CEN11FA468

NTSB accident investigation · Robinson Helicopter R44 II · Rising Sun, IN · July 9, 2011

Accident · FatalField investigationFinal report
Date
July 9, 2011, 09:27 local (13:27 UTC)
Place
Rising Sun, IN
Injuries
1 fatal
Damage
Substantial damage
Phase of flight
Enroute
Aircraft
N42333Robinson Helicopter R44 II
Defining event
Enroute-cruise: Loss of visual reference
Weather
Visual (VMC) · Day
Status
Completed · report March 7, 2014
Report
Approved by Office Director
NTSB office
Central Region
Parties
Robinson, Lycoming, FAA Indianapolis FSDO
FAA report
20110709014499A
Case key
81068

From the NTSB’s public API. By law, NTSB reports can’t be used as evidence in lawsuits over the accident.

On this page

Probable cause

The noninstrument-rated pilot's decision to continue the visual flight rules flight into instrument meteorological conditions, which resulted in his spatial disorientation and failure to maintain clearance from terrain.

Findings · 6

NTSB’s coded findings. Those marked are part of the probable cause; the rest are factors or other findings. Under each, the cases with the same finding.

Ceiling/visibility/precip: low ceilingEnvironmental issues › Conditions/weather/phenomena · Contributed to outcomeRobinson Helicopter R44 II: 3 casesAll aircraft: 190 cases
Ceiling/visibility/precip: low visibilityEnvironmental issues › Conditions/weather/phenomena · Contributed to outcomeRobinson Helicopter R44 II: 5 casesAll aircraft: 175 cases
Ceiling/visibility/precip: fogEnvironmental issues › Conditions/weather/phenomena · Contributed to outcomeRobinson Helicopter R44 II: 4 casesAll aircraft: 78 cases

Sequence of events

The events NTSB coded, in order, by phase of flight. The defining event is the one that best describes the accident. Under each, the cases with the same event anywhere in their sequence.

Analysis

The noninstrument-rated pilot contacted approach control and requested clearance through class B airspace with visual flight rules (VFR) radar service to his destination. About 7 minutes later, the pilot reported that he needed to descend because he was "getting into too many clouds." The approach controller approved the VFR descent and instructed the pilot to maintain VFR at or below 2,000 feet. About 6 minutes later, radar data were lost. Recorded radar track data indicated that the helicopter was on a northwest heading and then turned west, that the helicopter's altitude varied between 1,100 to 1,300 feet above ground level, and that the helicopter appeared to be in a right turn before impact. The helicopter impacted trees near the top of a ridgeline located about 0.3 mile west of the Ohio River at an elevation of about 700 feet. The Cincinnati/Northern Kentucky International Airport, located about 13 nautical miles northeast of the accident site, reported 4 miles visibility, haze, and scattered clouds at 1,100 feet. Witnesses reported dense ground fog along the river and on the ridgeline near the accident site at the time of the accident. A postaccident examination of the airframe and engine revealed no evidence of mechanical malfunctions or failures that would have precluded normal operation. Based on the pilot's inexperience, the radar data, and the reduced visibility at the time of the accident, it is likely that the he experienced spatial disorientation, which led to his failure to maintain clearance from the terrain.

