Pilot Debrief

CESSNA 172S near Incline Village, NV — 2008-08-08

Final reportLAX08FA261
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Date
2008-08-08
Location
Incline Village, NV, USA
Aircraft
CESSNA 172S
Registration
N15963
Category
Airplane
Highest injury
Fatal
Fatalities
1

Probable cause

The pilot's decision to initiate a flight for which he was neither approved nor qualified and his failure to maintain terrain clearance during the flight. Contributing to the accident were the dark night, the mountainous terrain, and the pilot's medical condition.

NTSB narrative

The student pilot initiated a 160-nautical-mile night cross-country flight without approval from his flight instructor for the intended purpose of gambling at a casino. Radar data and wreckage distribution were consistent with the airplane making a gradual controlled descent from cruise flight and impacting mountainous terrain on a direct course toward the intended destination. No preimpact anomalies were noted during examination of the airframe and engine. The pilot's total flight time was approximately 97 hours, of which 19 hours were solo. His total night flight time was 1.8 hours dual instruction, which took place during a single flight on the night before the accident. He had made solo cross-country flights to airports less than 50 nautical miles from his home airport, but had not yet received training in cross-country flight planning. Toxicological testing revealed that the pilot, a physician diagnosed with substance dependence, had been using cocaine and taking two prescription medications (lamotrigine and quetiapine) often used in the treatment of bipolar disorder, as well as a prescription antidepressant (fluoxetine), though the levels detected indicated he had not used cocaine within 24 hours of the accident and had likely recently discontinued use of the medications. Additionally, the testing detected buprenorphine, a prescription narcotic medication, at a level consistent with the chronic use of the medication for treating opioid dependence. The pilot had been treated on multiple occasions for substance dependence and abuse. The relatively recent use of a stimulant (cocaine), recent discontinuation of prescription medications, gambling, and the apparent intent to fly cross-country at night while a student pilot without approval from his instructor all are actions consistent with the pilot being in a manic episode of bipolar disorder at the time of the accident. It is also possible that he was experiencing some cognitive impairment as a result of his use of buprenorphine for the treatment of substance dependence.

NTSB coding

View NTSB final report

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