Aviation Accident Summaries

Aviation Accident Summary IAD00FA079

JONESTOWN, PA, USA

Aircraft #1

N9436V

Mooney M20F

Analysis

The pilot aborted a landing on a private sod strip 1,800 feet in length. The runway was oriented approximately 090 and 270 degrees magnetic, with trees at the east end, and trees, houses, and power lines at the west end. The pilot landed to the west with a 14-knot tailwind. During the aborted landing, the airplane struck wires, stalled, rolled inverted, and crashed beyond the departure end of the runway. Examination of the wreckage revealed no pre-impact anomalies. Interpolation of performance charts revealed that the airplane required 1,754 feet of runway to land over a 50-foot obstacle with a 14-knot tailwind. A review of pharmacy records and toxicological testing revealed the pilot had ingested an unapproved pain medication prior to flight.

Factual Information

HISTORY OF FLIGHT On August 29, 2000, at 1554 eastern daylight time, a Mooney M20F, N9436V, was destroyed when it collided with a power line and terrain during an aborted landing at the Dee Jay Airport (8PA1), Jonestown, Pennsylvania. The certificated private pilot/owner was fatally injured. Visual meteorological conditions prevailed for the personal flight that originated at Deck Airport (9D4), Lebanon, Pennsylvania, about 1540. No flight plan was filed for the flight conducted under 14 CFR Part 91. Dee Jay Airport was a private sod strip 1,800 feet in length. The runway was oriented approximately 090 and 270 degrees magnetic, with trees at the east end, and trees, houses, and power lines at the west end. Traffic that landed to the west negotiated an uphill runway with a slight "dogleg" to the left. A three-way road intersection was immediately beyond the departure end of runway 27. One road ran north/south across the runway end, and the other road continued away from the airport oriented approximately 240 degrees magnetic. One witness said he was traveling eastbound in his truck directly towards the airport when the accident airplane came into view. According to the witness: "He was going west and I was going east. He came up over the corn. He was directly on top of me. It looked like he was coming up and he hit the right wing on the wires. He hit the orange ball and it looked like he was going to land on me and my kids. I didn't know whether to hit the gas or the brakes. It looked like he got up over those lines and turned too soon. He hit the wires, the wings started rocking, and he went right over. After he hit the wires, it just didn't look like he was going fast enough." When asked to describe the airplane's engine noise, the witness said: "When he came up over the corn, he was buzzing good. It sounded okay." An off-duty trooper with the Pennsylvania State Police was driving south towards the departure end of the runway. He said the airplane came into view from the east and passed from his left to his right. He said: "I'm coming south down the road. The first thing that caught my eye was; I saw the orange ball come flying through the air. The airplane went up in the air and spun around. It banked to the left, spun to the left, then went straight down." When asked to describe the airplane's engine noise, the trooper said: "I never heard it. I'm pretty sure I had my windows up." A third witness turned eastbound from his driveway towards the airport when he saw the accident airplane. He said: "I pulled out of the driveway and saw the airplane coming over the cornfield. The wings were wobbling then it nose dived into the ground." In an interview, the owner/operator of the Dee Jay Airport said the pilot was scheduled to bring the airplane to him for an annual inspection. He said he had performed the annual inspections on the airplane for the past 10 years. The airport owner said he did not hear the airplane on arrival, and learned of the accident when his hanger lost electrical power and he went outside to investigate the cause. The accident occurred during the hours of daylight at 40 degrees 24 minutes north latitude and 076 degrees 13 minutes west longitude. PERSONNEL INFORMATION The pilot held a private pilot certificate with ratings for airplane single engine land, multi-engine land, and instrument airplane. He was issued a third class medical certificate on March 6, 2000, and reported 3,410 hours of flight experience on that date. The pilot's flight records were not immediately recovered. However, loose-leaf handwritten logs found in the airplane reflected dates, tachometer times, and fuel and oil purchases. The dates and tachometer times were consistent with those in the maintenance logbooks. The logs revealed the pilot accrued 11.8 hours of flight time since January 2000. According to the log, the pilot's most recent flight was May 14, 2000, and was 7/10 of an hour in duration. The pilot's logbooks were found several months after the accident. During a telephone interview, the pilot's wife explained that the times could not be reconciled. Some of the pilot's loose-leaf logs were with the logbooks, but the times had not been transcribed into the logs. During the interview, the pilot's wife was able to provide a general overview of the pilot's experience by reviewing the logs and the pilot's military records. The records reflected approximately 2,400 hours of single engine experience, 51 hours of multi-engine experience, and 950 hours of helicopter experience. She estimated that the pilot had about 2,000 hours of experience in the Mooney M20C and the Mooney M20F. AIRCRAFT INFORMATION Examination of the