14 CFR Part 91: General Aviation
Accident occurred Tuesday, June 28, 2011 in Poughkeepsie, NY
Probable Cause Approval Date: 08/07/2013
Aircraft: CESSNA 172M, registration: N61579
Injuries: 2 Fatal.
NTSB investigators either traveled in support of this investigation or conducted a significant amount of investigative work without any travel, and used data obtained from various sources to prepare this aircraft accident report.
The airplane was flying in the airport traffic pattern in good weather and was in radio and radar contact with air traffic control. While on short final approach, without warning or distress, the airplane descended nose-down and impacted a field about 1/4 mile before the runway threshold. Examination of the airframe and engine did not reveal evidence of any preimpact mechanical malfunctions or failures that would have precluded normal operation. Although the pilot’s autopsy report listed the cause of death as multiple blunt impact injuries, it also noted significant coronary artery disease with stenosis of 85 to 90 percent in one of the arteries.
Review of the pilot's personal medical records revealed that about 3 years before the accident, he was found to have paroxysmal atrial fibrillation and hypertension. Subsequent treatment with medications was unsuccessful, and 1 year before the accident, he underwent a procedure to ablate a foci initiating the abnormal heart rhythm. The procedure was initially successful with a return to normal sinus rhythm, but by 1 month before the accident, the atrial fibrillation recurred and medications were restarted. Toxicological testing confirmed the presence of medications used to treat high blood pressure, control the rate of atrial fibrillation, and thin the blood.
None of the cardiology or prescription medication information was reported to a Federal Aviation Administration aviation medical examiner during any of the pilot's applications for medical certificates. Had the pilot reported the atrial fibrillation, he would have been initially disqualified for a medical certificate. However, pilots with well controlled rates, who are mostly asymptomatic and without concomitant coronary artery disease, could be issued a special issuance medical certificate with appropriate follow-up. In the pilot’s case, such follow-up would have likely detected the undiagnosed coronary artery disease, which, in combination with the atrial fibrillation, put him at increased risk for sudden cardiac death. It was very likely that the pilot became impaired or incapacitated by his underlying cardiac disease during the accident flight.
The National Transportation Safety Board determines the probable cause(s) of this accident as follows:
The pilot’s loss of airplane control due to impairment or incapacitation as a result of coronary artery disease in combination with atrial fibrillation. Contributing to the accident was the pilot's failure to report his paroxysmal atrial fibrillation to the Federal Aviation Administration, which would have required follow-up testing that would likely have detected his undiagnosed coronary artery disease.
HISTORY OF FLIGHT
On June 28, 2011, at 1212 eastern daylight time, a Cessna 172M, N61579, registered to Millbrook Flight LLC., and operated by a private individual, was substantially damaged when it nosed over and impacted the ground during short final approach to runway 24 at Dutchess County Airport (POU), Poughkeepsie, New York. The airline transport pilot and passenger were fatally injured. The personal flight was conducted under the provisions of 14 Code of Federal Regulations Part 91. Visual meteorological conditions prevailed and no flight plan was filed for the local flight, which departed POU about 1207.
According to the owner of the airplane, a mechanic had replaced the airplane's horizontal situation indicator just prior to the accident flight. The pilot wanted to conduct a brief local flight to verify that the new instrument operated correctly, and offered the mechanic a ride in the airplane.
Review of air traffic control (ATC) audio data and radar data, provided by the Federal Aviation Administration (FAA), revealed that the airplane departed POU at 1207, and remained in a left traffic pattern for runway 24. At 1209, the pilot reported that the airplane was on a left downwind leg and the controller cleared the flight for the option to land or touch-and-go on runway 24. No distress calls or further radio communications from the accident airplane were received by ATC. The last radar target was recorded at 1212:32, about 1/2 mile from the runway 24 threshold, indicating an altitude of 300 feet mean sea level.
According to an ATC controller in the POU tower, the airplane was on final approach and everything appeared normal. Approximately 1/4 mile from the runway threshold, about 800 feet above the ground, the airplane nosed down, dove straight into the ground, and came to rest inverted.
The pilot, age 60, held an airline transport pilot certificate with a rating for airplane multiengine land. He also held a commercial pilot certificate, with ratings for airplane single-engine land and airplane single-engine sea. The pilot also held a flight instructor certificate, with ratings for airplane single-engine, airplane multiengine, and instrument airplane. The pilot's most recent FAA second-class medical certificate was issued on February 23, 2011. At that time, the pilot reported a total flight experience of 14,750 hours. The pilot's logbook was not recovered.
