WPR19FA172

NTSB accident investigation · Nanchang CJ6 · Porter Ranch, CA · June 15, 2019

Accident · FatalClass 3 · FieldFinal report
Date
June 15, 2019, 09:10 local (16:10 UTC)
Place
Porter Ranch, CA · mountainous terrain
Injuries
1 fatal
Damage
Substantial damage
Phase of flight
Enroute
Aircraft
N269AGNanchang CJ6
Defining event
Enroute-cruise: Controlled flight into terr/obj (CFIT)
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
20190615007049A
Case key
99631

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 continued flight into marginal visual meteorological conditions, which resulted in controlled flight into terrain.

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.

Ceiling/visibility/precip: low ceilingEnvironmental issues › Conditions/weather/phenomena · Decision related to conditionNanchang China CJ-6A: 1 caseAll aircraft: 190 cases

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.

Analysis

After departure, the airplane maneuvered around the coastline and then flew on a northerly heading toward the destination airport. During the final segment of the flight, the airplane gradually climbed from an altitude of 2,300 ft mean sea level (msl) to an altitude of 3,025 ft msl before being lost off radar. The airplane impacted rising terrain, in a level attitude, at an elevation of about 3,000 ft. Recorded weather information indicated marginal visual meteorological conditions prevailed at the time of the accident. The lowest cloud layer was reported as overcast at 1,300 ft above ground level (agl); however, the cloud layer was likely lower at the higher elevation of the accident site. Weather advisories for instrument meteorological conditions and mountain obscuration were in effect at the time of the accident; however, it is unknown whether the pilot obtained weather information for the flight before his departure. Postaccident examination of the airplane revealed leading edge damage to both wings and crushing damage to the front section of the airplane, indicative of a controlled flight into terrain. No evidence was observed of any preimpact mechanical malfunctions or failures that would have precluded normal operation. Toxicology testing of the pilot’s blood detected the presence of two sedating medications: diphenhydramine and zolpidem. However, the medications were detected at levels not likely to have a significant impact on performance. Thus, effects from the pilot’s use of these medications likely did not contribute to the accident. Based on the level attitude of the airplane when it impacted the rising terrain, it is likely the pilot encountered a cloud layer en route to his destination and was unable to see the terrain before impact because it was obscured by the low cloud ceiling.

Factual narrative

On June 15, 2019, about 0910 Pacific daylight time, an experimental Nanchang CJ6 airplane, N269AG, sustained substantial damaged when it was involved in an accident near Porter Ranch, California. The airline transport pilot was fatally injured. The airplane was operated as a Title 14 Code of Federal Regulations Part 91 personal flight. According to radar data provided by the Federal Aviation Administration (FAA), the airplane departed Zamperini Field Airport (TOA), Torrance, California, and the first radar data point was recorded at 0845:10, just north of TOA. The airplane flew on a northeast heading, then a northerly heading, before turning back to a northwest heading and finally a northerly heading again, roughly following the coastline. During the final segment of the flight, from 0902:38 to 0903:31, the airplane gradually climbed from an altitude of 2,300 ft mean sea level (msl) to an altitude of 3,025 ft msl before it was lost off radar. The wreckage was located on 45º sloping terrain at an elevation of about 3,000 ft. The airplane remained intact, and the debris field was contained to the main wreckage. The nose section of the airplane displayed aft crushing damage. The undercarriage, as well as the undersides of both wings, sustained upward crush damage. The inboard sections of both wings were partially separated at the root and crushed. Leading edge damage was also observed on both wings. The empennage remained attached to the fuselage but had partially separated. The tail section had minor damage. Flight control continuity was confirmed from the cockpit to each flight control surface. The engine remained attached to the airframe and the propeller hub assembly remained attached to the crankshaft. The airplane was removed from the accident site and a postaccident examination of the wreckage was conducted. The crankshaft was rotated by hand using the propeller and rotational continuity was established throughout the engine and valve train. The cylinders were examined internally using a lighted borescope; no evidence of any mechanical malfunction was observed. Both the left and right magnetos produced spark on all ignition leads when the drive shafts were rotated using a hand drill. Examination of the automotive-style spark plugs revealed normal operational signatures. Satellite weather information for the time of the accident indicated low stratiform clouds over the accident area likely associated with a marine cloud layer. Instrument meteorological conditions (IMC) were reported at the closest airport to the accident site prior to the accident, with marginal visual meteorological conditions (VMC) prevailing at the time of the accident. The lowest cloud layer was reported as overcast at 1,300 ft above ground level (agl); however, conditions were likely lower at the higher elevation of the accident site. Airmen’s meteorological information advisories for IMC and mountain obscuration were in effect at the time of the accident. Although thepilot held an instrument rating, his recent instrument experience is unknown. An autopsy of the pilot was performed by the County of Los Angeles, Department of the Medical Examiner – Coroner, which listed the cause of death as “blunt trauma.” Toxicology testing performed at the Federal Aviation Administration Forensic Sciences Laboratory identified 44 (ng/mL) diphenhydramine in the pilot’s cavity blood and in his liver tissue. Tadalafil was detected in the pilot’s muscle and liver tissue but not quantified. Zolpidem was detected in the pilot’s heart blood and liver tissue but also not quantified. Diphenhydramine is a sedating antihistamine (commonly marketed as Benadryl) and is available over the counter in many products used to treat colds, allergies, and insomnia. Zolpidem is a sedative-hypnotic drug indicated for the short-term treatment of insomnia that is commonly marketed as Ambien. Tadalafil, commonly marketed as Cialis, was generally considered non-impairing.

Aircraft

Registration
N269AG
Reported as
Nanchang CJ6 (A)
Category
Airplane
Serial number
3532007
Built
1979
Damage
Substantial damage
Flight
Personal · Part 91
Airworthiness certificate
Special, Experimental (Special)
Departed
TOA · Torrance, CA
Destination
O22 · Columbia, CA
Equipment
ADS-B

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
66
Injuries
Fatal
Certificates
Airline transport, Flight instructor, Commercial
Airplane ratings
Multi-engine land, Single-engine land, Single-engine sea
Instrument ratings
Airplane
Medical
Class 2, With waivers/limitations
Seat
Center
Toxicology
Performed
Flight hours
12,500 total · 80 in this make and model

Weather

Conditions
Visual (VMC) · Day
Wind
160° at 5 knots
Visibility
7 statute miles
Lowest ceiling
1,300 ft overcast
Temperature
63 °F, dew point 57 °F
Altimeter
29.95 inHg
Observed at
VNY, 8 nm away

Docket · 9

The files NTSB released with the investigation on August 10, 2022, on NTSB’s docket system: statements, records, photos and specialists’ reports. 6.7 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.