Loss of control Accident Piper PA-25-260 Pawnee N4369Y,
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ASN Wikibase Occurrence # 179059
 
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Date:Thursday 27 August 2015
Time:12:06
Type:Silhouette image of generic PA25 model; specific model in this crash may look slightly different    
Piper PA-25-260 Pawnee
Owner/operator:Southern California Soaring Academy Inc
Registration: N4369Y
MSN: 25-4872
Year of manufacture:1969
Total airframe hrs:11789 hours
Engine model:Lycoming O-540 SERIES
Fatalities:Fatalities: 1 / Occupants: 1
Aircraft damage: Substantial
Category:Accident
Location:Near Crystal Airport (46CN), Llano, CA -   United States of America
Phase: Approach
Nature:Banner and glider towing
Departure airport:Llano, CA (46CN)
Destination airport:Llano, CA (46CN)
Investigating agency: NTSB
Confidence Rating: Accident investigation report completed and information captured
Narrative:
The tow plane pilot had performed six uneventful glider launches on the morning of the accident with turnaround times of about 15 minutes. The seventh launch was uneventful, and, after releasing the glider, the pilot made an appropriate radio call and was observed normally entering the downwind traffic pattern. Video data and witness accounts indicated that, shortly after, the airplane descended well below pattern altitude and overshot the runway centerline by about 1/4 mile during the turn from the base leg to final approach. The airplane then began to maneuver erratically as it passed back across the centerline, and subsequently collided in a dirt field 900 ft southwest of the threshold of the gravel portion of the runway.

Postaccident examination of the airframe and engine did not reveal any anomalies that would have precluded normal operation, and the engine data monitor information indicated that the engine performed similarly for all of the flights on the day of the accident, including the accident flight.

The pilot was issued a second-class medical certificate 6 days before the accident. At that time, he reported having high blood pressure, which had been controlled with medication for many years. Two years before the accident, he had taken a cardiac stress test, which had to be stopped prematurely due to shortness of breath. Further, his wife reported that he had a bout of unusual dizziness while hiking on a hot day about 1 year before the accident.

The autopsy revealed hypertrophic heart disease, a condition associated with an increased risk of developing atrial fibrillation, an arrhythmia that typically causes a fast heart rate, which may lower blood pressure, even to the point of causing fainting. Onset of atrial fibrillation is typically sudden. It was a hot day, and there may have been a component of sweating and heat effects, particularly during the periods when the airplane was on the ground, which may have increased the amount of physiologic stress and the likelihood of an arrhythmia. The sudden onset of an arrhythmia can cause symptoms ranging from palpitations to loss of consciousness but leaves no evidence after death.

The lack of mechanical problems, the pilot's successful completion of six tow flights before the accident flight, the radar track, and the pilot's failure to make a radio call regarding an emergency are consistent with sudden incapacitation, and it is likely the pilot's incapacitation caused the accident.
Probable Cause: The pilot's loss of airplane control during the landing approach due to an incapacitating medical event.

Accident investigation:
cover
  
Investigating agency: NTSB
Report number: WPR15FA250
Status: Investigation completed
Duration:
Download report: Final report

Sources:

NTSB
FAA register: http://registry.faa.gov/aircraftinquiry/NNum_Results.aspx?NNumbertxt=4369Y

Location

Revision history:

Date/timeContributorUpdates
27-Aug-2015 20:43 Geno Added
31-Aug-2015 06:36 Anon. Updated [Registration]
21-Dec-2016 19:30 ASN Update Bot Updated [Time, Damage, Category, Investigating agency]
17-Mar-2017 10:29 PiperOnslaught Updated [Phase, Source, Narrative]
19-Aug-2017 13:59 ASN Update Bot Updated [Other fatalities, Nature, Departure airport, Destination airport, Source, Narrative]

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