# NTSB CEN09CA354: Throckmorton Matthew E F1-EVO, N540MT, Mitchell, IN, June 12, 2009 - Type: NTSB accident investigation - Classification: Accident · Serious injuries · Data collection · Final report - Date: June 12, 2009, 15:30 local (19:30 UTC) - Place: Mitchell, IN - Coordinates: 38.742778, -86.476112 (estimated) - Nearby events: https://openairdocs.org/map.md?lat=38.7428&lon=-86.4761&mi=10 - Phase of flight: [Enroute](https://openairdocs.org/ntsb-phases/400) (OpenAirDocs' grouping) - Defining event: [Enroute-cruise: Loss of engine power (total)](https://openairdocs.org/ntsb-events/341) - Highest injury: Serious injuries - Injuries: 1 serious, 1 minor - Status: Completed, report November 9, 2009 - Report: Approved by Office Director - NTSB office: Central Region - Parties: FAA-Indianapolis FSDO - NTSB case key (mKey): 74041 - NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=CEN09CA354 - NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/74041/pdf - NTSB docket: https://data.ntsb.gov/Docket?ProjectID=74041 - Page: https://openairdocs.org/ntsb/CEN09CA354 ## Probable cause A total loss of engine power due to the disconnection of an oil line and the subsequent loss of engine oil. ## Findings NTSB's coded findings; those marked are part of the probable cause. - [Eng oil sys (airframe furnish): eng oil dist (airframe furn)](https://openairdocs.org/ntsb-findings/01057920): Aircraft › Aircraft power plant · Malfunction (probable cause); cases with it: [Throckmorton Matthew E F1-EVO, 1 case](https://openairdocs.org/ntsb-findings/01057920/cases.md?model=056220K), [All aircraft, 18 cases](https://openairdocs.org/ntsb-findings/01057920/cases.md) - [Runway/land/takeoff/taxi surface: soft surface](https://openairdocs.org/ntsb-findings/03023020): Environmental issues › Physical environment · Contributed to outcome; cases with it: [Throckmorton Matthew E F1-EVO, 1 case](https://openairdocs.org/ntsb-findings/03023020/cases.md?model=056220K), [All aircraft, 264 cases](https://openairdocs.org/ntsb-findings/03023020/cases.md) ## Sequence of events The events NTSB coded, in order, by phase of flight. The defining event best describes what happened. - [Enroute-cruise: Loss of engine power (total)](https://openairdocs.org/ntsb-events/341) (defining event); cases with it: [Throckmorton Matthew E F1-EVO, 1 case](https://openairdocs.org/ntsb-events/341/sequence.md?model=056220K), [All aircraft, 3,820 cases](https://openairdocs.org/ntsb-events/341/sequence.md) - [Emergency descent: Off-field or emergency landing](https://openairdocs.org/ntsb-events/440); cases with it: [Throckmorton Matthew E F1-EVO, 1 case](https://openairdocs.org/ntsb-events/440/sequence.md?model=056220K), [All aircraft, 3,365 cases](https://openairdocs.org/ntsb-events/440/sequence.md) - [Landing: Nose over/nose down](https://openairdocs.org/ntsb-events/096); cases with it: [Throckmorton Matthew E F1-EVO, 1 case](https://openairdocs.org/ntsb-events/096/sequence.md?model=056220K), [All aircraft, 2,287 cases](https://openairdocs.org/ntsb-events/096/sequence.md) ## Analysis The pilot reported that during cruise flight he observed an oil pressure warning indication on the electronic flight instrument system and noted that the engine oil pressure had dropped to approximately one pound per square inch. He immediately turned toward the nearest airport, which was about 7 miles away; however, the engine stopped producing power about one minute later. The pilot prepared for a forced landing to a farm field. The field consisted of chest-high grass with soft, muddy areas. The airplane subsequently nosed over during the landing. A postaccident examination of the airplane revealed that an oil line between the oil cooler and the engine became disconnected. The oil line and fitting appeared to be otherwise intact. The examination also noted oil residue along the bottom of the fuselage. The oil line connection was not equipped with a clamp, and relied on the interference