Who screwed up here?

I don't think ATC said anything technically worn, but said something that was very easy to get confused. It's on the pilot to maintain the altitude on the chart, ATC never told him to decend. They were at 12k, ATC said "At or above 7800..." So they had clearance for anywhere between 12k and 7800, but should have stayed above 10k per the approach they were doing.
 
jordane93 said:
The at or above 7800 at CEGAN clearance didn’t even make any sense because you need to be at or above 8500 until SERTE. Or am I missing something?

http://155.178.201.160/d-tpp/1803/00251VDC.PDF
Click to expand...

Looks like 10K on the arc AND until BRKET. Then established on the LOC 8500 at SERTE. I think the crew didn't interpret the approach altitudes correctly, and why the controller issued at or above 7800' doesn't make sense either. Definitely would have been a factor I think if they had hit rock.
 
It didn't seem like Approach was phased at all. That last return at 078 should've thrown up an alert to ATC, being that they were less than 200' above that terrain, no?
 
I think the controllers instructions could be easily confused but the crew should not have descended below any altitude restrictions on the plate. Like most things in Aviation there is shared fault but ultimately it’s the PIC that’s held accountable. They descended below a minimum altitude on a segment of the published approach. Even if atc told them to descend and maintain that doesn’t mean you should actually comply with the instruction.
 
It isn't unusual to be cleared like that, they were cleared via the arc which had a min altitude of 10000'. It was the crew's responsibility to fly the approach as published. That includes maintaining 10000' until the procedure allowed them to go lower. At or above does not mean descend to 7800' immediately, it means cleared via the published approach. The 7800' is in this case a clearance limit.

I did not at any time hear ATC tell them to deviate from the published procedure.
 
The fault seems to be shared by ,both the controller and the air crew.
 
Simple. The controller jacked up the clearance. While 7,800 may have complied with his MVA in that area, it also has to comply with the minimum altitude established for that approach. The aircraft in this case would be established on the approach after passing CEGAN at or above the minimum altitude published for the approach. That’s 10,000, not 7,800.

.65 4-8-2 aircraft 1 example
 
Last edited:
frfly172 said:
The fault seems to be shared by ,both the controller and the air crew.
Click to expand...

I agree with this - yes the controller’s instruction kind of led the pilots down the primrose path, but it doesn’t absolve the crew from noticing the altitude on the arc.
 
kayoh190 said:
I agree with this - yes the controller’s instruction kind of led the pilots down the primrose path, but it doesn’t absolve the crew from noticing the altitude on the arc.
Click to expand...
Ditto. My CFII even pulled the same stunt on me during training to see what I would do (I asked him for clarification).
 
The controller said "cross cegan at or above 7800"

That would get most folks thinking they can cross it at 7800
 
Why could he not have said,
"Cleared VOR/DME-C into MFR, maintain 11000 until established on the arc"?
after the last vector to intercept the arc.
 
Last edited:
Clearly the pilot's are at fault but the controller shouldn't have given a confusing altitude assignment. If 7800 put them in contact with the ground why even mention it?
 
The flight crew is conditioned to accept altitudes below the charted altitudes in the early phase of an approach because it happens to them all the time being vectored onto ILS approaches at busy airports.

But, the VOR/DME-C at Medford isn't an ILS approach. Had their skill set been better, they would have/should have:

1. Questioned the clearance to at or above 7,800 when the DME arc altitude is 10,000.
2.Understood they weren't on radar vectors so the clearance to 7,800 didn't make any sense on its face.
3. Not descended below 10,000 until reaching BRKET.

The controller screwed up because he was looking at the MVA at the point he issued the clearance. He failed to look forward towards BREKT where the MVA rises to 8,700. That is a violation of his duty to provide a minimum safe instrument altitude.

Attached is the plan view of the FAA VOR/DME-C chart with the MVAs.

EGPWS prevented this CFIT because both the crew and the controller screwed up.
 

