BP Accepts Responsibility For Texas City Explosion
Posted: 23 May 2005
A series of failures by BP personnel before and during the startup of the Isomerization (ISOM) process unit in the Texas City refinery led to an explosion and fire which claimed the lives of 15 workers and injured more than 170 people, according to BP Products North America's interim fatal accident investigation report made public today.
The investigation team determined the explosion occurred because BP ISOM unit managers and operators greatly overfilled and then overheated the Raffinate Splitter, a tower that is part of the ISOM unit. The fluid level in the tower at the time of the explosion was nearly 20 times higher than it should have been.
The presence of water or nitrogen in the tower at startup may have also contributed to a sudden increase in pressure that forced a large volume of hydrocarbon liquid and vapor into the adjacent blow down stack, quickly exceeding its capacity. The resulting vapor cloud was ignited by an unknown source.
If ISOM unit managers had properly supervised the startup or if ISOM unit operators had followed procedures or taken corrective action earlier, the explosion would not have occurred, the investigation team said.
The number of deaths and injuries was greatly increased by the presence of workers in temporary trailers near the blow down stack and the failure to evacuate personnel when it became apparent pressure was building in the ISOM unit and that vapors were being vented to the atmosphere.
The decision to place the trailers near the blow down stack was preceded by hazard reviews that did not recognize the possibility that multiple failures by ISOM unit personnel could result in such a massive flow of fluids and vapors to the blow down stack.
The investigation team also concluded the use of a flare system, instead of a blow down stack, would have reduced the severity of the incident.
"The mistakes made during the startup of this unit were surprising and deeply disturbing. The result was an extraordinary tragedy we didn't foresee," said Ross Pillari, president of BP Products North America, Inc.
"We regret that our mistakes have caused so much suffering.
We apologize to those who were harmed and to the Texas City community. We cannot change the past or repair all the damage this incident has done. We can assure that those who were injured and the families of those who died receive financial support and compensation. Our goal is to provide fair compensation without the need for lawsuits or lengthy court proceedings."
BP Products has started contacting the families of the deceased, through their attorneys, in order to begin the process of evaluating and settling claims. To expedite and simplify that process, BP Products has agreed with the three contractors whose workers were killed to assume responsibility for compensating their injured employees and the families of the deceased.
BP's incident investigation was conducted by a team of BP executives,BP refining and safety experts and salaried and union employees of the Texas City refinery. The team was directed to determine the cause of the March 23 explosion and make recommendations for preventing similar incidents in the future. It decided to publish an interim report because the fluid sample analysis and computer modeling that remains to be done is not expected to change the root causes or the recommendations made public today.
"We have accepted the report and its findings and we will implement he team's recommendations," Pillari said. "Some will take time to complete. However, refinery management did not wait for this report to take action.
"They have clarified and reinforced roles, responsibilities and expectations around startup, operating and evacuation procedures. They have prohibited the occupancy of trailers within 500 feet of blow down stacks and flares and non-essential personnel are being moved out of process areas."
As recommended in the report, the company will commission a third party led facility study to make recommendations for the safe placement of temporary structures.
"Our goal is to eliminate or greatly reduce the need for temporary buildings at the refinery by limiting the workforce in process areas to operators and people involved in hands-on maintenance," Pillari said. "We are assessing space needs for workers whose jobs require them to be located at the refinery.
We are also looking at options for securing leased space in the community for workers whose duties can be performed away from the refinery."
BP will modify or replace all blow down systems which handle heavier-than-air hydrocarbon vapor or light hydrocarbon liquids (gasoline and lighter). In the meantime the company has instituted additional operating requirements to ensure those systems are safely operated until they can be modified or replaced.
"We will move expeditiously to modify these units," Pillari said. "Before work can begin we must complete engineering design and obtain permits and materials. Work will be completed as soon as possible."
To drive implementation of the recommendations in the investigation report, the company has appointed Colin Maclean manager of the Texas City site. He has previously managed BP refineries in Whiting, Indiana; Grangemouth, Scotland; and Bulwer Island in Australia.
"Colin is one of our most experienced operations managers.
He will focus his full and undivided attention on the safe operation of the complex," Pillari said. To provide assurance about processes and procedures at the refinery, BP is conducting a process and operational review of the facility.
The review will address all aspects of Texas City operations from procedures and training to process safety and maintenance.
The review, which began May 9, is being led by former Deputy Assistant Secretary for OSHA James W. Stanley. BP expects a preliminary view within a month.
In response to the report, BP Products will take disciplinary action against both supervisory and hourly employees directly responsible for operation of the Isomerization Unit March 22 and 23. These actions, which began today, will range from warnings to termination of employment. As the investigation continues, and as new information is discovered, others also may be disciplined.
"The failure of ISOM unit managers to provide appropriate leadership and the failure of hourly workers to follow written procedures are among the root causes of this incident. We cannot ignore these failures," Pillari said. ISOM unit supervisors did not verify correct procedures were being used by unit operators and were absent from the unit during critical periods. Unit operators failed to sound evacuation alarms, contributing to the severity of the incident.
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