LAX93FA311

NTSB accident investigation · Robinson R44 · El Monte, CA · July 31, 1993

Accident · FatalField investigationFinal report
Date
July 31, 1993, 13:49 local (20:49 UTC)
Place
El Monte, CA
Injuries
3 fatal
Damage
Destroyed
Phase of flight
Initial climb
Aircraft
N445RHRobinson R44
Weather
Visual (VMC) · Day
Status
Completed · report April 15, 1994
Report
Approved by Office Director
Safety recommendations
Yes
FAA report
19930731027339A
Case key
28340

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

Fatigue failure of the cyclic control (stick) assembly, which resulted in loss of cyclic (pitch & roll) control.

Sequence of events

NTSB’s coding before 2008: each occurrence and phase of flight, and the causes and factors under it. The codes are defined in NTSB’s coding manual.

Airframe/component/system failure/malfunctionTakeoff - initial climb
Rotorcraft flight control,cyclic control - fatigueCause
Cyclic - not possiblePilot in command
Loss of control - in flightTakeoff - initial climb
In flight collision with terrain/waterDescent - uncontrolled

Analysis

The pilot and two passengers departed in the helicopter from the approach end of runway 19. Witnesses reported that the helicopter accelerated to about 50 knots and climbed to between 50 and 100 feet above the runway. They said it then suddenly pitched down, rolled to the right, and crashed on the runway. An examination of the wreckage disclosed that it had impacted in about a 35 degree nose down attitude and a 30 degree right bank. The helicopter was destroyed by impact and post impact fire; many of the flight control system components were found fractured and/or fire damaged. This included a fracture at the lower end of the cyclic control (stick) assembly. Metallurgical examination of this fracture revealed evidence of fatigue. The helicopter, which had been certificated in December 1992, had accumulated 174 hours of flight time since being manufactured.

Factual narrative

History of the Flight

On July 31, 1993, at 1349 hours Pacific daylight time, a Robinson R44 helicopter, N445RH, crashed during takeoff at El Monte airport, El Monte, California. The helicopter was being operated as a visual flight rules (VFR) personal flight in the local area when the accident occurred. The helicopter, registered to, and operated by Uni West Aviation Inc., Alhambra, California, was destroyed by impact and post impact fire. The certificated private pilot, and two passengers received fatal injuries. Visual meteorological conditions prevailed.

The helicopter was cleared for takeoff by the El Monte Air Traffic Control Tower (ATCT) and departed from a hover at the approach end of runway 19. Several witness reported that the pilot maintained the runway heading over the centerline. The takeoff and initial climb appeared normal. About 50 to 100 feet above the ground (AGL), and at 50 knots of airspeed, the helicopter rapidly descended to the runway in about a 35 degree nose down attitude with about a 30 degree right bank. The helicopter struck runway 19 about 1,900 feet from the departure end. An intense post crash fire erupted and the fuselage came to rest about 300 feet from the initial point of impact.

The accident occurred during the hours of daylight at latitude 34 degrees 05.16 minutes north and longitude 118 degrees 02.09 minutes west.

Crew Information

The pilot held a private pilot certificate, with a rotorcraft helicopter rating that was issued on January 22, 1991. The most recent third class medical certificate was issued to the pilot on January 13, 1992, and contained no limitations. On the application for the medical certificate, the pilot listed his total accumulated pilot time as 210 hours, with 50 hours accrued in the previous 6 months.

Complete flight records for the pilot were not recovered and the aeronautical experience listed in this report was obtained from a review of the airman FAA records on file in the Airman and Medical Records Center located in Oklahoma City. In addition, partial pilot logbook pages from Robinson Helicopters files and a portion of fire damaged logbook pages were reviewed.

According to the pilot/operator report submitted by the operator, the pilot's total aeronautical experience consisted of 640 hours, of which 60 hours were accrued in the accident aircraft make and model. In the preceding 90 and 30 days prior to the accident, the report lists a total of 50 and 10 hours respectively flown.

Safety Board investigators attempted to validate and reconstruct the pilot's experience. On November 11, 1992, the pilot attended a three day Robinson R22 Safety Course, conducted by Robinson Helicopters. At that time, the pilot indicated that he had accrued 425 hours of flight time. Robinson Helicopters required 500 hours of total time to act as pilot-in-command of an R44. On May 28, 1993, the pilot attended a one day R44 Pilot Check-Out training course at Robinson Helicopters. As verification that the pilot that accrued 500 hours of flight time, the pilot sent a facsimile of two pages of a logbook to Robinson Helicopters that reflected a total time of 525.2 hours. The logbook pages were not dated.

