- Date
- May 15, 2019, 11:51 local (18:51 UTC)
- Place
- Pleasant Grove, CA · open field
- Injuries
- 2 fatal
- Phase of flight
- Enroute
- Defining events
- Enroute: Midair collisionEnroute: Midair collision
- Weather
- Visual (VMC) · Day
- Status
- Completed
- Report
- Approved by Office Director
- Investigation class
- Class 3
- NTSB office
- Western Pacific Region
- Parties
- Federal Aviation Administration
- FAA report
- 20190515024112A
- Case key
- 99431
From the NTSB’s public API. By law, NTSB reports can’t be used as evidence in lawsuits over the accident.
On this page
Probable cause
The failure of both pilots to see and avoid the other airplane, which resulted in a midair collision.
Findings · 2
NTSB’s coded findings. Those marked are part of the probable cause; the rest are factors or other findings. Under each, the cases with the same finding.
N6787K · Grumman G164
N6929K · Grumman G164
Sequence of events
The events NTSB coded, in order, by phase of flight. The defining event is the one that best describes the accident. Under each, the cases with the same event anywhere in their sequence.
N6787K · Grumman G164
N6929K · Grumman G164
Analysis
The pilot of the white airplane departed to the south on the agricultural application flight, enroute to a field over which he was going to spread rice seed. At the same time, the pilot of the yellow airplane had just completed his agricultural application flight and was flying north/northwest to return to his departure airport. The two airplanes collided midair and subsequently impacted terrain; both pilots were fatally injured. Examination of the airplanes revealed no evidence of any mechanical malfunctions or anomalies. Day visual meteorological conditions prevailed in the area of the accident site at the time of the accident. Neither air traffic control radar data nor Automatic Dependent Surveillance – Broadcast (ADS-B) flight track information was available for either airplane. Autopsy of the pilot of the yellow airplane revealed severe coronary atherosclerosis and an enlarged heart, which placed him at increased risk for a sudden cardiac event including a heart attack or arrhythmia that could cause acute symptoms such as chest pain, shortness of breath, palpitations, or fainting without leaving evidence on autopsy of an acute event. However, given the circumstances of the accident, it is unlikely that the pilot’s medical condition was a factor in the accident. Toxicology testing revealed that the pilot of the yellow airplane had used cannabis. The primary psychoactive compound, THC, was found in his blood at a low concentration (1.7 ng/mL); the short-lived psychoactive metabolite 11-hydroxy-delta-9-THC was detected in urine and not blood. The non-psychoactive metabolite, THC-COOH, was found in blood and urine. THC blood concentrations in the first few hours after inhalation are commonly 50 times higher than what was found in the pilot’s blood, suggesting that the cannabis use was not within the last few hours. Since both THC and THC-COOH can be detected in blood weeks after using cannabis, concentrations cannot be used to demonstrate that the pilot was impaired at the time of the accident. While there may be residual effects from using cannabis, peak effects typically occur in the first few hours. Given the low concentration of the psychoactive compounds and the circumstances of the accident, it is unlikely that the effects of the pilot’s use of cannabis contributed to the accident. Based on the available information, it is likely that the pilots of both airplanes failed to see and avoid the other airplane, which resulted in a midair collision.
Factual narrative
On May 15, 2019, at 1151 Pacific daylight time, a Grumman Aircraft Corporation-Schweizer G-164C, N6787K, and a Gulfstream-Schweizer Aircraft Corporation Gulfstream AM G-164D, N6929K, were substantially damaged when they collided midair near Pleasant Grove, California. The two pilots were fatally injured. Both airplanes were operated as Title 14 Code of Federal Regulations Part 137 aerial application flights. The pilot of N6787K (the white airplane) departed on his first flight of the day to apply rice seed to a field about 3 nautical miles southeast of the departure point. The pilot of N6929K (the yellow airplane) departed from a different airstrip to spread rice seed on another field. The pilot of the white airplane was flying south toward the field he intended to treat, while the pilot of the yellow airplane had completed his application and was flying in a north/northwesterly direction while returning to the departure airstrip to land when the collision occurred. A witness near the accident site reported that he saw the yellow airplane fly south and spray the field behind his location. The airplane banked east, turned around, and flew north to spray another field. He looked away, and seconds later, heard the sound of an impact. When he looked back toward the airplane, he saw the white airplane in a “nosedive” toward a field and also saw the yellow airplane crash into a rice field. There was no Federal Aviation Administration (FAA) air traffic control radar data associated with either airplane. A SATLOC agricultural GPS unit recovered from the yellow airplane revealed its flight track on the day of the accident. (see Figure 1.) A similar unit recovered from the white airplane did not contain any recorded data from the day of the accident. Figure 1. Flight track information obtained from N6929K (yellow airplane) An autopsy was performed on the pilot of the white airplane by the County of Sacramento Department of Coroner. The cause of death was multiple blunt force injuries. No significant natural disease was identified. Toxicology testing by the FAA Forensic Sciences Laboratory identified the non-sedating antacid medication ranitidine in the pilot’s urine. An autopsy of the pilot of the yellow airplane was performed by the County of Sacramento Department of Coroner. The cause of death was multiple injuries. The autopsy identified an enlarged heart (470 grams) and severe atherosclerosis with 70 to 90% narrowing in several coronary arteries and branches. Toxicological testing by the FAA Forensic Sciences Laboratory identified delta-9-tetrahyrdocannabinol (THC) at 1.7 ng/mL in the pilot’s femoral blood. 