# NTSB DEN06FA013: Beech A36, N1548Y, Datil, NM, November 8, 2005 - Type: NTSB accident investigation - Classification: Accident · Fatal · Field investigation · Final report - Date: November 8, 2005, 12:30 local (19:30 UTC) - Place: Datil, NM - Coordinates: 34.368331, -107.718612 - Nearby events: https://openairdocs.org/map.md?lat=34.3683&lon=-107.7186&mi=10 - Phase of flight: [Enroute](https://openairdocs.org/ntsb-phases/400) (OpenAirDocs' grouping) - Highest injury: Fatal - Injuries: 1 fatal - Status: Completed, report August 29, 2006 - Report: Approved by Office Director - Parties: Teledyne Continental Motors, Inc., Federal Aviation Administration, Raytheon Aircraft Company - NTSB case key (mKey): 62808 - NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=DEN06FA013 - NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/62808/pdf - Page: https://openairdocs.org/ntsb/DEN06FA013 ## Probable cause the pilot's loss of control during flight as a result of incapacitation due to atherosclerotic cardiovascular disease. ## Sequence of events In NTSB's coding before 2008 (https://www.ntsb.gov/GILS/Documents/codman.pdf). - Loss of control - in flight, cruise - aircraft control - not possible, pilot in command (cause) - incapacitation(cardiovascular), pilot in command (cause) - In flight collision with terrain/water, cruise - terrain condition - mountainous/hilly - terrain condition - rising ## Analysis Approximately 45 minutes into the cross-country flight, the airplane collided with hilly terrain during daytime hours in visual meteorological conditions. Examination of the airframe, engine, and propeller revealed no anomalies that precluded normal operation prior to impact. Postmortem examination of the pilot revealed atherosclerotic cardiovascular disease with severe blockage of the coronary arteries, and a clot noted in the left anterior descending artery. The autopsy report stated, "...the presence of significant atherosclerotic narrowing of the left anterior descending artery may have precipitated an abnormal heart rhythm (dysrhythmia) producing an incapacitating event during flight that resulted in the crash." ## Factual narrative HISTORY OF FLIGHT On November 8, 2005, approximately 1230 mountain standard time, a Beech A36 single-engine airplane, N1548Y, was destroyed when it collided with terrain on the Double H Ranch near Datil, New Mexico. The private pilot, who was the sole occupant, sustained fatal injuries. The airplane was registered to and operated by the pilot. Visual meteorological conditions prevailed, and a flight plan was not filed for the Title 14 Code of Federal Regulations Part 91 personal flight. The flight departed Block Ranch Airport (4AZ2), Capitan, New Mexico, approximately 1145, and was destined for Phoenix Deer Valley Airport (DVT), Phoenix, Arizona. According to the Block Ranch manager, the pilot departed for Phoenix approximately 1145 from the ranch airstrip. The pilot flew over the ranch residence and then departed toward the west. The manager reported no anomalies with the airplane during the takeoff or when it flew over the residence. Approximately 1300, a Double H ranch hand noticed a fire on a hillside in the northwest corner of the ranch property. The ranch hand informed the Double H ranch manager of the fire, and they responded to the site. Upon reaching the fire location, the ranch manager realized the fire had been started as a result of an airplane accident. The ranch manager then contacted the United States Forest Service (USFS), Magdalena, New Mexico, and the New Mexico State Police. The USFS responded to the accident site and extinguished the fire. PERSONNEL INFORMATION The 77-year old pilot held a private pilot certificate with airplane single-engine land, airplane multi-engine land, and instrument airplane ratings. The pilot was issued a third-class medical certificate on February 28, 2005, with the limitations: "Must wear corrective lenses for near and distant vision. Not valid for any class after February 28, 2006." According to the Federal Aviation Administration's (FAA) medical records, on March 10, 2005, the pilot's medical certificate was suspended due to a history of glaucoma with visual field defect left eye. On June 6, 2005, the pilot successfully completed a FAA medical flight test, and the pilot received a third-class medical certificate. The pilot reported no "heart or vascular trouble" on any previous medical applications. The pilot's logbooks were not located; however, according to the pilot's February 28, 2005, medical application, the pilot reported a total time of 11,010 hours and 100 hours in the past 6 months. On January 21-23, 2005, the pilot completed a Beech Pilot Proficiency Program Approved Bonanza Recurrent Course. AIRCRAFT INFORMATION The 1989-model Beech A36, serial number E-2483, was a low wing, retractable landing gear, semi-monocoque design airplane. The airplane was powered by a six-cylinder, direct drive, air cooled, horizontally-opposed, fuel injected Teledyne Continental Motors IO-550-B engine (serial number 297185-R), rated at 300 horsepower, and equipped with a McCauley three-bladed constant speed propeller. The airplane was configured to carry a maximum of six occupants, and the maximum gross weight for the airplane was 3,650 pounds. The airplane was issued a standard airworthiness certificate and was certificated for normal category operations. The airplane's current registration was issued to the pilot on July 2, 2002. Complete airframe, engine, and propeller logbooks were not located; however, charred remnants of airplane maintenance records were found in the airplane wreckage. According to the maintenance facility that completed the last annual and 100-hour inspections on May 26, 2005, the airframe and engine had accumulated total times of 3,404.8 and 336.6 hours, respectively. The total airframe and engine times at the time of the accident could not