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31 August 1986 - Aeromexico 498

Aeroméxico Flight 498, registration XA-JED, was a Douglas DC-9-32 enroute from Mexico City, Mexico to Los Angeles International Airport, Los Angeles, California, United States (with stops in Guadalajara, Loreto, and Tijuana) on August 31, 1986. N4891F, callsign Piper 4891 Foxtrot, was a privately-operated Piper PA-28-181 Archer owned by the Kramer family enroute from Torrance to Big Bear City, California. The two aircraft collided in mid-air over Cerritos, California, killing all 67 aboard both aircraft and 15 people on the ground. In addition, 8 persons on the ground sustained minor injuries from the crash.

The Piper aircraft, N4891F, with the pilot and two passengers aboard, had departed Torrance, California at approximately 11:40 PST. At approximately 11:46, Flight 498 began its descent into Los Angeles with 58 passengers and six crew members aboard. At 11:52, the Piper's engine collided with the left horizontal stabilizer of the DC-9; shearing off the top of the Piper's cockpit, killing the pilot and both passengers. The heavily-damaged Piper fell onto an empty playground at Cerritos Elementary School.

The DC-9 inverted and fell to the earth in a residential neighborhood at Holmes Avenue and Reva Circle in Cerritos, killing 15 on the ground and all 64 passengers and crew. The impact and fire destroyed five houses and damaged seven more. A fire sparked by the crash contributed significantly to the damage. When the air traffic controller assigned to Flight 498 could not find the aircraft on the radar, he called up an inbound American Airlines jet for assistance. The pilot on American Airlines Flight 333 replied said that he saw a large smoke plume off to his left, indicating that Flight 498 had crashed.

The National Transportation Safety Board investigation found that N4891F, the Piper, had deviated into the LAX Terminal Control Area. It was out of radio contact with air traffic control, which had been distracted by another flight entering his control area without having received clearance.

Moreover, the Piper was not equipped with a Mode C transponder, which would have indicated its altitude, and LAX had not been equipped with automatic warning systems. Finally, apparently neither pilot sighted the other aircraft because neither attempted any evasive maneuvers, even though they were in visual range. When an autopsy revealed significant arterial blockage in the heart of the Piper's pilot, there was public speculation that he had suffered a heart attack, causing incapacitation and contributing to the collision; however, further forensic evidence discounted this, and error on the part of the Piper pilot was determined to be the main contributing factor to the collision.

As a result of this accident and other near mid-air collisions (NMAC) in terminal control areas, the Federal Aviation Administration required that all commercial aircraft be equipped with traffic alert and collision avoidance systems (TCAS), and required that light aircraft operating in dense airspaces be equipped with "Mode C" transponders that could report three-dimensional position.

A jury ruled that the Aeroméxico plane bore no fault, instead deciding that Kramer and the FAA each acted equally negligently and had equal responsibility. U.S. District Judge David Kenyon agreed with the notion that the FAA shared responsibility.

Download the full NTSB report


Transcript of the Cockpit Voice Recorder (CVR)

COAST = Coast Approach Control
LA APP = Los Angeles TRACON (Approach Control)
RDO-1 = Captain headset/mic
RDO-2 = First Officer headset/mic
CAM = Cockpit Area Microphone
COMPANY = Aeromexico Company at Los Angeles IAP
@ = Expletive deleted
* = Unintelligible word
( ) = Questionable text
(( )) = Editorial insertion

Communications between Los Angeles Approach and other flights are not included in this transcript. Please refer to the NTSB/AAR-87/07 report for a transcript that includes these communications.  

 

Time Source Content
11:41:21 RDO-1 Coast Approach good morning, this is Aeromexico four ninety eight is level one zero thousand
11:41:27 COAST Aeromexico four ninety eight, Coast Approach good morning, roger one zero thousand proceed direct Seal Beach El Toro altimeter two niner niner six
11:41:35 RDO-1 Direct Seal Beach altimeter two niner niner six
11:42:35 CAM * *
11:43:36 COAST Aeromexico four ninety eight, cross one zero miles southeast of Seal Beach at and maintain seven thousand
11:43:44 RDO-1 One zero miles seven thousand Aeromexico four ninety eight
11:44:54 RDO-1 Aeromexico four ninety eight is leaving one zero thousand for seven thousand
11:44:58 COAST Aeromexico four ninety eight roger
11:46:15 CAM They are runways twenty four right and ah left
11:46:46 CAM ((Sound of LAX ATIS starts))
11:46:59 COAST Aeromexico four ninety eight contact Los Angeles Approach one two four point niner
11:47:03 RDO-1 One two four point niner, good day
11:47:04 CAM ((ATIS ends))
11:47:05 COAST Good day
11:47:23 CAM --- departure
11:47:24 CAM One seven and twenty four
11:47:28 RDO-1 Los Angeles Approach good morning, this is Aeromexico four sixty four four ninety eight uh we're leaving, we're level one, correction seven thousand
11:47:34 CAM *
11:47:37 CAM Yes man
11:47:39 LA APP Aeromexico four ninety eight Los Angeles Approach depart Seal Beach three two zero vector ILS two five left final approach, do you have Information Uniform
11:47:46 RDO-1 Affirmative two five left runway
11:47:49 CAM ((Sound similar altitude alert tone))
11:47:50 CAM Two two zero for the runway ---
11:48:09 CAM ((Sound of attendant call tone))
11:48:14 CAM Course two four nine ---
11:48:15 CAM Flight director up
11:48:16 CAM Flight director up
11:48:31 CAM *
11:49:35 RDO-1 Aeromexico *
11:49:40 COMPANY (Aeromexico four nine eight go ahead)
11:49:41 CAM ((Sound of tone))
11:49:41 COMPANY * * Aeromexico four ninety eight estimate fifteen minutes, you have assigned gate one hundred and nineteen and ninteen one one nine awaiting your arrival
11:49:52 RDO-1 Thank you (four one) eight nine
11:50:05 CAM ((Unintelligible female voice))
11:50:08 LA APP Aeromexico four ninety eight, reduce speed to two one zero
11:50:46 LA APP Aeromexico four ninety eight, traffic ten o'clock one mile northbound, altitude unknown
11:50:50 RDO-1 Roger four ninety eight
11:51:03 LA APP Aeromexico four ninety eight reduce speed to one niner zero then descend and maintain six thousand
11:51:09 RDO-1 One niner zero an then descend and maintain six thousand
11:51:20 CAM *
11:51:30 CAM Thank you
11:51:44 LA APP Aeromexico four ninety eight maintain your present speed
11:51:48 RDO-1 Roger Aeromexico four ninety eight uh what speed do you want, we're reducing to two niner to one niner zero
11:51:57 LA APP Okay, you can hold what you have sir, and we have a change in plans here, stand by
11:52:00 RDO-1 All right we'll maintain one nine --- nine zero
11:52:10 CAM Oh @ this can't be
11:52:18 LA APP Aeromexico four ninety eight, expect the ILS runway two four right approach localizer frequency is one zero eight point five
11:52:32   ((End of tape))
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