Farmerville, LA, USA
N5134N
Cessna 182Q
The commercial pilot was supposed to be performing a flight to patrol a pipeline. However, he was flying in an erratic manner away from the pipeline he was suppose to be patrolling. In telephone communications with the pipeline company, he seemed "weird and disorientated." The airplane collided with trees and was destroyed by impact and post-impact fire. Examinations of the airframe and engine revealed no evidence of mechanical malfunctions or failures. Post-accident toxicological tests on specimens from the pilot found a blood ethanol level of 373 mg/dL (0.373 percent), and a urine ethanol level of 556 mg/dL, indicating that the pilot's blood level had been higher than 0.556 percent at some time within the previous 6 to 8 hours. Toxicology tests also detected a very high level of citalopram, a prescription antidepressant, and its metabolites in the pilot's blood, consistent with either ingestion of larger than typical amounts or accumulation of the substance as a result of liver impairment. On his most recent FAA application for a medical certificate less than one month prior to the accident, the pilot reported one Driving Under the Influence (DUI) conviction, which occurred less than 1 year prior to the accident; the FAA medical records contained no details of that DUI, but a review of publicly available court documents for the conviction noted that the pilot's blood alcohol concentration was 0.31 percent during that arrest. The pilot denied any history of alcohol dependence, abuse, or of mental disorders on his most recent application for medical certificate, though his employer was aware of his attendance at a rehabilitation program due to alcohol problems in 2006. The FAA specifically disqualifies pilot applicants with a history or clinical diagnosis of substance dependence, which is defined in 14 CFR 67.107, 67.207, and 67.307 as "evidenced by (A) increased tolerance, (B) manifestation of withdrawal symptoms, (C) impaired control of use, or (D) continued use despite damage to physical health or impairment of social, personal, or occupational functioning." Had the FAA obtained details regarding the pilot's DUI conviction and/or contacted the pilot's employer, the FAA would have been aware that this pilot met the FAA's definition for substance dependence, and he likely would have not been issued a medical certificate without having undergone thorough evaluation and additional treatment.
HISTORY OF FLIGHT On November 28, 2007, approximately 1235 central standard time, a Cessna 182Q single-engine airplane, N5134N, was destroyed when it impacted trees and terrain while maneuvering near Farmerville, Louisiana. The commercial pilot, who was the sole occupant, was fatally injured. The airplane was registered to and operated by Brentco Aerial Patrol, Inc., East Canton, Ohio. Visual meteorological conditions prevailed, and a flight plan was not filed for the Title 14 Code of Federal Regulations Part 91 aerial observation flight. The flight originated from Jackson, Tennessee, approximately 0700. Company personnel reported that the pilot was conducting an aerial observation "pipeline patrol" flight along the Mid-Valley pipeline from the Mississippi River to Longview, Texas. During the flight about 1130, the pilot contacted the pipeline company via cell phone to give required position and pipeline condition reports. According to the pipeline company representative that answered the pilot's telephone call, the pilot at first did not recognize the representative's voice or recall her name. This representative had spoken with the pilot on several occasions through the four years he was patrolling that pipeline. She stated the following about the conversation, "He usually is more precise, faster, and more descriptive. He took several pauses between each part of the report he gave me. I never have to say, 'ok continue,' but that day I had to say that several times. He took long pauses between each word he gave me. In between the downtime, I asked him if he was ok and that I heard he had been sick. He is usually more friendly and talkative, but barely responded and said, 'a little, I have been sick.' After giving me the reports, he said I cannot give you the [Global Positioning System] coordinates and descriptions to the reports at this time. [The pilot] also said that he dropped the papers on the floor of the plane...he replied, 'I'll call you right back.' After I hung up the phone, I stated to [other company representative] that [the pilot] sounded 'weird and disorientated' and that he would be calling back." No further communications were received by the company from the pilot. The airplane was equipped with a portable Garmin GPSMAP 295 global positioning system (GPS) receiver. A specialist with the NTSB's Vehicle Recorder Division extracted the data stored in the receiver. The GPS data from the unit contained 2 recorded tracks dated November 28, 2007. The accident flight began at 1048 with the aircraft in flight near Lake Providence, Louisiana, with a GPS altitude of 1,030 feet and a groundspeed of 144 miles per hour (mph). The airplane maneuvered in that area for approximately 31 minutes at altitudes from 515 and 1,289 feet. The airplane then turned and flew on a westerly course for about 40 miles with altitude varying between 601 feet and 1,290 feet. The airplane began maneuvering again in the area of Twin Oaks, Louisiana, for approximately 30 minutes at altitudes of 538 feet and 2,014 feet. The airplane then turned and flew on a westerly course again for about 30 miles with altitude varying between 601 and 1,290 feet. The airplane then began maneuvering in the area of Conway, Louisiana, for approximately 18 minutes with altitude varying between 409 and 1,131 feet. During this time, there was a break in the recorded position information lasting 17 seconds. The last GPS update was at 1235, at recorded a position of 32 degrees, 52.885 minutes north latitude, and 92 degrees, 32.158 minutes west longitude, at an altitude of 261 feet. The last computed groundspeed was 134 mph and course was 219 degrees true. During the afternoon hours on the day of the accident, the aerial patrol company and local pilots initiated a search for the airplane. On November 29, 2007, approximately 0845, the airplane was located in a heavily wooded area by local residents. PERSONNEL INFORMATION Flight Experience The pilot, age 46, held a commercial pilot certificate with single-engine land, multi-engine land, and instrument airplane ratings. The pilot also held a flight instructor certificate with single-engine land and instrument airplane ratings. The pilot was issued a second-class medical certificate on October 29, 2007, with a limitation for corrective lenses. According to the pilot's most recent medical certificate application, he had accumulated 5,840 total flight hours and 525 flight hours in the previous 6 months. Alcohol History The following medical information was extracted from the records maintained on the pilot by the FAA Aerospace Medical Certification Division. A review of the pilot's most recent application for an airman medical certificate revealed that he pilot checked the box "yes" in response to question 18.v. "History of (1) any conviction(s) involving driving while intoxicated by, while impaired by, or while under the influence of alcohol or a drug; or (2) history of any conviction(s) or administrative action(s) involving an offense(s) which resulted in the denial, suspension, cancellation, or revocation of driving privileges or which resulted in attendance at an educational or rehabilitation program." In the "explanations" area following that box, the pilot wrote "DUI Conviction, 4/24/2007 - Ohio". The pilot checked the box "no" in response to question 18.n., which queried if the applicant had, or currently has substance dependence. The Federal Aviation Administration (FAA) Aerospace Medical Certification Division records contained no indications of either a request for or receipt of additional documentation of the pilot's arrest or prior alcohol history. The pilot had reported his occupation on his previous 5 medical applications as a "Pilot" or "Flight Instructor." On January 5, 2007, a letter from the pilot to the FAA Internal Security and Investigation Division noted, in part, "In accordance with [Federal Aviation Regulation] 61.15(e), the following information is being provided: ...Charged with Driving under the influence of alcohol which resulted in the suspension of driver's license. Date of Action: November 13, 2006...This is the first report in relation to this motor vehicle action." The records also indicated a letter submitted by the pilot for a conviction for driving under the influence of alcohol in April 2007 for the same offense. A letter to the pilot from the manager of the FAA Aerospace Medical Certification Division noted, in part, "You are cautioned that any further alcohol related offenses, or evidence of alcohol abuse will require re-evaluation of your medical certification." There is no indication in the pilot's FAA medical records that any further information was requested related to the driving under the influence offense. The Safety Board Investigator-In-Charge obtained the court documents for the DUI conviction the pilot listed on his medical application. The Ohio State Highway Patrol arrested the pilot for driving while intoxicated at 2337, on November 13, 2006. A copy of the arrest report was requested, however, at the time of