Cirrus Crash Near Agua Dulce: Pilot Not Instrument-Rated

An instrument rating entitles a pilot to legally navigate an aircraft when the weather is bad enough that he can't see outside.  A pilot who is not instrument-rated must always stay out of the clouds. If the weather is such that he can't do that, he must stay on the ground.  

The training required to obtain an instrument rating is extensive.  In most cases, it takes a pilot longer and costs him more to obtain the rating than it did for him to get his pilot's license in the first

place. But without an instrument rating, a pilot who flies into clouds will quickly become disorAgua Dulce Crash Siteiented, be unable to keep the aircraft "right side up," lose control of the aircraft, and crash. According to one popular article, the life expectancy of a non-instrument rated pilot who wanders into the clouds is about 178 seconds. 

"Technologically advanced aircraft," such as the Cirrus, are equipped with sophisticated autopilots that are capable of keeping the aircraft right side up. That may tempt pilots who don't have instrument ratings to fly through the clouds, thinking they can always rely on the autopilot if things get dicey.  But that thinking is illegal and dangerous. 

Cirrus N427MC crashed near Agua Dulce, California.  The pilot and his two passengers were killed. The weather, according to the NTSB preliminary report, was cloudy. (As the NTSB put it, "instrument meteorological conditions prevailed.")  But the pilot, Dale Smet, did not hold an instrument rating.  (Though the NTSB report doesn't mention that fact, Smet's piloting credentials can be found here.)    

Witness accounts are consistent with this accident being caused by a non-instrument rated pilot venturing into the clouds, losing control of the aircraft, and crashing.  According to an article appearing in the Signal, one witness saw the aircraft come out of the clouds while out of control:

[The witness] was riding her horse along Canyon Quail Trail when she heard the plane’s engine. Moments later, she saw a white plane spinning out of the clouds. It flew over her head -  the plane was about 40 feet above the ground and plummeting fast.

Other witness accounts are similar.  

An overconfident pilot is a dangerous thing. 

Cirrus Safety and Risk Homeostasis

The Cirrus aircraft is loaded with advanced safety features lacking in older "legacy" aircraft.  Yet, the Cirrus safety record appears to be no better -- and perhaps even worse -- than that of the legacy fleet.  How can this be? 

I've written before that "risk homeostasis" may be one factor at work.  I suggested here and here that pilots might tend to use the advanced features of the aircraft to fly into more challenging conditions than they otherwise would.  While using the features in that fashion might increase the utility of the aircraft, it necessarily undercuts many of the features' safety benefits.  

It turns out that that three human factors experts have published a short article (see below) on risk

homeostasis theory as it applies to technologically advanced aircraft.  I discussed the article recently with one of the authors, Steven Meyers.  I came away convinced that the theory deserves more attention than it has to date received.

Meyer's article explains risk homeostasis as follows: 

If people assess the level of risk associated with a particular activity to be greater than the acceptable level, they tend to exercise greater levels of caution. . . The opposite is also true: If they assess the level of risk to be lower than their acceptable level, they tend to engage in actions that increase their level of risk taking.

What follows is that, when provided with a safer airplane, a pilot may simply chose to "push harder." 

If the level of risk for a particular activity is somehow reduced, [the participant] may react by increased risk-taking to return himself to an "acceptable level".

Risk homeostasis theory explains why pilots who are experienced in legacy aircraft wouldn't be any safer when they fly the Cirrus. 

But what about the cadre of new pilots who were drawn to aviation by the Cirrus' safety features?  By standing on the sidelines until the safety features were introduced, those pilots demonstrated that the Cirrus provides the highest level of risk that they are willing to accept. Risk homeostasis theory wouldn't suggest they would engage in riskier behavior because of the plane's novel safety features. Therefore, one might expect that their safety record would be better than that of equally experienced pilots flying legacy aircraft. 

Yet, that doesn't seem to be the case.  That means other factors must also be at work.Pilot Error and Technically Advanced Aircraft

NTSB: Glass Cockpits Associated With Higher Rate of Fatal Accidents

Most general aviation aircraft manufactured today come with "glass cockpits."  Instead of being equipped with mechanical gauges and indicators, they are equipped with computer screens.  The screens integrate and display all sorts of useful flight information.  The information displayed may include satellite weather, synthetic vision, infrared vision, terrain awareness information, traffic

information, and moving maps. Glass cockpits are supposed to help improve the pilot's "situational awareness." 

Not surprisingly, glass cockpits have been marketed as a safetCirrus Glass Cockpity advantage.  From the website of one manufacturer, Cirrus Aircraft:

We included new safety features to reduce your work load and anxiety by giving you more time to think and improving flight environment manageability. Ultimately, with [our glass cockpit] you get a smoother, more precise flying experience while all the time knowing you are flying smarter, flying safer.

The NTSB agrees that glass cockpits have the potential to improve safety.  But to the surprise of many, the NTSB has now found that, to date, they have not.  To the contrary, aircraft equipped with glass cockpits have a higher than fatal accident rate than comparable aircraft equipped with the old-fashioned, hard-to-decipher mechanical gauges.

Study analyses of aircraft accident and activity data showed a decrease in total accident rates but an increase in fatal accident rates for the selected group of glass cockpit aircraft when compared to similar conventionally equipped aircraft during the study period. Overall, study analyses did not show a significant improvement in safety for the glass cockpit study group.

How can this be?  More information, presented to the pilot in an easy-to-understand fashion, is supposed to be a good thing.  The NTSB's findings have left many scratching their heads.

