The West Fertilizer Explosion Ten Years Later

It was exactly a ten years ago tonight that that my wife called me from another room to say she had just seen something on TV about a big explosion in Texas. I did a quick web search which turned up an explosion at a fertilizer facility in West, Texas. I was Deputy Assistant Secretary at OSHA at the time, and immediately called our Regional Administrator in Texas. He hadn’t heard about it yet, but quickly confirmed the event and deployed OSHA inspectors from the agency’s Fort Worth office.

The explosion of tons of ammonium nitrate that night killed 15 people, including 12 emergency responders,  injured 252 and damaged or destroyed 500 buildings in the small town of West Texas.  The explosion itself was huge, more than five times the size of the blast of the 1995 Oklahoma City bombing, which was also fueled by ammonium nitrate. It injured almost 10 percent of West’s population and launched debris as far as 2¹/₂ miles away. For a thorough report on the causes of the disaster, there is no better source than the Chemical Safety Board report issued in January 2016.

The wide-spread effects of the blast yet another reminder that unsafe chemical use and storage was not just a deadly risk for workers at the plants, but also emergency responders and people living, working and going to school in the neighborhood. It was also a reminder that the regulatory protections that had evolved over the previous 20 years were not adequate and needed quick improvement.

The people of West are still mourning for their fallen friends and neighbors and journalists are visiting the town to see how the buildings and the people have recovered. One of the best is by Rick Jervis at USA Today. I defy you to read it without fighting back tears. Several others are listed at the end of this post.

What progress has been made in preventing this kind of disaster over the last ten years?

Short answer: not nearly enough. Over the past several years, I’ve marked several West anniversaries in Confined Space and compiled some lessons learned that are still relevant today. But as we will see below, this nation has a long road to travel before workers and communities can feel safe about the chemical plants they work in and live near.

The Lasting Impact of West

The impact of the West Fertilizer explosion wasn’t limited to West; the disaster impacted the country like no other (non-coal mine related) workplace disaster in recent memory — perhaps because it wasn’t just a workplace disaster — it was a community catastrophe.

Rick Jervis,  in the first of many ten-year anniversary articles, describes in USA Today, the heartbreaking detail the effect the catastrophe had — and continues to have — on the citizens of West, Texas.

The nightmares have eased, but the images remain singed in Michael Irving’s mind.

The blown-out apartment complex, its walls and roof sheared off and refrigerators and mattresses still visible inside. The mushroom cloud billowing menacingly into the North Texas sky. The single severed leg poking out of the rubble, boot still firmly on foot.

As the first law enforcement officer on the scene of the 2013 West Fertilizer Plant fire, Irving was the first to smell smoke, the first official to call in the fire and the first to begin evacuating people in harm’s way….

Ten years later, the town has mostly recovered from the devastating blast, one of the biggest industrial explosions in Texas history. But, for many, the trauma lingers.

For years, memories of that scene haunted Irving. Nightmares and anxiety attacks trailed him, eased only after months of therapy. His wife, Kimberly, knew only fragments of what he saw and endured that night. Only recently, a decade later, has he been able to recount that day.

“I will never be the same person again,” Irving said in an exclusive interview with USA TODAY. “There are parts of me that are just gone.”

President Obama spoke at the funeral, and on August 1, 2013, he issued Executive Order 13650 “Improving Chemical Facility Safety and Security” to enhance the safety and security of all US chemical facilities and to reduce the risks associated with hazardous chemicals to workers and communities.  Obama’s executive order directed the Environmental Protection Agency (EPA), the Department of Labor (DOL), the Department of Homeland Security (DHS), and a number of other federal agencies modernize policies, regulations, and standards to enhance safety and security in chemical facilities.

“I will never be the same person again. There are parts of me that are just gone.” — Emergency Responder Michael Irving

Six months later, OSHA cited the facility  for 24 violations and $118,300 in fines related to OSHA’s 40 year old Explosives and Anhydrous Ammonia standards. Interestingly the investigation by OSHA was not considered to be a fatality investigation, because all of the workers killed were either volunteers or public employees, neither of whom are covered by OSHA in Texas.

Negative Corpus Nonsense

Three years later, in 2016,  the US Bureau of Alcohol, Tobacco and Firearms shocked the country by announcing its finding that the fire at the West facility was caused by arson.

What was their finding based on? Finger prints? A confession by the perpetrator? A video tape? A witness?

None of the above.

Their finding was based on incompetence. Literally.