the request, the report had already been destroyed. The information contained in the court documents relating to the case revealed that the DUI blood test indicated the pilot's blood alcohol concentration (BAC) was 0.31 percent at the time of testing. During a telephone conversation with the owner of Brentco Aerial patrol, he stated the pilot was removed from flying in October 2006 due to "problems related to alcohol." The owner reported that the pilot completed a rehabilitation program and was then allowed to continue flying pipeline patrol. The company did not possess any records for the pilot pertaining to his completion of the rehabilitation program. The owner reported that the company had a random drug and alcohol testing program (not required by the FAA under Part 91), however, no records were available that indicated this pilot had been tested during his employment with the company. The owner reported that he was not aware of the pilot's DUI conviction from April 2007. AIRCRAFT INFORMATION The 1980-model Cessna 182Q, serial number 18267539, was a single-engine, high wing, fixed tri-cycle landing gear, semi-monocoque design airplane. The airplane was powered by a normally aspirated, direct drive, air-cooled, horizontally opposed, carburetor equipped, six-cylinder Teledyne Continental Motors O-470-U2B engine, serial number 466139, rated at 230 horsepower, and equipped with two-bladed constant speed propeller. The airplane was configured to carry a maximum of two occupants. The airplane was issued a standard airworthiness certificate for normal category operations. The airplane was registered to the owner on August 6, 1988. The maintenance logbooks were reported to be onboard the airplane at the time of the accident and were not located. METEOROLOGICAL INFORMATION At 1249, the Ruston Regional Airport (RSN), Ruston, Louisiana, weather observation facility, located approximately 20 miles southwest of the accident site, reported the wind from 240 degrees at 7 knots, visibility 10 miles, sky clear, temperature 17 degrees Celsius, dew point 5 degrees Celsius, and an altimeter setting of 30.20 inches of Mercury. Local authorities reported the weather at the time of the accident as clear skies and calm winds. WRECKAGE AND IMPACT INFORMATION The accident site was located in a pine tree plantation adjacent to a road at 32 degrees 52.857 minutes north latitude, and 92 degrees 32.170 minutes west longitude, at an elevation of approximately 230 feet mean sea level. The site was approximately 5 miles south of the pipeline that was to be patrolled. The main wreckage came to rest near a group of pine trees and the wreckage was distributed along a measured magnetic heading of 200 degrees, approximately 300 feet in length. The airplane was destroyed by a post-impact fire. Several pine trees were cut at various heights along the distribution path. The main wreckage consisted of the inboard sections of the left and right wings, the fuselage, and the empennage. The instrument panel and forward fuselage were destroyed and consumed by fire. The left and right wing tips were separated and located on the left and right side of the debris path, respectively. Both ailerons were fragmented and destroyed and located in the debris path. Flight control continuity to the ailerons could not be established. The empennage remained partially intact and separated from the airframe. Control continuity was established from the empennage control surfaces to the separation points located were the empennage separated from the airframe. The cable separations displayed broomstraw features. The left door was located within the main wreckage and right door was separated. The two forward seats were separated from their seat rails. The two lap belts for the forward seats were found unlatched. A 1.75 liter bottle of vodka, three-quarters empty with the bottle cap loosely screwed on, was found next to the pilot's body, which was lying forward of the main wreckage. The engine was separated from the airframe at the firewall. Continuity to the accessory gears and valve train was established, and thumb compression was noted on all cylinders. According to the engine manufacturer, "The inspection of the engine did not reveal any abnormalities that would have prevented normal operation and production of horsepower." The propeller assembly was separated from the engine crankshaft. Both propeller blades displayed leading and trailing edge gouging. Both blades were broken loose in the propeller hub. MEDICAL AND PATHOLOGICAL INFORMATION An autopsy was performed on the pilot by a forensic pathologist for Union Parish Coroner's Office on December 30, 2007. The pathologist's diagnosis as cause of death was noted as, "multiple injuries." The FAA Civil