N680HP – Piper Aircraft Corp PA-31-350 – 2002-08-16 NTSB Accident Report

HISTORY OF FLIGHT

On August 16, 2002, about 1135 eastern daylight time, a Piper PA-31-350, N680HP, was destroyed when it impacted terrain during a descent near Sanderson, West Virginia. The certificated commercial pilot was fatally injured. Visual meteorological conditions prevailed for the flight that originated from the Charleston International Airport (CHS), Charleston, South Carolina, destined for the Yeager Airport (CRW), Charleston, West Virginia. An instrument flight rules flight plan was filed and activated for the positioning flight conducted under 14 CFR Part 91.

According to witnesses, the pilot flew five passengers from Charleston, West Virginia, to Charleston, South Carolina, earlier in the day. The flight was conducted without incident, and once on the ground, the passengers deplaned. After the lineman serviced the airplane with a full load of fuel, he and the pilot had a short conversation. During the conversation, the pilot seemed relaxed, not rushed, and in good health. The conversation ended, the pilot conducted a walk around inspection, and reboarded the airplane for the flight back to Charleston, West Virginia.

According to air traffic control data, the airplane departed Charleston, South Carolina, and proceeded towards Charleston, West Virginia. Once in the Charleston, West Virginia, area the pilot was given a frequency change from Indianapolis Center to Charleston Approach Control. After contacting approach, the pilot was cleared to descend from 8,000 feet msl to 5,000 feet msl. According to radar data, after leaving 8,000 feet msl, the airplane maintained approximately a 500-foot per-minute descent until radar contact was lost at approximately 1,700 feet msl. During the descent, the airplane's ground track varied between 000 and 024 degrees magnetic, and ground speed varied between 178 and 197 knots.

The accident occurred during the hours of daylight. The wreckage was located in a creek at 38 degrees, 21.58 minutes north latitude, 81 degrees, 18.69 minutes west longitude, and an elevation of approximately 860 feet msl.

AIRCRAFT INFORMATION

According to the airplane manufacturer, the airplane was manufactured in 1980. It was equipped with two 350-horsepower Lycoming TIO-540-J2BD engines, with constant speed propellers, and capable of carrying eight occupants, including the pilot.

The airplane was modified with a Colemill Panther conversion, which included adding 4-bladed "Q-tipped" propellers, Woodward governors and synchrophasers, modified propeller spinners, unfeathering accumulators, a Shadin digital fuel management computer, and winglets.

Examination of the airframe logbooks revealed that an annual inspection was performed on November 16, 2001. At the time of the inspection, the airplane had accrued 4,493.2 hours of flight time. According to the airframe logbook and company flight logs, the airplane had approximately 4,690 hours of flight time at the time of the accident.

PERSONNEL INFORMATION

The pilot held a commercial pilot certificate with ratings for airplane single-engine-land, multi-engine land, and instrument airplane. On his last Federal Aviation administration (FAA) first-class medical certificate, which was dated July 16, 2002, he reported a total flight experience of 5,720 hours. The pilot's logbook was not located, and presumed destroyed in the postcrash fire.

METEOROLOGICAL INFORMATION

A weather observation was taken about 7 minutes after the accident at the Yeager Airport, which had a field elevation of 981 feet msl, and located 15 miles to the west of the accident site. At the time of the observation, wind was 220 degrees at 6 knots, visibility was 9 miles, clouds were scattered at 7,500 feet, ceiling was broken at 12,000 feet, temperature was 81 degrees Fahrenheit, dew point was 70 degrees Fahrenheit, and the altimeter setting was 30.27 inches of mercury.

WRECKAGE AND IMPACT INFORMATION

Debris Path

The debris path was orientated on a magnetic heading of 005 degrees, and was approximately 1,450 feet long. Within the debris path, all the major structural components for the airplane were identified, along with portions from all the flight control surfaces. The topography of the debris path varied. It started at a ridgeline then transitioned to approximately a 60-degree descending slope, before terminating in a creek bed at the bottom of a ravine. Freshly broken tree branches on the south side of the 1,300-foot ridge marked the beginning of the debris path. The ridge was orientated east to west, and covered with trees, except for its crest, which had been cleared several months before the accident to install a gas well. In addition, the broken tree tops on the south and north sides of the ridge were higher in elevation than the ridge crest. The down angle from the broken branches on the south side to the broken tree trunks on the north was approximately 4 degrees.

