Aircraft: CESSNA R182, registration: N133BW
Injuries: 1 Fatal.
This is preliminary information, subject to change, and may contain errors. Any
errors in this report will be corrected when the final report has been
completed. NTSB investigators either traveled in support of this investigation
or conducted a significant amount of investigative work without any travel, and
used data obtained from various sources to prepare this aircraft accident
report.
On May 15, 2016, about 0829 Pacific daylight time, a Cessna R182, N133BW, was
destroyed when it impacted terrain during cruise flight near Altadena,
California. The airplane was registered to San Diego Skylane LLC., and operated
by the pilot under the provisions of Title 14 Code of Federal Regulations Part
91. The private pilot, sole occupant of the airplane, was fatally injured.
Instrument meteorological conditions prevailed and an instrument flight rules
(IFR) flight plan was filed for the personal flight. The cross-country flight
originated from Montgomery Field, San Diego, California, at 0737, with an
intended destination of the Santa Monica Airport (SMO), Santa Monica,
California.
Preliminary information provided by the Federal Aviation Administration (FAA)
indicated that the pilot was being vectored for an instrument approach to SMO.
The pilot established radio communication with the controller and subsequently
acknowledged obtaining weather information at the destination airport. About 2
minutes, 26 seconds later, the controller issued the pilot a heading change to
290 degrees and a descent clearance to 3,000 feet for vectors to final
approach. However, the controller received no response from the pilot despite
multiple attempts over the course of about 2 minutes. The pilot then
transmitted that he was on a 030 degree heading. The controller continued to
issue vectors away from rising terrain and made several attempts to communicate
with the pilot; however, no further radio communication from the pilot were
heard. Radar contact with the airplane was subsequently lost and an alert
notice (ALNOT) was issued by the FAA. The wreckage was located later that
evening by a Los Angeles County Sheriff Office air unit. The wreckage was
located within mountainous terrain near Brown Mountain, about 2 miles north,
northwest of Altadena. Law enforcement personnel and initial responders
reported that the airplane was mostly consumed by a post impact fire. Recovery
of the wreckage is currently pending.
-------------------------------------------------------------------
http://ntsb.gov/_layouts/ntsb.aviation/Results.aspx?queryId=b32c728a-eb8a-4169-8fae-41e5c707734f
Pilot name: Thomas Bruff
Airman: THOMAS CHRISTOPHER BRUFF
Personal Information
THOMAS CHRISTOPHER BRUFF 
XXXX WARING RD STE 7
SAN DIEGO CA 92120-2700
County: SAN DIEGO
Country: USA
Medical
Medical Class: Third, Medical Date: 6/2015
MUST WEAR CORRECTIVE LENSES.
Certificates
PRIVATE PILOT
Date of Issue: 6/16/2010
Certificate: PRIVATE PILOT     Print
Ratings:
PRIVATE PILOT
  AIRPLANE SINGLE ENGINE LAND
  INSTRUMENT AIRPLANE
Limits:
ENGLISH PROFICIENT.
--------------------------------------------------------------------
http://fox5sandiego.com/2016/05/15/small-airplane-that-departed-san-diego-discovered-crashed-near-pasadena/
One dead after plane from San Diego crashes near Pasadena
POSTED 9:54 PM, MAY 15, 2016, BY FOX 5 DIGITAL TEAM AND JASON SLOSS, UPDATED AT
01:15AM, MAY 16, 2016
SAN DIEGO - One person died after a small airplane that departed from a San
Diego airport crashed in the mountains north of Pasadena Sunday, authorities
said.
The white Cessna 182 aircraft with blue stripes was spotted before 9 a.m. near
Mount Wilson in the Angeles National Forest, according to a Los Angeles County
Fire Department dispatcher. The wreckage was near Mount Wilson Road at the
Angeles Crest Highway, state Route 2.
A heavy deck of clouds limited visibility to 200 feet, the dispatcher said.
"They (search and rescue teams) can see it, but they're unable to tell if there
are any passengers," she said. "They're having an access problem."
The FAA reported the pilot had indicated a flight from San Diego to Santa
Monica, west of Los Angeles. The crash site was not on a direct route, as Mount
Wilson is about 90 miles northwest of San Diego and 35 miles northeast of Santa
Monica.
Radar data from Flightaware.com showed that the plane had departed from
Montgomery Field in San Diego at 7:37 a.m. Sunday, and was apparently in an
approach pattern to Santa Monica Airport when it flew in a straight line to the
northeast. The radar path ended near Mount Wilson.
FAA spokesman Allen Kenitzer said the plane had been en route from Montgomery
Field to Santa Monica. It lost contact with ground controllers when it was 17
miles east of Van Nuys Airport, but no time of the contact loss was released.
The Cessna's tail number was N133BW, and FAA records indicate it was owned by a
San Diego company.
The plane was among a fleet belonging to the Plus One Flyers club at Montgomery
Field.
“You join the club as a pilot or as a student under the supervision of a flight
instructor. You pay your dues and if you’re checked out in a particular
airplane, you can fly it. You just get on the schedule and go fly it," said
local pilot Bill Winsor.
Shane Terpstra, a safety officer with the club, said the planes are regularly
checked out by mechanics.
“Very nice airplane, for the age. It’s very well-maintained. I’ve flown it many
times myself. A lot of the more experienced pilots choose to fly this -- it's a
little faster," said Terpstra.