I've written before that the poor safety record may simply be the result of "Risk Homeostasis" at work.  Risk Homeostasis theory suggests that, when given the opportunity, pilots will use a safety feature to enhance the aircraft's utility rather than enjoy the increased level of safety the feature could provide.  In other words, pilots use the the glass cockpits to fly into conditions that they would otherwise avoid.  And, instead of painstakingly preparing for the flight before they depart, they prepare "on the fly" (so to speak), relying on the glass cockpit to tell them what they need to know.

A feature - whether it is a glass cockpit or an airframe parachute - can serve as a safety feature or one that enhances an aircraft's utility.  It can't do both.

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Cirrus FIKI Marketing Irresponsible?

Cirrus aircraft are now available with "flight into known icing" (FIKI) capability.  That's a great feature. I've written before, however, that Cirrus is asking for trouble with its marketing.  Cirrus sells the feature as one that both enhances safety and increases the aircraft's utility.  But Cirrus can't have it both ways.  If a pilot uses the FIKI capability by, for example, flying in conditions that would otherwise keep him on the ground, he necessarily undermines that feature's safety benefits.  I discuss why Cirrus' marketing is a problem here.

Steve Wilson, who is an air safety investigator (among other things), now slams Cirrus' marketing even harder.  According to Wilson, some aspects of Cirrus' marketing encourage pilots to use the FIKI capability to take risks that are simply foolish.

Some say that Wilson's criticisms should be discounted because he sells Cessna aircraft and Cessna competes with Cirrus.  But Wilson isn't criticizing Cirrus' product, just its marketing.  It seems hard to argue with him. 

Recent Crashes Stoke Debate on Cirrus Safety

The Cirrus is a “new generation” aircraft loaded with safety features. For example, if a pilot flying after dark gets too close to a ridge line, the Cirrus' on-board Terrain Awareness Warning System generates a voice urging him to “Pull Up! Pull Up!”  The plane’s wings secrete fluid that helps prevent them from icing up in poor weather. The cockpit has airbags, and its seats protect the passengers in a crash by absorbing 26 times the force of gravity.  The Cirrus is the only aircraft of its kind that comes with a rocket propelled parachute that can shoot out of the back of the plane in an emergency. Partly as a result of all its safety features, the Cirrus has become the most popular general aviation aircraft, with sales surpassing long-time industry leaders Cessna, Beechcraft, and Piper.

Critics, however, say that the aircraft has a lousy safety record, with a fatal accident rate significantly higher than the “old style” Cessnas and Beechcrafts. They say that the Cirrus, made mostly of fiberglass rather than the traditional aluminum, is not crashworthy. Not only does the

fiberglass splinter instead crushing to absorb impact forces like aluminum, but they say the fiberglass and the parachute are prone to catching fire after impact with the ground.  They point out that, unlike other aircraft, the Cirrus is not recoverable if the pilot enters an inadCirrus NASA Photovertent spin.  

Cirrus owners say their aircraft is well-designed and that its safety record is not bad when compared to aircraft performing the same mission, rather than to the population of general aviation aircraft as a whole.  Some Cirrus owners argue that the critics should be disbelieved because they are either salesmen trying to sell Cessnas or, worse yet, plaintiffs' lawyers.

So, where does an owner who is also a plaintiffs' lawyer weigh in on the debate?

The Safety Record:  

Cirrus fans who parse the statistics miss the point.  Cirrus markets itself as a company dedicated to providing “unprecedented levels of safety.”   Spend some time with the statistics and you have to conclude that the Cirrus is, at best, only marginally safer than other aircraft.  But no matter how you look at it, Cirrus' safety record is nothing to brag about.  The aircraft may have been designed to provide “unprecedented levels of safety” but, in practice, it really doesn’t.

Why the Record Fails to Live Up to the Design’s Promise: 

My bet is that “Risk Homeostasis” is at work.  Risk Homeostasis theory suggests that, when given the opportunity, pilots will use a safety feature to enhance the aircraft's utility rather than enjoy the increased level of safety the feature could provide.  For example, a pilot without on-board weather equipment will go many miles out of his way to avoid a deadly thunderstorm, regardless of how inconvenient, because he is uncertain where the storm begins or ends.  If given weather depiction equipment, the pilot will use it to get closer to the thunderstorm than he otherwise would.  Because the equipment provides better information concerning the storms contours, the pilot will not give the storm the same wide berth and will instead cut his safety margins and shorten his trip.  

Similarly, a pilot who would not otherwise fly over inhospitable terrain due to fear of engine failure might make the flight if his plane has a built-in parachute, because the parachute improves the odds of surviving should the engine quit.  By choosing to make the flight, the pilot has used a safety feature (the parachute) to increase the plane's utility, but he takes a risk he would not otherwise have exposed himself to. 

The Marketing Should Be Changed:  

A feature should be marketed as either a safety feature or a feature that increases an aircraft's utility.  To blur the distinction is to invite trouble.  And that's what Cirrus' marketing does.  For example, Cirrus now sells an improved anti-icing system for its aircraft.  Should the system be used to increase safety?  Or to increase the aircraft's utility?  It can't do both.  But according to Cirrus' website: 

Cirrus again delivers increased aircraft safety and utility. With Known Ice Protection. . .pilots can now launch or continue flight with the peace of mind . . .that they're both legal and safe. . .

This type of marketing only invites trouble.   

The Training Should Be Changed: 

Pilots who fly Cirrus aircraft need to be trained on the differences between using a feature to enhance safety and to increase the aircraft's utility.  Using a feature to increase the aircraft's utility necessarily undermines the feature's safety benefits.