To facilitate the investigation, the debris path was divided into 1-foot increments called stations, and the beginning of the debris path was designated as station 1. On the ridge crest at station 20 was the inboard section of the right aileron, along with the aileron trim tab, which was approximately in the neutral position. This section of wreckage was approximately 2 feet long, and displayed impact damage. On the north side of the ridge crest at station 60 were freshly broken tree trunks. The trunks had a diameter of 10 to 14 inches, and ranged in height from approximately 15 to 30 feet above the ground. In addition, the broken tree branches on the south side of the ridge and the center of the broken tree trunks on the north side, were approximately level in elevation.

At station 70 was the outboard section of the right wing, minus the winglet. This section of wing was approximately 5 feet long and displayed leading edge impact damage. The aileron, along with the aileron counterweight had separated from the wing section, the associated attachment points were deformed, and the fracture surfaces were gray in color and absent of beach marks. At station 80 was the inboard section of the left aileron. It was approximately 2 feet long, and displayed impact damage. At station 85, and approximately 10 feet left of debris path center, was the outboard section of the left wing, minus the aileron and winglet. This section of wing was approximately 4 feet long, the aileron counterweight was attached, and the leading edge displayed impact damage.

At station 90, approximately 15 feet left of debris path center, and approximately 20 feet above the ground, was a section of left wing wrapped around a tree trunk. At station 95, and approximately 20 feet above the ground, were fresh cut marks on a tree trunk. The marks were approximately 12 inches long, and 90 degrees to the horizontal axis of the debris path. At station 100 were the left and right winglets. Also at station 100, and approximately 15 feet left of debris path center, were the outboard sections of the left aileron, and left horizontal stabilizer. The aileron section was approximately 3 feet long, the stabilizer section was approximately 2.5 feet long, and both displayed impact damage. Located between stations 105 and 220 were approximately the outboard 4 feet of the right flap, the outboard 3 feet of the right aileron, the outboard 3 feet of the left flap, and the outboard 2.5 feet of the right horizontal stabilizer. All of which displayed impact damage.

At station 225 was a section from the left wing. This section of wing was approximately 3 feet long, and contained the left aileron bellcrank. The bellcrank was in place, and the aileron and balance cables were still attached. Both cables were approximately 4 feet long, and the ends were broomstrawed. In addition, the aileron push-pull rod was fractured. Examination of the fracture revealed it was gray in color and absent of beach marks. At station 320 was the upper half of the right engine cowling. At station 400 was the outboard section of the left stabilizer, with the corresponding elevator. This section of wreckage was approximately 2.5 feet long and displayed impact damage.

At station 800 was a piece of cut wood. The wood was approximately 2.5 inches in diameter, and was cut on a 45-degree angle. At station 980 was the right engine propeller. The No. 1 blade displayed leading edge gouges, and "S" bends. The No. 2 blade was bent mid span opposite the direction of rotation and displayed "S" bends. The No. 3 blade was bent mid span opposite the direction of rotation, had one leading edge gouge, and chordwise gouges on the non-cambered side of the blade. The No. 4 blade had separated from the propeller hub and was not recovered. Examination of the fracture surfaces associated with the No. 4 blade revealed they were gray in color, and absent of beach marks.

Main Wreckage

The main wreckage was located at station 1,450, in a small creek at the base of the ridge, and orientated on a magnetic heading of approximately 200 degrees. It was fragmented, and displayed severe impact and fire damage. It was comprised of remnants from the cockpit, left inboard wing, left inboard flap, left engine, cabin, empennage, horizontal stabilizer, elevator, vertical stabilizer, rudder, right engine, inboard right wing, and inboard right flap.

