In language that was uncharacteristically blunt and direct, National Transportation Safety Board (NTSB) chairman Robert Sumwalt accused the doors-off photo tour company NYONair, parent of FlyNYON, of turning âa perfectly good helicopter into a death trapâ and characterizing it as âmadness.â
Sumwaltâs remarks came as the NTSB held a public hearing on December 10 in Washington to determine the probable cause of the fatal March 11, 2018 crash of an Airbus AS350B2 into New York Cityâs East River that killed all five passengers aboard. The passengers drowned after the helicopter rolled inverted in the water when the emergency floats failed to fully inflate. They were unable to extricate themselves from supplemental harnesses they were wearing as a âsafety measureâ during a doors-off, âshoe selfieâ photo flight. The harnesses were cross-attached to the rear cabin bulkhead or floor attach points via a tether and locking carabiner with a D-ring. The pilot, who was wearing only a standard seatbelt, extricated himself and survived. The flight was operated by Liberty Helicopters for NYONair.
The NTSB determined the probable cause of the accident was âLiberty Helicopterâs use of an NYONair provided passenger harness tether system which caught and activated the floor-mounted engine fuel shutoff lever and resulted in the loss of engine power and subsequent ditching.â The NTSB listed contributing factors, including deficient safety management at Liberty and NYON; Liberty allowing NYON to influence operational control of the flights; and inadequate FAA oversight.
According to the Board, the severity of the accident was affected by âthe rapid capsizing of the helicopter due to partial inflation of the emergency flotation systemâ and Liberty and NYONâs use of a supplemental âharness tether system that hindered passenger egress.â
The helicopterâs engine failed during a âdoors-offâ photo tour flight conducted under 14 CFR 119.1(e)(4)(iii), which allows aerial photography flights to be operated under Part 91 as opposed to the more stringent Part 135 that typically covers air tourism flights. The exemption was designed to allow professional photography flights and other types of aerial work.
During the hearing, NTSB members repeatedly blasted Liberty and NYONâs exploitation of what they saw as a glaring loophole in FAA regulations. Co-chairman Bruce Landsberg called it âa loophole one could fly a helicopter or a truck through.â He added, âWhat happened here was beyond the pale.â
Landsberg struggled to contain his incredulity. âI went to FlyNYONâs website. They said since inception in 2012 they have flown over 250,000 passengers and now offer flights in Miami [and] Los Angeles. That doesnât sound like aerial workâŚand the FAA had difficulty understanding this?â
As it turns out, NTSB staff investigators did discover that FAA inspectors had raised concerns about FlyNYONâs operations to their supervisors but were rebuffed. However, none of these inspectors or supervisors availed themselves to obtain a legal opinion from the FAA as to the legality of the operations.
âWhat they did not do, and we did during the investigation, is contact their legal departmentâwhich is a tool available to themâto ask what was this (operation) supposed to be under [Part 91 or Part 135],â said NTSB investigator David Lawrence. âHad they done that, they would have gotten the same legal interpretation we received that said that this [FlyNYON] is not aerial photography, it is an air tour.â Lawrence also added that the agreement Liberty had in place with NYONair was a charter agreement that specified Part 135.
However, NYON instructed its employees never to use the words âtour or charterâ and to be on the watch for overly inquisitive visitors and âanyone with a badge,â according to the NTSB. Sumwalt said both Liberty and NYON were more than ânot vigilant, they went beyond the lack of vigilance. They exploited a regulatory loophole to the detriment of their customersâ safety.â
Sumwalt continued, âOnce you hang out a shingle and charge money in exchange for goods and services, there needs to be a higher standard of care. I think we need to take a hard line and say, âIf you are going to charge people to go up for an air tour, it will be conducted under Part 135.â
âThere is nothing like the experience of an air tour to see a location from a different perspective, but it is madness to allow the thrill of such an experience to be spiked with unnecessary risk to passengers, to crew, and to innocent bystanders,â he said.
The FAA received additional Board criticism with regard to its STC approval of the Dart emergency floats on the helicopter, specifically with regard to the position of the float activation lever on the cyclic, the inordinate amount of pull force required to activate that lever (greater than 59 pounds), and the failure of the year 2000 crossfeed tube modification to prevent asymmetrical float inflation in the event one of the gas cylinders failed.
But the boardâs most scathing criticism was reserved for Liberty and NYON, which were broadly faulted for their respective safety cultures characterized as âdeficient.â Safety shortcomings mentioned by the Board included: a lack of a safety management system (SMS) at both organizations; a "misleading" NYON passenger safety video that characterized the supplemental harnesses as quick-release and equipped with an easily used cutting tool; purging pilots from safety meetings; and disregarding pilot safety concerns.
A crisis communications firm hired by NYONair to field media inquiries failed to respond to AINâs request for comment. Liberty executive Jerry Eisenberg said the company could not comment on the NTSBâs findings âat this timeâ due to ongoing accident litigation. An FAA spokesperson told AIN, âWe are reviewing the NTSBâs recommendations and will respond as required within 90 days.â
Along with its probable cause finding, the NTSB issued 20 findings and 15 recommendations.
The Board found that âLiberty Helicopterâs and NYONairâs decision to use locking carabiners and ineffective cutting tools for passengers to rapidly release from the harness tether system was inappropriate and unsafe.â It further said the FAAâs approval process for supplemental passenger restraint systems implemented after the crash is âinadequateâ because âit doesnât provide guidance to inspectors to evaluate any aircraft specific installations or the potential for entanglement that passengers may encounter during emergency egress.â Dart was faulted for not âspecifying pull force limitations for the emergency flotation systemâs activation handle."
NTSB recommendations included suspension of doors-off passenger flights until the FAAâs supplemental restraint approval process is improved; mandating SMSs for all air tour operators; closing the photo-flight loophole; modifying the fuel shutoff lever on the AS350 to protect it from âinadvertentâ activation; and training employees to recognize signs of passenger impairment and to deny boarding as appropriate. The front-seat passenger, whose entangled tether triggered the fuel shutoff lever, was found to have a blood alcohol content level of 0.18âmore than twice the legal limit. However, his intoxication was found not to be a factor in the accident by the NTSB. Sumwalt praised the airmanship of accident pilot Richard Vance.
âI do want to talk about the pilot performance. Within two seconds, he initiated descent. He went to shut off the fuel shut off lever. He slammed it back down to try to open the valve and then went back to try to relight the engine. He did activate the floats. He had a lot going on in that less than a minute. And I was frankly impressed that he got that much done under a high-stress situation.â
âThe ditching was survivable,â Sumwalt said.