Cuyahoga County Airport
Aircraft Accident/Incident Report

Mayfield Village, Ohio 44143
Tuesady, April 28, 2009 16:15 EDT

NTSB Narrative Summary Released at Completion of Accident

The instrument certified airplane climbed into instrument meteorological conditions about 30 seconds after takeoff. Radar track data showed that the airplane entered a right turn shortly after takeoff and entered the cloud base. The airplane remained in that right turn until it completed nearly 1-1/2 complete turns. The airplane rolled out and subsequently climbed 1,500 feet over next 17 seconds. The airspeed decreased to 50 knots and the airplane’s heading abruptly transitioned from the south to the north-northwest which could have represented an aerodynamic stall. The airplane then descended before beginning another climb. The airplane completed two additional descent and climb oscillations with minimum airspeeds of 60 knots and 50 knots, respectively. Maximum pitch angles of 50 degrees nose up and nose down, and bank angles of 75 degrees were recorded during the flight. The duration of the accident flight was approximately 4 minutes and 30 seconds. The airplane impacted a wooded area located about 3 miles from the departure airport and was destroyed by impact forces and a postimpact fire. An examination of the airframe and engine did not revealed preimpact anomalies. No flight display and/or autopilot system faults were recorded during the accident flight. Further review of the flight data did not reveal inconsistencies within the data itself. The data indicated that the pilot initially engaged the autopilot about 5 seconds after lifting off when the airplane was approximately 61 feet above ground level. The autopilot bugs were set to the assigned heading and initial altitude prior to takeoff. However, after takeoff the pilot failed to properly engage the autopilot altitude preselect mode; the altitude hold mode was entered instead. As a result, the altitude and vertical speed bug settings were reset automatically to maintain the airplane’s altitude. At that point, the airplane’s altitude was above that specified by the autopilot bug. Subsequent attempts to engage the vertical speed/altitude pre-select mode caused the system to begin a descent to intercept the inadvertent altitude set in the autopilot. About 1 minute into the flight, the pilot reset the altitude bug above the airplane’s current altitude at that time. The data suggests that the pilot never adequately regained control of the airplane. The pilot purchased the accident airplane about 7 months prior to the accident. He completed visual flight rules transition training at the time he took delivery of the airplane. The training did not include an instrument proficiency check. Prior to the transition training, the pilot reported a total flight time of 1,344 hours, which included 20 hours flight time and 4 hours instrument flight time within the one-year period preceding the training.

NTSB Probable Cause Narrative

The pilot’s failure to maintain control of the airplane while operating in instrument meteorological conditions due to spatial disorientation. Contributing to the accident was the pilot’s inattention to basic aircraft control while attempting to program the autopilot system.

Event Information

Type of Event Accident
Event Date 4/28/2009
Event Day of the Week Tuesday
Time of Event 1615
Event Time Zone Eastern Daylight Time
Event City Mayfield Village
Event State OHIO
Event Country --
Zipcode of the event site 44143
Event Date Year 2009
Event Date Month 4
MidAir Collision Indicator No
On Ground Collision occurred ? No
Event Location Latitude 413333N
Event Location Longitude 0812613W
Event Location Airport Cuyahoga County
Event Location Nearest Airport ID CGF
Indicates whether the acc/inc occurred off or on an airport Off Airport/Airstrip
Distance from airport in statute miles 2
Degrees magnetic from airport --
Airport Elevation 879
Weather Briefing Completeness --
Investigator's weather source Weather Observation Facility
Time of the weather observation 1616 Eastern Daylight Time
Direction of event from weather observation facility (degrees) 280
Weather Observation Facility ID CGF
Elevation of weather observation facility 879
Distance of event from weather observation facility (units?) 2
Time Zone of the weather observation EDT
Lighting Conditions Day
Lowest Ceiling Height 200
Lowest Non-Ceiling Height --
Sky/Lowest/Cloud Conditions --
Sky Condition for Lowest Ceiling Overcast
Visibility Runway Visual Range (Feet) --
Visibility Runway Visual Value (Statute Miles) --
Visibility (Statute Miles) 4
Air Temperature at event time (in degrees celsius) 7
Dew Point at event time (in degress fahrenheit) 6
Wind Direction (degrees magnetic) 10
Variable Wind Indicator Wind direction could be determined
Wind Speed (knots) 8
Wind Velocity Indicator --
Wind Gust Indicator Not Gusting
Wind Gust (knots) --
Altimeter Setting at event time (in. Hg) 30.38
Density Altitude (feet) --
Intensity of Precipitation --
METAR weather report --
Event Highest Injury Fatal
On Ground, Fatal Injuries --
On Ground, Minor Injuries --
On Ground, Serious Injuries --
Injury Total Fatal 2
Injury Total Minor --
Injury Total None --
Injury Total Serious --
Injury Total All 2
Investigating Agency NTSB
NTSB Docket Number (internal use) 27500
NTSB Notification Source FAA-AGL ROC
NTSB Notification Date --
NTSB Notification Time --
Fiche Number and/or location -used to find docket information --
Date of most recent change to record Dec 21 2010 1:07PM
User who most recently changed record lema
Basic weather conditions Instrument Meteorological Cond
FAA District Office --

