NTSB CAROL · Event
Event CEN20FA019
Aircraft involved
Probable cause & findings
The pilot’s loss of control shortly after takeoff in instrument meteorological conditions for reasons that could not be determined based on the available information.
Factual narrative
HISTORY OF FLIGHTOn November 20, 2019, about 0600 central standard time, a Raytheon (Beechcraft) A36 airplane, N88855, was destroyed when it was involved in an accident near San Marcos, Texas. The pilot was fatally injured. The airplane was operated as a Title 14 Code of Federal Regulations Part 91 business flight. The pilot filed an instrument flight rules flight plan and was issued a clearance for departure, but the pilot did not make contact with air traffic control after takeoff, nor did he transmit any distress calls. The airplane was observed on radar after departure, but radar contact was lost shortly thereafter. A witness reported that he saw the airplane taxi by his hangar before it departed. He stated that the airport’s weather observing station was reporting an overcast ceiling 300 ft above ground level and 1/4-mile visibility at the time. He stated that the visibility was less than reported, adding that he could barely see the accident airplane near the runway because the weather was so poor. The witness reported that the engine sounded “normal” and that the engine rpm increased, so he assumed that the airplane departed. The wreckage was located about ½ mile northeast of the departure runway. PERSONNEL INFORMATIONThe pilot was issued a temporary airman’s certificate on November 12, 2019, for Second-in-Command (SIC) privileges for a Cessna 650. A review of the pilot’s resume revealed 81 total hours of instrument experience (actual and simulated). METEOROLOGICAL INFORMATIONAt 0556, the automated weather facility located at HYI recorded wind from 179° degrees at 4 knots, 1/2-mile visibility in fog, an overcast cloud ceiling at 300 ft above ground level, temperature 63°F, and dew point 63°F. The pilot accessed weather information through ForeFlight the night before the accident and again about one hour before departure. The information provided included a forecast for continued low instrument flight rules (LIFR) conditions through the morning of the accident. Additional weather information is included in the public docket for this accident. WRECKAGE AND IMPACT INFORMATIONThe airplane impacted terrain in a firearm target practice area. The entire wingspan displayed accordion-like crush damage. The cabin area was crushed and the engine was buried in the ground. Airplane damage and ground scars were consistent with a near-vertical impact attitude. There was no post-crash fire. Control continuity was partially established from the cockpit to the corresponding flight control surfaces through multiple cuts made by first responders. The landing gear was retracted and the flap actuator was extended about 1 3/8 inches, which corresponded to a flaps-retracted position. The wing fuel tank bladders were ruptured and the fuel selector was on the right fuel tank position. Residual fuel was consistent with 100LL aviation fuel and did not contain water. The airplane was equipped with a standby instrument air pump driven by an electric motor. The pump was separated from the electric motor and disassembled. The carbon rotor and vanes were impact damaged. The drive coupling was intact. The engine-driven instrument air pump remained attached to the engine. The pump was removed, and the drive coupling was found intact. The carbon rotor and vanes were impact damaged. All fracture edges were sharp, and the broken pieces remained tightly together. The engine displayed significant impact damage, and the crankshaft could not be rotated by hand. Internal engine components were observed through use of a borescope. The rocker covers were removed, and no discrepancies were noted with the valve train and accessory section. The two magnetos were removed and rotated by hand; spark was observed from each top ignition lead. The engine-driven fuel pump was intact and the drive shaft rotated, with some binding, when operated by hand. The top set of sparkplugs exhibited normal-colored combustion deposits and “worn out-normal” electrodes when compared to the Champion Check-a-Plug guide. The fuel throttle body and mixture control were recovered and examined. The throttle plate was in the “full” open position. All control arms remained attached to corresponding shafts and attaching hardware was intact. The fuel screen was removed and was free of debris. The propeller separated from the crankshaft flange; two of the three