The four-seat, high-wing, fixed tricycle-gear airplane, serial number 17264654, was manufactured in 1975. It was powered by a Lycoming, O-320, 150-horsepower engine. Review of the aircraft logbooks revealed that the airplane's most recent annual inspection was completed on February 17, 2011. At that time, the airplane had accumulated 4725.0 total hours of operation. The engine had accumulated 4,725.0 total hours of operation, and 1,151.7 hours of operation since major overhaul. The airplane had flown about 49 hours since the annual inspection.
The reported weather at POU, at 1153, was: wind calm; visibility 10 miles; few clouds at 4,100 feet; temperature 27 degrees Celsius; dew point 18 degrees Celsius; altimeter 29.89 inches Hg.
A debris path originated with an approximate 3-foot by 5-foot crater, and extended approximately 75 feet on a 250-degree magnetic course to the main wreckage. The debris path consisted of ground scars and the nose landing gear. The ground scars were consistent with landing gear contact, in a nose-low, left wing low, left crab angle at ground impact. The airplane came to rest inverted on a heading of about 180 degrees magnetic, with the empennage partially separated and canted left. Evidence of a small postcrash fire was noted in the vicinity of the carburetor.
Both wings remained attached to the airframe, with the ailerons and flaps attached to their respective wing. The ailerons were approximately neutral and measurement of the flap jackscrew corresponded to an approximate 20-degree flap extended position. The fuel caps remained secured to their respective wing fuel tanks, and approximately 2 to 3 gallons of fuel were observed in each wing. Additionally, fuel staining and browning vegetation was noted, consistent with fuel leakage after the accident. The remaining fuel was clear and light blue in color, with no visible contamination observed. The horizontal stabilizer, vertical stabilizer, rudder, and elevator remained intact and undamaged. Measurement of the elevator trim jackscrew corresponded to an approximate neutral trim position. Flight control continuity was confirmed from the cockpit controls to the flight control surfaces.
The cockpit was crushed; however, the seatbelts and shoulder harnesses remained attached. The mixture control was in the full rich position, the carburetor heat control was off, and the throttle control was about 1 inch from the full throttle position. Additionally, both magnetos were selected and the engine primer was in and locked.
The engine remained partially attached to the airframe and the propeller remained attached to the engine. One propeller blade exhibited s-bending and chordwise scratching, while the other blade was undamaged. The engine was separated from the airplane and the propeller was removed from the propeller flange to facilitate further examination of the engine. The valve covers were removed and oil was noted throughout the engine. The spark plugs were also removed for inspection; their electrodes were intact and light gray in color. When the crankshaft was rotated by hand, camshaft, crankshaft, and valvetrain continuity were confirmed and thumb compression was attained on all cylinders. Both magnetos produced spark at all leads when rotated by hand. Inspection of the carburetor revealed that the floats and needle valve remained intact. Fuel was found in the fuel line from the gascolator to the carburetor. Examination of the oil filter did not reveal any contamination. The vacuum pump remained attached to the engine and was disassembled for inspection. The drive coupling, rotor, and rotor vanes remained intact. Rotational scoring was noted on the rotor and vacuum pump housing.
MEDICAL AND PATHOLOGICAL INFORMATION
An autopsy was performed on the pilot on June 29, 2011, by the Dutchess County Office of the Chief Medical Examiner, Poughkeepsie, New York. Although the autopsy report noted the cause of death as multiple blunt impact injures, it also noted:
"Focal high grade stenosis of mid-left anterior descending artery due to atherosclerotic cardiovascular disease… Coronary arteries show focal atherosclerosis as follows: in the right coronary artery there is 10% stenosis; in the mid-left anterior descending coronary artery there is 85-90% stenosis; in the left circumflex coronary artery there is 10-20% stenosis."
Toxicological testing was performed on the pilot by the FAA Bioaeronautical Science Research Laboratory, Oklahoma City, Oklahoma.