------------------------------------------------------------------
Don Poitras
June 3rd 16, 10:19 PM
Nonsense. They vectored him for an instrument approach into Santa
Monica when he was just passed LAX. He never responded to later
instructions and flew another 15 minutes at 150 knots straight
into the hills to the north east. If ATC hadn't given him that
heading, he wouldn't have been able to fly the approach. Here's
a similar flight:
http://flightaware.com/live/flight/N554MC/history/20160602/2122Z/KMYF/KSMO
Larry Dighera > wrote:
> The Air Traffic Controller issued the flight a heading of 030 (toward the
> mountains), evident in this video
> <http://www.cbs8.com/story/32010167/air-traffic-controllers-desperately-tired-to-save-san-diego-pilot-before-crash>.
> But that vector appears to have been omitted from the NTSB report.  
> At this point, it looks like ATC made an error to me.
> --------------------------
> You can see where the 030 sent the flight on maps on this page:
> http://www.kathrynsreport.com/2016/05/cessna-r182-skylane-rg-san-diego.html
-- 
Don Poitras
Larry Dighera
June 4th 16, 03:23 AM
Hello Don,
Thank you for your response to my post.
I see what you are saying.  The pilot must maintain situational awareness at
all times.  However, there are a few troubling things about ATC's instructions
and the preliminary NTSB report.
  1.  Presumably, before arriving abeam of KLAX, SoCal TRACON instructed the
pilot to fly heading 210 (SW).  The pilot then requested a heading of 310 (NW)
instead, according to the ATC audio recording in the video at 00:36 minutes. A
heading of 310 was about direct KSMO.  But, the NTSB report states: "the
controller issued the pilot a heading change to 290 degrees and a descent
clearance to 3,000 feet for vectors to final approach."  Clearly ATC and the
pilot had different expectations, as the altitude for entry at the DARTS IAF is
4,500' <https://skyvector.com/files/tpp/1606/pdf/05023VGA.PDF>, but the
altitude for BEVEY INT is 2,600'.
  2.  Then LA CENTER turned the flight to a heading of 030 ostensibly to
intercept the IAF DARTS, but the approach plate indicates that the altitude at
the IAF is to be 4,500', but ATC had previously assigned the flight to 3,000'.
The NTSB report fails to mention the 3,000' altitude assignment that is in the
video
<http://www.cbs8.com/story/32010167/air-traffic-controllers-desperately-tired-to-save-san-diego-pilot-before-crash>
at 00:55 minutes.  There's a flight track log here:
<http://flightaware.com/live/flight/N133BW/history/20160515/1424Z/KMYF/KSMO/tracklog>.
There is no indication that the pilot requested nor ATC reassigned the flight a
higher altitude.  
  3.  Then LA CENTER issued an Low Altitude Alert and (01:10 in the video), and
"turn left immediately try to maintain 6,000" (at 02:13 in the video), but
apparently radio communications had been lost before that occurred.
I'm guessing, but from the 210 heading and 3,000' SoCal altitude assignment
instructions, ATC was aiming for a BEVEY INT intercept of the final approach
course, but the pilot intended to fly the full approach from DARTS.  The
approach plate indicates that a BEVEY INT entry is for radar vectors.  Baring a
medical or mechanical/electrical issue, it appears that the PIC failed to
maintain situational awareness.
Tragic.
Larry
FLIGHT TRACK LOG:
<http://flightaware.com/live/flight/N133BW/history/20160515/1424Z/KMYF/KSMO/tracklog>
Time (EDT)	Latitude	Longitude	Course	Direction	KTS MPH
feet	Rate	Reporting Facility
Sun 10:37:00 AM	Departure (KMYF) @ Sunday 07:37:00 AM PDT		 Los
Angeles Center
Sun 10:37:20 AM	32.8167	-117.1667	272°	West	101	116	1,100
Level	 Southern California TRACON
Sun 10:38:26 AM	32.8333	-117.2000	301°	West	112	129	2,200
796 Climbing	 Southern California TRACON
Sun 10:39:13 AM	32.8361	-117.2214	279°	West	105	121	2,600
606 Climbing	 Los Angeles Center
Sun 10:40:15 AM	32.8639	-117.2439	325°	Northwest	120	138
3,300	683 Climbing	 Los Angeles Center
Sun 10:41:16 AM	32.8961	-117.2578	340°	North	122	140	4,000
738 Climbing	 Los Angeles Center
Sun 10:42:17 AM	32.9342	-117.2753	339°	North	123	142	4,800
732 Climbing	 Los Angeles Center
Sun 10:43:19 AM	32.9628	-117.2881	339°	North	119	137	5,500
554 Climbing	 Los Angeles Center
Sun 10:44:27 AM	33.0000	-117.3000	345°	North	103	119	6,000
246 Climbing	 Southern California TRACON
Sun 10:45:21 AM	33.0167	-117.3167	320°	Northwest	126	145
6,000	 Level	 Southern California TRACON
Sun 10:46:27 AM	33.0667	-117.3333	345°	North	131	151	6,000
Level	 Southern California TRACON
Sun 10:47:27 AM	33.1000	-117.3500	337°	Northwest	130	150
