DHSG Document Library Search selected newspaper articles, hearings transcripts, white papers and other materials.
Gulf of Mexico Oil Spill Key Documents from the Law Library of University of California, Berkeley
Working Papers by DHSG:
After the Dust Settles... by Karlene Roberts, Professor Emeritus Haas Management of Organizations Group and Center for Catastrophic Risk Management, University of California, Berkeley. "...every major disaster that has been subject to investigation includes often blatant, sometime subtle, people, organizational, and systemic issues...This paper examines the people, organizational, and systems issues identified in a number of catastrophic accident investigations."
Air Quality Issues Air Monitoring Needed for Cleanup Workers in Vessels by George Lane, Director of Research and Development, Emergency Response Technology, Baton Rouge, Louisiana. "According to the Louisiana Department of Health and Hospitals (DHH), from April 25, 2010, five days after the explosion aboard the Deepwater Horizon Rig, until September 18, 2010, there were four hundred and forty one (411) reports of health complaints believed to be related to exposure to pollutants from the oil spill... Most frequently reported symptoms include headache, dizziness, nausea, vomiting, weakness/fatigue and upper respiratory irritation. But because of a lack of chemical-specific air monitoring for cleanup workers in vessels, direct specific causes and determination of health effects to workers from chemical exposures are not possible."
An Industry Stress Test for Deepwater Drilling and Exploration Companies? by Emery Roe, Center for Catastrophic Risk Management, University of California, Berkeley. "An industry-wide stress test is proposed for the deepwater drilling and exploration sector along the lines of the banking-sector stress test of major holding companies and investment firms undertaken after the 2008 financial meltdown. As part of the proposed test, major drilling and exploration companies would have to demonstrate conformity to industry better practices when it comes to risk assessment and management and other key decision-making processes. Failure to do so could lead to remedial regulatory measures, ranging from temporary decertification of the deepwater driller to indefinite reimposition of an industry-wide moratorium on deepwater drilling."
Causative Technical and Operational Elements of the Deepwater Horizon Blowout by Gary L. Marsh, retired Shell employee. "Without intimate detail of plans, permits, and most of all, operations, a thoroughgoing and definitive analysis of the blowout is impossible. Hence, much of what is presented here deals with only the salient features of the planning and drilling of the Macondo well, most of which has been obtained from participants' sworn testimony and submissions to investigative boards—US Senate, US House, and Coast Guard/MMS joint hearings."
Cementing 7"x 9⅞" Production Casing at MC 252#1 Well by Gary L. Marsh, retired Shell employee. "The latest BP investigative report indicates from results of independent testing that the nitrogenated cement used on the 7 in x 9⅞ in tapered production string was likely flawed, and was likely to have suffered Nitrogen separation downhole...Moreover, if separated Nitrogen commenced filling a sufficient height of channels in the cemented annulus, the productive zones could have been induced to flow hydrocarbons into the wellbore as well."
Considerations for Underwater Investigation and Salvage of Deepwater Horizon by David Rosenberg. "This White Paper...addresses the general challenges of investigation and salvage in deepwater, available technology and experience base, as well as a brief discussion including four semisubmersible drill ships-- including Deepwater Horizon and others which may yield relevant experiences."
Looking Back and Forward: Could Safety Indicators Have Given Early Warnings about the Deepwater Horizon Accident? by Jon Espen Skogdalen (corresponding author), Department of Industrial Economics, Risk Management and Planning, University of Stavanger, Norway; Ingrid B. Utne Department of Marine Technology, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Jan Erik Vinnem Department of Industrial Economics, Risk Management and Planning, University of Stavanger, Norway. "In this paper, we present information and indicators from the Risk Level Project (RNNP) in the Norwegian oil and gas industry related to safety climate, barriers and undesired incidents, and discuss relevance for drilling, in particular for deepwater drilling."
Deepwater Well Complexity – The New Domain by David M. Pritchard, Owner of Successful Energy Practices International, LLC and Kevin D. Lacy, Senior Vice President of Global Drilling and Completions for Talisman Energy. "The discussions herein indicate that in some categories of complex wells, wellbore stability events are as high as 10% of the total deepwater well time and well control incidents over four times those of normal wells. This indicates that serious risk mitigation is a significant issue in drilling complex wells...It is imperative that the industry adopt standards which ensure process safety around design and execution to ensure safe and reliable deepwater operations."
