Written in blood

By David Jack Kenny

Clichés become clichés because they express some essential truth—and capture it so neatly that it seems pointless to look for other wording. Eventually sheer repetition makes those clever phrases feel a little shopworn, but the insights they express remain just as valid. Case in point: It’s no longer original to say that the federal aviation regulations were “written in blood”; nevertheless, a great many of the constraints they place on pilots grew out of somebody else’s tragedy.

On May 21, 2012, a 33-year-old airline pilot took off from the Hidden Lake residential airpark in Port Richey, Fla., in his personal airplane, a single-seat Pitts S1D. He had invited his wife and her parents to watch him practice aerobatics over the Gulf of Mexico. He did this fairly frequently, entertaining neighbors along with his family. One said it was “like having a free air show every week.”

That day, however, his wife thought his flying looked less crisp than usual. After about 20 minutes of maneuvers that included “aileron rolls, wingovers, loops, and stalls,” he performed a loop she described as “very sloppy … finished very low.” After recovering, he attempted another loop from an altitude that witnesses guessed was somewhere between 200 and 500 feet. As the Pitts began descending from the apex, it became clear to the onlookers that it wasn’t going to pull out in time. The little biplane hit the water nose-first and left wing low, killing the pilot on the spot.

It’s not entirely clear whether any mechanical discrepancy might have contributed to his inability to complete the loop. His father-in-law said that there was no appreciable change in the engine noise before the impact, but several other witnesses thought they heard “popping” or “backfiring” sounds. Only one blade of the propeller was bent. Partial disassembly of the engine found no apparent anomalies, though the engine itself was uncertified and heavily modified (entirely legal in an experimental amateur-built airplane). It was equipped with an inverted oil system, aftermarket fuel injection, one conventional magneto, and one electronic ignition module.

It’s also possible that the pilot’s physical condition played some role. While he was both young and fit, in the habit of getting regular exercise, he’d been under the weather the previous few days. It began with eye pain during an airline flight that became severe enough for him to have been relieved of duty; then he was diagnosed with bronchitis and put on antibiotics. Two nights before the accident he had slept badly, perhaps as a fever broke (his wife told a Civil Aerospace Medical Institute doctor that he’d been sweating heavily); the next day’s activities included about five hours working on the airplane in an un-air-conditioned hangar (probably warm in Florida in May). He’d slept well the night before the accident, but continued to suffer from lingering digestive upsets into the morning. His wife had tried to dissuade him from making the flight, but after having not flown any aerobatics in the past couple of weeks, he said he didn’t want to get out of practice.

That history raises the possibility that some combination of dehydration and fatigue might have left him unexpectedly susceptible to G-induced loss of consciousness. If that’s what happened, another thousand feet or two of cushion might not have made much difference. However, the NTSB called attention to FAR 91.303(e), which prohibits aerobatics at altitudes below 1,500 feet agl. Like most of Part 91, this defines an absolute minimum, with no guarantee that it’s enough to be safe in any specific situation. It was added to the regulations for a reason. If the problem was simply that on an off day (for whatever reason) he wasn’t able to fly with quite his customary precision, another thousand feet at the bottom of the loop would have made all the difference in the world.