Attachments

  • MVA on FAA Chart.jpg
    MVA on FAA Chart.jpg
    254.9 KB · Views: 34
Let'sgoflying! said:
I'm going to give the crew some credit for their timely and appropriate response to the alert and for their upfront attitude about it with atc.
Click to expand...
I suppose. But, their response to the EGPWS is drilled into them in training. It's a big deal in Part 121. You don't question it when you can't see the threat. You do a rote emergency climb.

The old saying, it takes two "adda boys" to overcome one f*up. I give them one.
 
Reminds of the old "If the pilot screws up, the pilot dies. If ATC screws up, the pilot dies." While ATC may not have technically screwed up, there is clearly room for improvement in the phrasing.
 
Let'sgoflying! said:
I'm going to give the crew some credit for their timely and appropriate response to the alert and for their upfront attitude about it with atc.
Click to expand...

The pilot working the radios sounded a bit behind. Maybe not.
 
Last edited:
The bottom line is that they were cleared for the approach via the arc, the arc only allowed them to descend to 10000'. Regardless of how ATC gave them that clearance the crew had an absolute obligation to stay at 10000' while on the arc.

In reality nobody is out there holding your hand! It is the crew's responsibility to keep the airplane out of the rocks. The approach plate was quite clear as to the altitude on the arc and when they were allowed to go below 10000'. They disregarded the published approach procedure and busted their altitude and are fortunate the the GPWS alerted them in time to pull up.
 
ATC should take a hit too IMO. All approaches clearances require an altitude to maintain until established, and I don't recall using MVA for that when I controlled years ago. Maybe it's changed but I doubt it. Besides the altitude the controller issued couldn't be for that or the next MVA sector with that tower there as you turned to intercept final.
 
It was an at or above clearance not a descend to clearance. In any case the approach procedure was controlling.

Actually in reality once they were cleared for the approach they were cleared all the way down to the MDA.
 
Last edited:
Stickman said:
It was an at or above clearance not a descend to clearance. In any case the approach procedure was controlling.

Actually in reality once they were cleared for the approach they were cleared all the way down to the MDA.
Click to expand...

There still were altitudes to maintain on portions of the approach. But yes, cleared to MDA as you said.
 
Last edited:
aterpster said:
I suppose. But, their response to the EGPWS is drilled into them in training. It's a big deal in Part 121. You don't question it when you can't see the threat. You do a rote emergency climb.

The old saying, it takes two "adda boys" to overcome one f*up. I give them one.
Click to expand...
So, you take points off for not following their training, but don't give them points because they followed their training. Not following that logic.
 
Clear as mud for ATC. :confused:

https://www.stuckmic.com/faa-rules-regulations/15147-mva-approach-minimum.html

I disagree with some controllers interpreting the MVA as being authorized even though that approach segment specifically calls for a higher altitude. I’ve never assigned an at or above altitude that is below the published altitude on any approach segment.

If you look at the example for aircraft #1 on page 4-8-2 in the .65, you’d see even though the controller has an MVA of 3000, the aircraft is assigned an altitude of at or above 3500. This is consistent with the published minimum altitude. Since no revised route is issue after LEFFT, the approach clearance starts at LEFTT. If the aircraft were assigned at or above 3000 at LEFFT and the aircraft actually arrived at 3000, technically they wouldn’t be established on the approach.

Same as the DME arc example. The clearance starts at CEGAN but in order to be established and fly the published approach, the aircraft has to be at or above the published altitude. 10000 works, 12000 works, 7800 doesn’t.

That’s my interpretation of issuing altitude in an IFR approach clearance. If the FAA sees it differently I’d love to hear their logic of allowing a lower than published altitude based on MVA.
 
Stickman said:
It was an at or above clearance not a descend to clearance. In any case the approach procedure was controlling.

Actually in reality once they were cleared for the approach they were cleared all the way down to the MDA.
Click to expand...
And, for the missed approach as well. But, neither the final segment, MDA, or missed approach apply until the appropriate location.

The unambiguous, best clearance would have been, "Cross CEGAN at or above 10,000. Cleared for the VOR-DME Charlie approach." Or, if they were on V-122, simply "Cleared for the VOR-DME Charlie approach via CEGAN." In the latter case, hopefully the crew would not descend to 9,000 prior to CEGAN.
 