Review of the toxicology report revealed:
"Atenolol detected in Liver
Atenolol detected in Blood (Heart)
Omeprazole detected in Blood (Cavity)
Warfarin detected in Urine
Warfarin detected in Blood (Heart)"
Review of the pilot's FAA medical records, dating back to 1988, revealed "No" for items 18g and 18h (heart or vascular trouble and high or low blood pressure) on his applications for airman medical certificates. Additionally, the pilot did not report the use atenolol, a medication that treats hypertension and slows the heart rate, or the use of warfarin, a blood thinner. He did report the use of a medication for heartburn similar to omeprazole.
Review of the pilot's personal medical records revealed that in 2008, he was found to have paroxysmal atrial fibrillation and hypertension, complicated by thrombosis of the ulnar artery, which was believed to have been embolic. Initially, the pilot’s paroxysmal atrial fibrillation was controlled with warfarin anticoagulation and rate control medications, but in 2010, he was increasingly symptomatic, even while on medications. He elected to undergo a procedure to ablate the foci initiating the abnormal rhythm. The procedure was initially successful with a return to normal sinus rhythm, but by May 2011, the atrial fibrillation recurred and medications were restarted. It was unclear from the records what quality of heart rhythm and rate control was achieved in the weeks leading up to the airplane accident.
Report of atrial fibrillation to an FAA aviation medical examiner would have been initially disqualifying for a medical certificate. For pilots with well controlled rates, who were mostly asymptomatic and without concomitant coronary artery disease, could be issued a special issuance medical certificate with appropriate follow-up. Such follow-up would have included stress testing that most likely would have detected his undiagnosed coronary artery disease.
DUTCHESS COUNTY, N.Y. -- Police have not yet released the names of the two men involved in Tuesday's fatal plane crash in Dutchess County. We are told both men are from the Hudson Valley. One victim is from Dutchess, the other from Putnam.
An NTSB Investigator says the men worked at the airport.
"Just, just horrible. I mean, it's just you don't know what you're going to find, what you're going to see when you get there. The reports coming in were that the plane was on fire, people trapped. Just a horrific scene," said Lt. John Watterson.
Watterson, of the Dutchess County Sheriff's office, describes his reaction to receiving reports of a plane crash just after noon on Tuesday. The sheriff's office confirms both men on board died.
"It appears as though it was attempting to land," Watterson said.
According to Federal Investigators, the pilot of the 1975 single engine Cessna 172 was practicing touch and go landings.
"I was told that this was not a training exercise, that it was just a pleasure flight, just two people going up and doing some take offs and landings here at the Poughkeepsie airport," said Robert Gretz, NTSB Senior Air Safety investigator.
The plane, which was owned by Millbrook Flight LLC, crashed in a field just across the street from the runway.
According to the NTSB, initial reports of a fire were false.
"Initially, I'm told that it crashed nose down and over inverted," said Gretz.
The cause of the crash is still unknown. And federal investigators say it will take more than six months until the investigation is complete. The sheriff's office says it is interviewing several witnesses and are unsure if the pilot made contact with the radio tower before the crash.
Two people have died following a small plane crash near Dutchess County Airport, according to the Federal Aviation Administration.
Two males were sent to Saint Francis Hospital, according to the Dutchess County Sheriff's Office. There were no details on their injuries, but they were described as "badly injured."
Arlene Salac, FAA spokeswoman, said around 2:15 p.m. two people were on board the single-engine Cessna 172. It crashed during "touch and go" maneuvers just short on Runway 24. She said FAA personnel are traveling to the crash scene.
Salac says federal investigators at the scene have reported the plane was destroyed and both victims have died. There's no information yet on what might have caused the accident.
Salac said the plane is registered to Millbrook Flight LLC out of Poughquag.
The plane is upside down in a field off Route 376. Four fire trucks were on the scene, as well as ambulances.
The Dutchess County Sheriff’s Office responded to the crash site, as did Wappingers Falls police. State police were helping direct traffic.
No further information was available. The report of the crash came in around 12:15 p.m.
MYFOXNY.COM - Two people are dead after a small plane crashed near the Dutchess County Airport in Wappingers Falls, N.Y.
A witness tells MyFoxNY.com that it appears that the plane either skipped off of the runway or did not make the runway off of State Route 376.
Emergency personnel were on the scene and a blue tarp covers part of the plane. Two people were on the plane when it went down at about 12:15 p.m. on Tuesday.
The FAA says the plane is a single engine Cessna 172 registered to Mill Brook Flight LLC, out of Poughkeepsie.
