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NTSB Report

September 7, 1998 · Piper PA-44-180 · N922ER

Daytona Beach, FL

Overview

Report Status
Final with probable cause
Event Type
Accident
Date
September 7, 1998
Injury Outcomes
1 injury (1 fatality)
Location
Daytona Beach, FL
Aircraft
Piper PA-44-180
Tail Number
N922ER
Operator
Michael J Nawrocki
Injuries
Fatal
Aircraft Damage
Destroyed
NTSB Number
MIA98FA239

The pilot gained unauthorized access to the aircraft and departed the airport followed a short time later by a request to ATC for an ILS approach to runway 7 left. As the flight approached the runway it was observed at a high altitude and when questioned if he could get down and land, the pilot reported 'this will be my final landing.' Witnesses observed the aircraft fly over the end of the runway at about 600 feet and then descend in a nose low attitude until impact with the runway. Engine power was observed to go to full power as the aircraft descended. The pilot was observed to have consumed alcohol beverages prior to the accident and was found to have a alcohol level of .15 g/dl in the liver. The pilot left a note stating 'I do not want to live.' The Medical Examiners Office ruled the manner of death as suicide.

NTSB Probable Cause

The pilot's use of the aircraft to commit suicide.

Full Narrative

History of the Flight On September 6, 1998, about 2323 eastern daylight time, a Piper PA-44-180, N922ER, registered to Embry-Riddle Aeronautical University, crashed on runway 7 left at Daytona Beach International Airport, Daytona Beach, Florida, while on a Title 14 CFR Part 91 personal flight. Visual meteorological conditions prevailed at the time and no flight plan was filed. The aircraft was destroyed and the commercial-rated pilot was fatally injured. The flight originated from Daytona Beach, the same day, about 2304. Embry-Riddle Aeronautical University personnel stated the pilot was employed as a flight instructor. At 2249, the pilot attempted to use his issued key to gain access to the Embry-Riddle flight line. Due to the late hour, the security computer system would not allow him access. The pilot then climbed the 8-foot, barbed wire topped fence to the flight line and gained unauthorized access to N922ER. At 2259:32, the pilot called the FAA Daytona Beach Control Tower and requested to taxi to the active runway for takeoff. The pilot was cleared to taxi to runway 7 left. The pilot of another Embry-Riddle aircraft observed the aircraft start taxiing from the ramp with one pilot, who was located in the right seat. At 2304:07, the pilot requested and was given takeoff clearance on runway 7 left. After takeoff the pilot flew east to the beach and then proceeded north along the beach. At 2308:52, when northeast of the airport, the pilot requested radar vectors for the instrument landing system (ILS) approach to runway 7 left. At 2316:50, the flight was cleared for the ILS 7 left approach and at 2318:13, the flight was cleared to land. At 2320:57, the FAA controller noticed the flight was at a higher than normal altitude on the approach and he asked the pilot if he would be able to "get down from there." The pilot replied, "and riddle nine two two roger this will be my final landing." The controller and witnesses observed the flight cross over the end of the runway at about 600 feet agl and then nose over and descend rapidly from which it collided with the runway in a nose down attitude. Witnesses located near the arrival end of the runway report hearing the engines go to full power as the aircraft started the descent. Friends of the pilot stated after the accident that the pilot had been to a local restaurant and consumed alcoholic beverages. He was driven home about 2150. At 2220, the pilot obtained a note pad and returned to his bedroom. At 2235, the pilot left his apartment, stating he was going for a walk. He was not seen again. When the pilot's roommate was informed of the accident at about 0830 on September 7, 1998, he went into the pilot's room and found a note in which the pilot stated " I do not want to live." Personnel Information Information on the pilot is contained in this report under First Pilot Information and in attachments to this report. Aircraft Information Information on the aircraft is contained in this report under Aircraft Information and in attachments to this report. Meteorological Information Visual meteorological conditions prevailed at the time of the accident. The moon was at an altitude 27.8 degrees on a bearing of 117.1 degrees at the time of the accident. The moon had a 99 percent illumination. Additional meteorological information is contained in this report under Weather Information and in attachments to this report. Wreckage and Impact Information The aircraft crashed on the approach end of runway 7 left at Daytona Beach International Airport, Daytona Beach, Florida. Examination of the crash site showed the aircraft impacted the runway about 1,077 feet from the approach end of the runway. The initial impact point was to the left of the runway center line on about a 090-degree heading. The aircraft was in about a 30-40 degree nose down attitude at the time of impact. Slash marks were present in the runway surface from both propellers. The distance between the first two sets of slash marks from each propeller was about 41 inches. After impact the aircraft continued in a easterly direction, coming to rest about 850 feet from the initial impact point. General breakup of the aircraft occurred after initial impact and an explosion and fire occurred in both wing fuel tanks after impact. All components