Pilot Debrief

RUTTER HERBERT G LONG EZ near Wakefield, VA — 2010-05-21

Final reportERA10LA277
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Date
2010-05-21
Location
Wakefield, VA, USA
Airport
AKQ
Aircraft
RUTTER HERBERT G LONG EZ
Registration
N91HR
Category
Airplane
Highest injury
Fatal
Fatalities
1
Phase of flight
Approach

Probable cause

The pilot’s failure to properly align the airplane with the final approach path to the runway and his subsequent loss of control during his attempts to correct the flight path. Contributing to the accident was the pilot’s progressive cognitive decline due to Alzheimer’s disease.

Contributing factors

Contributing to the accident was the pilot’s progressive cognitive decline due to Alzheimer’s disease.

NTSB narrative

Acquaintances of the pilot indicated that his intended destination was an airport located about 200 miles to the south of his departure airport. A witness reported that he observed the airplane approach, and after completing the first legs of a traffic pattern, it over flew the turn onto the final approach path. The airplane then executed a left 360 degree turn about 700 feet above ground level. After the turn, the airplane was again past the extended runway centerline. The airplane continued the left turn for several seconds, and then followed with a sharp turn to the right. The airplane impacted terrain about 250 feet prior to the runway threshold; ground scars indicated that it struck in a right wing down attitude. At the time of the accident, the wind velocity was about 4 knots and the sky was clear of clouds. The majority of the witness observations were corroborated by global positioning system (GPS) data that was recovered from a unit in the airplane. Examination of the GPS data, the airplane, and the engine did not reveal any evidence of preimpact mechanical failures. No definitive reasons for the pilot's decision to land at the accident airport, or his difficulties in aligning with the runway, were discovered. The pilot's most recent Federal Aviation Administration third-class medical certificate expired about 22 months prior to the accident. Shortly thereafter, the FAA withdrew the pilot's eligibility for medical certification, and his eligibility for medical certification was never re-established. Neurological evaluations, family member observations, and autopsy findings were consistent with the pilot experiencing progressive cognitive decline due to Alzheimer’s disease.

Analysis

Primary failure mode
Human factors
First missed decision gate
Pilot could have aborted the approach earlier to avoid the accident.

NTSB coding

Evidence available

  • ADS-B / radar
  • Photos
  • 19 docket documents
View NTSB final reportView NTSB docket

Docket documents19

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