# NTSB ERA12FA387: Phillips William L Challenger, N2571T, Plant City, FL, June 9, 2012 - Type: NTSB accident investigation - Classification: Accident · Fatal · Field investigation · Final report - Date: June 9, 2012, 11:26 local (15:26 UTC) - Place: Plant City, FL - Coordinates: 28.135555, -82.141113 (estimated) - Nearby events: https://openairdocs.org/map.md?lat=28.1356&lon=-82.1411&mi=10 - Phase of flight: [Approach](https://openairdocs.org/ntsb-phases/500) (OpenAirDocs' grouping) - Defining event: [Approach-VFR pattern final: Loss of control in flight](https://openairdocs.org/ntsb-events/240) - Highest injury: Fatal - Injuries: 1 fatal - Status: Completed, report April 10, 2013 - Report: Approved by Office Director - NTSB office: Eastern Region Aviation - Parties: FAA Tampa FSDO - NTSB case key (mKey): 83903 - NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=ERA12FA387 - NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/83903/pdf - NTSB docket: https://data.ntsb.gov/Docket?ProjectID=83903 - Page: https://openairdocs.org/ntsb/ERA12FA387 ## Probable cause The non-certificated pilot’s loss of control during approach and landing. Contributing to the accident was the pilot’s lack of both total and recent flight experience. ## Findings NTSB's coded findings; those marked are part of the probable cause. - [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: [Phillips William L CHALLENGER, 1 case](https://openairdocs.org/ntsb-findings/01062040/cases.md?model=05904FQ), [All aircraft, 809 cases](https://openairdocs.org/ntsb-findings/01062040/cases.md) - [Use of equip/info: aircraft control](https://openairdocs.org/ntsb-findings/02063040): Personnel issues › Task performance · Pilot (probable cause); cases with it: [Phillips William L CHALLENGER, 1 case](https://openairdocs.org/ntsb-findings/02063040/cases.md?model=05904FQ), [All aircraft, 9,295 cases](https://openairdocs.org/ntsb-findings/02063040/cases.md) - [Experience/qualifications: recent experience](https://openairdocs.org/ntsb-findings/02031035): Personnel issues › Experience/knowledge · Pilot (probable cause); cases with it: [Phillips William L CHALLENGER, 1 case](https://openairdocs.org/ntsb-findings/02031035/cases.md?model=05904FQ), [All aircraft, 76 cases](https://openairdocs.org/ntsb-findings/02031035/cases.md) - [Experience/qualifications: total experience](https://openairdocs.org/ntsb-findings/02031015): Personnel issues › Experience/knowledge · Pilot (probable cause); cases with it: [Phillips William L CHALLENGER, 1 case](https://openairdocs.org/ntsb-findings/02031015/cases.md?model=05904FQ), [All aircraft, 126 cases](https://openairdocs.org/ntsb-findings/02031015/cases.md) ## Sequence of events The events NTSB coded, in order, by phase of flight. The defining event best describes what happened. - [Approach-VFR pattern final: Loss of control in flight](https://openairdocs.org/ntsb-events/240) (defining event); cases with it: [Phillips William L CHALLENGER, 1 case](https://openairdocs.org/ntsb-events/240/sequence.md?model=05904FQ), [All aircraft, 5,002 cases](https://openairdocs.org/ntsb-events/240/sequence.md) - [Uncontrolled descent: Collision with terr/obj (non-CFIT) ](https://openairdocs.org/ntsb-events/470); cases with it: [Phillips William L CHALLENGER, 1 case](https://openairdocs.org/ntsb-events/470/sequence.md?model=05904FQ), [All aircraft, 10,189 cases](https://openairdocs.org/ntsb-events/470/sequence.md) ## Analysis According to the airport manager, the purpose of the flight was for the pilot/owner to get “one last flight” in the airplane before he sold it. The pilot had experienced health issues and undergone surgery in the years prior to the accident, and had not flown the airplane in about 1 year. The manager watched the entire flight and described the takeoff as “normal.” The first landing approach was “fast and long,” and the pilot performed a go-around and entered the traffic pattern for a second approach. The manager and other witnesses stated that the airplane descended on the base leg of the traffic pattern to about 500 feet, and that the airplane turned and aligned with the runway. During the descent on final approach, the airplane pitched up, leveled off, descended, and pitched up multiple times with corresponding changes in engine power. The airplane “wandered” to the west and was briefly flying parallel to the runway as it headed toward the witnesses on the grass apron and the hangars on the west side of the field. The airplane then pitched up, the nose dropped, and the airplane impacted the ground in a nose-down attitude of about 25-30 degrees. During the descent and at ground contact, the engine was running “at cruise power,” according to the airport manager. The engine continued to run after the accident, and first responders had to pull one of the carburetors from its mount in order to stop the engine. The 79 year-old pilot/owner had never obtained a pilot certificate. Over the 60 years that he documented his flight time, the pilot reported 122 total flight hours. The accident airplane was purchased almost 20 years before the accident but was not registered until 5 years before the accident. At the time of the accident, the airplane had accumulated 19 total airframe hours. ## Factual narrative HISTORY OF FLIGHT