maintenance records revealed the last annual inspection was completed on July 9, 1999. An overhauled engine was installed in the airplane on December 8, 1999, and the airplane logged 22.2 hours of operation since that date. A new 'zero time' tachometer was installed January 18, 2000. The tachometer displayed 11.8 hours at the accident scene. METEOROLOGICAL INFORMATION At the time of the accident, the weather reported at Harrisburg, Pennsylvania, 18 miles southwest of Dee Jay Airport was broken ceiling at 2,600 feet with winds from 090 degrees at 14 knots. Witnesses reported the winds at the time of the accident were from the east and described them as "strong", "very strong", and "fairly heavy." WRECKAGE AND IMPACT INFORMATION The wreckage was examined at the site on August 30, 2000, and all major components were accounted for at the scene. Rescue personnel cut the windshield and roof posts and removed the roof. The distance from the end of the runway to the initial ground scar was approximately 660 feet. The wreckage path was oriented 260 degrees magnetic and the distance from the initial ground scar to the main wreckage was approximately 78 feet. The airplane came to rest upright, and faced opposite the direction of travel. The propeller was separated from the engine and was found 21 feet from the initial ground scar. The propeller blades displayed similar twisting, bending, leading edge gouging, and chordwise scratching. The engine was crushed up, aft, and over the instrument panel. The instrument panel was destroyed and crushed aft of the cockpit into the cabin area. The fuel system was intact. There was no odor of fuel and no evidence of fuel spillage at the scene. The right fuel tank was full. Examination of the left fuel tank revealed the fuel level was down approximately 4 inches from the fuel port opening. The instrument panel, flight controls, and engine controls were completely destroyed by impact. Control continuity was established from the flight control surfaces to the cockpit area. The fuel selector was in the 'Left Tank' position. The leading edges of both wings were crushed aft in compression. The empennage displayed compression buckling of the aircraft skin forward of the tail section. The landing gear was down and impact damaged. The nose gear doors were open, and the nose gear was crushed and bent back into the well. The left main landing gear was separated from its mounts and attached by a control tube. The right main gear was collapsed back into its well. MEDICAL AND PATHOLOGICAL INFORMATION The coroner for Lebanon County, Pennsylvania, performed an autopsy on August 31, 2000. The Federal Aviation Administration (FAA) Toxicology and Accident Research Laboratory performed toxicological testing on November 22, 2000. The painkiller Tramadol was detected in the liver, urine, and blood. A concentration of 0.131 (ug/ml, ug/g) was measured in the blood. During a telephone interview, the pilot's wife stated that her husband hurt his back lifting boxes on or about August 14, 2000. She said he aggravated the injury on August 23, 2000, while helping their daughter move to college, and saw a doctor on August 24, 2000. Examination of pharmacy records revealed the pilot filled a prescription for Ultram (Tramadol) on August 24, 2000. According to the Physician's Desk Reference, a precaution listed for the use of Tramadol was: "Tramadol HCI may impair mental or physical abilities required for the performance of hazardous tasks such as driving a car or operating machinery." Information was extracted by the Safety Board Medical Officer from the journal article "Assessment of analgesia in man: tramadol controlled release formula vs. tramadol standard formulation" by T. Hummel et. al. published in the European Journal of Clinical Pharmacology (1996) v. 51, pp. 31-38. The article reported on a study that compared 3 different preparations and dosages of tramadol in 20 healthy volunteers. Each subject underwent a variety of evaluations before, and 2, 4, 6, and 12 hours after receiving a dose of each tramadol formulation. The three formulations studied were 100mg of tramadol in standard formulation, 100mg of tramadol in a controlled release formulation, and 150mg of tramadol in a sustained release formulation. The article noted, "in order to detect changes in the state of vigilance, subjects were requested to perform a tracking task on a video screen." It further noted that "tramadol produced a decrease in tracking performance throughout the sessions." TESTS AND RESEARCH The engine was examined on the airframe at the scene, and was rotated by hand. The engine was rotated through the accessory section and continuity was established through the powertrain, valvetrain, and accessory sections. Compression was confirmed using the thumb method and both magnetos produced spark at all terminal leads. ADDITIONAL INFORMATION Interpolation of model M20F performance planning charts by Mooney flight test engineers revealed that, with a 14-knot tailwind component, the computed landing distance over a 50-foot obstacle was 1,754 feet. The airplane wreckage was released on October 4, 2000, to a representative of the owner's insurance company.

Probable Cause and Findings

The pilot's delay in aborting the landing, which resulted in a collision with transmission wires. Factors in the accident were the pilot's improper inflight decision to attempt a landing with a 14-knot tailwind, and his use of an unapproved pain medication.

 

Source: NTSB Aviation Accident Database

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