Tucson, AZ, USA
N89059
CESSNA 152
The pilot rented the airplane from the fixed-base operator (FBO) to fly to an airport about 11 miles away to practice takeoff and landings. He spoke briefly with two people in the FBO office and then went out to the airplane to preflight it and have it fueled. Review of the departure airport air traffic control tower (ATCT) communications and air traffic control radar tracking data did not reveal any abnormalities with the departure or flight. About 7 minutes after departure, the pilot contacted the ATCT at his destination airport and advised the controller that he was planning to do three touch-and-go maneuvers. Per instructions from the controller, the pilot entered a right downwind for his assigned landing runway. When the airplane was near a location consistent with it being established on the base leg, several motorists observed it in a steep nose-down attitude and descending rapidly. The airplane impacted flat terrain about 1.5 miles from the airport. Neither of the two ATCT controllers observed the descent or impact. Examination of the airframe and engine did not reveal any preimpact anomalies that would have precluded continued engine operation or flight. The pilot had obtained his first Federal Aviation Administration (FAA) medical certificate about 10 years before the accident, received annual recertification, and his most recent medical certificate was issued about 13 months before the accident. Review of the pilot's FAA medical records indicated that, for the intervening 9 years, the pilot was being treated for multiple cardiac issues and was subject to repetitive specialized medical testing. Further review indicated that the pilot had slow, essentially asymptomatic, progression of at least two components of his cardiac disease that are both independently associated with a significantly increased risk of sudden cardiac death as a result of a sudden arrhythmia. Although autopsy results indicated that the cause of death was blunt trauma, it is likely that a complication of the pilot's cardiac disease caused him to become incapacitated, which resulted in his loss of control of the airplane and the subsequent crash. The 0707 code found on the transponder was likely an artifact of the pilot's attempt to switch to the 7700 emergency code to indicate a problem to the controllers, but neither the timing nor the underlying reason for that action could be determined.
HISTORY OF FLIGHTOn February 8, 2013 about 0930 mountain standard time, after the Cessna 152, N89059, airplane was established on a right downwind leg for runway 6R at Ryan Field (RYN), Tucson, Arizona, radio and visual contact was lost by the air traffic control tower (ATCT) controller. The airplane, which impacted terrain about 1.5 miles southwest of RYN, was substantially damaged, and the private pilot received fatal injuries. The personal flight was conducted under the provisions of Title 14 Code of Federal Regulations Part 91. Visual meteorological conditions prevailed, and no Federal Aviation Administration (FAA) flight plan was filed for the flight. The 75-year-old pilot rented the airplane from Arizona Aero-Tech (AAT), located at Tucson International Airport (TUS), Tucson, with the stated intent of practicing landings and takeoffs at RYN. RYN was located about 11 miles west of TUS. Although the airplane reportedly had sufficient fuel for the flight, the pilot decided to have the fuel tanks filled; a total of 15.2 gallons were added before the flight. The pilot was observed to sump the tanks both before and after the airplane was fueled. He was also observed to seat himself in, and start the airplane from, the right seat. The airplane departed from TUS runway 11R about 0923, and was approved for an early turnout on-course. FAA ATC tracking radar data showed that the airplane flew towards RYN from TUS, at a maximum indicated altitude of 4,300 feet. The pilot contacted the RYN ATCT and, as instructed, entered a right downwind leg for runway 6R. Visual and radio contact was then lost by the controller. Shortly thereafter, the controller noticed a dust cloud rising from the ground about 1.5 miles southwest of the airport. Multiple motorists on Ajo Highway, an east-west thoroughfare that passed just south of RYN, witnessed the airplane's final descent and resulting impact dust cloud. The first motorists on scene cut the pilot's seat belt, and extracted him from the cockpit, while others summoned emergency services. The first Pima County Sheriff Office (PCSO) officer arrived on scene about 0940, shortly after the motorists had extracted the pilot. Attempts by PCSO personnel and paramedics to resuscitate the pilot were unsuccessful. In a telephone