Tucson, AZ, USA
N60858
CESSNA 150J
A flight instructor, who was located adjacent to the accident site, reported that the commercial glider pilot was conducting his first solo takeoffs and landings as part of his training to obtain an airplane single-engine add-on rating. The instructor stated that the pilot conducted two uneventful takeoffs and landings and, during the third takeoff and approach to landing, everything looked normal. As the airplane was on short final approach for the runway, the flight instructor observed the airplane pitch downward and descend into terrain near the approach end of the runway. Postaccident examination of the airframe and engine revealed no evidence of mechanical malfunctions or failures that would have precluded normal operation. Review of the pilot’s medical records revealed that he had longstanding, significant, untreated hypercholesterolemia. An autopsy on the pilot revealed that he had both “severe” coronary atherosclerotic disease and septal hypertrophy; both conditions put him at substantial risk for acute myocardial infarction or sudden cardiac arrhythmia. Neither event would be detectable by autopsy; however, it is likely that the pilot experienced a medical emergency and was incapacitated during the accident flight, rendering him unable to maintain airplane control.
HISTORY OF FLIGHT On November 14, 2010, about 1215 mountain standard time, a Cessna 150J airplane, N60858, sustained substantial damage when it impacted terrain on final approach to runway 33 at the Ryan Field Airport, near Tucson, Arizona. The airplane was registered to a private individual and operated by Kelly's Aviation under the provisions of Title 14 Code of Federal Regulations Part 91. The commercial pilot, the sole occupant of the airplane, sustained fatal injuries. Visual meteorological conditions prevailed, and no flight plan was filed for the local supervised solo flight. The flight originated from RYN about 15 minutes prior to the accident. A certificated flight instructor (CFI) employed with Kelly's Aviation reported that the pilot was in the process of obtaining his single-engine land add on rating. Prior to the accident flight; he had flown with the pilot within the airport traffic pattern at RYN. After about 40 minutes of pattern work, the instructor had the pilot taxi to a run-up area near runway 6R, where the instructor exited the airplane with the intent of watching the pilot conduct a solo flight within the airport traffic pattern. The flight was to consist of three takeoffs and landings. The CFI stated that upon exiting the airplane, and remaining in an area near the air traffic control tower, he observed the pilot takeoff from runway 6R uneventfully. The CFI continued to observe the pilot conduct one touch-and-go landing on runway 6R and a second touch-and-go landing on runway 33. The CFI said that the third approach to landing seemed normal, with a turn to final about 1/2 mile from the runway. As the airplane was on short final at an altitude of about 60 feet above ground level (agl), the CFI observed the airplane pitch downwards to a severe nose down attitude. Subsequently, the airplane descended out of sight below a hangar followed by the sound of impact. PERSONNEL INFORMATION The pilot, age 56, held a commercial pilot certificate with a glider rating. In addition, the pilot possessed a flight instructor certificate with a glider rating. A third-class airman medical certificate was issued on May 18, 2010, with no limitations stated. The pilot reported on his most recent medical certificate application that he had accumulated 248 total flight hours. Review of the pilot's personal logbook revealed that as of November 13, 2010, he had logged a total of 29 hours in single-engine aircraft, of which 4.9 hours were within the previous 30 days. The pilot logged a total of 9.1 hours in the accident make/model airplane. The pilot reported on an airman certificate and/or rating application for a flight instructor certificate reinstatement, dated August 14, 2008, that he had accumulated 20 hours of flight time in airplanes and 235 hours of flight time in gliders. AIRCRAFT INFORMATION The two-seat, high-wing, fixed-gear airplane, serial number (S/N) 15070625, was manufactured in 1969. It was powered by a Teledyne Continental Motors O-200-A, serial number 252600, rated at 100 horsepower. The airplane was also equipped with a McCauley fixed pitch propeller. Review of the airplane's maintenance logbooks revealed that the most recent annual inspection was performed on March 3, 2010, at a tachometer hour reading of 2,391.62 hours, airframe total time of 4,788.52 hours, and engine total time of 1,303.52 hours since major overhaul (TSMOH). The most recent 100-hour inspection was conducted on September 15, 2010, at a tachometer time of 2,685.78 hours and an engine TSMOH of 1,596.78 hours. The most recent maintenance performed on the airplane was an oil change conducted on October 28, 2010, at a tachometer time of 2,744.69 hours. METEOROLOGICAL INFORMATION A review of recorded weather data from Ryan Field Airport's automated weather observation station (AWOS) revealed that at 1204, weather conditions were wind from 340 degrees at 6 knots, visibility 10 statute miles, clear sky, temperature 19 degrees Celsius, dew point -8 degrees Celsius, and an altimeter setting of 29.99 inches of mercury. AIRPORT INFORMATION The Ryan Field Airport operates under class-delta airspace. The airport features three asphalt runways (runway 6L/24R, runway 6R/24L, and runway 33/15). Runway 33 is a 4,000-foot long and 75-foot wide runway. WRECKAGE AND IMPACT INFORMATION Examination of the accident site revealed that the airplane impacted sandy terrain about 72 feet from the