What happened
On February 3, 2013, a Beechcraft C90A, registration PP-AJV, departed from Maringá (SBMG) on a night-time passenger transport flight destined for São Paulo (SBSP). The flight was conducted under Instrument Flight Rules (IFR) at flight level 210. Approximately 35 minutes after takeoff, air traffic control lost radar contact with the aircraft.
The aircraft was located the following day in an agricultural area near Cândido Mota, São Paulo. All five occupants—the pilot and four passengers—perished in the accident. The aircraft was found totally destroyed.
The investigation
CENIPA's investigation established that the aircraft encountered a cold front characterized by active thunderstorms and multiple layers of clouds. Meteorological data indicated that at the flight level maintained by the pilot, temperatures and dew points were close enough to favor severe icing. A passenger in the cockpit even observed ice forming on the exterior of the aircraft.
The investigation revealed that the pilot's IFR rating had expired and he was not properly qualified for the specific type of flight planned. Furthermore, investigators found evidence of irregular maintenance practices, noting that the pilot had previously manipulated the aircraft's hour-meter to mask total flight time. During the flight, the pilot was reportedly distracted by conversation with passengers, which contributed to a lack of situational awareness.
Findings
- Severe icing conditions encountered at FL210 led to a degradation of aircraft performance.
- The pilot failed to activate the Ice Protection System despite being informed of ice accumulation.
- The pilot's inattention and distraction prevented the prompt identification of an impending stall.
- The pilot made an inappropriate flight level selection, choosing a level known to be prone to icing despite being offered a higher altitude.
- The aircraft experienced a loss of lift and subsequent structural failure during the stall event.
- A lack of adherence to standard checklists and prescribed emergency procedures contributed to the loss of control.