At the conclusion of the R44 training, the instructor pilot from Robinson Helicopters issued the pilot a certificate of training after finding that the pilot's performance was satisfactory to fly the R44 as a 2-place helicopter for at least 50 initial hours. To qualify to carry more than 1 passenger, the pilot needed to return for another flight check after gaining the required R44 flight time. On July 22, 1993, the pilot returned to Robinson Helicopters for his second flight check in the R44. The instructor pilot did not require the pilot to produce any verification that the pilot had accrued an additional 50 hours of R44 flight time. The instructor pilot verbally acknowledged that the pilot was authorized to carry more than one passenger; however, he did not issue a new certificate of training at that time.

The operator produced a copy of a pilot logbook recovered from the helicopter wreckage that was fire damaged. The logbook pages appeared to reflect flight time accumulated by the pilot in the R44. The record did not reflect the dates of various flights; however, the two pages totaled 35.0 hours.

Aircraft Information

The recording hour meter in the helicopter was destroyed. Examination of the fire damaged aircraft maintenance logbook revealed that the helicopter was manufactured on February 12, 1993. A 100-hour inspection was completed by Robinson Helicopters on May 21, 1993, at an hour meter reading of 104.0, 70 hours before the accident. The helicopter was purchased by the operator on May 27, 1993. At that time the helicopter had accrued 106 hours. The operator and a flight test mechanic for Robinson Helicopters reported that just prior to the accident flight, the helicopter had accumulated a total time in service of about 174 flight hours.

The last entry in the maintenance logbook was July 14, 1993, at a hour meter reading of 158.9. On that date the low rotor RPM warning horn unit was replaced and the main rotor blades were re-tracked by a Robinson Helicopter mechanic. The main rotor blade tracking was accomplished by adjustment of a trailing edge tab. No portion of the flight controls, swash plate assembly, or pitch change links were disturbed. The cyclic control assembly installed in the helicopter was revision H.

The fuel system is gravity-fed (no fuel pumps) from the main fuel tank. An auxiliary fuel tank (smaller and mounted higher than the main) drains into the main tank through an inter-connecting line. The tanks are metal and are mounted above a firewall separating the engine from the main transmission and fuel tank area. The main rotor mast from the transmission is mounted vertically between the two fuel tanks.

Fueling records at El Monte airport established that the helicopter was last fueled just prior to departure with the addition of 15.4 gallons of 100LL octane aviation fuel, which completely filled the main fuel tank. A mechanic for Robinson Helicopters reported that the main fuel tank gage indicated full and the auxiliary tank indicated less than 1/8 full.

Meteorological Information

The closest official weather observation station is El Monte, California, which is located at the accident site. At 1349 hours, a surface observation was reporting in part:

Sky condition and ceiling, scattered clouds at 18,000 feet; visibility, 7 miles; wind, 180 degrees at 8 knots; altimeter, 30.00 inHg.

Communications

Review of the air-ground radio communications tapes maintained by the FAA at the El Monte ATCT facility revealed that the aircraft communicated with the local control position. No unusual communications were noted between the local controller and the pilot during the review of the tapes.

Aerodrome and Ground Facilities

The El Monte airport is owned by The County of Los Angeles. The operation of the airport is contracted to Comarco Airport Services Inc. The published elevation of the airport is 296 feet mean sea level.

The airport is equipped a single hard surfaced runway on a 010 to 019 degree magnetic orientation. The runway is 3,995 feet long by 75 feet wide, and is equipped with medium intensity runway lights (MIRL), runway end identifier lights (REIL), and a visual approach slope indicator (VASI) lights. An Automatic Terminal Information Service (ATIS) weather broadcast is provided on a discrete frequency of 118.75 mhz. No formal crash, fire fighting, or rescue services or facilities are located on the airport, nor are any required. A small fire truck is stationed on the airport.

Wreckage and Impact Information

Safety Board investigators examined the wreckage at the accident site on July 31, 1993. The examination of the impact site revealed paint marks and ground scars in the ru

Aircraft

Registration
N445RH
Reported as
Robinson R44
Category
Helicopter
Serial number
005
Airframe hours
174
Engine
Lycoming O-540-F1B5, 260 horsepower, reciprocating
Damage
Destroyed
Fire
On-Ground
Flight
Personal · Part 91
Operator
Benjamin F. Venti, Sr.
Registered owner
Uni West Aviation Inc.
Airworthiness certificate
Standard, Normal
Last inspection
100 hour · May 21, 1993 · 70 hours before
Departed
EMT
Destination
EMT
Airport
EMT · El Monte, runway 19, 3,995 × 75 ft, asphalt

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
30
Certificate
Private
Medical
Class 3, Valid Medical--no waivers/lim.
Seat
Right
Toxicology
Performed
Flight hours
640 total · 60 in this make and model · 585 as pilot in command · 50 in the last 90 days · 10 in the last 30 days

Weather

Conditions
Visual (VMC) · Day
Wind
180° at 8 knots
Visibility
7 statute miles
Lowest ceiling
None
Altimeter
30.00 inHg
Observed at
EMT, 1 nm away

FAA reports on this event · 1

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