Deepwater Well Design, Competency – Management of Risks by Yngvar Duesund, Special Advisor to Citris, University of California, Berkeley and Ove T Gudmestadi, Professor of Marine Technology at University of Stavanger, Norway. "We will in this paper discuss what characterizes a professional team and competent personnel. It must also be recognized that a professional team must be given the opportunity to act as such within the organization and the limits of its responsibility and authority. An organization where the top management only accepts reports of successes can never learn from failures or near misses."
Drilling Hazards Management – Excellence in Drilling Performance Begins with Planning (Part 1 of DHM Series) by David M. Pritchardi,
Owner of Successful Energy Practices International, LLC. "Complex wells require multi-disciplinary alignment to ensure and sustain performance. Aligning objectives is necessary to manage drilling hazards and associated mechanical risk critical to successful well execution...These objectives usually conflict. It is important to understand disciplinary trade-offs necessary to ensure drilling performance."
The Value of the Risk Assessment Process (Part 2 of DHM Series) by David M. Pritchardi, Owner of Successful Energy Practices International, LLC. "Drilling Hazards Management is the practice of managing the mechanical and efficiency risk...of all drilling operations. Managing risks requires applying the best practices and mitigating technologies to successfully reduce the risk profile while improving the risk adjusted cost of applying such mitigants successfully."
Mitigating Drilling Hazards with Technologies (Part 3 of DHM Series)
by David M. Pritchardi, Owner of Successful Energy Practices International, LLC. "Managing drilling hazards requires understanding of how practices and technologies can improve the risk profile and add value. This requires understanding how the risk assessment process can be applied to both practices as well as technologies."
Looking Back and Forward - Evacuation, Escape and Rescue (EER) from the Deepwater Horizon Rig by Jon Espen Skogdalen Department of Industrial Economics, Risk Management and Planning, University of Stavanger, Norway; Jahon Khorsandi Center for Catastrophic Risk Management, University of California, Berkeley; Jan Erik Vinnem
Department of Industrial Economics, Risk Management and Planning, University of Stavanger, Norway. "Escape, Evacuation, and Rescue (EER) operations played a vital role safeguarding the crewmembers' lives on the night of the April 20th blowout on board the Deepwater Horizon...The capability to quickly and efficiently rescue personnel at all times should be analyzed."
Final Fateful Flaws by Gary L. Marsh, retired Shell employee. "In the final stages of the developing Deepwater Horizon blowout, some fateful flaws manifested themselves. The original design of the mud/gas separation system was flawed. The planning for its use as reflected in advance control settings were not appropriate and probably not monitored on a timely basis. Finally, regulatory requirements not to vent oil mud directly overboard may have been mindlessly honored to the detriment of safety."
Generalized Temporary Abandonment Procedure for Pull of Subsea BOP for Repair by Gary L. Marsh, retired Shell employee. "Every time the BOP (Blowout Preventer) has to be recovered for repairs in a deep-water-drilling well, the potential exists for considerable underbalance to be induced during any open-hole interval...The purpose here is to outline a proposed minimum approach to establishing suitable barriers in wells with protective casing and a protective liner."
Highly Reliable Governance of Complex Socio-Technical Systems by W. E. Carnes, Center for Catastrophic Risk Management, University of California, Berkeley. "The purpose of this paper is...to offer a perspective on the governance approach that allows Deepwater and kindred accidents such as Three Mile Island, Columbia, and Texas City to pose as singular examples of technical and corporate failure rather than as dying gasps of a governance model no longer suited for the techno-centric world we have created."
A High Reliability Management Perspective on the Deepwater Horizon Spill, Including Research Implications by Emery Roe, Center for Catastrophic Risk Management, University of California, Berkeley and Paul R. Schulman, Professor of Government, Mills College. "Looking back on events leading up to the Deepwater Horizon Spill raises questions about how the Spill is currently portrayed. We run the risk of focusing too narrowly on a sequence of particular events as the main culprit when the accidents and failures that did not happen are just as important to understand in drawing the right policy implications. Looking forward means we also have to better understand how and why "better regulation" can't be the only or even primary answer to more reliable deepwater drilling."
How Safe Is Safe? Coping with Mother Nature, Human Nature and Technology's Unintended Consequences by Dr. Edward Wenk, Jr. "This treatise has been prepared for readers ranging from professionals in risk management to non-specialists with heavy portfolios to adopt and implement policies to shield citizens from threats of bodily harm or of property damage. Finally, it is directed toward citizens exposed to involuntary risks who feel responsible for participating in civil decisions that affect their safety and security and that of the community."