be determined. METEOROLOGICAL INFORMATION Approximately 1045, the pilot obtained a weather briefing from the Albuquerque Flight Service Station. According to the weather brief audio recording, the briefer informed the pilot that the weather along the pilot's intended route of flight was clear below 12,000 feet msl and visibility was unrestricted. The briefer stated the pilot may experience moderate turbulence near Socorro, New Mexico (located approximately 50 east of the accident site) below 18,000 feet msl. The winds aloft near Socorro at 9,000 feet msl were from 280 degrees at 11 knots, and at 12,000 feet msl, were from 260 degrees at 28 knots. According to employees of the Double H ranch, at the time the accident site was located, the sky was clear and the wind was calm. WRECKAGE AND IMPACT INFORMATION The accident site was located in hilly and rocky terrain on the northwest corner of the Double H ranch property, approximately 10 miles northeast of Datil. Examination of the accident site revealed the airplane impacted terrain on a measured magnetic heading of 255 degrees at an elevation of 7,676 feet msl. The Global Positioning System coordinates recorded at the accident site were latitude North 34 degrees 22.608 minutes and longitude West 107 degrees 43.732 minutes. Examination of the accident site revealed the left wing impacted the tops of pinion pine trees prior to impact with terrain. The outboard portion of the right wing came to rest entangled in a pinion pine adjacent to the initial ground scar. Measurements of the pinion pine tree cuts at the initial impact indicated the airplane impacted the vegetation in a 3 degree nose down and 10 degree right wing down attitude. Navigation antennas, mounted on the underside of the fuselage, were located in the initial impact ground scar. Airplane debris fanned outward from the initial ground scar to the main wreckage and was distributed on rising terrain. The incline of the rising terrain measured approximately 19 degrees. The debris field contained sections of the left and right wings, engine cowling, engine accessories, one propeller blade, and broken sections of the windscreen. The main wreckage came to rest upright on a measure magnetic heading of 205 degrees and was located approximately 136 feet from the initial ground scar at an elevation of 7,720 feet msl. The main wreckage consisted of the fuselage, portions of the left and right wings, the empennage, and the engine. The main wreckage was destroyed by a post-impact fire. The inboard portion of the left wing remained attached to the fuselage and partially consumed by fire. The flap and inboard section of the aileron remained attached to the wing, and the outboard section of the aileron was separated and located in the debris field. The flap actuator and its attach points were consumed by fire. The trailing edge of the flap was intact. The left main landing gear remained partially attached to the wing structure and was in the retracted position. The inboard portion of the right wing with the flap attached, remained attached to the fuselage, was bent aft and partially consumed by fire. The outboard portion of the right wing with the aileron attached, was located in a pinion pine adjacent to the initial impact. The flap actuator and its attach points were consumed by fire. The trailing edge of the flap was intact. The right main landing gear remained partially attached to the wing structure and was in the retracted position. The empennage remained partially attached to the fuselage. The vertical stabilizer remained partially attached to the empennage and exhibited fire damage. The rudder remained attached to the vertical stabilizer and exhibited fire damage. The left horizontal stabilizer was intact and displayed damage to the leading edge. The left elevator remained attached to the horizontal stabilizer. The right horizontal stabilizer and elevator were consumed by fire, and the control cable and rod terminating ends were located at the position of the right elevator. Measurement of the left and right actuators corresponded to ## Aircraft - Registration: [N1548Y](https://openairdocs.org/deregistered/N1548Y-2017-06-14), registration cancelled 2017-06-14, S/N E-2483, built 1989 (OpenAirDocs) - Reported make and model: Beech A36 - Registry model: [Beech A36](https://openairdocs.org/model/beech-a36) (registry code 1151604) (OpenAirDocs) - Registry engine: [Continental IO-550 series](https://openairdocs.org/engine/continental-io-550-series) (registry code 17042, reciprocating) (OpenAirDocs) - Category: Airplane - Serial number: E-2483 - Airframe hours: 3404.8 - Engines: Teledyne Continental IO-550-B 300 horsepower reciprocating - Damage: Destroyed - Fire: On-Ground - Flight: Personal, Part 91 - Registered owner: R. A. Canning - Airworthiness certificate: Standard, Normal - Last inspection: Annual, May 1, 2005 - Departed: 4AZ2, Capitan, NM - Destination: DVT, Phoenix, AZ ## Flight crew As NTSB recorded them. NTSB leaves out names. - Pilot; age 77; injuries: fatal; private; airplane ratings: single-engine land, multi-engine land; instrument ratings: airplane; medical: class 3, with waivers/limitations; last flight review January 1, 2005; seat: left; toxicology performed; flight hours: 11,000 total, 9,000 in this make and model ## Weather - Conditions: Visual (VMC), Day - Wind: calm - Visibility: 10 statute miles - Lowest ceiling: none - Temperature: 70 °F ## FAA reports on this event (1) The FAA's own accident and incident reports, matched to the aircraft by N-number and date (OpenAirDocs). - [Accident 20051108027199A](https://openairdocs.org/incident/20051108027199A), Nov 8, 2005: Beech A36, Datil, NM, Destroyed, 1 fatal. (-23) On November 8, 2005, at approximately 1245 MST, a Beech BE-36, a single engine airplane, N1548Y, was destroyed when it impacted terrain while maneuvering… 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.