6,000	 Level	 Southern California TRACON
Sun 10:49:27 AM	33.1569	-117.3789	337°	Northwest	131	151
6,000	 Level	 Los Angeles Center
Sun 10:50:29 AM	33.1969	-117.3972	339°	North	131	151	6,000
Level	 Los Angeles Center
Sun 10:51:30 AM	33.2311	-117.4139	338°	Northwest	131	151
6,000	 Level	 Los Angeles Center
Sun 10:52:33 AM	33.2667	-117.4333	336°	Northwest	134	154
6,000	 Level	 Southern California TRACON
Sun 10:54:33 AM	33.3167	-117.5000	312°	West	133	153	6,000
Level	 Southern California TRACON
Sun 10:55:33 AM	33.3333	-117.5333	301°	West	133	153	6,000
Level	 Southern California TRACON
Sun 10:57:39 AM	33.3911	-117.5944	318°	Northwest	132	152
6,000	 Level	 Los Angeles Center
Sun 10:58:41 AM	33.4231	-117.6317	315°	West	132	152	6,000
Level	 Los Angeles Center
Sun 10:59:28 AM	33.4500	-117.6500	331°	Northwest	135	155
6,000	 Level	 Southern California TRACON
Sun 11:00:40 AM	33.4833	-117.6833	320°	Northwest	136	157
6,000	 Level	 Southern California TRACON
Sun 11:01:28 AM	33.5000	-117.7167	301°	West	136	157	6,000
Level	 Southern California TRACON
Sun 11:02:28 AM	33.5333	-117.7500	320°	Northwest	137	158
6,000	 Level	 Southern California TRACON
Sun 11:03:34 AM	33.5500	-117.7833	301°	West	138	159	6,000
Level	 Southern California TRACON
Sun 11:04:40 AM	33.5833	-117.8167	320°	Northwest	137	158
6,000	 Level	 Southern California TRACON
Sun 11:05:40 AM	33.6167	-117.8500	321°	Northwest	136	157
6,000	 Level	 Southern California TRACON
Sun 11:06:29 AM	33.6333	-117.8833	301°	West	135	155	6,000
Level	 Southern California TRACON
Sun 11:07:40 AM	33.6667	-117.9167	320°	Northwest	138	159
6,000	 Level	 Southern California TRACON
Sun 11:08:40 AM	33.7000	-117.9500	320°	Northwest	137	158
6,000	 Level	 Southern California TRACON
Sun 11:09:35 AM	33.7000	-117.9833	270°	West	136	157	6,000
-261 Level	 Southern California TRACON
Sun 11:10:35 AM	33.7333	-118.0333	309°	West	151	174	5,500
-500 Descending	 Southern California TRACON
Sun 11:11:35 AM	33.7500	-118.0667	301°	West	154	177	5,000
-550 Descending	 Southern California TRACON
Sun 11:12:35 AM	33.7667	-118.1167	292°	West	153	176	4,400
-500 Descending	 Southern California TRACON
Sun 11:13:35 AM	33.7833	-118.1667	292°	West	157	181	4,000
-267 Descending	 Southern California TRACON
Sun 11:14:05 AM	33.7969	-118.1886	307°	West	153	176	4,000
Level	 Los Angeles Center
Sun 11:15:07 AM	33.8158	-118.2303	299°	West	148	170	4,000
Level	 Los Angeles Center
Sun 11:16:09 AM	33.8350	-118.2725	299°	West	147	169	4,000
Level	 Los Angeles Center
Sun 11:17:11 AM	33.8622	-118.3069	313°	West	156	180	4,000
Level	 Los Angeles Center
Sun 11:18:12 AM	33.8981	-118.3442	319°	Northwest	147	169
4,000	 Level	 Los Angeles Center
Sun 11:19:14 AM	33.9303	-118.3736	323°	Northwest	146	168
4,000	 Level	 Los Angeles Center
Sun 11:20:16 AM	33.9617	-118.4025	323°	Northwest	145	167
4,000	 Level	 Los Angeles Center
Sun 11:21:18 AM	33.9992	-118.3850	21°	North	150	173	4,000
Level	 Los Angeles Center
Sun 11:22:29 AM	34.0333	-118.3333	51°	Northeast	146	168
4,000	 Level	 Southern California TRACON
Sun 11:23:30 AM	34.0667	-118.3167	22°	Northeast	145	167
4,000	 Level	 Southern California TRACON
Sun 11:24:29 AM	34.1000	-118.2833	40°	Northeast	145	167
4,000	 Level	 Southern California TRACON
Sun 11:26:28 AM	34.1586	-118.2178	43°	Northeast	148	170
4,000	 Level	 Los Angeles Center
Sun 11:27:29 AM	34.1897	-118.1858	41°	Northeast	148	170
4,000	 Level	 Los Angeles Center
Sun 11:28:31 AM	34.2214	-118.1539	40°	Northeast	148	170
4,000	 Level	 Los Angeles Center
Sun 11:29:32 AM	34.2517	-118.1225	41°	Northeast	148	170
4,000	 Level	 Los Angeles Center
Sun 11:37:00 AM	Arrival (KSMO) @ Sunday 08:37:00 AM PDT Revised		
https://skyvector.com/files/tpp/1606/pdf/05023VGA.PDF
On Fri, 3 Jun 2016 20:19:49 +0000 (UTC),  (Don Poitras) wrote:
>Nonsense. They vectored him for an instrument approach into Santa
>Monica when he was just passed LAX. He never responded to later
>instructions and flew another 15 minutes at 150 knots straight
>into the hills to the north east. If ATC hadn't given him that
>heading, he wouldn't have been able to fly the approach. Here's
>a similar flight:
>
>http://flightaware.com/live/flight/N554MC/history/20160602/2122Z/KMYF/KSMO
>
>
>Larry Dighera > wrote:
>
>
>> The Air Traffic Controller issued the flight a heading of 030 (toward the
>> mountains), evident in this video
>> <http://www.cbs8.com/story/32010167/air-traffic-controllers-desperately-tired-to-save-san-diego-pilot-before-crash>.
>
>> But that vector appears to have been omitted from the NTSB report.  
>
>> At this point, it looks like ATC made an error to me.