The ATF was not able to identify the  ignition source  — what or who started the fire. Not faulty electrical wiring or lightning or a discarded cigarette. They couldn’t figure it out. And that wasn’t really surprising. If you talk to chemical disaster investigators, it’s not uncommon to be unable to identify an ignition source. Especially in this case where little was left after the explosion that registered as a magnitude-2.1 earthquake blew a crater in the earth 75 feet across and 8 feet deep.

Being unable to identify an ignition source, the ATF  reasoned that the fire must have been caused intentionally, a conclusion reached through process of elimination.

Sounds crazy? It is.  In fact, though, there’s actually a name for that investigative technique: “Negative Corpus.”

What does the National Fire Protection Association, the worlds leading authority on fire investigations,  think about negative corpus? Not much. In fact, they have declared negative corpus to be a “violation of scientific method.”

Being unable to identify an ignition source, the ATF  reasoned that the fire must have been caused intentionally, a conclusion reached through process of elimination. Sounds crazy? It is.

(But in case you’re interested in solving one of the nation’s most famous cold cases, the ATF offered a $50,000 reward for information leading to solving the case. No one has collected yet. And likely never will.)

We could have simply laugh this miscarriage of investigation off if it hadn’t had such significant political and regulatory implications a few years later — and right up to this day.

For example, if you read many of the 10-year anniversary articles about the blast, you’ll frequently find reporters writing that “It still isn’t completely clear what caused the explosion.”  This is not true.

What isn’t completely clear is what caused the fire.

What is completely clear is that if the AN had been stored safely, the fire wouldn’t have led to a catastrophic explosion.

The truth is that it matters far less how the far started than why the fire led to an explosion as I have explained before:

Ammonium nitrate (AN) doesn’t just blow up by itself, or even if exposed to a small fire.  The best theory for the West explosion was a combination of high heat from a large, out-of-control fire that had liquefied the AN which was contaminated with nearby seeds, soot from the fire or other contaminants.  Fires may be difficult to prevent completely, but storage of AN in metal bins, or concrete (non-combustible)​  bins and buildings​, away from contaminants (like seeds),  along with ​ with sprinklers to control a fire, minimizes the  chance that a fire​​ (however ignited) in the vicinity of AN will turn into an explosion. The Chemical Safety Board, for example, found that if the ammonium nitrate at West Fertilizer had been stored in metal, instead of wooden bins, and if contaminants like nearby seeds had not been stored nearby, the fire would likely have burned itself out, without causing the ammonium nitrate to detonate.

And that’s exactly why​ what initiated the fire doesn’t matter. Fires happen. You want to prevent them and control as many ignition sources as possible, but the main concern is ensuring that ignition of a fire doesn’t lead to a catastrophic explosion, and that’s where good ​design practices and safety procedures come in.  If ammonium nitrate is properly stored and handled, you don’t have to worry as much about fires and  ignition sources. If the mice chew through an electrical wire, if the Boy Scouts hold an illegal cookout, or if a rogue ISIS wannabe tosses in a Molotov cocktail, the facility may start to burn, but no catastrophic explosion will occur because the AN is stored properly and measures are in place to control the fire.

Ten Years Later

Ten years later, I find myself retired (for the second time) with a lot more gray hair and a two-year old grandson.  Unfortunately, those changes in my life are much more monumental than the changes the nation has experienced in the field of chemical plant safety over the last ten years.

Let’s look first at some of the specific improvements envisioned by Obama’s Executive Order

OSHA’s Process Safety Management Standard

In 1992 Congress passed legislation directing OSHA and EPA to issue regulations that would protect workers and the surrounding communities from chemical plant releases and explosions. The law was passed largely to address recent chemical disasters such as Bhopal in India and the 1989 Phillips Petroleum Company, Pasadena, TX, incident that resulted in 23 deaths and 132 injuries.

OSHA issued its Process Safety Management standard in 1992. In the 20 years from issuances of PSM and the West explosion, the PSM standard was in dire need of modernization.  Following the Obama Executive Order, OSHA immediately put PSM on its regulatory agenda, but OSHA’s regulatory process is notoriously slow and the agency was only able to finish the small business review process (SBREFA) before the end of the Obama administration.

The Trump administration relegated PSM modernization to the “Long Term Agenda” for four years where things sit on a shelf gathering dust. They also cut OSHA’s regulatory budget by 10%, a cut that OSHA only erased in last year’s budget.

Although the Biden administration rescued the PSM standard from the Long Term Agenda, little progress has been made. The agency spent its first few years consumed by COVID, and other standards like workplace violence, heat, tree care and emergency response have been given high priorities by the cash-strapped agency.