Who screwed up? They both did, but does it matter? Of the two, I put the stronger burden on the controller since he initiated the altitude. He should have been aware of the 10k altitude and not assumed the pilots would catch it. But the pilots should have briefed the approach and caught the altitude discrepancy.

I don't understand where 7800 came from. The terrain is lower in that area, not but no that much lower.
 
I doesn't matter to me who is at fault.
What matters is, can the FAA come up with a solution which makes it unambiguously clear to 100% of pilots and atc what is supposed to happen on such an approach.

(I fully reject the idea that the existing methods and rules are adequate; witness the very near cfit in this incident, and the very fact that many of us say atc or the pilots are partly to blame {we don't have a consensus}. It's patently obvious what we are doing is not working.)
 
bflynn said:
Who screwed up? They both did, but does it matter? Of the two, I put the stronger burden on the controller since he initiated the altitude. He should have been aware of the 10k altitude and not assumed the pilots would catch it. But the pilots should have briefed the approach and caught the altitude discrepancy.

I don't understand where 7800 came from. The terrain is lower in that area, not but no that much lower.
Click to expand...

Here are the MVAs on the plan view:
 

Attachments

  • MVA on FAA Chart.jpg
    MVA on FAA Chart.jpg
    254.9 KB · Views: 20
Crew messed up by descending below minimums but the controllers also shouldn't be issuing confusing clearances. We know all humans are foulable and our goal when something dangerous happens should not be to assign blame but to figure out why people did what they did and look for ways to avoid that in the future.
 
Similar clearance caused two pilots to die at Dillingham, AK. Controller and crew screw up. No EGPWS to make the save.

"At or above 2,000" in 2013 tells me there may be a systemic problem in the training of controllers in the past several years.

We know there has been a pilot training problem.
 

Attachments

  • ReportGeneratorFile.ashx.pdf
    117.1 KB · Views: 5
Tarheelpilot said:
Yes but it’s still up to the pilot to comply with the procedure.
Click to expand...
No doubt. Nonetheless, one of the prime lessons that came out of the 1974 TWA 514 CFIT was that the controller and the crew are supposed to be a team in regard to terrain clearance.
 
I can see why it happened and it was an odd clearance, but flight crew clearly busted the minimum altitude on the approach and that’s on them.

Surprised the controller didn’t get an altitude alert... heck I often get those from ATC on VOR approaches if defending faster than a 3 degree glide slope because it freaks out the radar’s Computer.

The altitude the controller gave may have been the minimum vector altitude in the area where they were when given the clearance although giving a minimum altitude that’s below where they need to join the approach is certainly not normal.
 
Last edited:
Will this sort of thing get the FAA's attention via atc's reports or does an asrs form have to be filed?
 
mscard88 said:
Could have ended up very badly.

Click to expand...

Pilot screwed up. I haven't looked at it yet. But there is that 'pull up' thing and the 'terrain warning' thing. Ya gotta know where you are and where the rocks are. I'll go listen to it. Controller may have screwed up and put the pilot in a position to invoke the 'basic rule,' don't let a controller screw you.

EDIT: They both screwed up. The clearance was wrong and the controllers rationale was BS. Yeah, 10000 is at or above 7800 but that doesn't take the controller off the hook. The pilot accepting the clearance and then descending below 10000 without question is on the pilot. I'm sure both have had their thinking realigned. Probably already been said, I haven't read the thread yet.
 
Last edited:
mscard88 said:
ATC should take a hit too IMO. All approaches clearances require an altitude to maintain until established, and I don't recall using MVA for that when I controlled years ago. Maybe it's changed but I doubt it. Besides the altitude the controller issued couldn't be for that or the next MVA sector with that tower there as you turned to intercept final.
Click to expand...

No doubt the controller took a hit. You notice the change of controller voice shortly after the incident and I'll betcha it was a few days before his voice was heard again.
 
It was a terrible clearance given by what sounds like a new controller
 
You must log in or register to reply here.
Back
Top