>
>> --------------------------
>> You can see where the 030 sent the flight on maps on this page:
>> http://www.kathrynsreport.com/2016/05/cessna-r182-skylane-rg-san-diego.html
Don Poitras
June 4th 16, 04:23 AM
It's not just "situational awareness", it was failure to follow bog-standard
instructions. They weren't sending him to DARTS, the were just sending him
far enough out so that they could turn him to intercept the final approach
course. 3000 feet is plenty high enough in that area as long as you turn
back when you're told to. I listened to the recording on LiveATC and the 
310/210 thing was just a garbled transmission from ATC that they corrected
when the pilot read back the wrong heading. The 290 heading was given later
to turn him back to intercept the approach course. That's the exact instruction
one would expect to get. Again, he's getting vectors to final, there was no
implication that he was going to fly the full approach and it's pretty unusual
to be asked to do so in LA. You're going to get vectors. Although LiveATC didn't
capture the airplane transmissions after the switch to SoCal approach, it's 
pretty clear that the pilot stopped responding after the instruction to turn
left to 290. They tried many times to reach him. We'll probably never know
what happened, but it was either a medical problem or something worse. The
one thing we _do_ know is that SoCal approach did nothing wrong and there was
nothing out of the ordinary in their instructions. They did all they could to
try to save him, including asking another aircraft in the area to listen for 
an ELT broadcast to locate him for possible rescue. 
 
Larry Dighera > wrote:
> Hello Don,
> Thank you for your response to my post.
> I see what you are saying.  The pilot must maintain situational awareness at
> all times.  However, there are a few troubling things about ATC's instructions
> and the preliminary NTSB report.
>   1.  Presumably, before arriving abeam of KLAX, SoCal TRACON instructed the
> pilot to fly heading 210 (SW).  The pilot then requested a heading of 310 (NW)
> instead, according to the ATC audio recording in the video at 00:36 minutes. A
> heading of 310 was about direct KSMO.  But, the NTSB report states: "the
> controller issued the pilot a heading change to 290 degrees and a descent
> clearance to 3,000 feet for vectors to final approach."  Clearly ATC and the
> pilot had different expectations, as the altitude for entry at the DARTS IAF is
> 4,500' <https://skyvector.com/files/tpp/1606/pdf/05023VGA.PDF>, but the
> altitude for BEVEY INT is 2,600'.
>   2.  Then LA CENTER turned the flight to a heading of 030 ostensibly to
> intercept the IAF DARTS, but the approach plate indicates that the altitude at
> the IAF is to be 4,500', but ATC had previously assigned the flight to 3,000'.
> The NTSB report fails to mention the 3,000' altitude assignment that is in the
> video
> <http://www.cbs8.com/story/32010167/air-traffic-controllers-desperately-tired-to-save-san-diego-pilot-before-crash>
> at 00:55 minutes.  There's a flight track log here:
> <http://flightaware.com/live/flight/N133BW/history/20160515/1424Z/KMYF/KSMO/tracklog>.
> There is no indication that the pilot requested nor ATC reassigned the flight a
> higher altitude.  
>   3.  Then LA CENTER issued an Low Altitude Alert and (01:10 in the video), and
> "turn left immediately try to maintain 6,000" (at 02:13 in the video), but
> apparently radio communications had been lost before that occurred.
> I'm guessing, but from the 210 heading and 3,000' SoCal altitude assignment
> instructions, ATC was aiming for a BEVEY INT intercept of the final approach
> course, but the pilot intended to fly the full approach from DARTS.  The
> approach plate indicates that a BEVEY INT entry is for radar vectors.  Baring a
> medical or mechanical/electrical issue, it appears that the PIC failed to
> maintain situational awareness.
> Tragic.
> Larry
> FLIGHT TRACK LOG:
> <http://flightaware.com/live/flight/N133BW/history/20160515/1424Z/KMYF/KSMO/tracklog>
> Time (EDT)      Latitude        Longitude       Course  Direction       KTS MPH
> feet    Rate    Reporting Facility
> Sun 10:37:00 AM Departure (KMYF) @ Sunday 07:37:00 AM PDT                Los
> Angeles Center
> Sun 10:37:20 AM 32.8167 -117.1667       272?    West    101     116     1,100
> Level    Southern California TRACON
> Sun 10:38:26 AM 32.8333 -117.2000       301?    West    112     129     2,200
> 796 Climbing     Southern California TRACON
> Sun 10:39:13 AM 32.8361 -117.2214       279?    West    105     121     2,600
> 606 Climbing     Los Angeles Center
> Sun 10:40:15 AM 32.8639 -117.2439       325?    Northwest       120     138
> 3,300   683 Climbing     Los Angeles Center
> Sun 10:41:16 AM 32.8961 -117.2578       340?    North   122     140     4,000
> 738 Climbing     Los Angeles Center
> Sun 10:42:17 AM 32.9342 -117.2753       339?    North   123     142     4,800
> 732 Climbing     Los Angeles Center
> Sun 10:43:19 AM 32.9628 -117.2881       339?    North   119     137     5,500
> 554 Climbing     Los Angeles Center
> Sun 10:44:27 AM 33.0000 -117.3000       345?    North   103     119     6,000
> 246 Climbing     Southern California TRACON
> Sun 10:45:21 AM 33.0167 -117.3167       320?    Northwest       126     145
> 6,000    Level   Southern California TRACON
> Sun 10:46:27 AM 33.0667 -117.3333       345?    North   131     151     6,000
> Level    Southern California TRACON
> Sun 10:47:27 AM 33.1000 -117.3500       337?    Northwest       130     150
