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Fatal plane crash on Gabriola Island, B.C., points to risk of disorientation, need for quick maintenance: TSB

The scene of a small plane crash on Gabriola Island, B.C., is shown on Wednesday, Dec.11, 2019. A plane that one witness describes as crashing in a "huge explosion" that left multiple people dead in British Columbia has been identified as a twin-engine propeller aircraft. THE CANADIAN PRESS/Paolo Gastaldello

Editor’s Note: An earlier version of the story said the pilot reported the failure of an altitude indicator. In fact, the TSB investigation found the pilot reported the failure of an attitude indicator. The story has been amended. 

An investigation into the 2019 plane crash near Gabriola Island, B.C., that claimed three lives highlights the risks of pilot disorientation and the need to promptly address aircraft deficiencies.

A private Piper Aerostar PA-60-602P aircraft crashed on the north end of the island on Dec. 10, 2019. Three people died: Allan and Katheryn Boudreau of Chemainus, B.C., and Alex Bahlsen of Alberta.

Click to play video: 'Gabriola crash pilot remembered for hundreds of animal rescues'
Gabriola crash pilot remembered for hundreds of animal rescues

The plane left Cabo San Lucas, Mexico, on Dec. 9 en route to Nanaimo on Vancouver Island, with an overnight stopover in California, said a report from the Transportation Safety Board on Monday.

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Just after 6 p.m. on Dec. 10, the aircraft was travelling at 2,700 feet and turning right when it began to lose altitude, according to the report. An air traffic controller told the pilot to gain altitude, but there was no response.

Click to play video: 'New details revealed in fatal Gabriola Island plane crash'
New details revealed in fatal Gabriola Island plane crash

The Aerostar then collided with a power pole and trees in a wooded park area on the island, broke into pieces and caught fire, killing everyone on board.

While the report did not determine the exact cause of the crash, it did note there had been issues with the plane’s electronic horizontal situation indicator, which shows its horizontal position, a month earlier.

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The owner of the plane had booked a maintenance appointment at Boundary Bay Airport in Delta on Dec. 11, the day after the fatal wreck.

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Click to play video: 'Small aircraft goes down on Gabriola Island'
Small aircraft goes down on Gabriola Island
The report also noted that “the pilot informed air traffic control that the FCI [attitude indicator] had failed.”

The TSB report concludes by saying aircraft owners must record and rectify any deficiencies in an aircraft before a flight.

It also warns of spatial disorientation, which it describes as “the inability of a pilot to correctly interpret aircraft attitude, altitude or airspeed in relation to the Earth or other points of reference.”

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Disorientation can be caused by a “lack of external visual cues, the loss of instruments, and the onset of acute stress with perceptual bias,” the report said.

“These illusions can cause pilots to sense that the aircraft is level even though it is in a bank or pitched up or down. This illusion may continue unrecognized until the aircraft impacts terrain.”

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