Aircraft Involved

Aircraft #1

Aircraft Registration Number N504MD
NTSB Number CEN09FA267
Missing Aircraft Indicator --
Federal Aviation Reg. Part Part 91: General Aviation
Type of Flight Plan filed IFR
Flight plan Was Activated? Yes
Damage Destroyed
Aircraft Fire Ground
Aircraft Explosion None
Aircraft Manufacturer's Full Name CIRRUS DESIGN CORP
Aircraft Model SR22
Aircraft Series Identifier --
Aircraft Serial Number 2695
Certified Max Gross Weight 3400
Aircraft Category Airplane
Aircraft Registration Class --
Aircraft is a homebuilt? No
Flight Crew Seats --
Cabin Crew Seats --
Passenger Seats --
Total number of seats on the aircraft 4
Number of Engines 1
Fixed gear or retractable gear Fixed
Aircraft, Type of Last Inspection Annual
Date of Last Inspection Oct 7 2008 12:00AM
Airframe hours since last inspection --
Airframe Hours 224.1
ELT Installed Yes
ELT Activated Unknown
ELT Aided Location of Event Site No
ELT Type Unknown
Aircraft Owner Name DORAN MICHAEL
Aircraft Owner Street Address --
Aircraft Owner City BUFFALO
Aircraft Owner State NY
Aircraft Owner Country USA
Aircraft Owner Zipcode 14209-1430
Operator is an individual? Yes
Operator Name DORAN MICHAEL
Operator Same as Owner? Yes
Operator Is Doing Business As --
Operator Address Same as Owner? Yes
Operator Street Address --
Operator City BUFFALO
Operator State NY
Operator Country USA
Operator Zip code 14209-1430
Operator Code --
Owner has at least one certificate None
Other Operator of large aircraft? No
Certified for Part 133 or 137 Operation --
Operator Certificate Number --
Indicates whether an air carrier operation was scheduled or not --
Indicates Domestic or International Flight --
Operator carrying Pax/Cargo/Mail --
Type of Flying (Per_Bus / Primary) Business
Second Pilot on Board No
Departure Point Same as Event No
Departure Airport Code CGF
Departure City Cleveland
Departure State OH
Departure Country USA
Departure Time 1612
Departure Time Zone EDT
Destination Same as Local Flt --
Destination Airport Code BUF
Destination City Buffalo
Destination State NY
Destination Country USA
Specific Phase of Flight --
Report sent to ICAO? --
Evacuation occurred --
Date of most recent change to record Aug 20 2010 11:53AM
User who most recently changed record sort
Since inspection or accident Last Inspection
Event Location Runway Number and Location 06
Runway Length 5102
Runway Width 100
Sight Seeing flight No
Air Medical Flight No
Medical Flight --