> 6,000    Level   Southern California TRACON
> Sun 10:49:27 AM 33.1569 -117.3789       337?    Northwest       131     151
> 6,000    Level   Los Angeles Center
> Sun 10:50:29 AM 33.1969 -117.3972       339?    North   131     151     6,000
> Level    Los Angeles Center
> Sun 10:51:30 AM 33.2311 -117.4139       338?    Northwest       131     151
> 6,000    Level   Los Angeles Center
> Sun 10:52:33 AM 33.2667 -117.4333       336?    Northwest       134     154
> 6,000    Level   Southern California TRACON
> Sun 10:54:33 AM 33.3167 -117.5000       312?    West    133     153     6,000
> Level    Southern California TRACON
> Sun 10:55:33 AM 33.3333 -117.5333       301?    West    133     153     6,000
> Level    Southern California TRACON
> Sun 10:57:39 AM 33.3911 -117.5944       318?    Northwest       132     152
> 6,000    Level   Los Angeles Center
> Sun 10:58:41 AM 33.4231 -117.6317       315?    West    132     152     6,000
> Level    Los Angeles Center
> Sun 10:59:28 AM 33.4500 -117.6500       331?    Northwest       135     155
> 6,000    Level   Southern California TRACON
> Sun 11:00:40 AM 33.4833 -117.6833       320?    Northwest       136     157
> 6,000    Level   Southern California TRACON
> Sun 11:01:28 AM 33.5000 -117.7167       301?    West    136     157     6,000
> Level    Southern California TRACON
> Sun 11:02:28 AM 33.5333 -117.7500       320?    Northwest       137     158
> 6,000    Level   Southern California TRACON
> Sun 11:03:34 AM 33.5500 -117.7833       301?    West    138     159     6,000
> Level    Southern California TRACON
> Sun 11:04:40 AM 33.5833 -117.8167       320?    Northwest       137     158
> 6,000    Level   Southern California TRACON
> Sun 11:05:40 AM 33.6167 -117.8500       321?    Northwest       136     157
> 6,000    Level   Southern California TRACON
> Sun 11:06:29 AM 33.6333 -117.8833       301?    West    135     155     6,000
> Level    Southern California TRACON
> Sun 11:07:40 AM 33.6667 -117.9167       320?    Northwest       138     159
> 6,000    Level   Southern California TRACON
> Sun 11:08:40 AM 33.7000 -117.9500       320?    Northwest       137     158
> 6,000    Level   Southern California TRACON
> Sun 11:09:35 AM 33.7000 -117.9833       270?    West    136     157     6,000
> -261 Level       Southern California TRACON
> Sun 11:10:35 AM 33.7333 -118.0333       309?    West    151     174     5,500
> -500 Descending  Southern California TRACON
> Sun 11:11:35 AM 33.7500 -118.0667       301?    West    154     177     5,000
> -550 Descending  Southern California TRACON
> Sun 11:12:35 AM 33.7667 -118.1167       292?    West    153     176     4,400
> -500 Descending  Southern California TRACON
> Sun 11:13:35 AM 33.7833 -118.1667       292?    West    157     181     4,000
> -267 Descending  Southern California TRACON
> Sun 11:14:05 AM 33.7969 -118.1886       307?    West    153     176     4,000
> Level    Los Angeles Center
> Sun 11:15:07 AM 33.8158 -118.2303       299?    West    148     170     4,000
> Level    Los Angeles Center
> Sun 11:16:09 AM 33.8350 -118.2725       299?    West    147     169     4,000
> Level    Los Angeles Center
> Sun 11:17:11 AM 33.8622 -118.3069       313?    West    156     180     4,000
> Level    Los Angeles Center
> Sun 11:18:12 AM 33.8981 -118.3442       319?    Northwest       147     169
> 4,000    Level   Los Angeles Center
> Sun 11:19:14 AM 33.9303 -118.3736       323?    Northwest       146     168
> 4,000    Level   Los Angeles Center
> Sun 11:20:16 AM 33.9617 -118.4025       323?    Northwest       145     167
> 4,000    Level   Los Angeles Center
> Sun 11:21:18 AM 33.9992 -118.3850       21?     North   150     173     4,000
> Level    Los Angeles Center
> Sun 11:22:29 AM 34.0333 -118.3333       51?     Northeast       146     168
> 4,000    Level   Southern California TRACON
> Sun 11:23:30 AM 34.0667 -118.3167       22?     Northeast       145     167
> 4,000    Level   Southern California TRACON
> Sun 11:24:29 AM 34.1000 -118.2833       40?     Northeast       145     167
> 4,000    Level   Southern California TRACON
> Sun 11:26:28 AM 34.1586 -118.2178       43?     Northeast       148     170
> 4,000    Level   Los Angeles Center
> Sun 11:27:29 AM 34.1897 -118.1858       41?     Northeast       148     170
> 4,000    Level   Los Angeles Center
> Sun 11:28:31 AM 34.2214 -118.1539       40?     Northeast       148     170
> 4,000    Level   Los Angeles Center
> Sun 11:29:32 AM 34.2517 -118.1225       41?     Northeast       148     170
> 4,000    Level   Los Angeles Center
> Sun 11:37:00 AM Arrival (KSMO) @ Sunday 08:37:00 AM PDT Revised         
> https://skyvector.com/files/tpp/1606/pdf/05023VGA.PDF
> On Fri, 3 Jun 2016 20:19:49 +0000 (UTC),  (Don Poitras) wrote:
> >Nonsense. They vectored him for an instrument approach into Santa
> >Monica when he was just passed LAX. He never responded to later
> >instructions and flew another 15 minutes at 150 knots straight
> >into the hills to the north east. If ATC hadn't given him that
> >heading, he wouldn't have been able to fly the approach. Here's
> >a similar flight:
> >
> >http://flightaware.com/live/flight/N554MC/history/20160602/2122Z/KMYF/KSMO
> >
> >
> >Larry Dighera > wrote:
> >
> >
> >> The Air Traffic Controller issued the flight a heading of 030 (toward the
> >> mountains), evident in this video
> >> <http://www.cbs8.com/story/32010167/air-traffic-controllers-desperately-tired-to-save-san-diego-pilot-before-crash>.