approach end of runway 33. The airplane came to rest inverted on an approximate magnetic heading of 179 degrees. Wreckage debris, which included plexi glass and the nose wheel, remained within about 80 feet of the main wreckage. The field elevation of the accident site was measured to be 2,391 feet mean sea level (msl). Examination of the wreckage revealed the left and right wings remained attached to the fuselage via all mounts. Both the left and right wing leading edges were crushed aft to the main wing spar throughout their entire span. Both the left and right ailerons and left and right flaps remained attached to their respective mounts. The stall warning horn system remained intact. When suction was applied to the stall warning horn system air line, the stall warning reed sounded. The flap actuator was measured to be in a position consistent with 30-degrees flaps. The left and right horizontal stabilizers remained attached to the empennage structure. The left and right elevators remained attached to the horizontal stabilizers via all mounts. The elevator trim tab remained attached and secure to the right elevator. The elevator trim actuator was measured and found in a position consistent with about 10-degrees nose up. The fuselage was mostly intact. The engine and firewall were displaced aft into the cockpit area. The engine remained attached to the airframe via various lines and partial engine mount structure. Flight control continuity was established from all primary flight control surfaces to an impact damaged area below the cockpit seats. The damage within this area prevented movement of the rudder, elevator, and aileron control cables. All control cables visually appeared to remain attached and continuous throughout. Both the left and right ears were separated from the left control yoke. The left control column was separated at the gust lock hole. The engine was removed from the airframe. The throttle, mixture, and carburetor heat controls remained attached. All engine accessories remained attached to the engine with the exception of the vacuum pump and carburetor, which were displaced from their mounts. All cylinders remained attached to the engine. The top spark plugs, rocker box covers, and propeller were removed. The engine was rotated by hand using a hand tool attached to an accessory drive pad. Rotational continuity was established throughout the engine and valve train. Thumb compression was obtained on all four cylinders. When the engine crankshaft was rotated, the left and right magnetos produced spark on all posts. The top and bottom spark plugs were removed and examined. When compared to the Champion Check-A-Plug comparison card, the spark plugs exhibited signatures consistent with normal operation. The propeller was intact and remained attached to the engine crankshaft propeller flange. One propeller blade exhibited chordwise scratching and blade face polishing from about midspan to the blade root. The other blade exhibited a slight aft bend and chordwise scratching from about midspan outboard to the blade tip. Blade face polishing was observed around the mid span area of the blade. No evidence of pre-impact malfunction was observed with the airframe or engine. MEDICAL AND PATHOLOGICAL INFORMATION The Pima County Medical Examiner conducted an autopsy on the pilot on November 15, 2010. The medical examiner determined that the cause of death was “...multiple blunt force injuries”. The FAA's Civil Aeromedical Institute (CAMI) in Oklahoma City, Oklahoma, performed toxicology tests on the pilot. According to CAMI's report, carbon monoxide, cyanide, volatiles, and drugs were tested, and had negative results. Review of the autopsy and toxicology tests by a National Transportation Safety Board (NTSB) Medical Doctor revealed that in addition to the pilot’s injuries, the pathologist documented cardiovascular atherosclerotic disease described as "severe" in the left anterior descending artery,"moderate" in the dominant right coronary artery, and "moderate to severe" in the aorta. The degree of stenosis (narrowing) was not quantified further. The cardiac septum was thickened, giving the left ventricle asymmetric hypertrophy. There was no evidence of previous myocardial infarctions on the gross exam, but histology of the septum showed mild perivascular fibrosis without myocyte disarray. The medical doctor found that toxicology from the medical examiner revealed salicylates (aspirin). Review of the pilot’s personal medical records revealed no evidence of hypertension, however, demonstrated repeated conversations with the physician on multiple visits about elevated cholesterol and several attempts to treat this with several medications. Electrocardiogram’s (EKG) throughout the years intermittently suggested left ventricular hypertrophy (voltage criteria), however, were otherwise unremarkable. The medical records indicated that the pilot was prescribed Claritin D (loratidine and pseudoephedrine) and Nasonex (topical steroids for the nose) as needed for his hay fever, and was instructed to take one tablet of aspirin daily. For further information, see the medical factual report within the public docket for this accident. TESTS AND RESEARCH A portable Garmin GPSMap 196 GPS unit was recovered from the airplane. The GPS unit was shipped to the NTSB Vehicle Recorders Laboratory in Washington, DC for further examination. No data from the accident flight was recovered from the GPS.
The pilot's inability to maintain airplane control while on final approach due to undiagnosed cardiac disease, which caused a medical emergency and subsequent pilot incapacitation.
Source: NTSB Aviation Accident Database
Aviation Accidents App
In-Depth Access to Aviation Accident Reports
