37000 Feet | Browse and search NASA's Aviation Safety Reporting System |
|
Attributes | |
ACN | 321690 |
Time | |
Date | 199511 |
Day | Thu |
Local Time Of Day | 1201 To 1800 |
Place | |
Locale Reference | atc facility : onl |
State Reference | NE |
Altitude | msl bound lower : 14200 msl bound upper : 15000 |
Environment | |
Flight Conditions | VMC |
Light | Night |
Aircraft 1 | |
Operator | general aviation : personal |
Make Model Name | Any Unknown or Unlisted Aircraft Manufacturer |
Operating Under FAR Part | Part 91 |
Flight Phase | descent other |
Route In Use | enroute airway : zmp |
Flight Plan | IFR |
Person 1 | |
Affiliation | Other |
Function | flight crew : single pilot |
Qualification | pilot : commercial pilot : instrument pilot : cfi |
Experience | flight time total : 4675 |
ASRS Report | 321690 |
Person 2 | |
Affiliation | government : faa |
Function | controller : radar |
Qualification | controller : radar |
Events | |
Anomaly | altitude deviation : overshoot non adherence : clearance other anomaly other |
Independent Detector | other controllera |
Resolutory Action | other |
Consequence | Other |
Supplementary | |
Primary Problem | Flight Crew Human Performance |
Air Traffic Incident | Pilot Deviation |
Narrative:
The IFR flight was assigned (cleared) 'descend to and maintain 15000 ft.' pilot's mother was buried 50 hours prior to altitude deviation. At funeral service pilot delivered a eulogy making the emotional experience doubly traumatic. Altitude deviation discovered when controller said 'say your altitude' pilot immediately initiated a climb. Pilot did not correctly evaluate the magnitude of his impairment. However pilot did advise the 2 passenger he wouldn't make the flight if it were not for the severe clear conditions existing in almost the entire united states. Passenger asked pilot to call a nearby airport unicom to forward a telephone message to friends at our destination. Pilot should not have attempted this, demonstrating impaired judgement. Next, pilot advised center of a loud noise or whistle on communications frequency (unicom). Center recognizes this as an ongoing problem to this date. Was this the straw that broke the camel's back? Also, controller was not required to, but might have recognized and advised pilot of the deviation sooner. There was not much traffic on the frequency. Although citing 3 contributing factors, pilot recognizes the gravity of the incident and that the responsibility lies with him. Failure to evaluate the magnitude of his impairment is the major cause. Remedial training or punitive measures is not the answer. The pilot's mother will not die again.
Original NASA ASRS Text
Title: PLT OF A SMA TWIN PISTON ENG ACFT FAILED TO LEVEL AT ASSIGNED ALT DURING DSCNT. ALTDEV ALT OVERSHOT.
Narrative: THE IFR FLT WAS ASSIGNED (CLRED) 'DSND TO AND MAINTAIN 15000 FT.' PLT'S MOTHER WAS BURIED 50 HRS PRIOR TO ALTDEV. AT FUNERAL SVC PLT DELIVERED A EULOGY MAKING THE EMOTIONAL EXPERIENCE DOUBLY TRAUMATIC. ALTDEV DISCOVERED WHEN CTLR SAID 'SAY YOUR ALT' PLT IMMEDIATELY INITIATED A CLB. PLT DID NOT CORRECTLY EVALUATE THE MAGNITUDE OF HIS IMPAIRMENT. HOWEVER PLT DID ADVISE THE 2 PAX HE WOULDN'T MAKE THE FLT IF IT WERE NOT FOR THE SEVERE CLR CONDITIONS EXISTING IN ALMOST THE ENTIRE UNITED STATES. PAX ASKED PLT TO CALL A NEARBY ARPT UNICOM TO FORWARD A TELEPHONE MESSAGE TO FRIENDS AT OUR DEST. PLT SHOULD NOT HAVE ATTEMPTED THIS, DEMONSTRATING IMPAIRED JUDGEMENT. NEXT, PLT ADVISED CTR OF A LOUD NOISE OR WHISTLE ON COMS FREQ (UNICOM). CTR RECOGNIZES THIS AS AN ONGOING PROB TO THIS DATE. WAS THIS THE STRAW THAT BROKE THE CAMEL'S BACK? ALSO, CTLR WAS NOT REQUIRED TO, BUT MIGHT HAVE RECOGNIZED AND ADVISED PLT OF THE DEV SOONER. THERE WAS NOT MUCH TFC ON THE FREQ. ALTHOUGH CITING 3 CONTRIBUTING FACTORS, PLT RECOGNIZES THE GRAVITY OF THE INCIDENT AND THAT THE RESPONSIBILITY LIES WITH HIM. FAILURE TO EVALUATE THE MAGNITUDE OF HIS IMPAIRMENT IS THE MAJOR CAUSE. REMEDIAL TRAINING OR PUNITIVE MEASURES IS NOT THE ANSWER. THE PLT'S MOTHER WILL NOT DIE AGAIN.
Data retrieved from NASA's ASRS site as of July 2007 and automatically converted to unabbreviated mixed upper/lowercase text. This report is for informational purposes with no guarantee of accuracy. See NASA's ASRS site for official report.