Pilot Debrief

CESSNA 150J near Tucson, AZ — 2010-11-14

Final reportWPR11FA046
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Date
2010-11-14
Location
Tucson, AZ, USA
Airport
RYN
Aircraft
CESSNA 150J
Registration
N60858
Category
Airplane
Highest injury
Fatal
Fatalities
1
Phase of flight
Approach

Probable cause

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.

NTSB narrative

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.

Analysis

Primary failure mode
Loss of control
First missed decision gate
Pilot could have aborted the landing when the approach became unstable.

NTSB coding

Evidence available

  • Photos
  • 12 docket documents
View NTSB final reportView NTSB docket

Docket documents12

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