NTSB Identification: CEN12FA611
14 CFR Part 91: General Aviation
Accident occurred Thursday, September 06, 2012 in Winnsboro, LA
Probable Cause Approval Date: 09/12/2013
Aircraft: FAIRLEY GOOCH LANCAIR IV, registration: N1126V
Injuries: 1 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 airline transport pilot was landing the airplane after a local test flight that involved calibrating the fuel system. According to several witnesses, they heard an increase in engine rpm consistent with the pilot adding power to perform a go-around. Several witnesses reported hearing a subsequent loss of engine power. The nose of the airplane rose and then dropped. The airplane was substantially damaged when it impacted terrain beyond the departure end of the runway. The damage to the airplane and the resultant ground scars were consistent with the airplane being in a stalled condition at the time of the accident. An examination of the airframe and engine revealed no anomalies that would have precluded normal operation. An examination of the fuel system revealed that the fuel selector was stiff and difficult to rotate. Further examination revealed that the O-rings on the fuel selector valve’s internal spindle were swollen past the plane of the shaft of the spindle, preventing easy rotation. The pilot was aware of the fuel selector valve anomaly; however, a service bulletin addressing the problem with the fuel selector O-rings had not yet been complied with. The fuel blighting evidence at the accident site and the quantity of fuel found in the right fuel tank suggest that the right wing contained fuel at the time of impact. Based on the circumstances of the accident, it is most likely that the engine lost power due to fuel starvation during the go-around with the fuel selector valve positioned to the left tank, and the pilot became distracted when he tried to switch fuel tanks and lost control of the airplane.
Toxicological testing revealed the presence of antidepressant and cardiac medications in the pilot’s system. The blood level of the antidepressant medication was higher than usual therapeutic levels, indicating a high dose and prolonged use. The antidepressant medication in the pilot’s system comes with the warning that it may impair mental and/or physical abilities required for the performance of potentially hazardous tasks. In addition, depression is associated with significant cognitive degradation.
A review of the pilot’s medical records revealed an extensive history of psychiatric and cardiac issues and subsequent difficulties obtaining a medical certificate for flight. Before the pilot’s most recent medical certification exam, he provided the Federal Aviation Administration (FAA) medical examiner with documentation indicating that he was no longer taking antidepressants. Required standardized neuropsychological testing placed the pilot at average, below average, or mildly impaired when compared with other (somewhat younger) pilots. Based on the levels of antidepressant medication in the pilot’s system, the pilot likely knowingly misreported his medication use to the FAA when he applied for his medical certificate. The pilot’s underlying depression, personality disorder, cognitive issues, and medication use likely contributed to his unwillingness to address the airplane’s fuel selector valve problem. In addition, these conditions would have adversely affected the pilot’s ability to maintain control of the airplane in an emergency.
The National Transportation Safety Board determines the probable cause(s) of this accident to be: The pilot’s failure to maintain control of the airplane after a loss of engine power during a go-around. Contributing to the accident was the difficult-to-operate fuel selector valve and the pilot’s continued operation of the airplane with a known mechanical anomaly. Also contributing to the accident was the pilot’s depression, personality disorder, cognitive issues, and medication use, which adversely affected his ability to maintain control of the airplane during the emergency and likely affected his decision not to address the airplane’s fuel selector valve problem. Full narrative available
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