Medical event: Piper PA-46-500TP Malibu Meridian, N444RR, fatal accident occurred on July 15, 2023, at Martha's Vineyard Airport (MVY/KMVY), Vineyard Haven, Massachusetts

• Location: Vineyard Haven, Massachusetts 
• Accident Number: ERA23LA300 
• Date & Time: July 15, 2023, 15:15 Local 
• Registration: N444RR 
• Aircraft: Piper PA46 
• Aircraft Damage: Substantial 
• Defining Event: Medical event 
• Injuries: 1 Fatal, 1 Minor 
• Flight Conducted Under: Part 91: General aviation - Personal

https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/192636/pdf

https://data.ntsb.gov/Docket?ProjectID=192636

On July 15, 2023, at 1515 eastern daylight time, a Piper PA46-500TP airplane, N444RR, was substantially damaged when it was involved in an accident near Vineyard Haven, Massachusetts. The pilot was fatally injured, and the passenger sustained minor injuries. The flight was operated as Title 14 Code of Federal Regulations Part 91 personal flight.

According to the passenger, the 79-year-old pilot was performing a go-around when he experienced a medical emergency and “blacked out.” The passenger took control of the airplane and made an emergency gear-up landing, which resulted in substantial damage to the left wing. First responders found that the pilot was in cardiac arrest upon extricating him from the airplane.

A review of the pilot’s medical history revealed his incapacitation was most likely due to a sudden in-flight cardiac event that led to the cardiac arrest. The event was likely related to the pilot’s significant underlying heart disease, which included coronary artery disease and damage from a previous heart attack.

The Federal Aviation Administration (FAA) granted the pilot a series of Authorizations for Special Issuance of third-class medical certification based on annual medical testing and favorable status reports from the pilot's primary care and cardiology physicians. However, records from the pilot’s most recent aviation medical examination did not include any indication that the pilot reported his history of coronary artery disease, heart attack, or coronary artery bypass graft (CABG) to the Aviation Medical Examiner (AME). There also was no indication that the pilot presented his previously issued Authorization of Special Issuance letter to the AME, as required, and his most recent batch of medical reports submitted to the FAA provided no obvious indication that his incapacitation risk was substantially higher than the FAA had previously found acceptable when it issued his third-class medical certification by Special Issuance.

The pilot reported using several medications. However, whether effects from the pilot’s medication contributed to his incapacitation could not be determined.

- Probable Cause: The pilot’s incapacitation due to a sudden in-flight cardiac event, which resulted in a gear-up landing.