# NTSB LAX91LA058: Mcdonnell Douglas 369D, N58240, Keanae, HI, December 18, 1990

- Type: NTSB accident investigation
- Classification: Accident · Minor injuries · Limited investigation · Final report
- Date: December 18, 1990, 07:45 local (17:45 UTC)
- Place: Keanae, HI
- Coordinates: 20.769901, -155.990615 (estimated)
- Nearby events: https://openairdocs.org/map.md?lat=20.7699&lon=-155.9906&mi=10
- Phase of flight: [Enroute](https://openairdocs.org/ntsb-phases/400) (OpenAirDocs' grouping)
- Highest injury: Minor injuries
- Injuries: 1 minor, 3 uninjured
- Status: Completed, report February 12, 1993
- Report: Approved by Office Director
- NTSB case key (mKey): 27080
- NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=LAX91LA058
- NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/27080/pdf
- Page: https://openairdocs.org/ntsb/LAX91LA058

## Probable cause

FUEL STARVATION CAUSED BY A LOOSE FUEL LINE 'B' NUT, DUE TO IMPROPER MAINTENANCE; AND THE FAILURE OF THE PILOT TO CORRECTLY JUDGE THE LANDING FLARE DURING THE AUTOROTATION.

## Sequence of events

In NTSB's coding before 2008 (https://www.ntsb.gov/GILS/Documents/codman.pdf).

- Loss of engine power(partial) - nonmechanical, climb - to cruise
  - fuel system,line fitting - not secured (cause)
  - fuel system - not maintained, company maintenance personnel (cause)
- Forced landing, descent - emergency
- Hard landing, landing - flare/touchdown
  - autorotation - misjudged, pilot in command (cause)

## Analysis

THE PILOT OF A HELICOPTER WAS IN CRUISE CLIMB AT 2600 FEET 300/400 FEET ABOVE A WATERFALL IN MOUNTAINOUS TERRAIN WHEN THE ENGINE OUT AND LOW RPM WARNING HORN AND LIGHT CAME ON. THE PILOT DECIDED TO MAKE A PRECAUTIONARY LANDING ON A FLOWER FARM DOWNHILL. DURING THE DESCENT HE MADE A SERIES OF POWER CHANGES WHICH REVEALED A DETERIORATION IN AVAILABLE POWER. THE HELICOPTER LANDED HARD ON THE REAR PORTION OF THE SKIDS. THE MAIN ROTORS SEVERED THE TAIL BOOM AND ROTOR SYSTEM.

## Aircraft

- Registration: [N58240](https://openairdocs.org/deregistered/N58240-2012-08-13), registration cancelled 2012-08-13, S/N 890560D (OpenAirDocs)
- Reported make and model: MCDONNELL DOUGLAS 369D
- Registry model: [Hughes Helicopters HUGHES 369D](https://openairdocs.org/model/hughes-helicopters-hughes-369d) (registry code 4470706) (OpenAirDocs)
- Registry engine: [Allison 250-C20 series](https://openairdocs.org/engine/allison-250-c20-series) (registry code 03020, turbo-prop) (OpenAirDocs)
- Category: Helicopter
- Serial number: 890560D
- Engines: ALLISON 250-C20B 420 horsepower turbo shaft
- Damage: Substantial damage
- Flight: Personal, Part 91
- Operator: Pacific Helicopters Inc.
- Departed: HNM, HANA, HI
- Destination: 0GG, KAHULUI, HI

## Flight crew

As NTSB recorded them. NTSB leaves out names.

- Pilot; age 32; airline transport, commercial, flight instructor; airplane ratings: single-engine land, multi-engine land; instrument ratings: airplane; medical: class 2, valid medical--no waivers/lim.; flight hours: 8,100 total, 3,650 in this make and model, 7,900 as pilot in command, 330 in the last 90 days, 90 in the last 30 days, 2 in the last 24 hours

## Weather

- Conditions: Visual (VMC), Day
- Wind: 360° at 1 knots
- Visibility: 15 statute miles
- Lowest ceiling: none
- Temperature: 73 °F, dew point -0 °F

## FAA reports on this event (1)

The FAA's own accident and incident reports, matched to the aircraft by N-number and date (OpenAirDocs).

- [Accident 19901218055159A](https://openairdocs.org/incident/19901218055159A), Dec 18, 1990: Hughes 369D, Keanae, Maui, HI, Substantial damage. Lost partial power. Elected make autorotation landing. Impacted hard,chopped tailboom. Fuel shut off,b nut loose.

## Other investigations on N58240 (2)

From the NTSB's public API. Aircraft are matched to registry aircraft by N-number and event date, checked against the reported serial number, make and model; the registry's history has gaps, so older matches can be wrong. Compare the reported make and model.

- [NTSB LAX93LA132](https://openairdocs.org/ntsb/LAX93LA132), Feb 22, 1993: Hughes 369D (N58240), Kahului, HI, substantial damage. Probable cause: THE PILOTS FAILURE TO MAINTAIN AN ADEQUATE VISUAL LOOKOUT FOR OBSTRUCTIONS WHILE PERFORMING A LOW ALTITUDE SURVEILLANCE OPERATION IN A MOUNTAINOUS AREA, AND, HIS FAILURE TO SELECT AN ALTITUDE…
- [NTSB FTW80FRD08](https://openairdocs.org/ntsb/FTW80FRD08), Oct 11, 1979: Hughes 369D (N58240), Abbeville, LA, substantial damage

From the NTSB's public API. Aircraft are matched to registry aircraft by N-number and event date, checked against the reported serial number, make and model; the registry's history has gaps, so older matches can be wrong. Compare the reported make and model.

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