The instrument panel was destroyed in the postcrash fire. The pilot side altimeter had separated from the panel and was located approximately 15 feet to the west of the main wreckage. The glass face was broken, and all three pointers were missing. No needle impact marks were observed, and the altimeter was set to 30.34 inches of mercury. The pilot side airspeed indicator was located about 10 feet to the west of the main wreckage. The glass was broken and the needle was missing. No needle impact marks were identified on the face of the indicator.

Due to impact and fire damage, the throttle levers, propeller control levers, mixture control levers, elevator trim wheel, rudder trim wheel, aileron trim wheel, trim indicators, cowl flap switches, cowl flap indicators, both fuel selectors, and crossfeed valve were not identified.

The left main landing gear displayed impact and fire damage, and was retracted. The right main landing gear displayed impact damage, the gear door was partially closed, and the gear was retracted. The left flap jackscrew was not identified. The right flap jackscrew was in the up position. The left and right inboard wing spars, along with the spar cap were destroyed in the postcrash fire. The airframe left wing aft attachment point was not identified. The airframe right wing aft attachment point was deformed, the connecting bolt was in place, and a portion of the aft right wing attachment was present. The left and right engine electric boost pumps, electric low-pressure boost pumps, and emergency shutoff valves were not located.

Both control columns displayed impact and fire damage, and had separated from the airframe. The elevator control cables were attached to the elevator control sector and continuity was confirmed through the autopilot elevator pitch control servo to the elevator bellcrank in the rear of the fuselage. The aft elevator torque horn was intact, the elevator push-pull tube connecting points were intact, and melted aluminum was identified in the area of the connecting points.

The first portion of the elevator pitch trim system identified was the trim control cables, which emerged from melted aluminum just forward of the autopilot elevator pitch control servo. The nose-up cable was wrapped around the cable drum, and continuity was confirmed from the control servo to the elevator trim tab through the elevator trim jackscrew. The jackscrew had approximately three threads exposed, which equated to approximately 1-degree of nose up trim.

The aileron control chain was fragmented, and had separated from the control column sprockets. The left side of the chain was connected to the left aileron control cable, and the right side was connected to the right aileron control cable. Aft of the cockpit area, the left aileron control cable was visible for about 5 feet before disappearing into melted aluminum, and the right was visible for about 2 feet before also disappearing into melted aluminum. The cable ends were not located. An approximately 4-foot section of the aileron balance cable was located in the cabin area. The left end of the cable was broomstrawed, and the right was incased in melted aluminum. The autopilot roll servo was identified, and the bridle cable was still attached to the balance cable.

Rudder cable continuity was confirmed from the cockpit rudder bar to the rudder horn. Continuity from the rudder pedals could not be confirmed because of impact and fire damage. Continuity of the rudder trim system also could not be verified because of impact and fire damage. The rudder trim jackscrew had approximately nine threads visible, which equated to approximately a neutral trim setting.

The wreckage was recovered and transported to a facility in Clayton, Delaware, where the left and right engines were examined on August 22, 2002.

Left Engine

The propeller was partially attached, and the governor was in place. The propeller hub displayed impact damage and was compromised. The No. 1 blade displayed no chordwise scratches, "S" bends, or leading edge gouges. The No. 2 blade displayed "S" bends, and chordwise scratches. The No. 3 blade had separated from the hub. The fracture surfaces were gray in color and absent of beach marks. The No. 3 blade was recovered, and displayed "S" bends. The No. 4 blade was bent aft approximately 40 degrees, and displayed chordwise scratches.

The fuel servo was not recovered. The oil sump, along with the induction plenum was consumed in the postcrash fire. The left and right intake manifolds were destroyed. Continuity of the fuel lines that connected the fuel servo to the fuel dividers could not be confirmed because of impact and fire damage. Continuity from the fuel dividers to the No. 3, No. 4, and No. 6 fuel nozzles was confirmed. Continuity was not confirmed to the No. 1, No. 2, and No. 5 fuel nozzles because of impact and fire damage. Examination of the No. 5 fuel nozzle fitting revealed that the "B" nut and washer for the nozzle were suspended from the associated fuel line. Examination of the "B" nut revealed no impact damage on the outside of the fitting. Examination of the inside revealed the threads were damage approximately 90 degrees to the direction of rotation. In addition, no fire damage was identified on the engine baffling downstream of the No. 5 fuel nozzle.