of the line and the fitting to maintain the connection. The pilot stated that the oil line manufacturer assured him that the design configuration was adequate. ## Factual narrative The pilot reported that during cruise flight he observed an oil pressure warning indication on the electronic flight instrument system (EFIS) and noted that the engine oil pressure had dropped to approximately one pound per square inch (psi). He immediately turned toward the nearest airport, which was about 7 miles away. However, the engine stopped producing power about one minute later. The pilot prepared for a forced landing to a farm field. The field consisted of chest-high grass with soft, muddy areas. The airplane subsequently nosed over during the landing. A post-accident examination of the airplane revealed that an oil line between the oil cooler and the engine became disconnected. The oil line and fitting appeared to be otherwise intact. The examination also noted oil residue along the bottom of the fuselage. The oil line connection was not equipped with a clamp, and relied on the interference of the line and the fitting to maintain the connection. The pilot stated that the oil line manufacturer assured him that the design configuration was adequate. ## Aircraft - Registration: [N540MT](https://openairdocs.org/deregistered/N540MT-2019-10-10), registration cancelled 2019-10-10, S/N 132 (OpenAirDocs) - Reported make and model: THROCKMORTON MATTHEW E F1-EVO - Registry model: [Throckmorton Matthew E F1-EVO](https://openairdocs.org/model/throckmorton-matthew-e-f1-evo) (registry code 056220K) (OpenAirDocs) - Category: Airplane, amateur-built - Serial number: 132 - Airframe hours: 150 - Engines: Mattittuck TMX-IO-540 260 horsepower reciprocating - Damage: Substantial damage - Flight: Personal, Part 91 - Airworthiness certificate: Special, Experimental (Special) - Last inspection: Condition, March 1, 2009 - Departed: 2R2, Indianapolis, IN - Destination: BWG, Bowling Green, KY - Flight plan: Unknown ## Flight crew As NTSB recorded them. NTSB leaves out names. - Pilot; age 50; injuries: serious; private; airplane ratings: single-engine land; instrument ratings: airplane; medical: class 3, with waivers/limitations; last flight review July 26, 2007; seat: front; flight hours: 1,800 total, 150 in this make and model, 1,800 as pilot in command, 33 in the last 30 days ## Weather - Conditions: Visual (VMC), Day - Wind: 300° at 3 knots - Visibility: 10 statute miles - Lowest ceiling: 2,700 ft overcast - Temperature: 70 °F, dew point 61 °F - Altimeter: 29.94 inHg - Observed at: BMG, 30 nm away ## Docket (4 files) The files NTSB released with the investigation on July 24, 2009, on NTSB's docket system: https://data.ntsb.gov/Docket?ProjectID=74041. 1.5 MB in all. - Pilot/Operator Aircraft Accident Report, NTSB Form 6120.1 (item 1, .PDF, 1.0 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40316108&FileExtension=.PDF&FileName=Pilot%2FOperator%20Aircraft%20Accident%20Report,%20NTSB%20Form%206120.1-Master.PDF - Pilot Statement (item 2, .PDF, 223 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40316109&FileExtension=.PDF&FileName=Pilot%20Statement-Master.PDF - Passenger Statement (item 3, .PDF, 166 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40316110&FileExtension=.PDF&FileName=Passenger%20Statement-Master.PDF - Wreckage Diagram (item 4, .PDF, 45 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40316111&FileExtension=.PDF&FileName=Wreckage%20Diagram-Master.PDF From the NTSB's public API. Aircraft are matched to registry aircraft by N-number and event date, checked against the reported serial number, make and model; the registry's history has gaps, so older matches can be wrong. Compare the reported make and model. --- OpenAirDocs.org is an independent research project of [Contrail Labs](https://contraillabs.com/). It is not affiliated with the FAA or the NTSB. Source documents are U.S. government works in the public domain.