Human Health by LuAnn White. "Health assessment methodology provides a framework for the systematic analysis of the routes by which populations may be exposed to contaminants and the characterization of public health implications. This assessment provides a basis for decision making to protect public health and inform the public of the risks associated with the event. The two major pathways for exposure are the inhalation of volatile compounds and the consumption of oil-contaminated seafood."
Institutional Recommendations by Michael Baram, Professor Emeritus, Boston University Law School. "In this Working Paper, we make recommendations to the Commission and BOEMRE regarding the legal and regulatory framework for preventing major accidents in offshore oil and gas operations."
Issue Management, Treatment of "Bad News" On The Incorporation of Risk Analysis Results and Messages from the "Floor" in a Project by Ove T Gudmestad, Professor of Marine Technology at University of Stavanger, Norway and Marianne Tiffany, School of Psychology, University of Aberdeen, UK. "Bad news" resulting from a risk analysis should professionally be taken into account and should lead to changes in a project to reduce the risk to an acceptable level. Likewise are messages from the ―floor raising concern, in particular when these report on uncertainties that should cause actions to be taken."
The Macondo Blowout Environmental Report by the Deepwater Horizon Study Group. "The purpose of this report is to give a comprehensive environmental impact assessment of the Deepwater Horizon oil spill, as well as summarize the lessons learned from the spill and its cleanup efforts. The information in this report should provide a more robust guide to future spill response, as well as a better understanding of the risks involved in oil exploration and production."
Managing Rapidly Developing Crises: Real-Time Prevention of Failures
by Robert G. Bea, Professor of Civil Engineering, University of California, Berkeley. "The vast majority of high-consequence, low-probability accidents involving engineered systems such as ships, fixed platforms, mobile offshore drilling units, and pipelines, are caused by human and organizational factors...Many of these accidents consist of rapidly unfolding sequences of events in which the pace of operations is dramatically increased and the normal organization structure rendered ineffective."
The New Domain in Deepwater Drilling: Applied Engineering and Organizational Impacts on Uncertainties and Risk by David M. Pritchard and Kenneth J. Kotow, Successful Energy Practices International, LLC. "This paper discusses key issues concerning setting and aligning safety objectives to achieve an acceptable balance among a plethora of risks and maintaining a healthy deep-water drilling industry. In particular we focus on how this impacts performance and, more importantly, safe well designs."
A Perspective from Within Deepwater Horizon's Unified Command Post Houma by R. Charles Epperson. "...this report focuses on three main functional areas: Incident Command, Unified Command, and the use of a Spill of National Significance (SONS) Organizational Structures; Managing Simultaneous Offshore Operations, Safety, and Risk Management Practices; Limitations of Existing Area Contingency Plans (ACP) and Preparation through current Training and Exercise Programs."
Perspectives on Changing Safety Culture and Managing Risk by W.E. Gale, Jr. of FireExperts.com. "This paper in brief looks at the history of BP and their recipe for success. The business model that, heretofore, has been embedded in BP's culture has been one of risk-taking, cost cutting, and capital efficiency improvement within the context of risk management…risk management of their portfolio of assets. This paper is not meant to be a commentary on good or bad corporate culture per se, but rather seeks simply to reveal some of the underlying issues that organizations must necessarily confront in order to manage risk comprehensively and successfully."
Preventing Accidents in Offshore Oil and Gas Operations: the US Approach and Some Contrasting Features of the Norwegian Approach by Michael Baram, Professor Emeritus, Boston University Law School. "This paper presents an analysis of the legal framework and regulatory approach of the United States (US) for preventing accidents in the development of the oil and gas resources of its outer continental shelf (OCS). Discussion is focused on prevention of major accidents which harm workers and the offshore and coastal environments, but also deals with some aspects of emergency response. References are made to Norwegian laws and regulations governing oil and gas operations in the Norwegian sector of the North Sea and illuminate a proven alternative approach for preventing OCS accidents."
Recommendations Regarding the Institutional Governance of Offshore Oil and Gas Development by Michael Baram, Professor Emeritus, Boston University Law School and Florian Buchler. "This section of the report provides preliminary recommendations regarding the legal and regulatory framework for preventing future major accidents in oil and gas developments on the Outer Continental Shelf (OCS)."
Looking Forward - Reliability of Safety Critical Control Systems on Offshore Drilling Vessels by Jon Espen Skogdalen, Department of Industrial Economics, Risk Management and Planning,
University of Stavanger, Norway and Øyvind Smogeli, Marine Cybernetics, Norway. "Hardware-In-the-Loop (HIL) testing is a well proven test methodology from automotive, avionics and space industries. The aim of this white paper is to clarify what HIL testing is, how third party HIL testing can be applied to control system software on drilling ships, semisubmersibles, jack-ups and FPSO's, and why this is an important contribution to technical safety for offshore operations."
