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ERA13LA042 · Piper PA-32R-300

28 Oct 2012 · Sevierville, TN, United States

Piper PA-32R-300 · Accident: air traffic event en route

From Gatlinburg-Pigeon Forge Airport (GKT) to Space Coast Regional Airport (TIX)

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Narrative check · The NTSB narrative appears to contradict this record's damage. Values are shown as recorded, not corrected; compare with the narrative.

Event

NTSB case
ERA13LA042
Event typeAccident: someone killed or seriously injured, or the aircraft substantially damaged (NTSB definition). Incident: an occurrence that affected or could have affected safety, short of that. Glossary
Accident
InvestigationHow far the investigation had got when the record was published: preliminary, ongoing, final or completed. Unknown where the source does not say. Glossary
Completed
API-reported fatalities
0 · all aircraft and ground
Ground fatalities
Unknown
OperationWhat kind of flying it was, grouped by the rules it flew under: airline (US Part 121), air taxi and commuter (Part 135), general aviation (Part 91 and similar), military or government. Glossary
General aviation
WeatherVisual meteorological conditions (VMC): good enough to fly by looking outside. Instrument conditions (IMC): cloud or low visibility, flying by instruments. Glossary
Instrument Meteorological Cond

Piper PA-32R-300

Aircraft type
Piper PA-32
Category
Airplane
RegistrationThe aircraft's tail number, such as N12345 or G-ABCD. Registrations are reissued, so the same one years apart can be a different aircraft. Glossary
N4478F
Operator
Unknown
Onboard fatalities
Unknown
Route
From Gatlinburg-Pigeon Forge Airport (GKT), Sevierville, TNTo Space Coast Regional Airport (TIX), Titusville, FL
Aircraft age
Not recorded
Flight rulesThe regulations the flight operated under: in the US, Part 91 (general aviation), Part 121 (airlines), Part 135 (air taxi and commuter) and others; for flights abroad, the NTSB's coarser commercial or non-commercial code. Glossary
Part 91: General Aviation
Phase of flightThe stage of the flight when things started to go wrong: standing, taxi, takeoff, initial climb, en route, maneuvering, approach or landing. Glossary
En route · climb to cruise
Defining eventThe single coded event the NTSB judges best describes what happened (records from 2008 on). Older records name the first occurrence in the sequence instead. Glossary
Air traffic event
DamageDestroyed: beyond practical repair. Substantial: damage that affects the structure, performance or handling and normally needs major repair. Minor: less than that. Glossary
Substantial Possible conflict

Cause areas

  • Environmental issues › Operating environment
  • Personnel issues › Action/decision

Approximate · Coordinates as recorded by the NTSB; no uncertainty radius is established.

NTSB narrative

Before departure, the pilot had contacted the air traffic control (ATC) facility and received his instrument flight rules (IFR) clearance, which entailed flying direct to a navigational facility about 22 miles west of the departure airport. Shortly after departure, the pilot contacted ATC, and was given radar vectors toward that navigational facility and toward rising terrain. Because the airplane was in instrument conditions, the pilot was unable to see the surrounding terrain. When the airplane’s global position system's terrain feature alerted the pilot of a possible terrain issue, the pilot queried the air traffic controller. However, before the controller responded, the airplane impacted a pole and trees; a postimpact fire ensued and consumed the airplane.

The Federal Aviation Administration (FAA) defines minimum vectoring altitude (MVA) as the lowest altitude at which an IFR aircraft will be vectored by a radar controller to ensure obstacle clearance. The FAA further states that air traffic controllers are to give first priority to separating aircraft, issuing safety alerts, and providing safety alerts regarding terrain or obstructions.

Despite FAA requirements, a review of accident-related ATC radar and voice data revealed that ATC personnel issued a radar vector without first identifying the accident airplane on radar, provided radar vectors when the airplane was below the MVA, and did not provide safety alerts to the accident airplane or another airplane that had departed just before the accident flight. Interviews with the accident ATC personnel indicated that a facility-wide culture of providing vectors to aircraft below minimum altitudes existed, air traffic controllers supervised other controllers while performing operational duties, and the facility was non-compliant with safety alert requirements. The accident air traffic controller failed to adhere to the required procedures for vectoring and providing appropriate safety alerts, which negated the safety margins afforded by those procedures. This culture of disregard for standard operating procedures among the controller workforce at the ATC facility was indicative of a continuous failure of management at the facility.

Probable cause

The air traffic controller’s failure to comply with the required vectoring and safety alert procedures, which resulted in the airplane’s flight into rising terrain. Contributing to the accident was the Federal Aviation Administration’s continued practice of using air traffic controllers who were performing required radar operational duties to supervise other controllers and the air traffic control facility’s culture of non-compliance with required procedures.

Verbatim NTSB analysis and probable cause from the NTSB dataset

Sources

NTSB record ERA13LA042
Event ID
20121028X71406
Case number
ERA13LA042
Dataset
full-current
Source SHA-256
5cf380f0061817c0331a6b2d8cc7e0ee3a79bea469a1001dc5c10e56f35f5ab3
Source notes (4)
  • Unreviewed is an editorial label, not an investigation status. API-sourced is not report-checked or human-reviewed. Explicit event totals are used without summing aircraft injury tables; onboard allocation is withheld. Unknown values remain unknown. The operation category is mapped from the NTSB-reported FAR part and has not been reviewed.
  • Filled from the NTSB case API where the bulk record had no value: investigation status. Values present in the bulk record are kept.
  • The date is the local date, which is the same as the UTC date the NTSB stores.
  • API snapshot SHA-256: e874ce081605d83bdf464778626093281b9d4f59fea9941a90546d780fe320ea; retrieved 2026-09-15T20:17:52.450Z.