Aeromedical Institute (CAMI) performed toxicological screenings on the pilot. According to CAMI's report (#200700287001) the toxicological findings were positive for ethanol (alcohol). Specifically, the following was detected in the pilot's specimens: 373 (mg/dL, mg/hg) ethanol in blood, 556 (mg/dL, mg/hg) ethanol in urine, 301 (mg/dL, mg/hg) ethanol in muscle, 336 (mg/dL, mg/hg) ethanol in brain, and 372 (mg/dL, mg/hg) ethanol in vitreous. In addition, the following drugs were present in the pilot's specimens: unspecified amount of amlodipine in blood and urine, 0.863 (ug/mL, ug/g) citalopram in blood, 0.244 (ug/mL, ug/g) N--desmethylcitalopram in blood, 0.04 (ug/mL, ug/g) Di-N-desmethylcitalopram in blood, and an unspecified amount of metoprolol in blood and urine. In the pilot's two most recent applications for an airman medical certificate on October 17, 2006, and October 29, 2007, he reported the use of metroprolol and amlodipine, and a "yes" response to "High or low blood pressure." The applications indicated that the medications were prescribed for the control of hypertension. No other medications were reported on those applications, and a "no" response was recorded on each for "Mental disorders of any sort; depression, anxiety, etc." See section above title "Alcohol History" for additional information regarding the pilot's applications for airman medical certificate. ADDITIONAL INFORMATION Regulations FAA regulation 14 CFR 91.17, alcohol or drugs, in part, stated: (a) No person may act or attempt to act as a crewmember of a civil aircraft -- (1) Within 8 hours after the consumption of any alcoholic beverage; (2) While under the influence of alcohol; (3) While using any drug that affects the person's faculties in any way contrary to safety; or (4) While having .04 percent by weight or more alcohol in the blood. (b) Except in an emergency, no pilot of a civil aircraft may allow a person who appears to be intoxicated or who demonstrates by manner or physical indications that the individual is under the influence of drugs (except a medical patient under proper care) to be carried in that aircraft. In FAA regulations 14 CFR 67.107(a)(4)(ii), 67.207(a)(4)(ii), and 67.307(a)(4)(ii), the FAA defined substance (including alcohol) dependence as "evidenced by (A) increased tolerance, (B) manifestation of withdrawal symptoms, (C) impaired control of use, or (D) continued use despite damage to physical health or impairment of social, personal, or occupational functioning." A history or clinical diagnosis of substance dependence was specifically disqualifying. The FAA required that airmen report a history of substance (including alcohol) dependence on each application for airman medical certificate. The FAA additionally required that airmen report any convictions involving driving while intoxicated by, while impaired by, or while under the influence of alcohol or a drug and performs a National Driver Register (NDR) inquiry for each application for medical certificate to verify that all such convictions are in fact reported. According to 14 CFR 67.403, "No person may make or cause to be made -(1) A fraudulent or intentionally false statement on any application for a medical certificate," or "(2) A fraudulent or intentionally false entry in any logbook, record, or report that is kept, made, or used, to show compliance with any requirement for any medical certificate." FAA Medical Applicant Screening According to the Regulatory Support branch in the FAA Security and Investigation Division, the FAA Medical Division electronically transmits all pilot medical applicant names into a query against the NDR. All positive matches will show up on a list that is disseminated among investigators that make up the regulatory support branch. These investigators attempt to confirm a positive identity of the applicant against the name matched in the NDR by either social security numbers, birth dates, or identifying features (e.g. eye color, height, etc.). Further, if the applicant had reported an offense on the medical application and that is the sole conviction listed on their NDR record, no additional investigation is conducted. If the offense has not been reported, then investigators will contact the state that the conviction occurred in a
The pilot's failure to maintain aircraft control due to the effects of impairment from alcohol consumption resulting in the collision with the trees.. A contributing factor was the Federal Aviation Administration's failure to identify existing evidence of substance (alcohol) dependence in this commercial pilot due to an inadequate and incomplete process of screening medical applications.
Source: NTSB Aviation Accident Database
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