of the aircraft which are necessary for flight were located on or around the main wreckage of the aircraft. Continuity of the aileron, rudder, stabilator, stabilator trim, and rudder trim flight control systems was established. All separation points within the flight control systems were consistent with overstress separation. The landing gear and wing flaps were in the retracted positions. The stabilator trim was set to 2 degrees tab down or aircraft nose up. The rudder trim system was damaged by impact forces and it could not be determined as to which position it was set to at the time of the accident. Examination of the left engine and propeller showed the left propeller blades had damage consistent with rotation at a high engine power at the time of ground impact. The propeller separated from the engine during ground impact when the engine crankshaft propeller flange separated due to overstress. Examination of the engine showed the engine would not rotate due to impact damage. Disassembly of the engine confirmed continuity of the crankshaft, camshaft, valve train, and accessory drives. Each cylinder had the intake and exhaust valves in place and showed no signs of mechanical failure or malfunction. The left magneto separated from the engine during impact. The left magneto produced normal spark when rotated by hand. The right magneto was destroyed by impact forces. The spark plugs had deposit color consistent with normal engine operation. The carburetor was destroyed by impact forces. The propeller governor rotated and pumped oil when turned by hand. Examination of the right engine and propeller showed the right propeller blades had damage consistent with rotation at a high engine power at the time of ground impact. The propeller separated from the engine during ground impact when the engine crankshaft propeller flange separated due to overstress. Examination of the engine showed the engine would not rotate due to impact damage. Removal of the cylinders allowed the engine to rotate. Continuity of the crankshaft, camshaft, and valve train was confirmed. Impact damage to the accessory drive section displaced the intermediate accessory drive gears which were not located or recovered. Examination of the crankshaft gear and camshaft showed no pre-impact damage. Each cylinder had the intake and exhaust valves in place and showed no signs of mechanical failure or malfunction. The left magneto separated from the engine during impact. The left magneto produced normal spark when rotated by hand. The right magneto was destroyed by impact forces. The spark plugs had deposit color consistent with normal engine operation. The carburetor and propeller governor were damaged by impact forces. Examination of the left and right wing tip navigation lights and rear wing tip position lights showed each to have stretched light bulb filaments. Examination of the right front seat showed damage consistent with it being occupied at the time of the accident. The seat belt and shoulder harness were found unbuckled and without damage. Medical and Pathological Information Postmortem examination of the pilot was performed by Marie A. Herrmann, M.D., Associate Medical Examiner, Daytona Beach, Florida. The cause of death was attributed to multiple blunt force injuries. The manner of death was attributed to suicide. Postmortem toxicology studies on specimens obtained from the pilot were performed by Bruce A. Goldberger, Ph.D., University of Florida, Gainesville, Florida, and Dennis V. Canfield, Ph.D., FAA Toxicology Laboratory, Oklahoma City, Oklahoma. The tests were positive for .15 g/dl ethanol in liver and .14 g/dl ethanol in urine. The tests were negative for carbon monoxide and drugs. The note found in the pilot's room by his roommate after the accident was investigated by the Medical Examiner's Office, Daytona Beach, Florida, and the Volusia County Sheriff's Department. The pilot wrote "I do not want to live." Based on this note the manner of death of the pilot was attributed to suicide. For additional medical and pathological information see Supplement K and the attached toxicology report. Tests and Research The propeller slash marks found on the runway from both the left and right propeller measured about 41 inches apart for the first two sets. Witnesses reported hearing the engines accelerate to full power as the aircraft descended toward the runway. Computer analysis showed that with the engines operating at full power, which produces 2,700 engine and propeller rpm, and slash marks 41 inches apart, the aircraft had a groundspeed of about 182 knots at the time of runway impact. (See attached analysis) Additional Information The aircraft wreckage was released by NTSB on September 8, 1998, to Mr. Grant Brophy, Aviation Safety Program Manager, Embry-Riddle Aeronautical University, Daytona Beach, Florida. No components were retained for further examination.

Flight

Event TypeAccident
Event Time23:23 EDT
Nearest AirportDaytona Beach Int'L (1nm WSW)
Runway7L
Runway Length10500 ft
Runway Width150 ft
Flight Plan FiledNone
Aircraft FireGrd
Aircraft ExplosionGrd

Aircraft

AircraftPiper PA-44-180
Tail NumberN922ER
Aircraft CategoryAir
DamageDestroyed
OperatorMichael J Nawrocki
Operating RulePart 91
Engines2
Engine TypeReciprocating
Engine DetailsLycoming · O-360-A1H6 · Reciprocating · 180
Seats4

People & Injuries

Injury Summary1 injury (1 fatality)
Fatal1
Serious0
Minor0
Uninjured0
Total1
Crew 1Age 26 · Second Class

Conditions

ConditionsVMC
LightBright Night
WindCalm
Visibility10 sm
CeilingNone
Altimeter30.00 inHg
Observation Time02:53
Weather SourceWFAC

Appendix: Source Data