conversation shortly after the accident, an NTSB investigator guided the first responder personnel in safing the airplane by shutting its systems and equipment off. Three inspectors from the Scottsdale Flight Standards District Office (SDL FSDO) arrived on scene about 1130. Representatives of the NTSB and Cessna Aircraft examined the wreckage in situ the day after the accident. The airplane was recovered by Air Transport of Phoenix, AZ later that same day, and examined by representatives of the NTSB, FAA, and Cessna on February 11, 2013. PERSONNEL INFORMATIONFAA records indicated that the pilot held a private pilot certificate with an airplane single-engine land rating. According to the pilot's flight logbook, as of February 2, 2013, he had accumulated a total flight experience of about 302 hours. His most recent flight review was completed on June 29, 2012, with a certificated flight instructor (CFI) and airplane from AAT. AIRCRAFT INFORMATIONFAA information indicated that the airplane was manufactured in 1979, and was equipped with a Lycoming O-235 series engine. The airplane was registered to the president and owner of AAT. According to AAT records the airframe and engine had a total time in service of about 8,037 hours, and the engine had a total time since overhaul of about 3,038 hours. METEOROLOGICAL INFORMATIONAWOS Data Capture An automated weather observation sensor and radio transmitter known as AWOS (automated weather observation system) was installed and operating at RYN. The system operated continuously, sensing/updating conditions, and then providing that information to the ATCT and also broadcasting the observations on a radio frequency accessible by aircraft communications radios. The AWOS was commissioned by the FAA, but it was not maintained or controlled by the FAA. In addition, hourly or more frequent observation sets of AWOS data were to be provided to the US National Airspace System (NAS) for distribution and archiving purposes as METARs (Meteorological Aviation Reports). The methods for providing AWOS data to the NAS were automated datalink, manual transmission/entry, or a combination of the two as a function of the time of day. RYN used this combination approach, where the automated datalink was used overnight, and the ATCT controllers captured and sent the data manually during their normal operating hours. However, controller air traffic management workload sometimes prevented the controllers from capturing and entering the data for the NAS archiving. Subsequent but unrelated to the accident, the RYN ATCT implemented a continuous automated data-capture and archiving system. RYN AWOS/METAR Information Review of archived RYN METAR data for day of the accident revealed that the AWOS data was not captured every hour. The only recorded weather observations for RYN near the time of the accident were for times of 0754 and 1051. Review of archived RYN AWOS/METAR data for the several days surrounding the accident revealed that the AWOS/METAR data for those days also had gaps in the temporal coverage. The 0754 RYN automated weather observation included winds from 110 degrees at 5 knots, visibility 10 miles, clear skies, temperature 8 degrees C, dew point minus 1 degrees C, and an altimeter setting of 29.92 inches of mercury. Review of the recorded radio transmissions from the ATCT to the flight revealed that when the RYN ATCT controller cleared the flight for its first touch and go, he advised the pilot that the wind was calm. TUS METAR Information The 0953 automated weather observation at TUS, which was located about 12 miles east of the accident site, included winds from 070 degrees at 5 knots, visibility 10 miles, clear skies, temperature 15 degrees C, dew point minus 3 degrees C, and an altimeter setting of 29.94 inches of mercury. AIRPORT INFORMATIONFAA information indicated that the airplane was manufactured in 1979, and was equipped with a Lycoming O-235 series engine. The airplane was registered to the president and owner of AAT. According to AAT records the airframe and engine had a total time in service of about 8,037 hours, and the engine had a total time since overhaul of about 3,038 hours. WRECKAGE AND IMPACT INFORMATIONThe accident site was located about 200 feet south of Ajo Highway, which passed just south of RYN. The main wreckage path was about 200 feet long, and oriented along a magnetic heading of about 240 degrees. The airplane came to rest inverted, with the nose oriented about 090 degrees magnetic. The underside of the nose was crushed. The aft fuselage was deflected about 90 degrees airplane left, and almost fully fracture-separated from the cabin. The empennage was essentially intact, and remained attached to the aft