Continuity from the air inlet box to the left and right fuel nozzle vent manifolds could not be confirmed because of impact and fire damage. Continuity was confirmed from the manifolds to the No. 4 and No. 6 fuel nozzles, but not to the No. 1, No. 2, No. 3, or No. 5 because of impact damage.

The top sparkplugs were removed, and the electrodes examined. The No. 1 and No. 2 were light gray in color, and absent of debris. The No. 3 and No. 4 were gray in color, and absent of debris. The No. 5 and No. 6 were dark gray in color, and absent of debris. The bottom sparkplugs were also removed and the electrodes examined. The No. 1 was gray in color, displayed impact damage, and contained debris. The No. 2 was destroyed. The No. 3 was destroyed. The No. 4 was gray in color, coated in oil, and displayed impact damage. The No. 5 was dark gray in color, and contained carbon deposits. The No. 6 was gray in color, and contained debris.

The No. 1 cylinder cooling fins were embedded with dirt, and both push rods displayed impact damage. The No. 2 cylinder valve assembly displayed impact damage, and both rocker arms and the intake push rod had separated from the cylinder. The No. 3 cylinder intake push rod displayed impact damage. The No. 4, and No. 5 cylinders displayed general impact damage. The No. 6 cylinder exhaust push rod displayed impact damage.

A rotational force was applied to the engine crankshaft. The crankshaft rotated about 300 degrees and then stopped. The idler gear was removed and the engine rotated 360 degrees. The idler gear was reinstalled, and once again, the crankshaft would only rotate about 300 degrees. Valve train continuity was confirmed for the No. 1 intake valve, No. 3 exhaust valve, No. 5 intake and exhaust valves, No. 4 intake and exhaust valves, and No. 6 intake valve. In addition, all the pistons actuated during crankshaft rotation.

The left and right exhaust manifolds displayed impact and fire damage, and continuity could not be confirmed to the turbo charger transition. The turbo charger was disassembled. The compressor impeller displayed damage opposite the direction of rotation. No rotational scoring was identified on the impeller housing. The turbine housing was opened, no damage to the turbine impeller was observed, and no scoring was identified on the turbine housing.

Examination of the accessory section revealed extensive impact and fire damage. The engine driven fuel pump was destroyed. The single drive dual magneto was consumed in the postcrash fire, except for the drive assembly. All twelve ignition leads displayed impact and fire damage, and continuity could not be confirmed. The vacuum pump was attached to the accessory drive housing, the shear coupling was melted, and the pump displayed impact and fire damage. The vacuum pump case was opened, and the rotor was found fractured, along with several of the vanes. The hydraulic pump was attached to the accessory section and displayed fire damage. The engine oil filter was removed and opened. The element displayed fire damage, and no metal contaminants were identified. The engine oil suction screen was not recovered.

Right Engine

The propeller had separated from the engine. The crankshaft flange was intact and a portion of the propeller flange was still attached. The fracture surfaces were gray in color, and no beach marks were observed. The propeller governor had separated from its mount consistent with impact damage, and a portion of the governor was located approximately half way between the beginning of the debris path and the main wreckage.

The fuel servo was connected to the induction housing. The throttle arm was in the open position, along with the throttle plate, and the throttle cable had separated from the throttle arm consistent with overload. The mixture control arm displayed impact damage, was in the full rich position, and the mixture control cable had separated from the control arm consistent with overload. The fuel screen was removed from the fuel servo, and no contaminants were observed. The fuel lines that connected the fuel servo to the left and right fuel dividers were intact. Continuity from the left fuel divider to the No. 2, No. 4, and No. 6 fuel nozzles could not be confirmed because of impact damage. Continuity from the right fuel divider to the No. 1, No. 3, and No. 5 fuel nozzles was confirmed.