EPA’s Risk Management Program

EPA’s Risk Management Program (RMP), also issued in 1992, protects communities surrounding chemical plants. Like PSM, it was also in dire need of an update. Happily, EPA is much large and better funded than OSHA, and has fewer legal hurdles in the way of issuing regulations. By the end of the Obama administration, EPA was able to issue a partial update of its RMP regulation which significantly improved communication between facilities and emergency responders, clarified information that emergency responders need to safely respond to incidents, required root cause analyses of chemical plant incidents and near misses, and required chemical facilities to consider “inherently safer” chemicals and production processes.

The chemical industry was not amused. Immediately after the Trump administration took power, they began lobbying the administration to repeal the new regulation.  The main argument they used was that the ATF arson finding (see above) meant that the explosion was unavoidable and that the requirements in the new EPA regulation were unneeded and illegitimate.

Like the ATF finding, the chemical industry’s arguments were illegitimate. As I’ve explained before, ultimately, what started the fire wasn’t as important as the conditions that allowed a fire (whatever caused it) to become a catastrophic explosion. That’s where the focus needs to lie: on how to prevent catastrophic explosions — and what public policy initiatives can get us there.

Nevertheless, the Trump EPA suspended, then repealed the Obama-era RMP regulation and then issued a new, hollowed-out regulation to replace it.

The Biden administration got right on the case and by the end of the year will likely issue a re-revised regulation with similar provisions as the Obama regulation, along with a requirement to consider natural disasters like floods and hurricanes in its risk assessment.

OSHA’s PSM “Retail Exemption”

OSHA had not inspected West Fertilizer since 1985 and the facility was not even on the agency’s Chemical Facility National Emphasis Program (NEP) that was in effect when the inspection happened.  Why wasn’t it on OSHA’s NEP inspection list?

The answer is simple: The retail exemption.

What was the retail exemption?

The PSM standard exempts “retail facilities” from coverage under the standard, but does not define what it means by a “retail facility.” The preamble to the standard suggested that OSHA intended the retail exemption to cover facilities like gas stations or hardware stores that sold small packages of chemicals.  But shortly after the PSM standard was issued, OSHA issued an “interpretation” defining a retail establishment as one that sold more than 50% of its highly hazardous materials to “end users.” And farms are considered end users.

Because of the OSHA PSM retail exemption, it doesn’t  matter how much of a hazardous material a plant stored — a hundred pounds or a hundred thousand pounds — if more than 50% was sold to farms, the facility was exempt from PSM.

So no matter how much of a hazardous material a plant stored — a hundred pounds or a hundred thousand pounds — if more than 50% was sold to farms, the facility was exempt from PSM.

Consequently, the President’s Executive Order also directed OSHA to identify any changes that needed to be made in the retail exemption.

Ironically, the 40 to 60 tons of ammonium nitrate stored at the facility would not have brought OSHA to the plant under the chemical facility NEP because ammonium nitrate is not covered by PSM (see below). But if the facility was not exempted from PSM by the retail exemption, the  tens of thousands of gallons anhydrous ammonia stored at the facility would have put West on the agency’s NEP list.  And even though AN isn’t covered by PSM,  had OSHA inspected the facility for potential anhydrous ammonia hazards, it’s likely inspectors may also have identified the problems with the facility’s storage of ammonium nitrate.

But the doomed emergency responders tackling the fire that night had little knowledge of the presence of ammonium nitrate, nor its hazards. It was the anhydrous ammonia at the plant that mostly concerned them.

Luckily, the anhydrous ammonia tanks suffered little damage and only a small amount of leakage as a result of the explosion.

In 2015 OSHA clarified the definition of retail to bring it into compliance with the original intent of the standard. Facilities like West would then be covered by PSM.  To make a long story short, however, the Agricultural Retailers Association and the agriculture industry in general strongly opposed OSHA’s new interpretation, delayed the change and then got Congress to prohibit OSHA from enforcing it. They also sued and a court overturned OSHA’s new interpretation of the retail exemption, requiring  the agency to go through years of full rulemaking to ensure that facilities like West were covered by PSM.

OSHA’s failure to change the retail exemption was an example of one of the major lessons learned from the explosion: Don’t Let a Good Catastrophe Go to Waste and its corollary: Protections Delayed are Protections Denied. If OSHA had managed to change the retail exemption within two months of the explosion, rather than two years after the explosion when the impact of the West disaster — and the urgency to implement changes — had largely faded from memory, it is likely that even the powerful agriculture lobby wouldn’t have dared to opposed the change.

Coverage of Ammonium Nitrate under PSM and RMP

Due to political pressure from the agriculture industry in the early 1990s, ammonium nitrate (AN) was not placed on the list of covered substances under OSHA’s Process Safety Management standard, nor EPA’s Risk Management Program. President Obama’s Executive Order directed OSHA and EPA to reconsider the exclusion of AN. Ten years later, neither agency has done so. As described above, OSHA is considering including AN in its updated PSM standard, but the agency is moving at a snail’s pace. EPA has decided to punt on the issue.

