Dutchess County Airport
Aircraft Accident/Incident Report

Poughkeepsie, New York 12590
Tuesady, June 28, 2011 12:12 EDT

NTSB Narrative Summary Released at Completion of Accident

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.

NTSB Probable Cause Narrative

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.

Event Information

Type of Event Accident
Event Date 6/28/2011
Event Day of the Week Tuesday
Time of Event 1212
Event Time Zone Eastern Daylight Time
Event City Poughkeepsie
Event State NEW YORK
Event Country --
Zipcode of the event site 12590
Event Date Year 2011
Event Date Month 6
MidAir Collision Indicator No
On Ground Collision occurred ? No
Event Location Latitude 413755N
Event Location Longitude 0735234W
Event Location Airport Dutchess County Airport
Event Location Nearest Airport ID POU
Indicates whether the acc/inc occurred off or on an airport Off Airport/Airstrip
Distance from airport in statute miles 1
Degrees magnetic from airport --
Airport Elevation 165
Weather Briefing Completeness --
Investigator's weather source Weather Observation Facility
Time of the weather observation 1153 Eastern Daylight Time
Direction of event from weather observation facility (degrees) 240
Weather Observation Facility ID POU
Elevation of weather observation facility 165
Distance of event from weather observation facility (units?) 1
Time Zone of the weather observation EDT
Lighting Conditions Day
Lowest Ceiling Height --
Lowest Non-Ceiling Height 4100
Sky/Lowest/Cloud Conditions Few
Sky Condition for Lowest Ceiling None
Visibility Runway Visual Range (Feet) --
Visibility Runway Visual Value (Statute Miles) --
Visibility (Statute Miles) 10
Air Temperature at event time (in degrees celsius) 27
Dew Point at event time (in degress fahrenheit) 18
Wind Direction (degrees magnetic) --
Variable Wind Indicator --
Wind Speed (knots) --
Wind Velocity Indicator Calm
Wind Gust Indicator --
Wind Gust (knots) --
Altimeter Setting at event time (in. Hg) 29.89
Density Altitude (feet) --
Intensity of Precipitation --
METAR weather report --
Event Highest Injury Fatal
On Ground, Fatal Injuries --
On Ground, Minor Injuries --
On Ground, Serious Injuries --
Injury Total Fatal 2
Injury Total Minor --
Injury Total None --
Injury Total Serious --
Injury Total All 2
Investigating Agency NTSB
NTSB Docket Number (internal use) 31389
NTSB Notification Source FAA Eastern ROC
NTSB Notification Date --
NTSB Notification Time --
Fiche Number and/or location -used to find docket information --
Date of most recent change to record May 28 2013 1:41PM
User who most recently changed record kenj
Basic weather conditions Visual Meteorological Cond
FAA District Office --

Aircraft Involved

Aircraft #1

Aircraft Registration Number N61579
NTSB Number ERA11FA369
Missing Aircraft Indicator --
Federal Aviation Reg. Part Part 91: General Aviation
Type of Flight Plan filed None
Flight plan Was Activated? No
Damage Substantial
Aircraft Fire Ground
Aircraft Explosion None
Aircraft Manufacturer's Full Name CESSNA
Aircraft Model 172M
Aircraft Series Identifier --
Aircraft Serial Number 17264654
Certified Max Gross Weight 2200
Aircraft Category Airplane
Aircraft Registration Class --
Aircraft is a homebuilt? No
Flight Crew Seats 2
Cabin Crew Seats --
Passenger Seats 2
Total number of seats on the aircraft 4
Number of Engines 1
Fixed gear or retractable gear Fixed
Aircraft, Type of Last Inspection Annual
Date of Last Inspection Feb 17 2011 12:00AM
Airframe hours since last inspection 49
Airframe Hours 4725
ELT Installed Yes
ELT Activated Yes
ELT Aided Location of Event Site No
ELT Type Unknown
Aircraft Owner Name Millbrook Flight LLC
Aircraft Owner Street Address --
Aircraft Owner City Poughquag
Aircraft Owner State NY
Aircraft Owner Country USA
Aircraft Owner Zipcode 12570
Operator is an individual? No
Operator Name Sean Bogart
Operator Same as Owner? No
Operator Is Doing Business As --
Operator Address Same as Owner? No
Operator Street Address --
Operator City Hopewell Junction
Operator State NY
Operator Country USA
Operator Zip code 12533
Operator Code --
Owner has at least one certificate None
Other Operator of large aircraft? No
Certified for Part 133 or 137 Operation --
Operator Certificate Number --
Indicates whether an air carrier operation was scheduled or not --
Indicates Domestic or International Flight --
Operator carrying Pax/Cargo/Mail --
Type of Flying (Per_Bus / Primary) Personal
Second Pilot on Board No
Departure Point Same as Event Yes
Departure Airport Code POU
Departure City Poughkeepsie
Departure State NY
Departure Country USA
Departure Time 1207
Departure Time Zone EDT
Destination Same as Local Flt dest & departure same, accident can occur anywhere
Destination Airport Code POU
Destination City Poughkeepsie
Destination State NY
Destination Country USA
Specific Phase of Flight --
Report sent to ICAO? --
Evacuation occurred --
Date of most recent change to record May 28 2013 1:42PM
User who most recently changed record kenj
Since inspection or accident Last Inspection
Event Location Runway Number and Location 24
Runway Length 5001
Runway Width 100
Sight Seeing flight No
Air Medical Flight No
Medical Flight --