The induction housing and plenum chamber displayed impact damage, and the plenum chamber was compromised. The left intake manifold displayed impact damage, and continuity to the No. 2, No. 4, and No. 6 cylinders could not be confirmed. The right intake manifold also displayed impact damage, and continuity to the No. 1, No. 3, and No. 5 cylinders could not be confirmed.

Continuity from the air inlet box to the left fuel nozzle vent manifold could not be confirmed because of impact damage. Continuity from the manifold to the No. 2, No. 4, and No. 6 fuel nozzles also could not be confirmed because of impact damage. Continuity from the air inlet box to the right fuel nozzle vent manifold could not be confirmed because of impact damage. Continuity from the manifold to the No. 3 fuel nozzle was confirmed, but not to the No. 1 and No. 5 fuel nozzles because of impact damage.

The top sparkplugs were removed, and the electrodes examined. The No. 1 was light gray in color, and absent of debris. The No. 2 was gray in color, displayed impact damage, and contained debris. The No. 3 was gray in color, and absent of debris. The No. 4 displayed impact damage and the electrode was destroyed. The No. 5 was light gray in color, and absent of debris. The No. 6 displayed impact damage, and the electrode was destroyed. The bottom sparkplugs were also removed and the electrodes examined. The No. 1 was gray in color, coated in oil, and contained debris. The No. 2 displayed impact damage, and the electrode was destroyed. The No. 3 was gray in color, and coated with oil. The No. 4 was gray in color, and contained debris. The No. 5 was gray in color, coated with oil, and contained debris. The No. 6 was light gray in color, and absent of debris.

The No. 1 cylinder intake and exhaust push rods were damaged, the valve cover had separated from the cylinder, and the valve housing was compromised. The intake rocker arm and pin had separated from the valve assembly. In addition, the front of the cylinder had finely chopped vegetation on and embedded in the cooling fins.

The No. 2 cylinder displayed impact damage. Both push rods had separated from the engine. The intake side of the cylinder head had separated from the cylinder, and the intake and exhaust valve springs were not recovered. The intake valve was not recovered, and the exhaust valve was located inside the cylinder. Examination of the cylinder wall revealed no mechanical wear or repetitive impact marks. The piston head had one gouge, and approximately four impact marks similar in size and shape to a cylinder valve.

The No. 3 cylinder was intact, and displayed impact damage to both push rods. The valve cover was attached and compressed inward, partially forming to the valves. The No. 4 cylinder and head displayed impact damage. The push rods were deformed, and the valve assembly was intact except for the exhaust valve rocker arm, which was not recovered. The No. 5 cylinder displayed minor impact damage. The valve cover was in place and compressed inward forming to the valves. The No. 6 cylinder also displayed minor impact damage.

Initial attempts to rotate the engine crankshaft were unsuccessful. The No. 1 and No. 2 cylinders were then removed, and a rotational force was reapplied. The crankshaft rotated, all six pistons actuated, and valve train continuity was confirmed for the No. 4, No. 5, and No. 6 cylinders. In addition, the magneto drive pad, hydraulic drive gear, fuel pump pad, and vacuum pump pad rotated.

The left exhaust manifold displayed impact damage, and continuity from the No. 2 cylinder to the turbo charger flange could not be confirmed. Continuity was confirmed from the No. 4, and No. 6 cylinders. The right exhaust manifold also displayed impact damage, and continuity could not be confirmed from the No. 1, No. 3, and No. 5 cylinders to the turbo charger flange. In addition, both turbo charger flanges had separated from the turbo charger transition. The turbo charger was disassembled. The compressor impeller fins were found bent and broken opposite the direction of rotation, and the compressor housing displayed rotational scoring. No scoring or damage was observed on the turbine impeller or turbine housing.

The engine accessory section displayed impact and fire damage. The engine driven fuel pump was intact. The single drive dual magneto case was compromised and the inside of the magneto displayed fire damage. All twelve ignition leads displayed impact and fire damage, and continuity could not be confirmed. The engine oil filter was removed and disassembled. The element displayed fire damage, and no metal contaminants were identified. The vacuum pump was opened and examined. The shear coupling was intact, the rotor was fractured, and several of the vanes were broken. The hydraulic pump was intact. The engine oil suction screen was removed, and several small pieces of carbon were identified.