On June 9, 2012, at 1126 eastern daylight time, a Phillips Challenger II, N1279T, was substantially damaged during collision with terrain while maneuvering for landing at Blackwater Airpark (9FD2), Plant City, Florida. The pilot/owner was fatally injured. Visual meteorological conditions prevailed, and no flight plan was filed for the local flight that departed 9FD2 about 1110. The personal flight was conducted under the provisions of 14 CFR Part 91. According to the airport manager, the purpose of the flight was for the pilot/owner to get “one last flight” in the airplane before he sold it. The pilot had experienced health issues and undergone surgery in the years prior to the accident, and had not flown the airplane in approximately one year. The manager watched the entire flight, and described the takeoff as “normal” with no problems noted. The first landing approach was “fast and long,” and the pilot performed a go-around and entered the traffic pattern for another approach. The manager and other witnesses stated the airplane descended on the base leg of the traffic pattern to about 500 feet, and then the airplane turned and aligned with the runway. During the descent on final approach, the airplane pitched up, leveled off, descended, and pitched up multiple times with corresponding changes in engine power. They observed as the airplane “wandered” to the west,and was briefly flying parallel to the runway as it headed towards their location on the grass apron and the hangers on the west side of the field. The airplane pitched up, the nose dropped, and the airplane imapcted the ground in a nose-down attitude of about 25-30 degrees. During the descent and at ground contact, the engine was running “at cruise power.” The engine continued to run after the accident, and first responders had to pull one of the carburetors from its mount in order to stop the engine. PERSONNEL INFORMATION According to Federal Aviation Administration (FAA) records, the pilot did not hold a pilot certificate. He most recently held a student pilot certificate, which expired April 30, 2009. A review of his logbooks revealed that he first logged an entry in 1952; he last logged an entry in 2006, and had accrued 122 total hours of flight experience as of that date. His most recent third-class FAA medical certificate was issued in November 2007. The pilot did possess a valid driver’s license. AIRCRAFT INFORMATION According to FAA and maintenance records, the airplane was purchased in 1993 and certificated in 2007, and was registered to the pilot/owner. It was a two-place, high wing, single-engine airplane, with fixed landing gear. According to the airplane’s maintenance records, the most recent condition inspection was completed on June 5, 2012, at 19 total aircraft hours. METEOROLOGICAL INFORMATION At 1115, the weather conditions reported at Plant City Municipal Airport (PCM), about 7 miles north of the accident site, included winds from 160 at 3 knots.There was a broken cloud ceiling at 5,000 feet and 8,500 feet. Visibility was 10 miles; the temperature was 30 degrees C, the dew point 24 degrees C, and the altimeter setting was 30.02 inches of mercury. WRECKAGE AND IMPACT INFORMATION The wreckage was examined at the site, and all major components were accounted for at the scene. The wreckage path was oriented 030 degrees magnetic, and was approximately 180 feet in length. The initial impact point was on the west side of the north/south runway, and the ground scar crossed the runway on an approximate 30-degree angle. The airplane came to rest upright on the east side of the runway. Fragments associated with the nose landing gear and nose enclosure were scattered along the wreckage path. The bottom of the fuselage was crushed upwards, and the fore and aft cabin structure was folded in on the cockpit area. The engine support structure was collapsed, and the engine rested on the bottom of the airframe. Control continuity was established from the cockpit to the flight control surfaces. Examination of the two-bladed wooden propeller revealed that both blades were fractured and splintered near the propeller hub. Splintered fragments of the propeller were scattered along the wreckage path. The examination did not reveal any defects or anomalies that would have precluded normal operation of the airplane. MEDICAL AND PATHOLOGICAL INFORMATION The Hillsborough County Medical Examiner Department, Tampa, Florida, performed the autopsy on the pilot. The autopsy revealed the pilot died from blunt injuries to the head and neck. The FAA Bioaeronautical Sciences Research Laboratory, Oklahoma City, Oklahoma, performed forensic toxicology on specimens from the pilot. No carbon monoxide, cyanide, or ethanol, were detected in the specimens tested. The following Tested-for-Drugs were detected: Atenolol detected in Blood (Cavity) - Atenolol (Tenormin®) is a prescription synthetic, beta1-selective (cardioselective) adrenoreceptor blocking agent used to treat high blood pressure, and cardiovascular disease. Atenolol detected in Urine Clonidine detected in Urine – Clonidine (Catapres®) is a prescription centrally-acting alpha-agonist hypotensive agent used to treat high blood pressure. This centrally-acting medication has side effects including dizziness and