NTSB Factual Report

On November 15, 1999, at about 1700 eastern standard time, a Frederick Rocket II, N561L, registered to a private owner, operating as a 14 CFR Part 91 personal flight, crashed in the Everglades southwest of Willard Fish Camp located in the vicinity of Coral Springs, Florida. Visual meteorological conditions prevailed and no flight plan was filed. The airplane was destroyed. The commercial pilot sustained fatal injuries, and the passenger sustained serious injuries. The flight originated from Fort Lauderdale-Hollywood International Airport (FLL), Fort Lauderdale, Florida, about 1 hour 41 minutes before the accident. The airplane was reported as missing on November 16, 1999, and located that afternoon.

The passenger stated they departed FLL at about 1520, on November 15, 1999, and their final destination was going to be Fort Lauderdale Executive Airport (FXE), Fort Lauderdale, Florida. The pilot informed him that they were going to fly out over the Everglades, and then return to FXE. They over flew North Perry Airport, Hollywood, Florida, and continued westbound. When they crossed over highway 441, the pilot made a descent down to 250 to 300 feet, and continued to the north-northwest. They eventually reversed course and proceeded on a southerly course towards Willard Fish Camp. Upon arrival, they circled the fish camp several times. The pilot decided that he would make one more pass over the fish camp before returning to FXE. They were heading towards the fish camp at about 250 to 300 feet, when they experienced a total loss of engine power. The pilot pulled back on the control stick to gain altitude. The nose pitched downward about 45 degrees, the left wing dropped down, and the airplane collided with the everglades.

The pilot held a commercial pilot certificate issued on September 4, 1977, for airplane single and multiengine land, instrument airplane, rotorcraft-helicopter. Attempts to locate the pilot's logbook was uneventful. Review of FAA records indicate the pilot had accumulated 3,000 total flight hours. Review of an aviation insurance application submitted by the pilot to Falcon Insurance, on September 21, 1999, indicates the pilot had recorded 44 hours in the Rocket II airplane. The pilot held an expired third-class medical certificate, issued on March 24, 1995, with the following restrictions; holder shall wear corrective lenses. Block 17 on the Exam Report AMA Data indicates that the pilot was not using any medication at the time of his application for a third class medical certificate.

Review of records on file with the Aircraft Registration Branch revealed N561L was built by Mark Frederick. The current registered owner on file with the FAA is David E. Brattain. Mr. Brattain stated that he sold N561L in May 1998, to Dr. Wood. There is no bill of sale on file with the FAA. Mr. Brattain stated, at the time of the sale, the engine had been removed from the airplane, disassembled and evaluated for overhaul. There was evidence of metal contamination in the oil filter screen found during a routine oil change. He further stated that Dr. Wood shipped the disassembled engine to Victor Aviation Services, Inc., for overhaul and reassembly.

Attempts to locate the engine logbook was uneventful. The Executive Vice President for Victor Aviation stated that Dr. Wood contacted his company requesting that they inspect the engine. Examination of the engine revealed that the crankshaft main and rod journals were not useable due to excessive wear. They recommended that the crankshaft be ground to an approved undersize which was approved by Dr. Wood. The remaining components from the engine were shipped to Victor Aviation on June 15, 1998. The Vice President stated the work performed on the engine was considered a repair only, not a major overhaul. Victor Aviation did not receive any maintenance records, therefore their logbook entry indicates the total time and time since last major overhaul are unknown. The engine was reassembled, inspected, and a test run was completed before returning it to the customer on about August 1, 1998.

The builder of N561L stated that engine was reinstalled on N561L in Houston, Texas, after the engine was shipped by Victor Aviation to Dr. Wood. The airplane was then flown to Austin Avionics for rework of the instrument panel, avionics, and a new Hobbs meter was installed. Austin Avionics stated that a review of their records indicates that they did not perform an altimeter and static system certification or a transponder test to ensure proper operation for use in controlled airspace. He further stated he performed a condition inspection on N561L on November 7, 1998, while the airplane was parked at Austin Avionics. On July 14, 1999, he calculated a new weight and balance for N561L following the addition of avionics. Dr. Wood was informed at that time that the registration still reflected Dave Brattain as the registered owner.

The nearest weather reporting facility at the time of the accident was Fort Lauderdale, Florida. The 1453 surface weather observation was: 2,500 scattered, visibility 10 miles, temperature 80 degrees Fahrenheit, dewpoint temperature 58 degrees Fahrenheit, wind from 280 degrees at 9 knots, and altimeter 29.78 in Hg. Visual meteorological conditions prevailed at the time of the accident.

The wreckage of N561L was located in the everglades about 1/2 mile southwest of Willard Fish Camp, in the vicinity of Coral Springs, Florida.

