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Safety Recommendation Details

Safety Recommendation A-16-017
Details
Synopsis: On December 26, 2013, about 6:21 p.m. Pacific standard time, a Cessna 172K, N251JM, was destroyed when it impacted terrain while maneuvering near the Fresno Chandler Executive Airport (FCH), in Fresno, California. The airplane was privately registered and operated by the pilot under the provisions of Title 14 Code of Federal Regulations Part 91. The private pilot and his passenger sustained fatal injuries. At the time of the accident, it was dark night (about 1.5 hours after sunset) and visibility was 5 miles with haze, clear sky, and wind from 320° at 3 knots. No flight plan was filed for the personal flight.
Recommendation: TO THE AIRCRAFT OWNERS AND PILOTS ASSOCIATION: Include in your educational resources for pilots information about cataracts and the risks they pose to flight safety including a discussion of degraded vision at night, and encourage pilots with cataracts to communicate with their eye care professionals regarding diagnosis and treatment options.
Original recommendation transmittal letter: PDF
Overall Status: Closed - Acceptable Action
Mode: Aviation
Location: Fresno, CA, United States
Is Reiterated: No
Is Hazmat: No
Is NPRM: No
Accident #: WPR14FA078
Accident Reports: Safety Recommendation Report: Improving Pilot and Aviation Medical Examiner Knowledge of Cataract Hazards
Report #: ASR-16-03
Accident Date: 12/26/2013
Issue Date: 7/14/2016
Date Closed: 4/30/2018
Addressee(s) and Addressee Status: Aircraft Owners and Pilots Association (Closed - Acceptable Action)
Keyword(s):

Safety Recommendation History
From: NTSB
To: Aircraft Owners and Pilots Association
Date: 4/30/2018
Response: We note that you have incorporated additional educational materials about cataracts and the risks they pose to flight safety, especially at night, and information about returning to flight after cataract surgery in your medical self-assessment online course and on your online medical resources page. We also note that these resources are available at no cost on your website. These actions satisfy the intent of Safety Recommendation A-16-17, which is classified CLOSED--ACCEPTABLE ACTION.

From: Aircraft Owners and Pilots Association
To: NTSB
Date: 1/25/2018
Response: -From Richard McSpadden, Executive Director, AOPA Air Safety Institute: I am pleased to inform you and your agency of the work AOPA has performed in response to Safety Recommendation A-16-17. On July 14, 2016 the National Transportation Safety Board (NTSB) issued the following recommendation to AOPA: Include in your educational resources for pilots information about cataracts and the risks they pose to flight safety including a discussion of degraded vision at night, and encourage pilots with cataracts to communicate with their eye care professionals regarding diagnosis and treatment options. The Safety Recommendation noted that “the NTSB is vitally interested in this recommendation because it is designed to prevent accidents and save lives.” We share that interest and incorporated educational materials into our website, and also our Medical Self-Assessment online education course – which is free and available to anyone. The course is required for pilots who elect to fly under 14 CFR part 68, BasicMed. I have enclosed links and copy from both of those resources and believe, upon your review, you will agree that the Safety Recommendation can be changed to “Closed – Acceptable Action.” We thank you for the recommendation, hope it will make a positive impact, and look forward to working with you and the NTSB to further improve the safety of general aviation.

From: NTSB
To: Aircraft Owners and Pilots Association
Date: 11/4/2016
Response: Before we issued this recommendation, your medical staff informed us that the educational information about cataracts you provided to members was limited to a discussion about returning to flight after cataract surgery. We note that you intend to review your educational material about cataracts to ensure that it is current and accurate. We emphasize, however, that, in addition to providing information about returning to flight after cataract surgery, the intent of this recommendation is to ensure that pilots are well informed about cataracts and the risks they pose to flight safety, especially at night. In addition, we believe that pilots with cataracts should be encouraged to communicate with their eye care professionals regarding diagnosis and treatment options. Pending our review of educational resource material for pilots about cataracts that addresses the concerns discussed above, Safety Recommendation A-16-017 is classified OPEN—ACCEPTABLE RESPONSE. Mr. Perry’s letter also discussed concerns with recent NTSB accident investigations in which we found a pilot’s medical condition to be a contributing factor. As you know, we take into account all the facts revealed in an investigation—including available operational evidence of human and aircraft performance as well as the pilot’s medical fitness—to determine probable cause and develop recommendations to prevent future accidents. I assure you that all factual evidence is thoroughly deliberated by the Board before we issue a finding or recommendation.

From: Aircraft Owners and Pilots Association
To: NTSB
Date: 8/31/2016
Response: -From George Perry, Senior Vice President, Air Safety Institute: Before we received the Board's recommendation we did mention to your staff that AOPA's Air Safety Institute included this condition in our on-line aeromedical education course, which we were fortunate enough to preview with the NTSB team last year. We firmly believe that education is key to growing awareness about medical conditions and will result in a more informed pilot population. I would also like to take this opportunity to thank the Board for recognizing AOPA as the source to disseminate safety information and educational material to the GA pilot community. Our Air Safety Institute is the world's largest provider of free safety education for all pilots and has over two million users per year. As I am sure you and your team are aware, an aeromedical education course is now a required component to third class medical reform, signed into law by President Obama on July 15th. As such, we anticipate the course to be taken by hundreds of thousands of pilots- a safety outreach unparalleled by any government and/or industry effort. AOPA will continue to lead the effort on general aviation safety education and will ensure our educational material on cataracts and the risks they pose to safety are up to date and accurate. If I may, and I mention this with all due respect, recent accident investigations have raised questions within the pilot community and seem to divert from the longstanding facts driven work that the NTSB has followed for decades. For example, in a 2015 accident involving a Piper Meridian the Board determined the probable cause of the accident to be "the pilot's loss of airplane control during takeoff, which resulted from his impairment or incapacitation due to an acute cardiac event," yet the NTSB's Medical Factual Report, stated "there was no evidence of recent or old infraction. In a 2014 Cirrus SR22 accident report, even though communications between the pilot and the controller clearly indicated hypoxia as the likely cause, it 'was vague in suggesting the reason for the pilot's impairment and has led to inaccurate and speculative press reports. In this accident, the NTSB's probable cause statement included that, "the pilot's impairment and subsequent incapacitation for reasons that could not be determined because the pilot and airplane were not recovered". In similar accidents, even when the pilot and airplane are recovered and a cause cannot be determined based on findings at the scene or from a subsequent autopsy, it is more appropriate for a "no determination" statement in order to remove any doubt as to the actual cause of the accident. The FAA and industry use these NTSB accident reports and probable cause findings to learn what went wrong and focus our collective efforts on preventing them from occurring in the future. While we understand that collecting and analyzing all relevant materials and records are important in the findings process, we also believe that relying on those to solely determine or influence probable cause when other factual evidence is not forthcoming is speculative. We believe when the actual cause of the accident cannot be determined it is vital that the probable cause reflect those situations. Thank you 3gain for al! you and your team at NTSB do to help improve transportation safety. As AOPA's top safety officer, I firmly believe that by working together, we will improve aviation safety and ensure both the future and health.