What Might Have Been – Risk Assessment and Management Analysis (RAM) of BP Tapered Production Casing Plan by Gary L. Marsh, retired Shell employee. "BP might (or might not) have enjoyed at least some of the $7 million to $10 million savings they assessed would be gained by running an all-in-one string, and still had a safe well afterward had they performed a Risk Assessment and Management (RAM) analysis well in advance of the operation. Such an analysis should have focused far beyond the immediate rig plans to include risks that a second or the same rig might encounter in an eventual reentry and full completion."
Risk Assessment and Management: Challenges of the Macondo Well Blowout Disaster by Robert. G. Bea, Professor of Civil Engineering, University of California, Berkeley. "The purpose of looking back [at the Macondo well blowout failures] is to understand how the failures might have developed; these are plausible scenarios for the RAM failures. This is done so these plausible scenarios are accounted for in recommendations for future improvements. We look back to enable us to better look forward."
Summary of Various Risk–Mitigating Regulations and Practices applied to Offshore Operations by Jahon Khorsandi, University of California, Berkeley. "The following work is a brief summary of several of the risk-mitigating regulations and practices as part of the offshore regulatory framework applied in the UK, Norway and the U.S."
Summary of Mistakes and Omissions on Macondo Well by Gary L. Marsh, retired Shell employee. (An eighteen-point list.)
This Is Not About Mystics: Or Why a Little Science Would Help a Lot by Paul Donley. "This paper applies James Reason's systems approach intuitively from the perspective of the crew and workers on an Explorations and Completions rig, with particular focus on the role and attitudes of the driller and drilling engineer. Reviewing the aspects of sociotechnical analysis leads to recommendations for more effective, inclusive and efficient regulatory functions applying principles from Dr Robert Bea and Dr Reason and employing Web 2.0 technology. Recommendations may be taken individually or as a whole to provide a structural strategy for training, recruitment, PR, and logistics making all aspects available to as many stakeholders as security concerns allow."
The Tradeoffs of Chemical Dispersant Use in Marine Oil Spills by Artin Laleian & Thomas Azwell. "Chemical dispersants are petroleum solvents that move oil from the water surface to the water column by breaking an oil slick into small droplets. Their use does not reduce the total volume of oil in the environment, but rather changes its location and physical properties. The use of chemical dispersants has been described as a "risk-based paradigm" in which both positive and negative consequences must be weighed prior to their application."
Understanding the Macondo Well Failures by Robert. G. Bea, Professor of Civil Engineering, University of California, Berkeley. "There is plentiful evidence to indicate the Macondo well failures developed because of a cascade of poor decisions involving poor tradeoffs made by all of the organizations with primary responsibilities for the Macondo well project. Critical things were compromised for the wrong reasons in the wrong ways at the wrong times. From the outset, the hazards, uncertainties, and risks were not properly assessed or managed. The likelihoods and consequences of the disastrous failures were dramatically underestimated. As a result, preventative preparations, emergency response, containment, and clean-up processes were woefully inadequate."
Waste Management and the Deepwater Horizon Oil Spill by Sidhu Kubendran. "The Deepwater Horizon Oil Spill resulted in an influx of 4.9 million barrels of crude oil into the Gulf of Mexico, an unprecedented amount of oil emerging from the sea floor. Currently, 26% of the oil remains in the ocean. The rest of the oil was remediated using skimmers, sorbent booms, in-situ burning and chemical dispersants, as well as a portion that was natural dispersed, evaporated or dissolved. The spill and its subsequent clean-up methods generated 89,202.9 tons of solid waste and 1,193,084 BBLs of liquid waste (as of November 28, 2010) that needed to be disposed of effectively."
Why B/S RAMS May Not Have Sealed on ROV Deadman Command by Gary L. Marsh, retired Shell employee. "In the presence of the control system leak at the blind shear (B/S) ram T-lock, and with no replenishment of power fluid from surface, there was probably insufficient subsea accumulator capacity to both overcome the leak and to close the B/S rams and stop the blowout flow past it. The analysis shown in the BP investigative report is faulty and not in accordance with current American Petroleum Institute (API) standards (and probably Minerals Management Service (MMS) rules based on API) for a deepwater subsea blowout preventer (BOP) control system."