Examination of the crash site revealed the airplane collided with the Everglades in a nose-down left wing low attitude on a heading of 360 degrees magnetic. The engine assembly was displaced to the right and located below the water line about 1 feet. The propeller spinner exhibited evidence of rotation. Both propeller blades were bent aft with evidence of torsional twisting. One propeller blade sustained numerous nicks on the trailing edge in the vicinity of the propeller tip. The left wing was displaced aft and bent upward with the wing tip separated. The leading edge sustained compression damage extending outward from the wing root to the separated wing tip. The metal left fuel tank was ruptured. The right wing was accelerated forward and the leading edge was crushed inward and upward from the wing root extending outward 53 1/2 inches. The right metal fuel tank was ruptured. The fuel selector valve was selected to the left fuel tank. Both the left and right wing flaps were in the retracted position. The throttle was found in the mid range position, the propeller lever was found in the high rpm position, and the mixture was found in the full rich position. The Hobbs meter read 69.6 hours. The left and right main landing gear were displaced aft. The tail wheel was not damaged. The aft fuselage was compressed inward on the left side about 17 inches aft of the rear passenger seat. The remaining fuselage was not damaged.

Examination of the airframe and flight control system revealed no evidence of a precrash mechanical failure or malfunction. Continuity of the flight control system was confirmed for pitch, roll, and yaw.

The engine assembly was transported to Certified Engines Unlimited, Inc., an authorized FAA approved repair station. Examination of the engine revealed no data plate was installed. The engine serial number (L-7648-48) was stamped on the engine case. According to the data plate, the engine is a model IO-540-C4B5, and an inverted oil system is installed on the engine. The engine was placed in a test cell. The engine started, after a warm up period the engine ran smooth at all power settings. At full throttle, 2,500 rpm was achieved. An excessive magneto drop was present. The No. 2 cylinder bottom ignition lead sustained impact damage. (For additional information see the engine test run sheet an attachment to this report.)

Postmortem examination of the pilot was conducted by Dr. Linda Rush, Associate Medical Examiner, District 17, Fort Lauderdale, Florida, on November 17, 1999. The cause of death was multiple blunt force trauma injuries. Postmortem toxicology of specimens from the pilot was performed by the Forensic Toxicology Research Section, Federal Aviation Administration, Oklahoma City, Oklahoma. These studies were negative for ethanol. Amitriptyline 0.262 ug/ml, ug/g , a prescription antidepresant with sedative affects and nortriptyline 0.546 ug/ml, ug/g, a metabolite of amitriptyline was detected in the blood. Verapamil, a prescription blood pressure medication, and norverapamil was detected in the blood. Norverapamil, a metabolite of verapamil, verapamil, and nortriptyline was detected in the urine.

Review of a medical drug reference guide indicates the side effects of amitriptyline may cause drowsiness, dizziness, increased sun sensitivity or blurred vision, and to use caution when performing tasks that require alertness.

The passenger was transported to North Broward Medical Center, Pompano Beach, Florida. The pilot sustained serious injuries. Toxicology studies of specimens from the passenger was not requested or performed.

Review of information provided by D & J Harmon Company Inc., revealed that the calculated stalling speed for the Rocket II at a gross weight of 1,900 pounds, power off, flaps up is 66 mph, and with flaps down is 63 mph. The calculated stall speed with a pilot, passenger, and 18 gallons of fuel with flaps up is 64 mph and with flaps down is 61 mph.

Review of Figure 3-16. Part Throttle Fuel Consumption Curve - IO-540-C reveals at 65 percent power the engine will consume 15 U.S. gallons of fuel per hour. At 75 percent power the engine will consume 16 U.S. gallons of fuel per hour. At 85 percent power the engine will consume 18 U.S. gallons of fuel per hour.

Two Shadin Company indicators were removed from the aircraft. In addition, three Floscan fuel transducers that were connected in series by various fittings and housings were removed from the engine. All of the components were forwarded to an FAA representative for examination by Shadin Company Incorporated. A self test was performed on both indicators, and no deficiencies were noted. The three Floscan fuel flow transducers were installed in a fuel flow test bench, and no deficiencies were noted. (For additional information see Shadin Company Incorporated letter dated December 17, 1999, an attachment to this report.)

The Electronics International Inc., FL-2R was removed from the aircraft and forwarded to an FAA representative for examination by Electronics International Inc. According to the CEO of Electronics International Inc., the left and right fuel tanks were calibrated from 0 to 20 gallons. Data retrieved from the FL-2R indicated two power shutdowns occurred during the last 102 minutes of operation. "I believe the first shutdown was the crash and the second was when the battery went dead....NOTE: - From 68 to 52 min. before the First Power shutdown, the fuel usage was: (17-11) /16 min = approx. 22.5 gal/Hr. The fuel was being used from the right tank. The right tank stopped using fuel approximately 50 min. before the crash. The tank selector may have been switched to the left tank at that time. Approx. 50 min. at approx. 22.5 gal/Hr = approx. 18 gal. Used. This would have emptied the left tank." (For additional information see Electronics International Inc., Letter dated December 16, 1999, an attachment to this report.)

The wreckage of N561L was released to Mr. Charles Maynard, Sample International Aviation Inc., on November 18, 1999. The engine assembly was released to Mr. Maynard on November 19, 1999. Components of the Shadin fuel totalizer was released to Mr. Maynard on January 4, 2000.

NTSB Probable Cause

The pilot's failure to maintain airspeed while maneuvering (VSO) resulting in an inadvertent stall and subsequent in-flight collision with water. Contributing to the accident was the pilot's improper fuel management resulting in a total loss of engine power due to fuel starvation, and the pilot's use of a sedating prescription antidepressant drug.