11-hydroxy-delta-9-THC, and carboxy-delta-9-THC (THC-COOH) were identified in urine at 9.9 ng/mL and 15.8 ng/mL, respectively. The non-impairing high blood pressure medications amlodipine and valsartan were detected in blood and urine. The cannabis plant (Cannabis sativa) contains chemicals called cannabinoids; tetrahydrocannabinol (THC) is theprimary psychoactive cannabinoid compound. THC's mood-altering effects include euphoria and relaxation. In addition, cannabis causes alterations in motor behavior, perception, and cognition. Significant performance impairments are usually observed for at least 1-2 hours following cannabis use, and residual effects have been reported up to 24 hours. THC is rapidly metabolized, but the rate of metabolism is not linear and depends on the means of ingestion (smoking, oil, and edibles), potency of the product, frequency of use, and user characteristics. The primary metabolite, 11-hydroxy-delta-9-THC, is equally psychoactive, but is rapidly metabolized to the non-psychoactive metabolite THC-COOH. THC is fat soluble, so is stored in fatty tissues and can be released back into the blood long after consumption. So, while the psychoactive effects may last a few hours, THC can be detected in the blood for days or weeks. Commonly, peak THC concentrations of 100-200 ng/mL occur soon after smoking cannabis and are generally below 5 ng/mL after 3 hours. Very little THC is excreted in urine. Instead, THC-COOH can be found in urine days to weeks after the last use of the drug. Thus, both blood and urine test results do not necessarily reflect recent use and cannot be used to prove that the user was under the influence of the drug at the time of testing. The wreckage and debris path was distributed over about ¼ mile of rural agricultural terrain. The yellow airplane impacted a flooded rice field, while the white airplane came to rest in a dry field south of the yellow airplane. Various debris associated with both airplanes was located between the two main wreckage sites. The white airplane came to rest on its left side adjacent to an unpaved road. The airplane was mostly intact; the engine remained attached to the airframe and the propeller remained attached to the engine. The left lower wing was located about 140 ft from the main wreckage. A yellow aileron and a portion of a yellow wing strut were located near the white airplane’s left lower wing. Flight control continuity was established with no anomalies noted. The yellow airplane was not accessible at the accident site due to its location in the flooded rice field. The majority of the airplane was within the confines of the main wreckage. The engine separated and forward of the main wreckage. The propeller assembly separated from the crankshaft.
Aircraft · 2
- Registration
- N6787K
- Reported as
- Grumman G164 (C)
- Category
- Airplane
- Serial number
- 37 C
- Built
- 1978
- Airframe hours
- 12,155.6
- Engine
- Allied Signal TPE331, 840 horsepower, turbo prop
- Damage
- Substantial damage
- Fire
- On-Ground
- Flight
- Aerial application · Part 137
- Operator
- Moe's Crop Dusting Service Inc.
- Registered owner
- Haughey Burton A
- Airworthiness certificate
- Special, Restricted (Special)
- Last inspection
- Annual · April 5, 2019
- Departed
- Pleasant Grove, CA
- Destination
- Pleasant Grove, CA
- Flight plan
- Company VFR
- Airport
- 25CL · Van Dyke Strip
- Equipment
- Satellite tracking device
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.
- Registration
- N6929K
- Reported as
- Grumman G164 (D)
- Category
- Airplane
- Serial number
- 3 D
- Airframe hours
- 13,278.3
- Engine
- Pratt and Whitney PT6A-34, 1,000 horsepower, turbo prop
- Damage
- Substantial damage
- Flight
- Aerial application · Part 137
- Airworthiness certificate
- Special, Restricted (Special)
- Last inspection
- Annual · April 11, 2019
- Departed
- 25CL · Pleasant Grove, CA
- Destination
- 25CL · Pleasant Grove, CA
- Flight plan
- Company VFR
- Airport
- 25CL · Van Dyke Strip
- Equipment
- Stall warning system
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 · 2
As NTSB recorded them. NTSB leaves out names.
- Role
- Pilot, aircraft N6787K
- Age
- 58
- Injuries
- Fatal
- Certificate
- Commercial
- Airplane ratings
- Single-engine land
- Medical
- Class 2, With waivers/limitations
- Last flight review
- March 17, 2019
- Seat
- Center
- Restraint
- 5-point
- Toxicology
- Performed
- Flight hours
- 13,000 total
- Role
- Pilot, aircraft N6929K
- Age
- 62
- Injuries
- Fatal
- Certificate
- Commercial
- Airplane ratings
- Single-engine land, Multi-engine land
- Instrument ratings
- Airplane
- Medical
- Class 2, With waivers/limitations
- Seat
- Center
- Restraint
- 5-point
- Toxicology
- Performed
- Flight hours
- 7,950 total
Weather
- Conditions
- Visual (VMC) · Day
- Wind
- 170° at 7 knots
- Visibility
- 10 statute miles
- Lowest ceiling
- 8,500 ft broken
- Temperature
- 61 °F, dew point 55 °F
- Altimeter
- 29.84 inHg
- Observed at
- KLHM, 4 nm away
Docket · 9
The files NTSB released with the investigation on September 20, 2022, on NTSB’s docket system: statements, records, photos and specialists’ reports. 441 MB in all.
FAA reports on this event · 1
The FAA’s own accident and incident reports, matched to the aircraft by N-number and date.
Other investigations on N6787K · 1
Matched to the same aircraft by N-number and date.