> >
> >> But that vector appears to have been omitted from the NTSB report.  
> >
> >> At this point, it looks like ATC made an error to me.
> >
> >> --------------------------
> >> You can see where the 030 sent the flight on maps on this page:
> >> http://www.kathrynsreport.com/2016/05/cessna-r182-skylane-rg-san-diego.html
-- 
Don Poitras
Larry Dighera
June 4th 16, 04:49 PM
Which particular "bog-standard" ATC instructions are you referring to?  
The pilot seems to have complied with all the instructions he acknowledged
receiving that I'm aware of prior to the handoff to SoCal.  At that point it
appears that he lost radio contact with ATC and continued on the last vector he
had received.  From the LiveATC recording, SoCal's 290 heading assignment
doesn't appear to have been received by the pilot.  
N133BW is not on the LiveATC recording after the ATC handoff to SoCal at 01:05
into the recording here: 
<http://www.liveatc.net/forums/index.php?action=dlattach;topic=13234.0;attach=888 3>.
That could be a result of many things.  
Your assertion that there were transmissions from the aircraft after the
handoff to SoCal that were not captured on the LiveATC recording seems
unfounded.  Do you have another source for those transmissions from the
aircraft that you believe are missing on the LiveATC recording?  
I agree that the information available to date does not appear to imply a
violation by SoCal controllers.  
Here's one ATC controller's comment:
    Very familiar with this crash. Pilot went NORDO. Stayed on ATC assigned
    vector to his death. Who knows why the pilot stopped listening? Radio
    failure? Pilot did not fly his aircraft according to NORDO procedures. He
    should have turned onto Final Approach on his own and landed at the
    airport. Pilot knew there are high MVA's to the northeast. I think pilot
    had the plane on autopilot. Maybe pilot had a heart attack or stroke?
    That's why he stopped responding. 
    
    We vector aircraft towards terrain everyday. It works great when the pilot
    listens and follows instructions. 
On Sat, 4 Jun 2016 02:23:47 +0000 (UTC),  (Don Poitras) wrote:
>It's not just "situational awareness", it was failure to follow bog-standard
>instructions. They weren't sending him to DARTS, the were just sending him
>far enough out so that they could turn him to intercept the final approach
>course. 3000 feet is plenty high enough in that area as long as you turn
>back when you're told to. I listened to the recording on LiveATC and the 
>310/210 thing was just a garbled transmission from ATC that they corrected
>when the pilot read back the wrong heading. The 290 heading was given later
>to turn him back to intercept the approach course. That's the exact instruction
>one would expect to get. Again, he's getting vectors to final, there was no
>implication that he was going to fly the full approach and it's pretty unusual
>to be asked to do so in LA. You're going to get vectors. Although LiveATC didn't
>capture the airplane transmissions after the switch to SoCal approach, it's 
>pretty clear that the pilot stopped responding after the instruction to turn
>left to 290. They tried many times to reach him. We'll probably never know
>what happened, but it was either a medical problem or something worse. The
>one thing we _do_ know is that SoCal approach did nothing wrong and there was
>nothing out of the ordinary in their instructions. They did all they could to
>try to save him, including asking another aircraft in the area to listen for 
>an ELT broadcast to locate him for possible rescue. 
> 
>
>Larry Dighera > wrote:
>
>> Hello Don,
>
>> Thank you for your response to my post.
>
>> I see what you are saying.  The pilot must maintain situational awareness at
>> all times.  However, there are a few troubling things about ATC's instructions
>> and the preliminary NTSB report.
>
>>   1.  Presumably, before arriving abeam of KLAX, SoCal TRACON instructed the
>> pilot to fly heading 210 (SW).  The pilot then requested a heading of 310 (NW)
>> instead, according to the ATC audio recording in the video at 00:36 minutes. A
>> heading of 310 was about direct KSMO.  But, the NTSB report states: "the
>> controller issued the pilot a heading change to 290 degrees and a descent
>> clearance to 3,000 feet for vectors to final approach."  Clearly ATC and the
>> pilot had different expectations, as the altitude for entry at the DARTS IAF is
>> 4,500' <https://skyvector.com/files/tpp/1606/pdf/05023VGA.PDF>, but the
>> altitude for BEVEY INT is 2,600'.
>
>>   2.  Then LA CENTER turned the flight to a heading of 030 ostensibly to
>> intercept the IAF DARTS, but the approach plate indicates that the altitude at
>> the IAF is to be 4,500', but ATC had previously assigned the flight to 3,000'.
>> The NTSB report fails to mention the 3,000' altitude assignment that is in the
>> video
>> <http://www.cbs8.com/story/32010167/air-traffic-controllers-desperately-tired-to-save-san-diego-pilot-before-crash>
>> at 00:55 minutes.  There's a flight track log here:
>> <http://flightaware.com/live/flight/N133BW/history/20160515/1424Z/KMYF/KSMO/tracklog>.
>> There is no indication that the pilot requested nor ATC reassigned the flight a
>> higher altitude.  
>
>>   3.  Then LA CENTER issued an Low Altitude Alert and (01:10 in the video), and
>> "turn left immediately try to maintain 6,000" (at 02:13 in the video), but
>> apparently radio communications had been lost before that occurred.
