2010 A319 TS black hole undershoot Palermo Italy
During a VOR/DME approach the A319 was being flown by the F/O. At MDA the Captain ordered the F/O to continue descent although neither pilot had visual references. About 410 ft above the runway and 230 ft below MDA the F/O saw lights to the left, the Captain took control and disconnected the autopilot. The descent rate increased to 1350 fpm and the aircraft struck the ground 350m short of the runway.
The Captain was extremely experienced and very familiar with the airport. The F/O was very inexperienced and deferred to the Captain's expertise. No proper briefing was conducted as the Captain was engaged in conversation with a jump seat pilot and did not consider conditions demanding. However, in reality an extremely active thunderstorm with very heavy rainfall was crossing the area.
Subsequent to the Captain taking control, both pilots were focused outside the cockpit looking for visual cues which were first seen by the F/O. Subsequently both were likely subject to "black hole effect" visual illusions of being high, until the F/O called that in fact the PAPI indicated that they were in fact low just prior to impact.
The SOP allowed for the Captain as PM to make a "continue" call, but further descent below MDA was only permitted if the F/O had confirmed the visual references, which he stated he did not have. However the Captain repeated his "continue" order. The F/O was faced with a major conflict, and complied with the Captain's order rather than the SOP. The flaw inherent in this procedure is eliminated by the use of PicMA.
