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Upper Big Branch Mine disaster- by Shyam Nair

Shyam Nair©

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PURPOSE• This case study provides a useful tool for the U.S. Nuclear

Regulatory Commission (NRC) staff as it interacts with its stakeholders.

• It provides the regulated community with the findings of West Virginia Governor Manchin’s appointed independent investigation panel and the results of an investigation conducted by the U.S. Department of Labour's Mine Safety and Health Administration (MSHA).

• Many of these findings contrast starkly with the positive safety culture traits that the NRC has incorporated into its safety culture policy statement.

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Problem/Causes of the Disaster Rock Dust – Failed to meet government standards for the application of

rock dust. Result – Explosive coal dust had built up on surfaces and in the air

throughout the mine.

Ventilation – Upper Big Branch mine did not have sufficient ventilation to provide the miners with fresh, breathable air, and to remove coal dust as well as methane and other dangerous gases.

Result – 71% of autopsied victims showed sings of black lung disease.

Equipment Maintenance – Water sprays on the longwall shearer were not functioning properly.

Result – Miners were unable to extinguish the initial spark.

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Darker side of Massey:• Company used explosives to blast

away the tops of mountains to expose valuable seams of coal.

• Waste was dumped into the adjutant valley, polluting streams and contaminating drinking water.

• It has the worst fatality rate compared to any other coal company.

• Peabody had 1 fatality for every 296 million tons of coal, while Massey has 1 for every 18 million tons.

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Donald. L. Blankenship• In 1990, just 8 years after joining

he became the president and CEO of Massey.

• He increased Massey’s revenue from $1.2 billion to $2.7 billion, in first year.

• Increased Employees from 3700 to 5800.

• More than doubled companies coal reserve.

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Salary of Blankenship• Base salary in all 3 years was $1 million each year.

• Bonus of $300,000 each year.

• 2007- $9 million• 2008- $11 million• 2009- $18 million

• Estimate total of 10 years around- $129 million.

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Incentive Compensation PlanPARTICULAR SALARY %

EBIT 15 %

PRODUCED TONS 15 %

CONTINOUS MINER PRODUCTIVITY 5 %

SURFACE MINING PRODUCTIVITY 5 %

REDUCTION IN ENVIROMENTAL VIOLATION

10 %

FULLFILLMENT OF CONTRACT 15 %

REDUCTION IN NON FATAL DAYS LOST 10 %

IDENTIFUCATION OF SUCCESSOR 5 %

EMPLOYEE RETENTION 15 %

DIVERSITY OF MEMBERS 5 %

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Blankenship’s Darker side• “If you can’t go up there and run

coal, bring your lunch outside and go home’” - Manager

• “If you were hurt, you were said not to fill out the lost time accident paper”- Supervisor

• “The company will pay guys to sit in the bath house or to stay at home if they got hurt” - Former Massey Miner

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Safety & Health citation assessed penalties and amount

Year No. of CitationAssessed Penalty (in

$)Amount Paid (in

$)Paid Less (in

$)

2000 240 55325 55325

2001 398 48761 48761

2002 221 64726 64726

2003 175 41934 41405

2004 238 48371 48371

2005 143 32577 32576

2006 173 191249 84411 106838

2007 271 253984 61745 192239

2008 197 239566 105965 133601

2009 515 897325 292953 604372

Total 2571 1873818 836238

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WHAT CAN ORGANIZATIONS LEARN FROM THIS ACCIDENT?

This case study points to the following key lessons:

A balance must be maintained by the senior management between safety and the corporate performance.

No single event led to this catastrophe. Instead, it resulted from a series of events that were precipitated by a work environment in which workers were not encouraged to raise safety concerns. Thus, there must be a safety union committee to look after employees safety.

This disaster may have been avoided had there been a more robust, positive safety culture in which workers and managers were encouraged to raise concerns.

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Action taken by MSHA• Enhanced enforcement programs, such as impact inspections and a revised

pattern of violations process.

• The splitting of the southern West Virginia coal district into two districts.

• The upgrading of the Mt. Hope, W. Va., laboratory for better coal-dust and gas analyses.

• Reorganization of the Office of Assessments, Accountability, Special Enforcement and Investigations to better manage and support MSHA’s enforcement programs.

• Publication of final regulations on the maintenance of rock dust, examinations in underground mines and the pattern of violations program to rein in chronic violators.

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Continued…• Revision or development of more than 40 policy directives, including the

significant revision of mine inspection procedure handbooks and the development of a new coal roof control handbook.

• More than 20 separate training sessions for MSHA personnel on issues raised by the internal review.

• Creation of a centralized system to establish better oversight of all agency directives and policy guidance and to ensure their consistency.

• Modification of the Mine Plan Approval database system.

• Integration of a common tracking system to track inspector re-training.

• Creation (with the Holmes Safety Association and mining community) of a national mine-rescue organization to support and provide guidance on mine rescue.

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Result• As a result of actions taken by MSHA and the mining community, MSHA noted

that there have been a number of mine-safety improvements, including:

1. Substantially fewer mines with chronic-violation records.2. A record number of temporary reinstatements and discrimination cases filed on

behalf of miners.3. Reduced respirable-dust levels to lowest exposure levels in history.4. The lowest fatal and injury rates in 2011 and in 2012.5. The lowest fatal and injury rates and number of mining deaths ever recorded in a

fiscal year.

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Insights from case• The year before the disaster there was a spare spike in the violation

at the mine.

• Management started to contest the regulatory penalties than paying them.

• The men employed at Massey had no rights, justice or virtue as a coal minor.

• Blakenship made lots of benefits initially, but made the company lose so much in the end.

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Recommendation Getting better mangers to take care of the employees they

have.

New management must make sure that corrective steps are taken against violation & appropriate action along with precaution to fix them must be taken.

Government regulators and policy makers must visit mines regularly.

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References• Lawrence Messina & Greg Bluestein (April 8, 2010). "Fed official: Still too

soon for W.Va. mine rescue". News.yahoo.com. Retrieved April 8, 2010.

• U.S. Department of Labour – Mine Safety and Health Administration, 103(k) Order for Performance Coal Company Upper Big Branch Mine-South. April 5, 2010. Retrieved April 6, 2010.

• Trip Gabriel (November 13, 2014). "Ex-Executive Donald Blankenship Is Indicted in Disaster at Coal Mine". The New York Times.

• "Finley Coal Company Explosion". United States Mine Rescue Association. Retrieved April 14, 2010.

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In memory ofTHE MEN OF THE UPPER BIG BRANCH MINE

Shyam Nair ©