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CEN20LA374 · Piper PA28 235

1 Sept 2020 · Walker, MN, United States

Piper PA28 235 · Accident: medical event en route

From Saint Cloud Regional Airport (STC) to Bemidji Regional Airport (BJI)

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Event

NTSB case
CEN20LA374
Event typeAccident: someone killed or seriously injured, or the aircraft substantially damaged (NTSB definition). Incident: an occurrence that affected or could have affected safety, short of that. Glossary
Accident
InvestigationHow far the investigation had got when the record was published: preliminary, ongoing, final or completed. Unknown where the source does not say. Glossary
Completed
API-reported fatalities
1 · all aircraft and ground
Ground fatalities
Unknown
OperationWhat kind of flying it was, grouped by the rules it flew under: airline (US Part 121), air taxi and commuter (Part 135), general aviation (Part 91 and similar), military or government. Glossary
General aviation
WeatherVisual meteorological conditions (VMC): good enough to fly by looking outside. Instrument conditions (IMC): cloud or low visibility, flying by instruments. Glossary
Visual Meteorological Cond

Piper PA28 235

Aircraft type
Piper PA28
Category
Airplane
RegistrationThe aircraft's tail number, such as N12345 or G-ABCD. Registrations are reissued, so the same one years apart can be a different aircraft. Glossary
N8957W
Operator
Unknown
Onboard fatalities
Unknown
Route
From Saint Cloud Regional Airport (STC), St. Cloud, MNTo Bemidji Regional Airport (BJI), Bemidji, MN
Aircraft age
About 56 years (built 1964)
Flight rulesThe regulations the flight operated under: in the US, Part 91 (general aviation), Part 121 (airlines), Part 135 (air taxi and commuter) and others; for flights abroad, the NTSB's coarser commercial or non-commercial code. Glossary
Part 91: General Aviation
Phase of flightThe stage of the flight when things started to go wrong: standing, taxi, takeoff, initial climb, en route, maneuvering, approach or landing. Glossary
En route
Defining eventThe single coded event the NTSB judges best describes what happened (records from 2008 on). Older records name the first occurrence in the sequence instead. Glossary
Medical event
DamageDestroyed: beyond practical repair. Substantial: damage that affects the structure, performance or handling and normally needs major repair. Minor: less than that. Glossary
Substantial

Cause areas

  • Personnel issues › Physical

Approximate · Coordinates as recorded by the NTSB; no uncertainty radius is established.

NTSB narrative

The pilot was on the final leg of a cross-country flight at the time of the accident. A representative of the fixed base operator (FBO) reported that, during a fuel stop after the initial flight leg, the pilot landed without announcing his intentions over the radio. The pilot subsequently requested the airplane be fueled but remained in the airplane and stared straight ahead as it was being fueled. Afterward, the pilot exited the airplane and ate his lunch in the FBO conference room. He was offered a bottle of water but did not acknowledge.

During the second flight leg, air traffic controllers observed altitude and course deviations and noted slow radio responses that caused them to be concerned that the pilot was hypoxic or disoriented. They diverted the pilot to an intermediate airport and subsequently declared an emergency on the pilot’s behalf. He was met by emergency medical personnel but refused treatment. The pilot subsequently departed for the intended destination airport without refueling.

During the final flight leg, position data depicted the pilot altering course as the airplane approached a line of storms. He proceeded about 15 miles away from the storms but then abruptly reversed course toward the intended destination airport and again approached the line of storms. About 4 minutes before the accident and as the airplane continued to approach the line of storms, the pilot entered a descent from 7,000 ft, which appeared to continue until impact with the surface of a lake. The airplane came to rest in about 12 ft of water.

Post-recovery airframe and engine examinations did not reveal any anomalies consistent with a preimpact failure or malfunction. Based on the available information, the airplane flew about 4.5 hours since being fully fueled. However, due to submersion in the lake, no estimate could be made concerning the remaining fuel onboard at the time of the accident. Without additional data, whether fuel exhaustion occurred could not be determined.

The pilot was reportedly slow to respond during conversations, sleeping excessively, and seemed to have significant difficulty focusing in the weeks before the accident, which was noted to be unusual for the pilot. His autopsy revealed a previously undiagnosed brain tumor that had a compressive effect on his brain. Based on the autopsy findings and information about the pilot’s behavior on the day of the accident and during the preceding weeks, the pilot was likely impaired by effects of his brain tumor at the time of the accident.

The autopsy also identified two peripheral blood clots in the pilot’s left lung and blood clots in the deep veins of his left lower leg. Blood clots in deep leg veins may develop for a variety of reasons, including from slowed blood flow during prolonged sitting and from pro-clotting effects of cancer. However, whether symptoms from the blood clots contributed to the accident could not be determined from available information.

Probable cause

The pilot’s impairment from the effects of an undiagnosed brain tumor.

Verbatim NTSB analysis and probable cause from the NTSB dataset

Sources

NTSB record CEN20LA374
Event ID
20200902X14035
Case number
CEN20LA374
Dataset
full-current
Source SHA-256
5cf380f0061817c0331a6b2d8cc7e0ee3a79bea469a1001dc5c10e56f35f5ab3
Source notes (4)
  • Unreviewed is an editorial label, not an investigation status. API-sourced is not report-checked or human-reviewed. Explicit event totals are used without summing aircraft injury tables; onboard allocation is withheld. Unknown values remain unknown. The operation category is mapped from the NTSB-reported FAR part and has not been reviewed.
  • Filled from the NTSB case API where the bulk record had no value: local date, investigation status, cause areas. Values present in the bulk record are kept.
  • The date is the local date; the NTSB stores the UTC date 2020-09-02.
  • API snapshot SHA-256: a29ce4da1a490e5cca93229f792a5c7e2277f7c4a14be4bc70f558b17319d86d; retrieved 2026-09-15T07:19:06.385Z.