What happened
On May 24, 2001, at approximately 15:15 local time, an Embraer EMB 711C, registration PT-NLI, crashed in a pasture at Fazenda Lago Azul, near Bonópolis, Goiás. The aircraft had departed from São Miguel do Araguaia (SWUA) for Goiânia (SWNV) without a filed flight plan. The flight was intended to transport three passengers for the purpose of negotiating land transactions.
Roughly 15 minutes after takeoff, the aircraft struck the ground at high speed in a nearly inverted attitude, with a 30-degree nose-down angle. The impact was severe, resulting in the four fatalities of all occupants. There was no evidence of an attempted emergency landing or engine failure prior to the impact.
The investigation
CENIPA investigators examined the wreckage and interviewed witnesses to determine the cause of the loss of control. The investigation focused on the pilot's qualifications, the aircraft's mechanical state, and the prevailing meteorological conditions.
Investigators noted that the pilot was flying with an expired medical certificate and an expired technical rating (CHT). Furthermore, while the pilot was qualified for Visual Flight Rules (VFR), he was not rated for Instrument Flight Rules (IFR). At the time of the accident, witnesses reported heavy torrential rain in the area. The investigation also explored the possibility of a medical emergency, as a bottle of Isordil—a medication used for acute cardiac symptoms—was found among the debris, and the pilot had previously disclosed cardiac issues to a friend. Additionally, a piece of the control column was found in the hands of the front-right passenger, suggesting an attempt to intervene during the loss of control.
Findings
- Deficient Judgment: The pilot failed to correctly assess the severity of the weather, choosing to fly into instrument conditions for which he was not qualified.
- Deficient Planning: The decision to depart was made despite the presence of rain near the departure airfield.
- Flight Indiscipline: The pilot operated the aircraft with both medical and technical certifications expired.
- Potential Physiological Factors: The investigation could not rule out a sudden medical event, such as a cardiac episode, or spatial disorientation caused by the adverse weather and a potentially inoperative artificial horizon.
- Psychological Stress: The pilot was reportedly experiencing significant financial and legal pressure, which may have contributed to an emotional state of distress and rushed decision-making.