MIA92FA156

NTSB accident investigation · Bell 47J2 · Adjuntas, PR · July 29, 1992

Accident · FatalField investigationFinal report
Date
July 29, 1992, 08:30 local (12:30 UTC)
Place
Adjuntas, PR
Injuries
4 fatal
Damage
Destroyed
Phase of flight
Enroute
Aircraft
N8476EBell 47J2
Weather
Visual (VMC) · Day
Status
Completed · report January 4, 1994
Report
Approved by Office Director
FAA report
19920729027999A
Case key
32991

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

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Probable cause

The failure of the pilot-in-command to maintain adequate rotor RPM during a precautionary landing following the loss of engine oil. In addition, the pilot failed to insure that the engine contained adequate oil, and that the oil dip stick was secure prior to takeoff. A factor which contributed to the accident was the pilot's impairment due to marijuana.

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.

Miscellaneous/otherCruise - normal
Lubricating system,oil filler cap - looseCause
Aircraft preflight - improperPilot in commandCause
Impairment(drugs)Pilot in commandFactor
Fluid,oil - leakCause
Fluid,oil - starvationCause
Forced landingLanding - flare/touchdown
Hard landingLanding - flare/touchdown
Rotor rpm - not maintainedPilot in commandCause

Analysis

Witnesses observed the helicopter, and then a loud bang was heard & the engine was no longer audible. The helicopter immediately made a turn to the left & descended. As it approached the ground, the engine noise increased. The helicopter impacted hard on top of a hill. Post-crash examination indicated that the engine and transmission oil tank and engine oil system contained 2 qts of oil. The turn-to-lock type oil stick was not locked, and oil residue was visible exiting the filler neck and flowing out of the engine compartment and down the tail boom. No oil leakage was found on the ground at the crash site. The day before the accident, an FAA inspector had noted oil leakage in and around the helicopter's engine compartment. Toxicology tests results on the pilot was positive for for 0.010 ug/ml (blood-tetrahydrocannabinol carboxylic acid) marijuana, one passenger was positive for 0.038 ug/ml (blood) marijuana, and another passenger was positive for 2.4 mcg/ml (urine) diphenhydramine or benadryl.

Aircraft

Registration
N8476E
Reported as
Bell 47J2
Category
Helicopter
Serial number
1837
Airframe hours
7,732
Engine
Lycoming VO-540-B1B3, 305 horsepower, reciprocating
Damage
Destroyed
Fire
On-Ground
Flight
Part 135
Operator
Western Helicopters, Inc.
Registered owner
Western Helicopters, Inc.
Airworthiness certificate
Standard, Normal
Last inspection
Annual · July 13, 1992 · 29 hours before
Departed
ABO · Arecibo, PR
Destination
PSE · Ponce, PR

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
33
Certificates
Flight instructor, Commercial
Airplane ratings
Single-engine land, Multi-engine land
Medical
Class 1, Valid Medical--w/ waivers/lim
Seat
Front
Toxicology
Performed
Flight hours
1,078 total · 355 in this make and model · 904 as pilot in command · 35 in the last 90 days · 25 in the last 30 days · 1 in the last 24 hours

Weather

Conditions
Visual (VMC) · Day
Wind
100° at 7 knots
Visibility
15 statute miles
Lowest ceiling
None
Temperature
88 °F, dew point 72 °F
Altimeter
30.00 inHg
Observed at
PSE, 25 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.