NYC03FA132

NTSB accident investigation · Aviat A-1 · Tyringham, MA · June 19, 2003

Accident · FatalField investigationFinal report
Date
June 19, 2003, 17:25 local (21:25 UTC)
Place
Tyringham, MA
Injuries
1 fatal
Damage
Destroyed
Phase of flight
Landing
Aircraft
N49369Aviat A-1
Weather
Visual (VMC) · Day
Status
Completed · report October 28, 2004
Report
Approved by Office Director
Parties
Textron Lycoming, Massachusetts Aeronautics Commission, FAA FSDO Windsor Locks
FAA report
20030619013059A
Case key
57259

From the NTSB’s public API. By law, NTSB reports can’t be used as evidence in lawsuits over the accident.

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Probable cause

The pilot's incapacitation due to a heart attack, which resulted in a loss of aircraft control.

Sequence of events

NTSB’s coding before 2008: each occurrence and phase of flight, and the causes and factors under it. The codes are defined in NTSB’s coding manual.

Loss of control - in flightLanding
Aircraft control - not maintainedPilot in command
Incapacitation(cardiovascular)Pilot in commandCause
In flight collision with terrain/waterDescent - uncontrolled
Terrain condition - dirt bank/rising embankment

Analysis

Witnesses near the accident site recalled observing the airplane approach the airstrip heading north. The airplane then reversed its direction and began to head south. The witnesses then heard the airplane's engine quit, followed by the sound of a crash. The airplane came to rest about 300 yards beyond the airstrip, in a near vertical attitude, alongside a riverbank, where a post-crash fire ensued. The report of the autopsy performed on the pilot noted "Final Anatomic Diagnoses" including: "Multiple traumatic injuries," "Hypertrophy of heart," "Arteriosclerosis," and "Acute intramural hemorrhage." The "Clinical Summary" noted in part that the pilot had "a past medical history of coronary heart disease. " Review of the pilot's personal medical records revealed that he had a history of hypertension, elevated cholesterol, and coronary artery disease. Post-accident toxicological testing noted 11% carbon monoxide detected in the blood, and the prescription medications atenolol and diltiazem detected in blood and urine. Review of FAA medical records revealed that the pilot indicated on his two most recent applications for a third class medical certificate "No" in response to "Do You Currently Use Any Medication," have "Heart or vascular trouble," or "High or low blood pressure."

Factual narrative

History of flight

On June 19, 2003, at 1725 eastern daylight time, an Aviat A-1 Husky, N49369, was destroyed when it impacted terrain while departing a private airstrip near Tyringham, Massachusetts. The certificated private pilot was fatally injured. Visual meteorological conditions prevailed, and no flight plan was filed for the flight that originated from the Ellington Airport, Ellington, Connecticut. The personal flight was conducted under 14 CFR Part 91.

A witness near the accident site reported observing the airplane approach the airstrip heading north. The airplane then reversed its direction and began to head south. The witness then heard the airplane's engine quit, followed by the sound of a crash.

A second witness, who also observed the airplane approach the airstrip from the south, stated that the airplane descend below the tree line, as if it had landed. He then observed the airplane depart the airstrip in the reverse direction from which it had approached; however; he lost sight of it as it passed the departure end of the airstrip. The witness then recalled hearing the engine suddenly quit, followed by the sound of an impact about 1 second later.

The airplane came to rest about 300 yards beyond the airstrip, in a near vertical attitude, alongside a riverbank, where a post-crash fire ensued.

The accident occurred during the hours of darkness, at 41 degrees, 24.40 minutes north longitude, 70 degrees, 35.90 minutes west latitude, at an elevation of 55 feet.

Personnel information

The pilot held a private pilot certificate, with ratings for single-engine and multi-engine land, and instrument airplane. His most recent Federal Aviation Administration (FAA) third class medical certificate was issued on January 30, 2002. At the time, he reported approximately 2,100 hours of flight experience.

The pilot's flight logbook was not recovered during the investigation.

Aircraft information

The airplane's most recent annual inspection was performed on August 27, 2002. At that time, the airplane had accumulated approximately 406 hours of operation.

Meteorological information

The reported weather about the time of the accident, at Pittsfield Airport (PSF), Pittsfield, Massachusetts, about 13 nautical miles to the north, included winds from 330 degrees at 4 knots, visibility 10 miles, and clear skies.

Wreckage and impact information

The wreckage was examined at the accident site on June 20, 2003. The surrounding area consisted of flat land with scattered outcroppings of 40-foot trees, and a meandering, 20-foot-wide river.

About 18 feet north of the wreckage was an outcrop of three trees. Fractured limbs were observed at the top of one of the trees. Blue paint transfer was observed on the fracture surfaces.

