The National Transportation Safety Board determined the cause of the Jan. 26, 2020, crash was Ara Zobayan’s decision to fly under visual flight rules in cloudy conditions, which resulted in his spatial disorientation and loss of control of the aircraft. The board added that Zobayan’s “likely” self-induced pressure to get Bryant to his destination and inadequate review of safety management procedures by helicopter operator Island Express contributed to the crash.
Flying under visual flight rules, Zobayan was “legally prohibited” from flying through cloud cover, yet “continued his flight into clouds,” NTSB Chairman Robert Sumwalt said.
The Sikorsky helicopter was not in a controlled flight pattern when it crashed into the hillside near Las Virgenes Road and Willow Glen Street at 9:45 a.m.
NTSB member Michael Graham said Zobayan ignored his training, adding that as long as helicopters continue to fly into clouds while using visual flight rules “a certain percentage aren’t going to come out alive.”
Despite prior recommendations from the NTSB that helicopters be outfitted with crash-proof flight data and voice recorders, the Sikorsky that Bryant was flying on did not have such equipment. The Federal Aviation Administration did not require such features on the helicopter, nor was it required to have a safety management system.
Investigator Bill English told the board that Zobayan informed air traffic control that he was “climbing to 4,000 feet” to get above the clouds. But English said the pilot was experiencing spatial disorientation because the helicopter banked to the left, away from the 101 Freeway, while communicating with the controller that it had descended.
Zoboyan misperceived altitude and acceleration and suffered what is known as a somatogravic illusion, according to Dr. Dujuan Sevillian. He said the acceleration of the chopper could cause a pilot to sense the aircraft was climbing when it was not.
“Our inner ear can give us a false sense of orientation,” Sevillian said, noting that a lack of visual cues while being surrounded by clouds worsens the problem and the pilot suffers what is known as “the leans.”
Bryant and his daughter Gianna, along with several of her teammates, a few parents and coaches, took off shortly after 9 a.m. from John Wayne Airport in Orange County, heading to Camarillo Airport for the second day of a weekend tournament at the Mamba Academy in nearby Thousand Oaks.
Also killed in the crash were Christina Mauser; Payton and Sarah Chester; John, Keri and Alyssa Altobelli; and Zobayan.
A witness on a mountain bike trail in Calabasas told investigators that the area was surrounded by mist and that he heard the sound of a helicopter and saw a blue and white chopper emerge from the clouds. NTSB investigators noted that videos and photos from the public depicted fog and low clouds obscuring the hilltops.
In the days following the crash, NTSB board member Jennifer Homendy said a terrain awareness system, or TAWS, would have provided more information to Zobayan, but she did not say whether it could have prevented the deadly crash.
Sumwalt, however, said Tuesday that the helicopter was not in controlled flight, and given that the pilot was disoriented, a terrain awareness system would not have helped him.
The NTSB board made 13 findings of fact, including that the pilot lost visual references in the clouds, made a poor decision to fly at excessive airspeed, and experienced spatial disorientation.
It also noted the pilot’s decision to fly that morning was probably influenced by internal pressure he felt based on his relationship with Bryant. Vice Chairman Bruce Landsberg said there is a long history of pilots desperately trying to fulfill the requirements of a star, referencing previous crashes that killed music artists Buddy Holly, Patsy Cline, Aaliyah and Stevie Ray Vaughan.
The night before the crash, the broker arranging the flight had expressed concerns to the pilot that “weather could be an issue.” Zobayan assured the broker the next morning that it “should be OK,” according to text messages released by the NTSB.
In its findings Tuesday, the board also said a fully implemented safety management system by Island Express would have helped and that crash-proof flight data recorders could have provided vital information.
Investigators, however, said none of the actions of air traffic controllers led to the crash, and they rejected suggestions from Island Express to that effect. Island Express has sued the FAA, claiming its air traffic controllers were to blame for the crash.
The NTSB on Tuesday made recommendations to improve helicopter safety. Among them: implementing scenario-based training for changing weather conditions for helicopter pilots; identifying simulator training for spatial disorientation and conducting a study of it; and requiring safety management systems and crashproof flight data recorders and visual/audio recorders, so-called black boxes, to be installed in all such passenger helicopters.
Homendy noted that the helicopter that crashed was built with black boxes, and Island Express removed them.
“The recommendations that we issued today, if acted upon, will strengthen aeronautical decision-making skills related to weather … and would result in research on spatial disorientation simulation training devices,” Sumwalt concluded.
Source : LA TIMES