# NTSB LAX94LA160: American Champion 8KCAB, N189AC, Marana, AZ, March 12, 1994 - Type: NTSB accident investigation - Classification: Accident · Fatal · Limited investigation · Final report - Date: March 12, 1994, 10:35 local (17:35 UTC) - Place: Marana, AZ - Coordinates: 32.449787, -111.290802 (estimated) - Nearby events: https://openairdocs.org/map.md?lat=32.4498&lon=-111.2908&mi=10 - Phase of flight: [Maneuvering](https://openairdocs.org/ntsb-phases/450) (OpenAirDocs' grouping) - Highest injury: Fatal - Injuries: 1 fatal - Status: Completed, report November 14, 1994 - Report: Approved by Office Director - NTSB case key (mKey): 28694 - NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=LAX94LA160 - NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/28694/pdf - Page: https://openairdocs.org/ntsb/LAX94LA160 ## Probable cause The pilot's delayed pullout from a vertical aerobatic maneuver for undetermined reasons. ## Sequence of events In NTSB's coding before 2008 (https://www.ntsb.gov/GILS/Documents/codman.pdf). - In flight collision with terrain/water, maneuvering - maneuver - initiated, pilot in command - pull-up - delayed, pilot in command (cause) - reason for occurrence undetermined ## Analysis The accident was witnessed by several International Aerobatic Club judges, who were grading the pilot's aerobatic routine. The pilot performed the 1994 Intermediate Known Sequence, which was to be followed by a hammerhead turn course reversal to include a 1/4 roll on the up line and a 1/4 roll on the down line. After the hammerhead turn, the aircraft was descending on the vertical line and the witnesses did not see the pilot attempt to pull out until very near the ground when a 10- to 15-degree attitude change was noted. The witnesses said the engine continued at near full power throughout the maneuver to ground impact. All of the aircraft components were accounted for in the wreckage path. The entire flight control system was documented, with no discrepancies noted. ## Factual narrative On March 12, 1994, at 1035 mountain standard time, an American Champion 8KCAB, N189AC, collided with terrain while engaged in aerobatic maneuvers near Marana, Arizona. Visual meteorological conditions prevailed at the time and no flight plan was filed. The aircraft was destroyed in the ground collision sequence and the airline transport pilot, the sole occupant, sustained fatal injuries. The flight originated from the Avra Valley airport on the day of the accident at 1015 hours for a local area aerobatic flight. The accident was witnessed by several International Aerobatic Club judges, who were grading the pilot's aerobatic routine. According to the witnesses, the pilot performed the 1994 Intermediate Known Sequence, which was to be followed by a hammerhead turn course reversal to include a 1/4 roll on the up line and a 1/4 roll on the down line. After the hammerhead turn, the aircraft was descending on the vertical line and the witnesses did not see the pilot attempt to pull out until very near the ground when a 10- to 15-degree attitude change was noted. The witnesses said the engine continued at near full power throughout the maneuver to ground impact. According to a Federal Aviation Administration (FAA) inspector, ground scars and the extensively fragmented aircraft wreckage debris were found distributed on the flat desert terrain on a southeast to northwest line. A median bearing line through the ground scars and debris measured about 500 feet in length. At the request of the National Transportation Safety Board, the aircraft was examined by the holder of an FAA airframe and powerplant mechanic's certificate, who also holds an inspection authorization. According to his written report of the examination, all of the aircraft components were accounted for in the wreckage path. The entire flight control system was documented, with no discrepancies noted. An autopsy was performed by the Pima County Medical Examiner's Office, with specimens retained for toxicological analysis. The analysis was performed by the FAA Civil Aeromedical Institute, who reported negative results for alcohol and all screened drug substances. ## Aircraft - Registration: N189AC (not matched to a registry record) - Reported make and model: American Champion (ACAC) 8KCAB - Category: Airplane - Serial number: 721-93 - Airframe hours: 84 - Engines: LYCOMING AEIO-360-H1A 180 horsepower reciprocating - Damage: Destroyed - Flight: Personal, Part 91 - Operator: Michael P. Ilyin - Registered owner: Paul E. Shepley - Airworthiness certificate: Standard, Aerobatic - Last inspection: Annual, October 14, 1993, 84 hours before - Departed: E14, AVRA VALLEY, AZ ## Flight crew As NTSB recorded them. NTSB leaves out names. - Pilot; age 53; commercial, flight engineer, airline transport, flight instructor; airplane ratings: multi-engine land, single-engine land; instrument ratings: airplane; medical: class 1, valid medical--w/ waivers/lim; seat: front; toxicology performed; flight hours: 20,000 total, 45 in this make and model ## Weather - Conditions: Visual (VMC), Day - Wind: 360° at 4 knots - Visibility: 40 statute miles - Lowest ceiling: none - Temperature: 63 °F, dew point 36 °F - Altimeter: 30.00 inHg - Observed at: TUS, 22 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 19940312004839A](https://openairdocs.org/incident/19940312004839A), Mar 12, 1994: Bbavia 8KCAB, Marana, AZ, Destroyed, 1 fatal. Descended vertical after hammerhead stall. Slight attempt to pull out. Was in aerobatic judging contest. 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.