Interagency Coordination

One area that has seen some lasting progress is interagency coordination. That sounds like a bit of bureaucrat-speak, but note that three federal agencies — OSHA, EPA and the Department of Homeland Security — have major responsibility for chemical plant safety and security.  But the various laws that the agencies enforce have different requirements and no agency can be everywhere at once, so it helps to have access to the eyes and ears of other agency. When, for example, DHS is familiar with OSHA requirements, DHS inspectors can contact OSHA to let them know that they may have identified some violations at a facility that OSHA otherwise wouldn’t be aware of.

Conclusion

It’s been a decade since the West Explosion and the urgent call to further improve chemical facility safety and security in this country. Ten years later, we’ve seen almost no progress. While EPA will hopefully soon issue a new Risk Management Program regulation that will address some of the issues raised by West and the President’s Executive Order, OSHA has made virtually no progress in the past 6 years.  The Trump administration, budget issues and lack of strategic focus has gotten in the way . And as I and others have warned the agency, they’re going to look stupid and incompetent when — not if — when the next chemical plant catastrophe occurs and virtually no progress has been made.

OSHA is going to look stupid and incompetent when — not if — when the next chemical plant catastrophe occurs and virtually no progress has been made.

We had a close call — some would say a free warning — last year when a fire broke out at the Winston Weaver Company Fertilizer plant in Winston-Salem, NC. That plant was estimated to store 600 tons of ammonium nitrate, at least ten times the amount of AN that devastated the city of West almost 9 years before. Happily, that fire did not lead to a catastrophic explosion.   And we may have seen another warning a couple of weeks ago when a fire and explosion on a Texas dairy farm led to the deaths of 18,000 head of cattle.

As the East Palestine train derailment and chemical release (hopefully) made clear, even Republican politicians say they are concerned about environmental disasters — especially when they happen in their own back yards. But will we have to again wait until the next disaster to add urgency to the problems raised by the West explosion?

It seems so.

The Fallen

Morris Bridges Jr., 41, a fire sprinkler technician for Action Fire Pro in Waxahachie and a member of West Volunteer Fire Department.

Perry Calvin, 37, a student at Hill College Fire Academy and a member of Mertens and Navarro Mills volunteer fire departments.

Jerry Chapman, 26, a member of Abbott Volunteer Fire Department and in training to become an emergency medical technician.

Cody Dragoo, 50, a foreman at West Fertilizer Co. and a member of West Volunteer Fire Department.

Kenneth “Luckey” Harris Jr., 52, a Dallas Fire-Rescue captain and owner of Harris Home Inspections and Construction.

Adolph Lander, 96, a resident of West Rest Haven Nursing Home who died the day after the explosion. His death is attributed to trauma from the blast.

Jimmy Matus, 52, owner of Westex Welding and a member of West Volunteer Fire Department.

Judith Monroe, 65, a native of Sinton, Texas, moved to West in 2001. She was in the apartment complex adjacent to the West Fertilizer Co. plant when it exploded.

Joey Pustejovsky Jr., 29, secretary for the city of West and a volunteer firefighter. His parents and son have spearheaded a project to rebuild the town park complete with a memorial to those lost in the blast.

Cyrus Reed, 29, a member of Abbott Volunteer Fire Department. He was completing his last night of EMT basic training when he went to assist at the plant fire.

Mariano C. Saldivar, 57, a native of Mexico, lived in an apartment complex adjacent to the fertilizer plant. Saldivar retired to West after working for years in the warehousing industry in California.

Kevin Sanders, 33, a member of Bruceville-Eddy Volunteer Fire Department, was taking an EMT class when he went to assist at the plant fire.

Doug Snokhous, 50, a Central Texas Iron Works employee and a member of West Volunteer Fire Department.

Robert Snokhous, 48, a Central Texas Iron Works employee and a member of West Volunteer Fire Department.

William “Buck” Uptmor Jr., 45, owner of fence-building company Uptmor Welding and Construction.

Articles and Videos Marking the Tenth Anniversary

We don’t seem to learn’: 10 years after tragic Texas chemical explosion, risk remains high, USA Today

‘We are at risk of another West explosion’ safety experts warn, CBS News

A decade ago: 15 killed, more than a hundred homes destroyed by explosion at West fertilizer plant, KWTX.com

West, Texas approaching 10-year mark of fertilizer plant explosion,  wfaa.com

West going strong 10 years after blast but wounds remain, Waco Tribune Herald