fuselage. The right wing was fracture-separated at its aft fuselage attach point, and the left wing remained attached to the fuselage. Both wings exhibited some leading edge crush damage. There was no post-impact fire. No oil stains or puddles were observed on any of the exterior surfaces of the engine or airplane, interior surfaces of the engine compartment, or on the ground below the airplane. With the exception of a small segment of the outboard end of the left aileron, all flight control surfaces remained attached to their respective airfoils. The aileron segment was found in the debris path between the initial impact point and the main wreckage. The two cockpit yokes remained linked to one another, and flight control continuity from the cockpit controls to all respective flight control surfaces was established. The flap actuator extension corresponded to a flap setting of about 20 degrees. The pitch trim actuator extension corresponded to a trim setting of neutral. The transponder was found set to a code of 0707. The fuel selector valve was found between the ON and OFF positions, but its position was consistent with the airplane impact deformation. The left seat belt assembly was partially buckled and uncut. The right shoulder harness was engaged in its lap belt receptacle, and the outboard lap belt was cut, consistent with eyewitness reports that they found the pilot in the right seat. The engine remained attached to its mount, which remained attached to the fuselage. Continuity from the cockpit controls to the respective engine components was established. The engine did not exhibit any catastrophic failures of the case, cylinders, valve train, or intake or exhaust systems. All accessories remained attached to the engine. Manual rotation of the engine yielded thumb compressions on all cylinders, and the vacuum pump drive shaft was observed to rotate. The propeller was separated from the engine. Both ends of the propeller were bent aft at about 12 inches inboard from the tip, and bore some chordwise scoring. Both fuel tanks were intact, but both caps had been liberated by the impact, and were recovered on scene. Fuel stains were observed under the wreckage when it was lifted for recovery, and approximately 3 cups of fuel drained from the left wing when it was placed on the recovery trailer. Neither the on-scene nor the follow-up examination revealed any mechanical conditions, abnormalities, or failures that would have precluded continued engine operation and normal flight. Refer to the accident docket for additional details. ADDITIONAL INFORMATIONRadar Data Review of ATC radar tracking data revealed that the antenna sweep and data interval rate was 5 seconds. About 0934, the airplane entered a right downwind leg for runway 6R, at an indicated altitude of 3,200 feet. About 0935:28, the airplane passed abeam of the 6R threshold, at an indicated altitude of 3,000 feet. About 5 seconds later, the flight track deviated slightly south (away from the airport), before turning first northwest, and then almost south. The last secondary radar target in the continuous data was recorded at 0936:33, and was located 1.6 miles southwest of the 6R threshold, with an indicated altitude of 3,000 feet. The final, and only other, secondary target was recorded at 0936:56, and was located about 0.4 miles southeast of the previous point, with an indicated altitude of 2,700 feet. The reason for the flight path deviations and the 20-second (three radar sweep) gap could not be determined. No record of the 0707 code data which was found on the transponder was observed in the TUS radar target data. Eyewitness Observations A total of four eyewitnesses provided information for the investigation. A motorist who was driving eastbound on Ajo Highway first saw the airplane to the southeast of his location. He estimated that the airplane was about 500 yards away, at an altitude of about 1,000 feet above the ground, and headed approximately north. He described the attitude as unusually nose down, and stated that the airplane was descending very rapidly towards the ground. He saw the indications of ground impact, and stopped his car to render assistance. A passenger in a westbound car on the highway first saw the airplane to his south, when it was about 150 feet above the ground, and descending very rapidly. He initially thought the pilot was attempting to land on the road, but then he saw the airplane make a sharp turn to its left. The witness interpreted the turn as the pilot's maneuver to avoid the powerlines just south of the road. When the airplane was about half-way through the run, the left (lower) wingtip was approximately the same height as the top of the vegetation. The airplane