All major components of the airplane were accounted for at the scene. The exposed airframe structure was intact and oriented about a 030-degree magnetic heading.

The left wing remained attached to the fuselage. It exhibited impact damage along the leading edge. The fuel tank was ruptured and melted. The left flap was observed in the retracted position.

The right wing also remained attached to the fuselage and was bent forward, with the outer portion of the wing resting in water. The wing, with some painted blue fabric remaining, was crushed along the leading edge. The fuel tank remained intact; however, the upward-facing edge of the tank exhibited evidence of outward bursting. The right flap was observed in the retracted position.

The cockpit area was crushed, and the instrument panel was destroyed. Flight control continuity was confirmed from all control surfaces to cockpit.

The engine remained attached to the fuselage; however, it was submerged in approximately 4 feet of water.

The engine was examined at a recovery facility on July 29, 2003, and no abnormalities were noted.

Medical and pathological information

Under the direction of The Commonwealth of Massachusetts, Department of Health, Office of the Chief Medical Examiner, an autopsy on the pilot was performed on June 20, 2003.

Review of the autopsy report by the Safety Board Medical Officer revealed:

The "Final Anatomic Diagnoses" included: "Multiple traumatic injuries," "Hypertrophy of heart," "Arteriosclerosis," and "Acute intramural hemorrhage." "Clinical Summary" noted in part that the pilot had "a past medical history of coronary heart disease, mild asthma, and prostatitis."

Medical Officer review of medical records provided under subpoena by the New York Presbyterian Hospital revealed:

Emergency room notes recorded on March 29, 1999 indicated "...history of hypertension, elevated cholesterol, coronary artery disease ...presents with 1 week of worsening jaundice ... recent travel to Chile ... daily fevers ... Past surgical history:

Percutaneous Transluminal Coronary Angioplasty 6 years ago (3 vessel, 'failed') no chest pain on meds .. Meds: Zocor [simvastatin], Cardizem [diltiazem], atenolol ... Assessment ... acute hepatitis - most likely viral ..."

On the pilot's application for a third class medical certificate, issued on February 7, 2000, the pilot indicated on the application, "No" in response to "Do You Currently Use Any Medication," and to "Heart or vascular trouble," "High or low blood pressure," and "Stomach, liver, or intestinal trouble." The pilot indicated "Yes" in response to "Admission to hospital," and "Other illness, disability, or surgery." Under "Explanations," the pilot noted, "NY Hospital - Hepatitis E ... 2/99 ..." Under the Aviation Medical Examiner's "Comments on History and Findings" it was noted, "...Hepatitis E in Chile, no sequelae, followup in NYC Hospital..."

On the pilot's most recent application for a third class medical certificate, issued on January 30, 2002, he indicated on the application, "No" in response to "Do You Currently Use Any Medication," and to all entries under "Medical History," including specifically: "Heart or vascular trouble," "High or low blood pressure," "Stomach, liver, or intestinal trouble," "Admission to hospital," and "Other illness, disability, or surgery." Under "Explanations," the pilot noted, "NY Hospital ... 2/99 ..."

The FAA Toxicology and Accident Research Laboratory, Oklahoma City, Oklahoma conducted toxicological testing on the pilot. This testing noted 11% carbon monoxide detected in the blood, and atenolol and diltiazem detected in blood and urine.

Additional information

Wreckage Release

The airplane wreckage was released on July 29, 2003, to a representative of the owners insurance company.

Aircraft

Registration
N49369
Reported as
Aviat A-1
Category
Airplane
Serial number
1265
Airframe hours
406
Engine
Lycoming O&VO-360, 180 horsepower, reciprocating
Damage
Destroyed
Fire
On-Ground
Flight
Personal · Part 91
Registered owner
Lenox Capitol
Airworthiness certificate
Special, Limited (Special)
Last inspection
Annual · August 27, 2002
Departed
7B9 · Ellington, CT
Destination
NONE · Tyringham, MA
Airport
NONE

Matched to the registry by N-number and the event date; the registry’s history has gaps, so older matches can be wrong. Compare the reported make and model.

Flight crew

As NTSB recorded them. NTSB leaves out names.

Role
Pilot
Age
61
Injuries
Fatal
Certificate
Private
Airplane ratings
Single-engine land, Multi-engine land
Instrument ratings
Airplane
Medical
Class 3, With waivers/limitations
Seat
Front
Toxicology
Performed
Flight hours
2,100 total

Weather

Conditions
Visual (VMC) · Day
Wind
330° at 4 knots
Visibility
10 statute miles
Lowest ceiling
None
Temperature
72 °F, dew point 57 °F
Altimeter
29.78 inHg
Observed at
PSF, 13 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.