The cause of the accident is unknown, but the plane had been doing "touch and go" training shortly before the accident.
The crash occurred about 65 miles north of New York City.
DUTCHESS COUNTY, N.Y. -- Two people were seriously injured after a plane crash in Dutchess County. It happened just outside the county airport as the small plan was coming in for a landing.
The Dutchess County Sheriff's office says when rescue crews got on the scene, the plane was on fire. A lieutenant with the sheriff's department says both men are suffering from life threatening injuries. They haven't released the identities of the men, but say one is from Dutchess County and the other from Putnam.
"When you come into a scene like this, it is obviously very hectic because you have a lot of people trying to do things and care for the injured is always the most important thing. So the details are not really clear right now but will as time goes on," said Lt. John Watterson of the Dutchess County Sheriff's office.
The FAA will assist the Sheriff's office in the investigation and several witnesses are being interviewed.
Authorities say a plane has crashed and burned near an airport Dutchess County, killing two people.
Dutchess County Sheriff's Sgt. Jonathan Hughes says the plane went down just after noon Tuesday south of the county airport in Wappinger, about 65 miles north of New York City.
Fire and rescue crews were on the scene.
The FAA reports that the plane was a Cessna 172 that crashed short of runway 24. It burst into flames, killing both people aboard.
The plane was reportedly performing a "touch and go" training exercise at the time of the incident.
A small plane has crashed near Dutchess County Airport in the Town of Poughkeepsie. There is no immediate word on injuries, what caused the crash, or what type of plane is involved. The plane is upside down in a field off Route 376. Four fire trucks are on the scene, as well as ambulances. The Dutchess County Sheriff’s Office has responded to the crash site, as have Wappingers Falls police. State police are helping direct traffic. The report of the crash came in around 12:15 p.m.
MYFOXNY.COM - A small plane has crash across from the Dutchess County Airport in Wappingers Falls, N.Y. A witness tells MyFoxNY.com that a plane is upside down in a field accross from the runway. They say it appears that it either skipped the runway or did not make the runway off of State Route 376. Emergency personnel are on the scene. Initial reports indicate that two people were on the plane when it went down. It happened just after noon on Tuesday.WAPPINGERS FALLS — A 23-year-old Brewster man was identfied today as one of the two men who died Tuesday in a small plane crash Tuesday at Dutchess County Airport.
The Dutchess County Sheriff's Office said Matthew Smith, 23, of Brewster and William Kluz, 60, of the city of Poughkeepsie, suffered "extremely serious injuries" in the crash and were unconscious when emergency responders arrived. The single-engine, four-seater 1975 Cessna crashed in a field owned by Dutchess County Airport, east of Route 376 in the town of Wappinger around 12:15 p.m., authorities said.
Kluz was pronounced dead at the scene. Smith was taken to St. Francis Hospital in the town of Poughkeepsie, where he later died, Sheriff's Office spokesman Lt. John Watterson said in a written release.
The Dutchess County Medical Examiner's Office was scheduled to conduct autopsies this morning to determine the exact cause of death. The Federal Aviation Administration is working with the National Transportation Safety Board and local police to determine the cause of the crash. "At this time it is thought that Mr. Kluz was the pilot of the plane and Mr. Smith was a passenger; however that is still under investigation and has yet to be determined for sure.
The investigation into the cause of the crash is being led by the NTSB and the FAA, with the Sheriff’s Office assisting. The investigation is continuing and more information will be released as it becomes available," Watterson said.
FAA spokeswoman Arlene Salac said the plane crashed during "touch-and- go" maneuvers about 500 feet short of Runway 24. "It's a training procedure for aviation pilots," Salac said. "What they do is come in low to the runway and then pull back up and go back around into the flight pattern. It's a common training procedure."
Salac said the plane was registered to Millbrook Flight LLC in Poughquag. She said she did not know if either of the victims was a professional pilot. The downed Cessna lay in the field upside down, facing away from the airport, several hours after the crash. The tail number N61579 was visible from the road.
Watterson said initial reports indicated the plane was on fire when it landed. The wreckage, however, was not badly burned. Police blocked off the area around the plane with yellow tape as local authorities waited for the FAA to arrive. Josh Grafman, 19, a Westchester County resident, said he was taking a flying lesson and was about to taxi at the airport when he heard about the crash on the radio. "I could see smoke from where I was," he said.