>
>> I'm guessing, but from the 210 heading and 3,000' SoCal altitude assignment
>> instructions, ATC was aiming for a BEVEY INT intercept of the final approach
>> course, but the pilot intended to fly the full approach from DARTS.  The
>> approach plate indicates that a BEVEY INT entry is for radar vectors.  Baring a
>> medical or mechanical/electrical issue, it appears that the PIC failed to
>> maintain situational awareness.
>
>> Tragic.
>
>> Larry
>
>
>> FLIGHT TRACK LOG:
>> <http://flightaware.com/live/flight/N133BW/history/20160515/1424Z/KMYF/KSMO/tracklog>
>> Time (EDT)      Latitude        Longitude       Course  Direction       KTS MPH
>> feet    Rate    Reporting Facility
>> Sun 10:37:00 AM Departure (KMYF) @ Sunday 07:37:00 AM PDT                Los
>> Angeles Center
>> Sun 10:37:20 AM 32.8167 -117.1667       272?    West    101     116     1,100
>> Level    Southern California TRACON
>> Sun 10:38:26 AM 32.8333 -117.2000       301?    West    112     129     2,200
>> 796 Climbing     Southern California TRACON
>> Sun 10:39:13 AM 32.8361 -117.2214       279?    West    105     121     2,600
>> 606 Climbing     Los Angeles Center
>> Sun 10:40:15 AM 32.8639 -117.2439       325?    Northwest       120     138
>> 3,300   683 Climbing     Los Angeles Center
>> Sun 10:41:16 AM 32.8961 -117.2578       340?    North   122     140     4,000
>> 738 Climbing     Los Angeles Center
>> Sun 10:42:17 AM 32.9342 -117.2753       339?    North   123     142     4,800
>> 732 Climbing     Los Angeles Center
>> Sun 10:43:19 AM 32.9628 -117.2881       339?    North   119     137     5,500
>> 554 Climbing     Los Angeles Center
>> Sun 10:44:27 AM 33.0000 -117.3000       345?    North   103     119     6,000
>> 246 Climbing     Southern California TRACON
>> Sun 10:45:21 AM 33.0167 -117.3167       320?    Northwest       126     145
>> 6,000    Level   Southern California TRACON
>> Sun 10:46:27 AM 33.0667 -117.3333       345?    North   131     151     6,000
>> Level    Southern California TRACON
>> Sun 10:47:27 AM 33.1000 -117.3500       337?    Northwest       130     150
>> 6,000    Level   Southern California TRACON
>> Sun 10:49:27 AM 33.1569 -117.3789       337?    Northwest       131     151
>> 6,000    Level   Los Angeles Center
>> Sun 10:50:29 AM 33.1969 -117.3972       339?    North   131     151     6,000
>> Level    Los Angeles Center
>> Sun 10:51:30 AM 33.2311 -117.4139       338?    Northwest       131     151
>> 6,000    Level   Los Angeles Center
>> Sun 10:52:33 AM 33.2667 -117.4333       336?    Northwest       134     154
>> 6,000    Level   Southern California TRACON
>> Sun 10:54:33 AM 33.3167 -117.5000       312?    West    133     153     6,000
>> Level    Southern California TRACON
>> Sun 10:55:33 AM 33.3333 -117.5333       301?    West    133     153     6,000
>> Level    Southern California TRACON
>> Sun 10:57:39 AM 33.3911 -117.5944       318?    Northwest       132     152
>> 6,000    Level   Los Angeles Center
>> Sun 10:58:41 AM 33.4231 -117.6317       315?    West    132     152     6,000
>> Level    Los Angeles Center
>> Sun 10:59:28 AM 33.4500 -117.6500       331?    Northwest       135     155
>> 6,000    Level   Southern California TRACON
>> Sun 11:00:40 AM 33.4833 -117.6833       320?    Northwest       136     157
>> 6,000    Level   Southern California TRACON
>> Sun 11:01:28 AM 33.5000 -117.7167       301?    West    136     157     6,000
>> Level    Southern California TRACON
>> Sun 11:02:28 AM 33.5333 -117.7500       320?    Northwest       137     158
>> 6,000    Level   Southern California TRACON
>> Sun 11:03:34 AM 33.5500 -117.7833       301?    West    138     159     6,000
>> Level    Southern California TRACON
>> Sun 11:04:40 AM 33.5833 -117.8167       320?    Northwest       137     158
>> 6,000    Level   Southern California TRACON
>> Sun 11:05:40 AM 33.6167 -117.8500       321?    Northwest       136     157
>> 6,000    Level   Southern California TRACON
>> Sun 11:06:29 AM 33.6333 -117.8833       301?    West    135     155     6,000
>> Level    Southern California TRACON
>> Sun 11:07:40 AM 33.6667 -117.9167       320?    Northwest       138     159
>> 6,000    Level   Southern California TRACON
>> Sun 11:08:40 AM 33.7000 -117.9500       320?    Northwest       137     158
>> 6,000    Level   Southern California TRACON
>> Sun 11:09:35 AM 33.7000 -117.9833       270?    West    136     157     6,000
>> -261 Level       Southern California TRACON
>> Sun 11:10:35 AM 33.7333 -118.0333       309?    West    151     174     5,500
>> -500 Descending  Southern California TRACON
>> Sun 11:11:35 AM 33.7500 -118.0667       301?    West    154     177     5,000
>> -550 Descending  Southern California TRACON
>> Sun 11:12:35 AM 33.7667 -118.1167       292?    West    153     176     4,400
>> -500 Descending  Southern California TRACON
>> Sun 11:13:35 AM 33.7833 -118.1667       292?    West    157     181     4,000
>> -267 Descending  Southern California TRACON
>> Sun 11:14:05 AM 33.7969 -118.1886       307?    West    153     176     4,000
>> Level    Los Angeles Center
>> Sun 11:15:07 AM 33.8158 -118.2303       299?    West    148     170     4,000
