Tuesday, April 16, 2013

Warning Shot for Chevron

White vapor and black smoke.  From CSB report.
On August 6, 2012 a leaking pipe at the Chevron refinery in Richmond, CA led to a fire that shut down a crude oil distillation unit and caused over 15,000 people to report to local hospitals seeking treatment for respiratory and other health issues.  This was not a Texas City.  About 20 of the 15,000 people were admitted to local hospitals and there were some minor injuries to employees in the area of the fire but no fatalities.  However, it should be a wake-up call for Chevron. 

The proximate cause of the leak was a pipe ("4-sidecut") that had corroded because of the fluids that flowed through it.  But the Chevron and Chemical Safety Board (CSB) investigations showed there was a ten-year trail of missed possibilities to identify and correct the problem, including the following: In 2002, an employee inspector had expressed concern about sulfidation corrosion in the 4-sidecut and recommended upgrading it but his recommendation was never implemented.  In the same year, an incident at another Chevron refinery led the company to recommend 100% inspection of pipes for corrosion but this was not implemented at Richmond.  In 2009 and 2010 Chevron promulgated new warnings about sulfur corrosion and reiterated the recommendation for 100% inspection but Richmond did not implement any remedial actions on the 4-sidecut.*  In 2011, after a fire in another pipe, Richmond employees complained to Cal/OSHA about the company ignoring corrosion dangers but Chevron rationalized their way out of the issue.**

Chevron's incident investigation, including a root cause analysis, resulted in multiple corrective actions that will ring familiar to our readers.  Summarized, they are: look harder for corrosion; upgrade the hardware reliability program and supporting procedures; increase oversight and training; implement new rules for evaluating leaks; and emphasize the importance of process safety in decision making.  In even fewer words, tweak the system and retrain.

There is no mention of safety culture (SC) but the odor of a weak or compromised SC wafts from the report.  In a strong SC, the 2002 inspector would have identified the potential problem, documented it in the corrective action program and monitored progress until the issue was resolved.  The corrective action program would have evaluated, prioritized and resourced the problem's resolution consistent with its safety significance.  Outside experience and directives (from other Chevron entities or elsewhere) would have been regularly integrated into local operating practices, including inspection, maintenance and process procedures.

We are not alone in recognizing the importance of SC.  The local county supervisor, who also chairs the Bay Area Air Quality Management District, said “We need to do a thorough review of the safety culture at the refinery.”***  The CSB's managing director said the company had a “tolerance for allowing piping to run toward failure” and “I think it points to a certain cultural issue.”****  The CSB's interim report says “After reviewing evidence and decisions . . . the CSB has determined that issues relating to safety culture are relevant to this incident. The CSB will examine the Chevron Richmond Refinery’s approach to safety, its safety culture and any organizational deficiencies, to determine how to best prevent future incidents.” (p. 61)

We'll see if Chevron gets the hint.

*  CUSA Richmond Investigation Team, “Richmond Refinery 4 Crude Unit Incident August 6, 2012” (April 12, 2013).  Attachment to letter from S. Wildman (Chevron) to R.L. Sawyer (Contra Costa County Health Services), “Seventh Update to the 30-Day Report for the CWS Level 3 Event of August 6, 2012” (April 12, 2013).  

U.S. Chemical Safety and Hazard Investigation Board, “Interim Investigation Report Chevron Richmond Refinery Fire” (April 15, 2013).  In addition to Chevron, the CSB also criticizes regulatory and other government agencies, particularly Cal/OSHA, for shortcomings in their oversight of refinery activities.

**  J. Van Derbeken, “Chevron ignored risk in '11, workers say” sfgate.com (Oct. 13, 2012).

***  J. Van Derbeken, “Chevron fire report shows troubled history” sfgate.com (April 13, 2013).

****  J. Van Derbeken, “Chevron fire sign of weak oversight” sfgate.com (April 15, 2013).

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