Factual narrative

The helicopter was a Robinson R44 II, serial number 12601, manufactured in 2010. The helicopter's maximum gross weight was 2,500 pounds and it seated four. The helicopter was powered by a 260-horsepower Lycoming IO-540-AE1A5 engine. The last annual maintenance inspection was conducted on May 3, 2011, and it had a total airframe and engine time of 493.4 hours. The helicopter had 517.4 hours at the time of the accident, and had operated 24 hours since the last maintenance inspection. On July 9, 2011, about 0927 eastern daylight time, a Robinson R44 II, N42333, sustained substantial damage when it impacted trees and terrain near Rising Sun, Indiana. The pilot was fatally injured. The helicopter was owned and operated by the pilot as a personal flight under the provisions of the 14 Code of Federal Regulations Part 91. The flight departed from the Georgetown Scott County Airport (27K), Georgetown, Kentucky, about 0900, and was en route to the Anderson Municipal Airport (AID), Anderson, Indiana. Visual meteorological conditions prevailed at the time of the accident. No flight plan was filed. The pilot contacted the Cincinnati (CVG) approach control about 0911 requesting clearance through the CVG class B airspace with visual flight rules (VFR) radar service to AID. The controller instructed the pilot to squawk code 0432, and about 0912 advised the pilot of radar contact 25 miles south of CVG. The pilot stated that he was proceeding direct to AID on a course of 339 degrees. About 0919, the pilot reported that he needed to descend because, "…I'm getting into too many clouds." The controller approved the VFR descent, and instructed the pilot to maintain VFR at or below 2,000 feet. According to recorded radar data, the last target for the helicopter was seen about 0924. The controller advised the pilot, "…radar services lost" about 0925. About 0929, a commercial airliner advised the CVG approach control that he was receiving a, "…beacon on guard." (Emergency frequency 121.5 is also referred to as "guard" frequency) Radar track data indicated that the helicopter was on a northwest heading until it crossed an area which had a 650 foot tall smoke stack located about 12.5 nautical miles (nm) from CVG on a 226 degree bearing. The helicopter then turned about 90 degrees to the west. The radar data indicated that the helicopter's altitude varied between 1,100 to 1,300 feet above ground level, and it appeared that the helicopter was in a right turn prior to impact. The helicopter impacted trees on the top of a ridgeline located about 2 nm from the smoke stack, and about 0.3 miles west of the Ohio River. The elevation at the top of the ridgeline was about 700 feet. An autopsy of the pilot was conducted on July 10, 2011, at the Dearborn County Hospital, Lawrenceburg, Indiana. The "Cause of Death" was noted as "multiple blunt force injuries." A Forensic Toxicology Fatal Accident Report was prepared by the FAA Civil Aerospace Medical Institute. The results werenegative for all substances tested. The 0913 surface weather observation at the Cincinnati/Northern Kentucky International Airport (CVG), Covington, Kentucky, located about 13 nautical miles northeast of the accident site was: wind 090 degrees at 6 knots; 4 miles visibility; haze; scattered clouds at 1,100 feet; temperature 24 degrees Celsius (C), dew point 21 degrees C; altimeter 29.99 inches of mercury. Witnesses who lived near the accident site reported dense ground fog along the river and on the ridgeline near the accident site at the time of the accident. The 60-year-old pilot held a private pilot's certificate with a helicopter rating. He had a total of about 575 flight hours, with about 42 hours in the make and model of the accident helicopter. He held a third class medical certificate that was issued in July 2010 with limitations for corrective lenses. The helicopter impacted trees near the top of a ridgeline on a 325 degree magnetic heading, and the wreckage debris path covered about 333 feet. At the initial point of impact, the vertical stabilizer and horizontal stabilizer were found stuck in the top of a tree. Numerous tail rotor and tail boom parts were found in the debris field near the initial point of impact. The main wreckage, which included the fuselage, cockpit, engine, main rotor, and the front section of the tailboom, was located 261 feet down the hill. The instrument panel was found 333 feet from the initial impact point and near the end of the debris field. There was no postimpact ground fire. The airframe and engine were examined at the Rising Sun Fire Department, Rising Sun, Indiana. The examination of the airframe revealed drive train continuity from the engine to the transmission, the main rotor, the tail rotor flex plate couplings, and the tail rotor gear box. Flight control continuity from the helicopter's cockpit flight controls to their respective control surfaces on the main rotor and tail rotor was not established due to the extensive impact damage to the flight control tubes; however, all separations were consistent with overload failures. Impact signatures consistent with rotation were exhibited on the helicopter's lower sheave and V-belts, upper sheave and clutch, and flex plate assemblies. The tail rotor drive shaft was twisted. The main rotor blades exhibited extensive impact damage and were broken in numerous places. Both tail rotor blades were separated from the blade hub yokes. One of the tail rotor blades exhibited aft crushing of the leading edge. Engine control continuity from the cockpit to the engine was verified. The engine examination revealed that it could be rotated by hand. Crankshaft and camshaft continuity was observed and all valve train components were operating normally. The gears within the accessory gear section were observed rotating. All cylinders were inspected with a lighted borescope and no defects were noted. The spark plugs, fuel injector, engine driven fuel pump, fuel flow divider,magnetos, and oil system were checked and no pre-impact anomalies were observed.

