BP Amoco took a step toward recognizing reality today when it released its final Fatal Accident Investigation Report (pdf) on the March 23 Texas City explosion that killed 15 workers and injured 170. The report recognized a number of critical systemic problems and lapses in BP's safety "culture."

Meanwhile, the Occupational Safety and Health Administration, which fined the company $21.3 million at the end of September, has announced that it will refer the case to the Department of Justice for criminal prosecution. The OSHAct allows the agency to criminally prosecute if a worker is killed due to a willful violation of OSHA standards.

John Miles, regional administrator for the department's Occupational Safety and Health Administration, said the agency found more than 300 health and safety violations at the refinery, and in September fined it a maximum allowable $21m. Yet, given the nature of the violations, OSHA decided to take the matter further. The DoJ did not immediately comment.

"It was a wilful violation that resulted in the fatalities,'' Mr Miles said.

Wilful violations are defined as those committed with an intentional disregard, or plain indifference, to OSHA regulations. They range, in this case, from failing to correct deficiencies in equipment to failure to check alarms for reliability.

On the BP report, the Houston Chronicle reported,

BP today acknowledged that serious lapses in management's attitude toward safety at its Texas City refinery contributed to an explosion there in March that killed 15 people, the company's final report on its accident investigation says."Over the years the working environment had eroded to one characterized by resistance to change, and lacking of trust, motivation and a sense of purpose," states the report released after an 8-month investigation.

The Galveston Daily News reported that

BP has acknowledged that a lax approach to safety by managers on all levels was a major factor contributing to a series of fatal blasts at its Texas City refinery.

In its final report released Friday, BP admits that work conditions at its local refinery had eroded to the point that safety procedures were not followed and managers failed to support proper safe operations.

Refinery employees felt “disempowered” to push for improvements
because of a lack of leadership by managers within the facility, BP said in its report.

BP has backed down significantly from its interim report when it blamed employees for the explosion stating that "The mistakes made during the startup of this unit were surprising and deeply disturbing. The result was an extraordinary tragedy we didn't foresee," Six employees were subsequently fired.

In fact, however, the root causes of the explosion went far beyond any individual employee error and almost all of the conditions leading to the explosion could have been forseen by management. Today's report went much further in recognizing those facts.

The explosion occurred when a processing tower, called the raffinate splitter that housed hydrocarbon liquid and vapor, overfilled and overheated. The liquid and vapor mix was overpressurized, flooded into an adjacent Blowdown Drum & Stack, overflowed and escaped into the atmosphere and the sewer around the unit. The resulting vapor cloud was then ignited by a still-unknown source. Almost all of the workers killed were in or near temporary trailers located near the blast site.

The most significant admission by BP was that

The likelihood of this incident could have been reduced by discontinuing the use of the blowdown stack for light end hydrocarbon service and installing inherently safer options when they were available.

Preliminary findings by the US Chemical Safety and Hazard Investigation Board at the end of October showed that the accident could have been prevented if the refinery had installed a flare system to replace the blowdown drums years before, as OSHA had recommended, heeded past warnings from previous incidents and repaired broken alarms, pumps and other malfunctioning equipment.

The fact that BP had knowledge that there were seroius safety problems at the plant led to the hundreds of willful citations and the prospect of criminal prosecution. The maximum penalty under the OSHAct for a criminal conviction is only 6 months in jail, but environmental laws, like the Clean Air Act (CAA), have much stronger criminal penalties than the OSHAct. The CAA states that a person “negligently places another person in imminent danger of death or serious bodily injury” can be sentenced to one year in jail, and a person who who at the time knowingly places another person in imminent danger of death or serious bodily injury can serve up to 15 years in jail. 19,000 pounds of hexane, among other toxic substances were released during the explosion, making prosecution under the CAA and the OSHAct possible.

According to the Financial Times:

OSHA's investigators and lawyers will work with the DoJ, but any final decision on filing criminal charges against BP and/or particular staff will be up to the DoJ, Mr Miles said. "A criminal violation would be very damning.''

Even to have the case referred to the DoJ is another blow for BP. It is already being sued by dozens of those injured and many of the families of the deceased, and has been publicly humiliated by a string of revelations about the poor safety culture uncovered by the US Chemical Safety and Hazard Investigation Board, an independent federal agency charged with investigating industrial chemical accidents.

The industry had assumed OSHA was going to let the matter rest with its $21m settlement, which includes requiring BP to hire a company with expertise in process safety management and an expert in assessing how to improve communications among staff regarding safety practices. The fine was OSHA's biggest ever penalty.

The Chemical Safety and Hazard Investigation Board's comprehensive report on the explsion is not expected until next summer.

Full BP Report
BP Press Release
Houston Chronicle Special Report
BP Plant Explosion timeline

More Confined Space BP stories here.

Labels: BP, Chemical Safety Board, Criminal Prosecution