CHARLESTON, W.Va. (AP) — DuPont engineers didn’t build a
safety enclosure to prevent workers from breathing highly toxic gas at a West
Virginia chemical plant because they believed the $2 million project would set
a precedent for safeguarding other hazardous materials, a federal probe
released Thursday said.
The U.S. Chemical Safety Board cited the company’s 1988
cost-benefit analysis in a draft report on the causes of three leaks last year
at a DuPont plant in Belle, near Charleston.
The board said the internal analysis concluded that if the
phosgene enclosure were built there would be a risk of 2.3 on-site deaths every
10,000 years and that leaving the plant open to the atmosphere would result in
a risk of 16.7 on-site deaths per 10,000 years. The company computed the
“value of life plus public outrage at $143 million.” The analysis
added, according to the board, “It may be that in the present circumstances
the business can afford $2 million for an enclosure; however, in the long run
can we afford to take such action which has such a small impact on safety and
yet sets a precedent for all highly toxic material activities?”
In January 2010, a worker died after inhaling a lethal dose
of phosgene, which was used as a chemical weapon during World War I and today
is used as a building block in synthesis of pharmaceuticals and other organic
The board said 58-year-old Carl Fish likely wouldn’t have
died had the enclosure been built.
DuPont said in a statement that it doesn’t put cost above
safety, and it noted that all phosgene has been removed from the plant since
As for the cause of the accident, the board’s report blamed
an ineffective alarm system, maintenance deficiencies and an inadequate
emergency response process.
DuPont said it already has taken a series of corrective
actions, including performing an intensive operations safety review and improving
its maintenance and inspection system for hoses.
The federal board’s primary jurisdiction is to investigate
serious chemical accidents and make recommendations involving hazardous
releases to the air by fixed industrial facilities.
The leaks occurred over a 30-hour period. Fish was taking readings
when a line failed. Investigators said he was sprayed across the chest and face
with phosgene. They released a computer animation of how they believe it
Other leaks at the Belle plant involved the release of 2,000
pounds of methyl chloride and 22 pounds of a sulfuric acid solution. Methyl
chloride leaked for five days before being discovered.
Among the board’s findings:
— DuPont management approved a design for the rupture disc
alarm system that lacked sufficient reliability to advise operators of a
release of flammable methyl chloride.
— Corrosion under the insulation caused a small leak in the
— DuPont relied on a maintenance software program that was
subject to changes without authorization or review and did not automatically
initiate a change-out of phosgene hoses at the prescribed interval, nor did
they provide a backup process to ensure timely change-out of aging hoses.
— DuPont lacked a dedicated radio/telephone system and
emergency notification process to convey the nature of an emergency at the
Belle plant, thereby restricting the ability of personnel to provide timely and
quality information to emergency responders.
DuPont is widely considered as having a strong commitment to
safety, and because of that investigators were “surprised and
alarmed” at the breakdowns at the Belle plant, CSB Chairman Rafael
Moure-Eraso told reporters at a news conference held to discuss the report.
Board member John Bresland said he hopes DuPont re-evaluates its safety culture
across its company as a result of what happened.
The board made several recommendations for the company, the
government and the industry.
It said the DuPont plant should supplement the computerized
system with sufficient redundancy to ensure tracking and timely scheduling of
preventive maintenance for all critical equipment and revise the facility
emergency response protocol to require that a responsible and accountable
DuPont employee always be available to provide timely and accurate information
to emergency responders.
It also said DuPont should conduct annual phosgene hazard
awareness training for all employees who handle phosgene. The board recommended
that federal Occupational Safety and Health Administration regulations be
revised to require facilities that handle toxic materials in compressed gas
cylinders to incorporate provisions that are more effective.
“DuPont is committed to the long-term operation of the
Belle plant,” DuPont said. “We are hiring new employees, making
capital investments in the site, and continuing to be actively involved in the
local community. Safety is a core value at DuPont and is our most important