West Virginia's Office of Miners' Health, Safety and Training has issued what is now the fourth investigative report on the April, 2010, Upper Big Branch mine explosion. It largely agrees with the earlier reviews, but in language that's tepid in comparison.
The state mine safety agency echoes the earlier federal, independent and union reports in pinning the explosion on uncontrolled methane gas, excessive and explosive coal dust, faulty safety systems and management failures.
"All these defense mechanisms failed at [Upper Big Branch]," the report's summary says, in its strongest language. "The removal of hazards and violations identified during required mine examinations were not corrected in a timely manner."
The report summary neglects to mention Massey Energy, the owner of the Upper Big Branch mine at the time of the explosion.
Compare that to the United Mine Workers report, which called Massey "a rogue corporation" and characterized the disaster as "industrial homicide."
The federal Mine Safety and Health Administration concluded in its final report that "Massey allowed conditions in the UBB mine to exist that set the stage for a catastrophic mine explosion."
And a team of independent investigators led by former federal mine safety chief Davitt McAteer didn't mince words. McAteer's group blamed the disaster on a Massey Energy corporate culture "in which wrongdoing became acceptable, where deviation became the norm."
The West Virginia report says that the state mine safety agency issued 253 citations for safety violations discovered during the investigation. Two mine foremen were also issued "personal citations" for failing to clean up accumulations of explosive coal dust, which helped turn a relatively routine and controllable ignition of methane gas into a massive explosion.
In one of two complaints about inadequate state laws, the report notes that "the mine foreman is the highest ranking official that current state law addresses."
Foremen are low-ranking managers in coal mines and are often implementing the policies and orders of mine superintendants and company executives.
"Individuals involved in the day to day decision making at the mine must be held accountable regardless of their title," the report says.
A bill before the West Virginia legislature would do precisely that but, as The Charleston Gazette has reported, it and other mine safety reforms have stalled in the face of opposition from the mining industry, a major political force in the state.
Just Wednesday, federal prosecutors announced a criminal conspiracy charge against Gary May, an Upper Big Branch mine superintendant. May is accused of conspiring with others to "hamper, hinder, impede, and obstruct the lawful enforcement ... of mine health and safety laws" at the mine.
Under West Virginia law, May ranks too high to be cited for state mine safety violations.
The state's Upper Big Branch report also faults ventilation system failures at the mine, again echoing earlier reports. But special note is made of another weakness in West Virginia law.
The state mine safety agency "currently has insufficient statutory language to regulate the way that coal mines are ventilated," the report says. This means that regulators don't have the authority they believe they need to regulate a primary safety system in a coal mine. Proper ventilation sweeps away explosive and naturally-occurring methane gas and prevents concentrations that can ignite and explode.
Ken Ward of the Gazette has a story about the state's report here.
One formal report about this disaster has yet to be released. The federal Mine Safety and Health Administration is conducting an internal review of its own actions before the explosion. The agency's Upper Big Branch investigative report noted its own significant failure to respond to conditions that contributed to the explosion.
The federal mine safety agency has also been criticized for failing to use its toughest enforcement tools at Upper Big Branch and other Massey Energy mines despite safety and violations records that were among the worst in the industry.
A specific release date for the internal review has not been announced.
Massey was absorbed by Alpha Natural Resources last year. Alpha boasts a stronger and more systematic commitment to safety but the company also continues to employ former Massey managers responsible for Upper Big Branch and other troubled mines.