propeller blades remained in the propeller hub; the third bladed separated from the hub. All three blades exhibited leading edge gouging and twisting. MEDICAL AND PATHOLOGICAL INFORMATIONThe Central Texas Autopsy, PLLC, Lockhart, Texas, under the authority of the Justice of the Peace, Caldwell County, conducted an autopsy on the pilot. The cause of death was determined to be "multiple traumatic injuries.” The Federal Aviation Administration’s (FAA) Forensic Sciences Laboratory conducted toxicological testing on the pilot. Tests were negative for ethanol and tested-for drugs. The pilot filed an instrument flight rules flight plan for the cross-country flight and received a departure clearance. A witness reported seeing the accident airplane taxi by his hangar before it departed and noted that the visibility at the time was less than the 1/4-mile reported by the airport’s weather observation facility. The airplane departed and was seen on radar before contact was lost shortly thereafter; the pilot never established radio communication with air traffic control. The airplane impacted terrain in a near-vertical attitude about 1/2-mile from the departure runway. Examination of the airplane did not reveal any pre-impact anomalies that would have precluded normal operation. Low instrument flight rules conditions prevailed in the area of the departure airport, including a cloud ceiling of about 300 ft above ground level. The airplane’s sudden descent and near-vertical impact attitude are consistent with a loss of control shortly after takeoff; however, due to a lack of onboard data and complete radar data for the flight, the reason for the loss of control could not be determined based on the available information. Source: NTSB Aviation Accident Database Retrieved: 2026-02-12
NTSB Findings
Hierarchical cause / factor breakdown from the FAA bulk avdata database. Each finding tagged C (Cause) or F (Factor).
- C Not determined-Not determined-(general)-(general)-Unknown/Not determined - C
- C Personnel issues-Action/decision-(general)-(general)-Pilot - C
- — Environmental issues-Conditions/weather/phenomena-Ceiling/visibility/precip-Low visibility-Not specified
Verbatim from NTSB's published report. Source file
NTSB_2019_CEN20FA019.txt.
Findings + structured fields enriched from FAA avall.mdb.
Full investigation docket on
data.ntsb.gov ↗.
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Related research
What the literature says.
Academic papers and agency reports matching this event's aircraft type or causal vocabulary (loss of control). Sourced from NASA NTRS, NTSB Safety Studies, FAA CAMI, AOPA Air Safety Institute, Embry-Riddle Scholarly Commons, arXiv, and the Semantic Scholar academic graph.
- Embry-Riddle Scholarly Commons 2025 · Journal article (JAAER)
A Scoping Review of Aviation Loss of Control Inflight Research
Loss of control – inflight (LOC-I) contributes to aircraft accidents at unacceptably high rates. Significant industry efforts and research have aimed to improve LOC-I prevention, detection, and recove…
- SKYbrary (Eurocontrol) 2024 · SKYbrary article
Loss of Control In-Flight (LOC-I) — SKYbrary Knowledge Base
SKYbrary comprehensive knowledge-base entry on Loss of Control In-Flight — definitions, contributing factors, accident case studies (Air France 447, Colgan 3407), and prevention strategies.
- NTSB Aircraft Accident Reports 2022 · Accident report
Loss of Control on Takeoff in Icing Conditions — Citation 560XL
Cessna Citation 560XL fatal takeoff icing accident, March 2018. Investigation of a Citation 560XL loss-of-control takeoff accident in icing conditions.
- Semantic Scholar 2021 · Article (Aviation)
ANALYSIS OF GENERAL AVIATION FIXED-WING AIRCRAFT ACCIDENTS INVOLVING INFLIGHT LOSS OF CONTROL USING A STATE-BASED APPROACH
Inflight loss of control (LOC-I) is a significant cause of General Aviation (GA) fixed-wing aircraft accidents. The United States National Transportation Safety Board’s database provides a rich source…
- NASA NTRS 2021 · Presentation
Use of Design of Experiments in Determining Neural Network Architectures for Loss of Control Detection
Abstract—We describe empirical methods for selecting a neural network architecture to implement belief state inference on generic commercial transport aircraft.
- NASA NTRS 2021 · Conference Paper
Use of Design of Experiments in Determining Neural Network Architectures for Loss of Control Detection
We describe empirical methods for selecting a neural network architecture to implement belief state inference on generic commercial transport aircraft.
Browse the full corpus — academia portal ↗