continued the turn until it paralleled the road, and then disappeared behind the vegetation. The driver of his car pulled over to help after they saw the dust cloud from the impact. The witness reports did not yield any definitive information regarding whether the engine was running. All witnesses reported that the pilot was unresponsive, and that they cut his seatbelt to extract him from the right seat of the airplane. The witnesses reported that they could smell fuel, and that electrical power was continuing to operate mechanisms in the airplane. Refer to the accident docket for additional details. Information from the Fixed Base Operator The owner and president of AAT also owned Velocity Air, which provide maintenance, fuel, and logistical services, including tie-down spaces and hangars. Both AAT and Velocity Air were based at TUS. AAT shared an office with another FBO owned by the same president. AAT airplane rental procedures were typical of many FBOs, including provision of initial documentation plus oral, written, and practical training and evaluation of the pilots. Once checked out, pilots typically reserve airplanes by telephone; they normally speak to the office manager (OM). A 3-ring binder, specific to each airplane, contains airplane maintenance status and flight log information, as well as a variety of other relevant procedural and operational information. The binder resides in the AAT office, and is provided to the pilot when renting the airplane. The AAT airplanes cannot be seen from the office lobby According to the AAT office manager, the pilot arrived there about 0820, and left the office for the airplane about 10 minutes later. While he was still in the office, the pilot mentioned to the president that he was planning to fly in the right seat to RYN to conduct some touch and go landings and takeoffs. Although the president was unaware at that time, he was subsequently informed by one of his flight instructors that the pilot had recently flown in the right seat with that CFI, and that the pilot had "plenty of right seat experience." Records indicated that the pilot had flown about 13 hours each in AAT C-172 and C-152 airplanes, since starting with AAT in September 2012. The pilot's most recent previous flight with AAT took place on February 2, 2013. That flight was in a C-172, where he trained in the right seat with his CFI. The pilot was described as a "meticulous" individual, particularly with regard to his flying behaviors and practices. Information from Pilot's Flight Instructor The pilot's most recent certificated flight instructor (CFI) was employed by AAT. The CFI started flying with the pilot because the pilot wanted to practice his "radio work," due to the pilot's lack of experience operating at towered airports. The CFI elaborated that his use of the term "radio work" denoted both the pilot planning/skills and timing using the airplane radio hardware, as well as the pilot's communication and phraseology practices, and his proficiency with transmitting and receiving messages. The early "radio-work" flights were conducted between TUS and RYN, since both were towered airports. The CFI described the pilot as "meticulous." He reported that the pilot had good "stick skills," but he was "a numbers guy," meaning that he strongly preferred to use specific values (airspeed, attitudes, etc.) to operate the airplane. The CFI reported that the pilot was highly confident in his flying skills, but less confident in his radio skills. The CFI added that the pilot was proficient in his radio work, and the pilot did not give the CFI any cause for concern. The pilot's traffic pattern habits were consistent for both the C-152 and C-172 airplanes, and his traffic patterns were about the same as the CFI would fly. The pilot's typical airplane configurations in the traffic pattern included 10 degrees of flaps abeam the runway end, and 20 degrees on the base leg. According to the CFI, the pilot always used the airplane checklists. COMMUNICATIONSReview of audio recordings from TUS revealed that about 0917, the pilot contacted TUS clearance delivery for "departure to Ryan" and the airplane was assigned a transponder code of 0405. The pilot then contacted TUS ground control for taxi clearance for departure. He was assigned runway 11R as the departure runway. The flight was cleared for takeoff about 0923, and about 4 minutes later, the TUS ATCT controller instructed the pilot to contact departure control. Th
The pilot's incapacitation due to his preexisting cardiac disease, which resulted in his degraded or complete loss of ability to control the airplane.
Source: NTSB Aviation Accident Database
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