>> Level    Los Angeles Center
>> Sun 11:16:09 AM 33.8350 -118.2725       299?    West    147     169     4,000
>> Level    Los Angeles Center
>> Sun 11:17:11 AM 33.8622 -118.3069       313?    West    156     180     4,000
>> Level    Los Angeles Center
>> Sun 11:18:12 AM 33.8981 -118.3442       319?    Northwest       147     169
>> 4,000    Level   Los Angeles Center
>> Sun 11:19:14 AM 33.9303 -118.3736       323?    Northwest       146     168
>> 4,000    Level   Los Angeles Center
>> Sun 11:20:16 AM 33.9617 -118.4025       323?    Northwest       145     167
>> 4,000    Level   Los Angeles Center
>> Sun 11:21:18 AM 33.9992 -118.3850       21?     North   150     173     4,000
>> Level    Los Angeles Center
>> Sun 11:22:29 AM 34.0333 -118.3333       51?     Northeast       146     168
>> 4,000    Level   Southern California TRACON
>> Sun 11:23:30 AM 34.0667 -118.3167       22?     Northeast       145     167
>> 4,000    Level   Southern California TRACON
>> Sun 11:24:29 AM 34.1000 -118.2833       40?     Northeast       145     167
>> 4,000    Level   Southern California TRACON
>> Sun 11:26:28 AM 34.1586 -118.2178       43?     Northeast       148     170
>> 4,000    Level   Los Angeles Center
>> Sun 11:27:29 AM 34.1897 -118.1858       41?     Northeast       148     170
>> 4,000    Level   Los Angeles Center
>> Sun 11:28:31 AM 34.2214 -118.1539       40?     Northeast       148     170
>> 4,000    Level   Los Angeles Center
>> Sun 11:29:32 AM 34.2517 -118.1225       41?     Northeast       148     170
>> 4,000    Level   Los Angeles Center
>> Sun 11:37:00 AM Arrival (KSMO) @ Sunday 08:37:00 AM PDT Revised         
>
>
>
>> https://skyvector.com/files/tpp/1606/pdf/05023VGA.PDF
>
>> On Fri, 3 Jun 2016 20:19:49 +0000 (UTC),  (Don Poitras) wrote:
>
>> >Nonsense. They vectored him for an instrument approach into Santa
>> >Monica when he was just passed LAX. He never responded to later
>> >instructions and flew another 15 minutes at 150 knots straight
>> >into the hills to the north east. If ATC hadn't given him that
>> >heading, he wouldn't have been able to fly the approach. Here's
>> >a similar flight:
>> >
>> >http://flightaware.com/live/flight/N554MC/history/20160602/2122Z/KMYF/KSMO
>> >
>> >
>> >Larry Dighera > wrote:
>> >
>> >
>> >> The Air Traffic Controller issued the flight a heading of 030 (toward the
>> >> mountains), evident in this video
>> >> <http://www.cbs8.com/story/32010167/air-traffic-controllers-desperately-tired-to-save-san-diego-pilot-before-crash>.
>> >
>> >> But that vector appears to have been omitted from the NTSB report.  
>> >
>> >> At this point, it looks like ATC made an error to me.
>> >
>> >> --------------------------
>> >> You can see where the 030 sent the flight on maps on this page:
>> >> http://www.kathrynsreport.com/2016/05/cessna-r182-skylane-rg-san-diego.html
Don Poitras
June 4th 16, 11:08 PM
Larry Dighera > wrote:
> Which particular "bog-standard" ATC instructions are you referring to?  
"3BW, turn left, a heading of 290, vector to final, descend and maintain 3000."  
> The pilot seems to have complied with all the instructions he acknowledged
> receiving that I'm aware of prior to the handoff to SoCal.  At that point it
> appears that he lost radio contact with ATC and continued on the last vector he
> had received.  From the LiveATC recording, SoCal's 290 heading assignment
> doesn't appear to have been received by the pilot.  
Certainly it wasn't acknowledged.
> N133BW is not on the LiveATC recording after the ATC handoff to SoCal at 01:05
> into the recording here: 
> <http://www.liveatc.net/forums/index.php?action=dlattach;topic=13234.0;attach=888 3>.
> That could be a result of many things.  
The SoCal receiver is not the same as the Santa Monica tower receiver. These
are just volunteer radios, not official tapes from ATC. There's no way to
tell what the plane transmitted other than by inference.
> Your assertion that there were transmissions from the aircraft after the
> handoff to SoCal that were not captured on the LiveATC recording seems
> unfounded.  Do you have another source for those transmissions from the
> aircraft that you believe are missing on the LiveATC recording?  
The first SoCal transmission to the plane was clearly a response to a call
from the plane. He gave him the altimeter and didn't repeat it, which 
implies the plane read it back correctly. Two and a half minutes later,
ATC gave him the vector to final which he didn't respond to. They then
repeatedly tried to get him to respond, even calling him on another 
frequency. Two minutes later, it sounds as though ATC thought they had him,
"we've been trying to get ahold of you, turn left immediately and climb..."
Another 3 minutes of trying to get him to climb or turn, and then it was
too late.
> I agree that the information available to date does not appear to imply a
> violation by SoCal controllers.  
Good. "ATC error" in a fatal crash is not something to be expressed without
a very good reason.
-- 
Don Poitras
vBulletin® v3.6.4, Copyright ©2000-2025, Jelsoft Enterprises Ltd.