Pilot Debrief

HARRY L. WEBER ARION LI near Hedgesville, WV — 2011-10-05

Final reportERA12FA006
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Date
2011-10-05
Location
Hedgesville, WV, USA
Airport
WV22
Aircraft
HARRY L. WEBER ARION LI
Registration
N747HW
Category
Airplane
Highest injury
Fatal
Fatalities
1
Phase of flight
Takeoff roll

Probable cause

An aerodynamic stall at low altitude due to the pilot’s acute cardiac event.

NTSB narrative

Several witnesses reported that, shortly after takeoff, when the airplane was about 15 feet above ground level, it suddenly pitched up about 45 degrees, stalled, and then came to rest against a residence near the turf runway. GPS data were consistent with the witness reports. Examination of the airframe and engine revealed no mechanical malfunctions or abnormalities that would have precluded normal operation. The pilot's medical records revealed that he had hypertension and a pacemaker, and that, about 8 months before the accident, the pacemaker was upgraded to a combination pacemaker/Automatic Internal Cardiac Defibrillator (AICD). Medical records revealed that the pilot was using medications to treat hypertension, moderate-to-severe congestive heart failure, recurrent ventricular arrhythmias, and atrial fibrillation. Toxicology testing confirmed the presence of such medications in the pilot's body. Given the postmortem examination, reported medication use, and the upgrade to a pacemaker/AICD, it is likely that the pilot had experienced a serious arrhythmia and severe congestive heart failure some time before the accident. Although the exact degree of premortem cardiac dysfunction could not be determined, the presence of the AICD indicated that the pilot's doctors had identified a significantly elevated risk of sudden cardiac death. Although an AICD reduces the risk of sudden death from tachyarrhythmia, it does not reduce the risk of a sudden death from other cardiac-related causes. Federal regulations only require a valid driver's license to exercise the privileges of a sport pilot certificate in a light-sport aircraft as long as pilots are not aware of any medical condition that would make them unable to operate a light-sport aircraft safely. However, the pilot most likely did not have sufficient knowledge to accurately assess the aviation safety risks associated with his condition. It is likely that the pilot's underlying cardiac disease caused an acute medical event, which led to his loss of control of the airplane and the subsequent aerodynamic stall at low altitude and collision with terrain.

Analysis

Primary failure mode
Loss of control
First missed decision gate
Pilot could have aborted takeoff after initial climb pitch up.

NTSB coding

Evidence available

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

Docket documents12

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