NASHVILLE, Tenn. (AP) — A lack of oxygen that incapacitated the pilot and three passengers is likely what caused a private jet to become unresponsive before flying over the nation's capital and prompting the military to scramble fighter jets in 2023, according to a final report from the National Transportation Safety Board released on Tuesday.

The oxygen problem was likely caused by a loss of cabin pressure, according to the report. Investigators could not determine the exact reason for the pressure loss, but they noted that the Cessna Citation had a number of maintenance issues. They included no pilot-side oxygen mask and supplemental oxygen at its minimum serviceable level.

“At that level, oxygen would not have been available to the airplane occupants and passenger oxygen masks would not have deployed in the event of a loss of pressurization,” according to the report. It concluded that, “Contributing to the accident was the pilot’s and owner/operator’s decision to operate the airplane without supplemental oxygen.”

Four people died in the June 4, 2023 accident. They were pilot Jeff Hefner, 69; New York real estate broker Adina Azarian, 49; Azarian's 2-year-old daughter Aria; and Evadnie Smith, 56, who worked as live-in nanny for Aria. Prior to the crash, Azarian, Aria and Smith were in North Carolina to visit Azarian's adoptive parents.

Hefner stopped responding to air traffic control instructions within minutes of taking off from Elizabethton, Tennessee, at 1:13 p.m. The plane flew to New York, near its destination at Long Island's MacArthur Airport, then turned around and flew a straight path over D.C. Fighter jets sent after it caused a loud sonic boom that was heard across the capital region as they raced to catch up. The plane then plunged almost straight down in into a mountain near Montebello, Virginia, and burst into flames at 3:23 p.m.

Fighter pilots tasked with intercepting the wayward flight said Hefner “was laying and slumped completely over into the right seat and remained motionless throughout their observations,” according to NTSB records. They did not observe any movement within the cabin area nor any shapes that resembled a person.

Once Hefner lost consciousness, the plane likely was directed along its path by autopilot “until a point at which it was no longer able to maintain control,” according to the report.

Lack of oxygen, called hypoxia, can affect people differently, but it is known to cause confusion, disorientation and diminished judgment and reactions, according to the report. A pilot would likely have between 30 seconds and 2 minutes to take corrective action. That time could be less if the depressurization is rapid.

“However, gradual depressurization can be as dangerous or more dangerous than rapid depressurization because of its potential to insidiously impair a pilot’s ability to recognize and respond to the developing emergency,” according to the report. “Cognitive impairment from hypoxia makes it harder for affected individuals to recognize their own impairment.”

The report noted that Hefner had several health issues and had been prescribed at least one medication that was potentially impairing but did not list those issues as contributing to the accident.

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