MEDICAL AND PATHOLOGICAL INFORMATION

An autopsy was performed on August 17, 2002, at the Medical Examiner's office in Charleston, West Virginia.

The FAA Toxicology and Accident Research Laboratory in Oklahoma City, Oklahoma, performed a toxicological test on the pilot on October 1, 2002, which detected meperidine and normeperidine in tissue.

ADDITIONAL INFORMATION

The following medical information was extracted from a factual report produced by the Safety Board's medical officer, which consisted of material extracted from the pilot's FAA and personal medical records.

FAA Medical Records

On May 26, 1983, the pilot's gastroenterologist sent a letter to the Chief of the FAA Aeromedical Certification Branch stating that the pilot had been under his care for Crohn's disease of the small bowel since 1967. In spite of extensive small bowel involvement with recurrent small bowel obstruction requiring resections in 1967, 1968, 1972, and 1978, the pilot had gained weight, and was able to maintain a "vigorous athletic and work schedule." The gastroenterologist added that the disease had been in remission for 4 years, and the pilot maintained a "normal" blood count and a biochemical profile. Medications prescribed at the time were Prednisone, 20 mg every other day; Imuran [azathioprine], 100 mg daily; Cimetidine 300 mg, 4 times daily; multivitamin supplement; and vitamin B12, 1000 micrograms, monthly.

On June 22, 1983 the Chief of the FAA Aeromedical Certification Branch responded, "Our review of your medical records has established that you are eligible for third-class medical certificate. ...At the time of your next Federal Aviation Administration medical examination, please ask your aviation medical examiner to submit with the report of examination a follow up status report regarding your history of Crohn's disease. ...You are cautioned to abide by Federal Aviation Regulations, Section 61.53, relating to physical deficiency. Because of your history of Crohn's disease, operation of aircraft is prohibited at any time new symptoms or adverse changes occur - any time medication is changed."

On May 11, 1993, the pilot's gastroenterologist sent a letter to the pilot's aviation medical examiner stating that the pilot's Crohn's disease was in clinical remission. The pilot had been off all medication for a year, and had remained well with an "excellent," appetite and constant weight of 164 pounds. The gastroenterologist added that the pilot was still troubled by intermittent postprandial abdominal cramps, and up to five loose stools, daily; the cramping had been a long-standing problem, and was related to areas of small bowel narrowing, while his diarrhea was consistent with previous small bowel resections.

On October 27, 1993, the manager of the FAA Aeromedical Certification Division sent a letter to the pilot stating, "Our review of your medical records has established that you are eligible for a first-class medical certificate.... At the time of your next Federal Aviation Administration medical examination, please ask your aviation medical examiner to submit with the report of examination an interim status report from your treating physician regarding your history of Crohn's disease. You are cautioned to abide by Federal Aviation Regulations, Section 61.53, relating to physical deficiency. Because of your history of Crohn's disease, operation of aircraft is prohibited at any time new symptoms or adverse changes occur or any time medication is required...."

On November 10, 1997, the pilot's gastroenterologist sent a letter to the manager of the FAA Aeromedical Certification Division stating that the pilot was completely asymptomatic and on no medications, but was still having some chronic loose bowels secondary to multiple small bowel resections. Nevertheless, he remained in good nutritional status, with a constant weight of 163 pounds. The gastroenterologist added, "I would assess this individual to be in fairly good health in spite of his Crohn's disease, which I believe is in remission at this time. He is by no means disabled and I do not think his current health status should preclude him from engaging in any line of work he should choose without restrictions at least from the perspective of his Crohn's disease...."

On June 11, 1998, the manager of the FAA Aeromedical Certification Division sent a letter to the pilot stating, "Our review of your medical records has established that you are eligible for a first-class medical certificate ... you are cautioned to abide by Federal Aviation Regulations, Section 61.53, relating to physical deficiency. Because of your history of Crohn's disease, operation of aircraft is prohibited at any time new symptoms or adverse changes occur or any time medication is required...." There was no requirement noted on the letter for any additional follow up.

