# NTSB DEN08LA096: Commonwealth 185, N33384, Roanoke, TX, May 24, 2008 - Type: NTSB accident investigation - Classification: Accident · Minor injuries · Limited investigation · Final report - Date: May 24, 2008, 16:30 local (21:30 UTC) - Place: Roanoke, TX - Coordinates: 33.04972, -97.232223 - Nearby events: https://openairdocs.org/map.md?lat=33.0497&lon=-97.2322&mi=10 - Phase of flight: [Landing](https://openairdocs.org/ntsb-phases/550) (OpenAirDocs' grouping) - Defining event: [Landing-landing roll: Collision with terr/obj (non-CFIT) ](https://openairdocs.org/ntsb-events/470) - Highest injury: Minor injuries - Injuries: 1 minor - Status: Completed, report September 26, 2008 - Report: Approved by Office Director - Parties: FAA Flight Standards District Office - NTSB case key (mKey): 68137 - NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=DEN08LA096 - NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/68137/pdf - Page: https://openairdocs.org/ntsb/DEN08LA096 ## Probable cause The pilot's physiologic impairment and failure to attain the proper touchdown point during an intentional off airport landing. Contributing to the accident was the pilot's improper in-flight planning. ## Findings NTSB's coded findings; those marked are part of the probable cause. - [Runway/land/takeoff/taxi surface](https://openairdocs.org/ntsb-findings/03023000): Environmental issues › Physical environment · Not specified; cases with it: [Commonwealth 185, 1 case](https://openairdocs.org/ntsb-findings/03023000/cases.md?model=2370608), [All aircraft, 253 cases](https://openairdocs.org/ntsb-findings/03023000/cases.md) - [Info processing/decision: decision making/judgment](https://openairdocs.org/ntsb-findings/02041520): Personnel issues › Action/decision · Pilot (probable cause); cases with it: [Commonwealth 185, 1 case](https://openairdocs.org/ntsb-findings/02041520/cases.md?model=2370608), [All aircraft, 3,098 cases](https://openairdocs.org/ntsb-findings/02041520/cases.md) - [Health/Fitness: diet](https://openairdocs.org/ntsb-findings/02013015): Personnel issues › Physical · Pilot (probable cause); cases with it: [Commonwealth 185, 1 case](https://openairdocs.org/ntsb-findings/02013015/cases.md?model=2370608), [All aircraft, 1 case](https://openairdocs.org/ntsb-findings/02013015/cases.md) - [Performance/control parameters: descent/approach/glide path](https://openairdocs.org/ntsb-findings/01062040): Aircraft › Aircraft oper/perf/capability · Not attained/maintained (probable cause); cases with it: [Commonwealth 185, 1 case](https://openairdocs.org/ntsb-findings/01062040/cases.md?model=2370608), [All aircraft, 809 cases](https://openairdocs.org/ntsb-findings/01062040/cases.md) ## Sequence of events The events NTSB coded, in order, by phase of flight. The defining event best describes what happened. - [Landing-landing roll: Collision with terr/obj (non-CFIT) ](https://openairdocs.org/ntsb-events/470) (defining event); cases with it: [Commonwealth 185, 1 case](https://openairdocs.org/ntsb-events/470/sequence.md?model=2370608), [All aircraft, 10,189 cases](https://openairdocs.org/ntsb-events/470/sequence.md) ## Analysis The pilot, a diabetic on insulin, was in cruise flight when he felt ill due to low blood sugar. Though he was only two miles from his destination airport, he elected to land in a field. During the approach he was too high, and "could not get down in time." During the landing, he struck an embankment resulting in substantial damage to the airplane. An examination of the airplane systems revealed no anomalies. The pilot had not attempted to obtain a medical certificate after being diagnosed with diabetes in 2000, and had not accomplished a flight review since 2001. Low blood sugar (hypoglycemia), which is most commonly seen in diabetics on insulin, can lead to behavioral changes, confusion, fatigue, seizures, and loss of consciousness. ## Factual narrative On May 24, 2008, approximately 1630 central daylight time, a Commonwealth 185, N33384, owned and operated by the pilot, was substantially damaged during a precautionary landing near Roanoke, Texas. Visual meteorological conditions prevailed at the time of the accident. The personal flight was being conducted under the provisions of Title 14 Code of Federal Regulations Part 91 without a flight plan. The pilot sustained minor injuries. The cross-country flight departed Rhome, Texas, approximately 