ERA13FA388

The 58-year-old student pilot attempted a takeoff in light wind, but about 2,000 feet down the runway, he lost control of the airplane. Only one witness saw the airplane after liftoff, and noted that it was "swerving all over the place before it crashed." While airborne, the airplane veered off the left side of the runway, then impacted the ground with the right wing tip, nosed down, bounced, and came to rest upright, facing opposite the direction of takeoff. All witnesses heard the engine operating throughout the event, with one stating that it "was running smooth, normal sounding." Subsequent examination of the airplane revealed no preexisting mechanical anomalies that would have precluded normal operation. The pilot was obese, with a history of Type 2 diabetes and high cholesterol. Although he reported some medications on his Federal Aviation Administration (FAA) medical certificate applications, he routinely failed to report others. Documentation from his most recent FAA medical examination included the use of two medications not recommended to be used together because of the risk of hypoglycemia. Postmortem toxicology testing identified only salicylate, but would have been unable to identify many of the pilot's other medications. According to the medical examiner, the cause of death was multiple blunt impact trauma to the head and chest, indicating that the pilot was still alive when he lost control of the airplane. Diabetics who become symptomatic from hypoglycemia may not notice warning signs until their psychomotor functioning is very impaired. It is unknown what precautions the pilot may have taken that day to prevent hypoglycemia or what the pilot's eating schedule was. In addition, because postmortem glucose levels are low and do not correlate with premortem levels, even if the pilot was severely hypoglycemic at the time of the accident, there would be no specific evidence to identify it. The pilot also had severe coronary artery disease, with 85-95% occlusion of the left anterior descending artery, that put him at increased risk of a sudden, impairing cardiac event that would have left no observable evidence at autopsy. There were no operational or mechanical factors to explain the student pilot's loss of control at takeoff, but he did have multiple medical conditions that could have resulted in acute impairment without leaving evidence. Although the exact mechanism could not be determined, it is likely that the impairment resulted from one or more of the student pilot's medical conditions, which then caused him to lose control of the airplane.

The airplane was powered by a Continental O-300-A engine driving a two-bladed propeller. The latest annual inspection was completed on August 26, 2013, at tachometer time 4,242.0 hours, engine time 439.7 hours since major overhaul. The airplane was equipped with lap belt restraints only. The airport had a single runway, 11/29, that was 2,973 long and 50 feet wide. Airport elevation was 292 feet. There was no air traffic control tower, and no video or radio transmission recording devices. On August 30, 2013, about 1340 eastern daylight time, a Cessna 172, N8063B, was substantially damaged during a takeoff attempt at Limington-Harmon Airport (63B), Limington, Maine. The student pilot was fatally injured. Visual meteorological conditions prevailed, and no flight plan was filed for the local solo instructional flight, which was conducted under the provisions of 14 Code of Federal Regulations Part 91. According to several witnesses, the student pilot completed an engine run-up prior to taking off from runway 29. Only one witness saw the accident, and he stated that after liftoff, the airplane was "swerving all over the place before it crashed." All witnesses heard the engine operating throughout the event, with one stating that the engine "was running smooth, normal sounding." An autopsy was performed on the pilot at the Maine Office of the Chief Medical Examiner, Augusta, Maine, where the cause of death was reported as "multiple blunt impact trauma to head and chest." Additional findings, as noted in the NTSB Medical Factual Report, indicated that the pilot was 6 feet tall and weighed 295 pounds (Body Mass Index = 40.0 kg/m2). "In addition, the pilot was found to have significant hypertensive and coronary artery heart disease. The heart weighed 590 grams (average for a man of this size is 453 grams with a range from 343 to 598 grams). Approximately 85 to 95% of mid portion of the left anterior descending coronary artery was occluded by a stenotic plaque but the remaining coronary arteries were widely patent. The myocardium was uniformly dark red without pallor, hemorrhage, softening, or fibrosis but the left ventricle wall was 2.0 cm thick (normal is up to 1.3cm) Toxicological testing was subsequently performed by the FAA Forensic Toxicology Research Team, Oklahoma City, Oklahoma. Per the NTSB Medical Factual Report, testing "detected 35.9 ug/ml of salicylate in urine. Salicylate is a metabolite of aspirin. No other drugs were identified. According to an email exchange with a senior toxicologist at the FAA laboratory, lisinopril should have been identified if it had been taken recently. Because atorvastatin is heavily metabolized before being excreted in urine, its absence does not indicate whether or not it was being used. Neither of the other two medications [as noted in the pilot's FAA medical records] (exenatide and fenofibrate) would