On June 28, 2002, the pilot's application for first-class Airman Medical Certificate indicated "No" in response to "Do You Currently Use Any Medication," and "Yes" to "Stomach, liver, or intestinal trouble." Under "Explanations" was noted "Previously reported - no change." Under "Visits to Health Professional Within Last 3 Years" was noted "March 2001 ... Gastroenterologist - Crohn's disease." For the examination performed in conjunction with that application, the pilot's height was noted as 69 inches and 175 lbs. Under "Comments on History and Findings" was noted "Previously reported - no change."

July 16, 2002, the electronic record of the pilot's most recent application for a first-class Airman Medical Certificate indicated "No" in response to "Do You Currently Use Any Medication," and "Yes" to "Stomach, liver, or intestinal trouble." Under "Visits to Health Professional Within Last 3 Years" was noted "4/15/02 ... Gastroenterologist - Crohn's." The pilot's height was noted as 68 inches and weight 165 lbs. Under "Comments on History and Findings" was noted "Good health - No bouts of Crohn's."

Personal Medical Records

February 13, 2002 - Physician's notes indicated "Lost 10 pounds in past month. More cramps. Usual diarrhea. About 3 weeks ago passed dark black stool for 3-4 days. 'Lot of pain' in epigastric area, goes into back. Can't eat full meal - gets pain or nausea/vomiting. No energy. Occasional sore in mouth ... Assessment - Crohn's disease of small bowel, questionable small bowel obstruction, persisting abdominal pain - unrelenting. Plan - Prednisone 40 mg per day for 2 weeks 20 mg per day, Imuran 2mg/kg/day - 100 mg 150 mg per day, Oxycontin [oxycodone] 5 mg four times a day as needed # 50." Weight is noted as 163 lbs. Laboratory report indicates potassium 3.3 mmol/L (reference range 3.5 - 5.3), hemoglobin 10.4 G/dL (reference range 13.2 - 17.1), hematocrit 31.6% (reference range 38.5 - 50.0). Handwritten note on laboratory report indicates "Notify him: (1) Potassium slightly low - eat banana daily (2) Anemic mild, hemoglobin 10.4."

March 22, 2002 - Physician's notes indicated "Phone call - passed lot of blood, black and red, yesterday and today weak, short of breath with exertion. Seems to have stopped now. Recommendation: Prilosec 20 mg twice a day, Carafate 1 gm four times a day, go to ER if worsens."

March 25, 2002 - Physician's notes indicated "Passing black stool for 4-5 days. Today has been having brown stool. Vomited, no blood. Pain in right upper quadrant back. Lightheaded. Headache, dyspnea on exertion. Prilosec/Carafate started. ...Hemoglobin 6.3. Assessment - gastrointestinal bleed secondary to Crohn's, ulcerations of duodenum. Plan - transfuse 3 units of blood...." Admission note indicates among other medications "... Demerol [meperidine] 75 mg IM every 3 hours as needed for pain...." Radiology report notes "... For PICC [Peripherally Inserted Central Catheter] placement ... Tip of PICC line visible at the junction of the superior vena cava and right atrium."

March 26, 2002 - Physician's notes indicate "Transfused 3 units. Post transfusion hematocrit 25.7, hemoglobin 8.7."

May 29, 2002 - Laboratory report indicated Hemoglobin 9.6 g/dL (normal range 14.0 -16.0) and hematocrit 30.3 (normal range 41.0 - 53.0).

According to the following reference, "CD [Crohn's Disease] is chronic and recurrent with no clear surgical cure." Friedman S, Blumberg RS. Inflammatory Bowel Disease (Chapter 276). Harrison's Principles of Internal Medicine, 16th Edition (Dennis L. Kasper, Eugene Braunwald, Anthony S. Fauci, Stephen L. Hauser, Dan L. Longo, J. Larry Jameson, and Kurt J. Isselbacher, Eds). McGraw-Hill, 2005.

The airplane was released to the owner's representative on August 23, 2002.