NTSB CAROL · Event
Event WPR18LA197
Registry · N617MM
FAA Aircraft Registry record.
Make / Model
BEECH C90A
Year of manufacture
2000 · 18 years old at event
Engine
P&W CANADA PT6A-6 SERIES (950 hp)
Seats / Engines
9 seats · 2 engines
Last airworthiness date
20000325
ADS-B equipped
Yes — Mode-S A809DE
Registrant of record
CAL-ORE LIFE FLIGHT LLC
Source: FAA Aircraft Registry (releasable master file).
Aircraft involved
Probable cause & findings
An autopilot deviation during climb for undetermined reasons, which resulted in an in-flight upset and loss of airplane control. Contributing to the accident was the pilot’s failure to adequately monitor flight systems due to a distraction.
Factual narrative
On July 12, 2018, about 0305 mountain standard time, a Beech C90A King Air airplane, N617MM, was substantially damaged when it was involved in an accident near Tolani Lake, Arizona. The pilot and two passengers were not injured. The airplane was operated as a Title 14 Code of Federal Regulations Part 91 positioning flight. Instrument meteorological conditions (IMC) were reported along the route of flight about the time of the accident, and the flight was operated on an instrument flight rules flight plan. The flight originated from Flagstaff Pulliam Airport (FLG), Flagstaff, Arizona, about 0250 and was destined for Gallup Municipal Airport (GUP), Gallup, New Mexico. The pilot reported that the airplane was climbing out of 17,000 ft to a cruise altitude of 19,000 ft at 600 ft per minute and at an airspeed of 130 kts, with the autopilot engaged and set to capture 19,000 ft. The conditions were smooth with no turbulence and no known icing, although he had engaged all anti-icing systems, including the engine ice vanes. The pilot reported that he was working on the iPad when it stopped functioning. He was trying to reset it when there was a hard control input to the left as the airplane was at about 17,500 ft. He stated that when he engaged on the controls, the airspeed was increasing rapidly. The airplane was in a steep spiral, rolling left and pitching down as he attempted to regain control. The pilot reported the autopilot was fighting his control inputs during the event, and he disengaged it to affect the recovery. After several attempts, the pilot recovered the airplane, manually flew to the destination airport, and landed without further incident. Postflight examination of the airplane revealed deformation of the leading edges and wrinkling of the upper wing skins on the left and right outboard wings. Further examination revealed damage to the forward spar on the left outboard wing. The autopilot system was subjected to on-airplane testing after the accident. Initially, the autopilot modes were not annunciated on the control panel due to a dimmer switch that was on full dim. Contained tests revealed no anomalies with the autopilot system during on-airplane testing. The autopilot computer was removed and examined with no anomalies noted. Review of data downloaded from the airplane’s Stratus 2 receiver revealed a steady increase in pitch and decrease in airspeed from 16,770 ft through 18,861 ft. About 18,920 ft, the airplane began a left roll and continued through a series of about five-barrel rolls. The airplane recovered from the upset about 13,000 ft, then climbed to 16,000 ft and continued to the destination with no other anomalies. The pilot reported IMC conditions, with the lowest cloud heights about 14,000 ft msl, a broken layer of clouds at 18,000 ft, and light rain. A weather study showed the airplane was in IMC with light rain at the time of the accident. The weather study showed that light to moderate icing conditions were present and forecast along the airplane’s route of flight with echoes along the flight track indicating the possibility of supercooled large droplets. The pilot reported that the airplane was climbing in instrument meteorological conditions with light rain and with the autopilot engaged. The conditions were smooth with no turbulence and no known icing, although he had engaged all anti-icing systems. The airplane was climbing at 600 ft per minute at an airspeed of 130 kts from 17,000 ft to 19,000 ft. The pilot reported that he was working on an iPad when it stopped functioning. He said he was resetting the iPad when there was a hard control input to the left as the airplane was passing through about 17,500 ft. The airplane rolled left and pitched down as he attempted to regain control. The pilot reported the autopilot was fighting his control inputs during the event, and he disengaged it to affect the recovery. Onboard data equipment showed a steady increase in airplane pitch attitude and a steady decrease in airspeed before the upset. The airplane spiraled down, losing about 4,000 ft of altitude before the pilot regained control. The pilot manually flew the airplane to its destination and landed safely. The wings were substantially damaged. Postaccident examination of the autopilot revealed no mechanical anomalies that would have precluded normal operation. The autopilot computer was removed and examined with no anomalies noted. Thus, the reason for the autopilot deviation could not be determined. It is likely that the pilot was distracted with resetting the iPad and thus did not adequately monitor the autopilot, which led to his delayed awareness of the autopilot deviation. 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).
- — Not determined-Not determined-(general)-(general)-Unknown/Not determined
- — Personnel issues-Task performance-Use of equip/info-Aircraft control-Pilot
- — Personnel issues-Psychological-Attention/monitoring-Monitoring equip/instruments-Pilot
Verbatim from NTSB's published report. Source file
NTSB_2018_WPR18LA197.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 (icing, imc, turbulence, autopilot). Sourced from NASA NTRS, NTSB Safety Studies, FAA CAMI, AOPA Air Safety Institute, Embry-Riddle Scholarly Commons, arXiv, and the Semantic Scholar academic graph.
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An Analysis of U.S. Civil Rotorcraft Accidents by Cost and Injury (1990-1996)
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- NASA NTRS 2019 · Conference Paper
Analysis of Convair 990 rejected-takeoff accident with emphasis on decision making, training and procedures
This paper analyzes a NASA Convair 990 (CV-990) accident with emphasis on rejected-takeoff (RTO) decision making, training, procedures, and accident statistics.
- NASA NTRS 2019 · Technical Memorandum (TM)
Aircraft accident report: NASA 712, Convair 990, N712NA, March Air Force Base, California, July 17, 1985, facts and analysis
On July 17, l985, at 1810 P.d.t., NASA 712, a Convair 990 aircraft, was destroyed by fire at March Air Force Base, California.
- NASA NTRS 2013 · Conference Paper
Model comparison of July 7, 1990 microburst
Model comparison of July 7, 1990 microburst is presented in the form of view-graphs. The following topics are covered: 7 July 1990 Orlando, FL simulations; model input sounding for 7 July 1990 Orlando…
- Embry-Riddle Scholarly Commons 1993 · Journal article (JAAER)
Air Transportation Challenges of the 1990s, Part III
This is the final of a series of three editorials about the challenges of the air transportation system in the 1990s. The first of the series appeared in the fall 1992 issue of JAAER covered traffic d…
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