1515 and was en route to Northwest Regional Airport (52F), Roanoke, Texas. According to the Federal Aviation Administration (FAA) inspector who traveled to the scene, the pilot was in cruise flight when he started feeling "shaky" and felt his blood sugar was low. According to the Pilot Aircraft Accident Report Form submitted by the pilot, he had started flying around 1400, had stopped in Rhome to visit a friend, and was on his way back to Roanoke. He had the airport in sight when he "started feeling sick." The pilot indicated that he performed a precautionary landing to a field two miles southwest of the airport. During the approach he was too high, and "could not get down in time." During the landing, he struck an embankment and the main landing gear and nose gear were damaged. Further examination revealed that the firewall was wrinkled, the gear attach points had separated, and the engine mounts were bent. An examination of the airplane systems, conducted by the FAA, revealed no anomalies. The pilot was treated after the accident and his blood sugar was measured but he did not recall what that reading was. He was given something to eat and felt better. Following the accident, the pilot reported to the FAA and the Safety Board Investigator-in-Charge, that he had type II diabetes. The pilot noted that the condition had been diagnosed in 2000 and was controlled through the use of insulin. He stated that he had occasional problems with low blood sugar. He had been considering ending his time as a pilot but "did not do it soon enough." The pilot reported that his last medical certificate was issued in May of 1999 and his last flight review was conducted in April of 2001. He stated that he did not apply for a medical certificate after 1999 and had never been denied a medical certificate. He was aware that he could have been awarded a medical certificate, despite his medical conditions, with various limitations and operating requirements. He did hold a current driver's license at the time of the accident and believed he was operating under the requirements of a Sport Pilot Certificate. He did acknowledge that his airplane did not meet the requirements for Sport Pilot Operations, as it exceeded the requirement for gross weight. According to Title 14 Code of Federal Regulations Part 61.23 the pilot was required to hold at least a third class airmen medical certificate while "exercising the privileges of a private pilot certificate." According to Part 61.56 thepilot was required to have satisfied the requirements of a flight review within 24 calendar months of his last flight review while acting as pilot in command of an airplane. ## Aircraft - Registration: [N33384](https://openairdocs.org/aircraft/N33384), registered now, S/N 1605, built 1945 (OpenAirDocs) - Reported make and model: Commonwealth 185 - Registry model: [Commonwealth 185](https://openairdocs.org/model/commonwealth-185) (registry code 2370608) (OpenAirDocs) - Registry engine: [Continental C85 series](https://openairdocs.org/engine/continental-c85-series) (registry code 17008, reciprocating) (OpenAirDocs) - Category: Airplane - Serial number: 1605 - Airframe hours: 4050 - Engines: Continental C85-12E 85 horsepower reciprocating - Damage: Substantial damage - Flight: Personal, Part 91 - Airworthiness certificate: Standard, Normal - Last inspection: Annual, August 1, 2007 - Departed: 7TSO, Rhome, TX - Destination: 52F, Roanoke, TX ## Flight crew As NTSB recorded them. NTSB leaves out names. - Pilot; age 72; injuries: minor; private; airplane ratings: single-engine land; last flight review April 1, 2001; seat: left; flight hours: 2,670 total, 2,150 in this make and model, 2,650 as pilot in command, 18 in the last 90 days, 7 in the last 30 days, 2 in the last 24 hours ## Weather - Conditions: Visual (VMC), Day - Wind: 160° at 13 knots, gusting 22 - Visibility: 7 statute miles - Lowest ceiling: none - Temperature: 91 °F, dew point 70 °F - Altimeter: 29.84 inHg - Observed at: KAFW ## 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 20080524837589A](https://openairdocs.org/incident/20080524837589A), May 24, 2008: Comwth REARWIND185, Roanoke, TX, Substantial damage. (-23) On may 24, 2008, at approximately 1630 local, N33384, a commonwealth C185 aircraft, sustained substantial damage during a hard landing in the vicinity of… 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.