fatigue. According to the FAA, clonidine use was a disqualifying condition for the issuance of a medical certificate. A review of the autopsy report as well as statements from the pilot’s wife and his acquaintances revealed the pilot’s medical history included: Coronary artery disease (Blocked / narrowed coronary arteries) Myocardial infarction (old heart attack) at apex of heart Implanted pacemaker Aortic valve replacement Mitral valve repair Stage III renal failure (moderate reduction in the filtering capability of the kidneys) High blood pressure Stroke The pilot’s pacemaker logbook did not record any arrhythmias on the day of the accident. It could not bedetermined to what degree the pilot’s general health, or use of medication, affected his performance during the accident flight. ## Aircraft - Registration: [N2571T](https://openairdocs.org/deregistered/N2571T-2018-01-12), registration cancelled 2018-01-12, S/N CH20970, built 1993 (OpenAirDocs) - Reported make and model: PHILLIPS WILLIAM L CHALLENGER - Registry model: [Phillips William L CHALLENGER](https://openairdocs.org/model/phillips-william-l-challenger) (registry code 05904FQ) (OpenAirDocs) - Registry engine: [Rotax 503 series](https://openairdocs.org/engine/rotax-503-series) (registry code 55564, 2 cycle) (OpenAirDocs) - Category: Airplane - Serial number: CH20970 - Airframe hours: 19 - Engines: ROTAX 503 52 horsepower reciprocating - Damage: Substantial damage - Flight: Personal, Part 91 - Operator: Phillips William L - Registered owner: Phillips William L - Airworthiness certificate: Special, Experimental light sport (Special) - Last inspection: Condition, June 5, 2012, 0 hours before - Departed: 9FD2, Plant City, FL - Destination: 9FD2, Plant City, FL - Airport: 9FD2, Blackwater Creek Ultralight Fl, runway 36, 2,300 × 150 ft, grass/turf ## Flight crew As NTSB recorded them. NTSB leaves out names. - Pilot; age 80; injuries: fatal; student; seat: front; flight hours: 122 total, 20 in this make and model ## Weather - Conditions: Visual (VMC), Day - Wind: 160° at 3 knots - Visibility: 10 statute miles - Lowest ceiling: 5,000 ft broken - Temperature: 86 °F, dew point 75 °F - Altimeter: 30.02 inHg - Observed at: KPCM, 8 nm away ## 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 20120609011379A](https://openairdocs.org/incident/20120609011379A), Jun 9, 2012: Phillips William L CHALLENGER II, Plant City, FL, Destroyed, 1 fatal. On June 09 2012, at 11:15 EDT , a Challenger II elsa N2571T, registered to william l Phillips collided nose first with the ground at a high angle while trying… ## Docket (9 files) The files NTSB released with the investigation on February 11, 2013, on NTSB's docket system: https://data.ntsb.gov/Docket?ProjectID=83903. 2.1 MB in all. - NTSB Record of Conversations (item 1, .PDF, 56 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40386581&FileExtension=.PDF&FileName=NTSB%20Record%20of%20Conversations-Master.PDF - Witness Statements (item 2, .PDF, 875 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40386516&FileExtension=.PDF&FileName=Witness%20Statements-Redacted.PDF - Most Recent Condition Inspection (Note airframe total time.) (item 3, .PDF, 148 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40386527&FileExtension=.PDF&FileName=Most%20Recent%20Condition%20Inspection%20(Note%20airframe%20total%20time.)-Redacted.PDF - Toxicological Report (item 4, .PDF, 113 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40386663&FileExtension=.PDF&FileName=Toxicological%20Report-Master.PDF - Release of Aircraft Wreckage, NTSB Form 6120.15 (item 5, .PDF, 54 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40386580&FileExtension=.PDF&FileName=Release%20of%20Aircraft%20Wreckage,%20NTSB%20Form%206120.15-Redacted.PDF - Photo 1 – View of Wreckage Path in Direction of Travel. Note initial ground scar and impressions consistent with three main landing gear. (item 6, .PDF, 211 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40386520&FileExtension=.PDF&FileName=Photo%201%20%E2%80%93%20View%20of%20Wreckage%20Path%20in%20Direction%20of%20Travel.%20Note%20initial%20ground%20scar%20and%20impressions%20consistent%20with%20three%20main%20landing%20gear.-Master.PDF - Photo 2 - View of Main Wreckage Facing Opposite the Direction of Travel (item 7, .PDF, 225 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40386521&FileExtension=.PDF&FileName=Photo%202%20-%20View%20of%20Main%20Wreckage%20Facing%20Opposite%20the%20Direction%20of%20Travel-Master.PDF - Photo 3 - View of Main Wreckage Facing Intended Landing Direction (item 8, .PDF, 184 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40386522&FileExtension=.PDF&FileName=Photo%203%20-%20View%20of%20Main%20Wreckage%20Facing%20Intended%20Landing%20Direction-Master.PDF - Photo 4 - View of Engine and Propeller as found. Note splintered propeller blades and carburetor dismounted by first responders to affect engine stoppage. (item 9, .PDF, 187 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40386524&FileExtension=.PDF&FileName=Photo%204%20-%20View%20of%20Engine%20and%20Propeller%20as%20found.%20Note%20splintered%20propeller%20blades%20and%20carburetor%20dismounted%20by%20first%20responders%20to%20affect%20engine%20stoppage.-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.