Aircraft

Registration
N42333
Reported as
Robinson Helicopter R44 II
Category
Helicopter
Serial number
12601
Built
2009
Airframe hours
517
Engine
Lycoming IO-540-AE1A5, 260 horsepower, reciprocating
Damage
Substantial damage
Flight
Personal · Part 91
Operator
Joseph Ohnheiser
Registered owner
Joseph Ohnheiser
Airworthiness certificate
Standard, Normal
Last inspection
Annual · May 3, 2011 · 24 hours before
Departed
27K · Georgetown, KY
Destination
AID · Anderson, IN
Flight plan
Unknown

Matched to the registry by N-number and the event date; the registry’s history has gaps, so older matches can be wrong. Compare the reported make and model.

Flight crew

As NTSB recorded them. NTSB leaves out names.

Role
Pilot
Age
60
Injuries
Fatal
Certificate
Private
Medical
Class 3, With waivers/limitations
Last flight review
March 24, 2011
Seat
Right
Toxicology
Performed
Flight hours
575 total · 42 in this make and model · 25 in the last 90 days · 10 in the last 30 days

Weather

Conditions
Visual (VMC) · Day
Wind
90° at 6 knots
Visibility
4 statute miles
Lowest ceiling
None
Temperature
75 °F, dew point 70 °F
Altimeter
29.98 inHg
Observed at
CVG, 13 nm away

Docket · 35

The files NTSB released with the investigation on January 27, 2014, on NTSB’s docket system: statements, records, photos and specialists’ reports. 18.9 MB in all.

Interview with Bill KalodzikItem 1 · .PDF · 97 KBInterview with Kevin ArmstrongItem 2 · .PDF · 84 KBFAA Interview of Cindy BungerItem 3 · .PDF · 140 KBFAA Interview of Cincinnati (CVG) ATCItem 4 · .PDF · 346 KBRadar Plots of Accident FlightItem 5 · .PDF · 891 KBWreckage DiagramItem 6 · .PDF · 193 KBWeather InformationItem 7 · .PDF · 3.3 MBATC 3 - Factual Report of Group ChairmanItem 8 · .PDF · 922 KBATC 3 - CVG TRACON Post-Accident Training BriefingItem 9 · .PDF · 524 KBATC 3 - CVG Daily Record of Facility OperationItem 10 · .PDF · 65 KBAircraft Flight LogItem 11 · .PDF · 4.2 MBMaintenance Records ExcerptsItem 12 · .PDF · 2.3 MBEngine Examination ObservationsItem 13 · .PDF · 356 KBNTSB Party FormsItem 14 · .PDF · 787 KBWreckage ReleaseItem 15 · .PDF · 210 KBToxicological ReportItem 16 · .PDF · 283 KBPhoto 1. Helicopter empannage in the top of trees.Item 17 · .PDF · 185 KBPhoto 2. View of empennage at the top of the trees.Item 18 · .PDF · 227 KBPhoto 3. Part of langing gear in the wreckage path.Item 19 · .PDF · 188 KBPhoto 4. View of cockpit in the main wreckage.Item 20 · .PDF · 206 KBPhoto 5. View of main wreckage from the rear.Item 21 · .PDF · 214 KBPhoto 6. View of main wreckage from the right side.Item 22 · .PDF · 216 KBPhoto 7. Main rotor blades and hub.Item 23 · .PDF · 211 KBPhoto 8. Section of a main rotor blade found in the branches of a tree.Item 24 · .PDF · 222 KBPhoto 9. View of instrument panel.Item 25 · .PDF · 208 KBPhoto 10. View of transmission drive belts and clutch.Item 26 · .PDF · 164 KBPhoto 11. View of engine intake and exhaust system.Item 27 · .PDF · 190 KBPhoto 12. View of tail rotor layout.Item 28 · .PDF · 193 KBPhoto 13. Layout of the tailboom.Item 29 · .PDF · 182 KBPhoto 14. View of fuel bladders.Item 30 · .PDF · 192 KBPhoto 15. View of engine.Item 31 · .PDF · 186 KBPhoto 16. Upper sheave and V-belts.Item 32 · .PDF · 361 KBPhoto 17. Flex plate.Item 33 · .PDF · 432 KBPhoto 18. Tail rotor gearbox and broken pitch control tube.Item 34 · .PDF · 298 KBPhoto 19. Sections of main rotor blade.Item 35 · .PDF · 241 KB

FAA reports on this event · 1

The FAA’s own accident and incident reports, matched to the aircraft by N-number and date.