have been identified by the laboratory protocols." A witness described the wind as "light" and from the right ofthe runway. At 1351, the nearest weather reporting airport, about 17 nautical miles the southeast, recorded scattered clouds at 3,500 feet, variable winds at 3 knots, temperature 26 degrees C, dew point 18 degrees, and an altimeter setting 29.84 inches Hg. The student pilot, age 58, had a logbook endorsement, dated June 15, 2013, for solo cross country flights. His last logbook flight time entry, August 10, 2013, indicated 95 hours of total flight time. Per the NTSB Medical Factual Report: "According to the pilot's FAA medical record, the then-56-year-old student pilot first applied for a medical certificate in May, 2012. At that time, he reported having Type 2 diabetes and listed Lantus and lisinopril as his medications. Lantus is a brand name for insulin glargine, a long acting form of injectable insulin, used to treat diabetes. Lisinopril is an ACE-inhibitor also sold as Prinivil, used to treat hypertension and prevent kidney disease in diabetic patients. The note from the AME [Aviation Medical Examiner] indicated that his review of the pilot's primary care medical records demonstrated the pilot had also been prescribed Tricor, Liptior, and glipizide. Tricor (also called fenofibrate) and Lipitor (also called atorvatstatin) are used to treat high cholesterol. Glipizide (also called Glucoctrol) is a long acting sulfonylurea used to treat diabetes. The…AME deferred the application for review by the FAA as is the standard described for diabetic pilots using insulin in the FAA's Guide for Aviation Medical Examiners. The FAA sent the pilot a letter dated June 19, 2012 that denied his application for a medical certificate and cited that the major issue was the concomitant use of insulin and glipizide to treat his diabetes. In combination, these two drugs may increase the risk of hypoglycemia. In a letter dated June 26, 2012, the pilot's primary care physician wrote the FAA to state that the pilot had stopped glipizide and was only using Lantus to treat his diabetes. In a letter [dated] August, 2012, the pilot's endocrinologist wrote to report the pilot's continued use of Lantus alone to treat his diabetes. In a letter dated September 12, 2012, the FAA wrote the pilot to award him a special issuance third class medical certificate limited by the statement, "Not valid for use after 5/31/2013. Not valid outside the borders of the United States." The letter further described the information [the pilot] would need to provide the FAA before May 2013 to allow him to have a new medical certificate at that time. One of the pieces of information the pilot submitted included a dobutamine stress echocardiogram (a chemical stress test) that was reported as normal. In addition, serial measurements of his HgbA1c (a measurement of average blood sugar over 6-9 weeks) were included. These ranged from 6.1 to 6.4%, indicating good control of his blood sugar. On his application for a medical certificate in May 2013, the student pilot reported 60 total flight hours with20 in the most recent 6 months. He listed his medications as "Lantus, aspirin, and lisinopril". However, the records he provided the FAA included Tricor, Lipitor, and Bydureon. Bydureon is an extended-release formulation of exenatide, administered as an injection once every 7 days for the treatment of diabetes. The note including this information identifies the provider at the visit was the AME and the purpose of the visit was for an aviation medical exam. However, the length of time Bydureon had been prescribed was not included. In combination with other antidiabetic medicines, Bydureon may increase the risk of hypoglycemia; the FDA prescribing information states, 'The concurrent use of Bydureon with insulin has not been studied and cannot be recommended.'" It is unknown if or what precautions the pilot may have taken on the day of the accident or what the pilot's eating schedule was. On-scene documentation revealed that the airplane impacted the ground to the left of, and about 2,000 feet from the beginning of runway 29. A wreckage trail began an estimated 50 feet left of the runway with green lens material and the remnants of the right wingtip position light. About 20 feet beyond that, heading about 220 degrees magnetic, there was a 4-foot impact crater in the sandy soil. About 250 degrees, 60 feet beyond the crater, the airplane came to rest upright, facing opposite the direction of takeoff. All flight control surfaces were located at the accident scene, and flight control continuity was confirmed to all flight control surfaces, except that the aileron interconnect cable was separated in a broomstraw manner consistent with overload. The flaps were up. The airplane's engine compartment was bent to the right, and the underside exhibited upward and rearward crushing. The nose landing gear was fractured. The outer 2 feet of the right wing exhibited aft crush, and the right wingtip was deformed upward. The two control yokes were bent downward and to the right. There were no shoulder harnesses installed in the airplane. The propeller exhibited chordwise scratching and streaking on both blades, with burnishing on the leading edge of one blade. Engine crankshaft continuity, compression, and spark were all confirmed. The fuel selector was in the "Both On" position, and a fuel sample taken was absent of water and debris. The tachometer indicated 4,242.7 hours.