# NTSB NYC91FA212: Beech 58, N104SB, Brookhaven, NY, August 16, 1991

- Type: NTSB accident investigation
- Classification: Accident · Fatal · Field investigation · Final report
- Date: August 16, 1991, 15:21 local (19:21 UTC)
- Place: Brookhaven, NY
- Coordinates: 40.780193, -72.910133 (estimated)
- Nearby events: https://openairdocs.org/map.md?lat=40.7802&lon=-72.9101&mi=10
- Phase of flight: [Approach](https://openairdocs.org/ntsb-phases/500) (OpenAirDocs' grouping)
- Highest injury: Fatal
- Injuries: 1 fatal
- Status: Completed, report May 5, 1993
- Report: Approved by Office Director
- NTSB case key (mKey): 36807
- NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=NYC91FA212
- NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/36807/pdf
- Page: https://openairdocs.org/ntsb/NYC91FA212

## Probable cause

PILOT PHYSIOLOGICAL INCAPACITATION WHICH RESULTED IN A LOSS OF CONTROL IN FLIGHT, AND AN UNCONTROLLED DESCENT INTO WATER.

## Sequence of events

In NTSB's coding before 2008 (https://www.ntsb.gov/GILS/Documents/codman.pdf).

- Loss of control - in flight, go-around (vfr)
  - incapacitation(organic problem), pilot in command (cause)
  - airspeed - not maintained, pilot in command (cause)
  - directional control - not maintained, pilot in command (cause)
  - stall/spin - inadvertent, pilot in command (cause)
- In flight collision with terrain/water, descent - uncontrolled
  - remedial action - not possible, pilot in command
  - terrain condition - water

## Analysis

WHILE ON A HEADING OF APPROX 270, THE PILOT WAS INSTRUCTED TO FOLLOW ANOTHER AIRPLANE INTO THE AIRPORT. HE DID NOT TURN IN ON FINAL AND CONTINUED FOR ALMOST 3 MILES. WHEN THE ATCT TOLD HIM TO TURN TO 180 FOR RESEQUENCING, HE TURNED TO 330, TOWARD THE AIRPORT AND STARTED A DESCENT FROM 2000 FEET. THE AIRPLANE DESCENDED TO 1600 FEET, AND THEN STARTED A CLIMB BACK TO 2000 FEET, WITH A SHALLOW LEFT TURN, CONTACTED APPROACH CONTROL AND CONTINUED THE TURN TO 150. THE RADAR DATA SHOWED THE AIRCRAFT SPEED STARTED TO DECREASE WHEN THE AIRPLANE CLIMBED. THERE WAS A CONTINUED DECREASE OF SPEED TO 44 KNOTS, AT WHICH POINT, THE AIRPLANE STARTED A DESCENT, FOLLOWED BY A LEFT SPIN, AND IMPACTED WATER. THE RADAR DATA SHOWED NO RAPID COURSE CHANGES PRIOR TO THE LOW POINT OF SPEED. THE AIR/GROUND TAPES SHOWED THE PILOT SOMETIMES TOOK ALMOST A MINUTE BETWEEN FREQUENCY CHANGES, AND HIS VOICE WAS INDECISIVE AND HESITANT. THE PILOT HAD BEEN TREATED FOR SEIZURES SINCE 1974. ANTI-SEIZURE MEDICATION WAS FOUND IN HIS TOXICOLOGICAL SAMPLES.

## Aircraft

- Registration: [N104SB](https://openairdocs.org/deregistered/N104SB-1992-02-18), registration cancelled 1992-02-18, S/N TH1071 (OpenAirDocs)
- Reported make and model: BEECH 58
- Registry model: [Beech 58](https://openairdocs.org/model/beech-58) (registry code 1152740) (OpenAirDocs)
- Category: Airplane
- Serial number: TH-1071
- Airframe hours: 1394
- Engines: CONTINENTAL I0-520-CB 285 horsepower reciprocating
- Damage: Destroyed
- Flight: Personal, Part 91
- Operator: John G. Lauchner
- Registered owner: C & L Direct Corporation
- Airworthiness certificate: Standard, Normal
- Last inspection: Annual, December 4, 1990, 67 hours before
- Departed: GON, GROTON, CT
- Destination: ISP, ISLIP, NY
- Airport: ISP, Mac Arthur

## Flight crew

As NTSB recorded them. NTSB leaves out names.

- Pilot; age 87; private; airplane ratings: single-engine land, multi-engine land; instrument ratings: airplane; medical: class 3, invalid medical for flight; seat: left; toxicology performed; flight hours: 7,800 total, 7,600 as pilot in command

## Weather

- Conditions: Visual (VMC), Day
- Wind: 310° at 10 knots
- Visibility: 10 statute miles
- Lowest ceiling: none
- Temperature: 88 °F, dew point 63 °F
- Altimeter: 29.00 inHg
- Observed at: ISP, 6 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 19910816034609A](https://openairdocs.org/incident/19910816034609A), Aug 16, 1991: Beech 58, Islip, NY, Destroyed, 1 fatal. Observed spinning into bay. Missed runway alignment. Circling to realign. Under medication for seizures. No medical

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.

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