Deepwater Horizon crew lost focus, suggests Gulf oil spill panel

At one of the most critical phases of a deep exploratory dig at the Macondo well last April, operators of the Deepwater Horizon oil rig took their eyes off the highly pressurized deposit pushing up from nearly 20,000 feet beneath the earth's surface, an independent government panel suggested Tuesday.

The National Commission on the BP Deepwater Horizon Oil Spill and Offshore Drilling has found that a complex series of human, mechanical, engineering, and regulatory failures led to the tragic blowout of the BP-leased Deepwater Horizon, which caused one of the world's worst industrial oil spills.

But one of the most difficult aspects of the accident for federal investigators to fathom has been what one witness described as a common phenomenon on drilling rigs: As the ship buttons up the loose ends at the end of an exploratory drill, attentions drift toward the next job, the next adventure.

"It's a natural thing to worry about the next job at the end-of-well procedure – there's a tendency to lose focus," said Steve Lewis, an engineer with Seldovia Marine Services, responding to repeated questions about the phenomenon from deputy counsel Sam Sankar.

The Deepwater Horizon crew was in the process of temporarily abandoning the mile-deep Macondo well when the well experienced a blowout, causing an explosion that killed 11 aboard the rig. The floating drilling platform sunk two days later.

The tragedy jolted awake what the panel called "complacent" federal regulators and corporate oil explorers, all of whom are now trying to improve safety protocols and tests even as they argue over who bears the ultimate blame for what befell the Deepwater Horizon. Millions of dollars in fines and even criminal investigations of culpable officials hang in the balance.

The investigation has settled into one enduring storyline: While there's no proof that financial concerns overrode safety protocols, facts state that BP's well-plugging plans were changed at the last minute. Negative tests were downplayed. Critical warning signs from the well were either ignored or not seen by experienced crew members who knew fully the risks of deepwater drilling. These mishaps, laid on top of problems with the Halliburton-supplied concrete and the BP-designed well and plug, played into the disaster.

The commission has gone out of its way to say that it's not suggesting that the roughnecks, most of them from the US Gulf Coast, would risk their own lives or anybody else's to pad the profits of a company based in London.

Yet scheduling, financial, and even cultural pressures – including millions in cost overruns due to delays – were clearly bearing down on the crew and the on-board BP company men, investigators say.

"We are aware of what appeared to be a rush to completion," commission co-chairman Bill Reilly, a former Bush administration Environmental Protection Agency administrator, said. What's not clear, he added, is what exactly motivated drillers to go ahead with the procedure instead of waiting for equipment and materials that could have made the operation safer.

Indeed, even though troubling test results – and even physical rumblings – aboard the rig began to worry the crew, the rig moved forward with its plan to disconnect from the massive Macondo well. Before crews could shut the rig down, a mixture of sand, gas, and oil moving with the momentum of a 550-ton freight train burst up the mile-high riser pipe, exploding as it burst onto the rig floor.

"At no point during the three hours [between commencement of 'temporary abandonment' and the blowout] did anyone on that rig floor call back to shore and say, 'Boy, we're getting weird readings, there's a problem here,' " said Sean Grimsley, deputy chief counsel for the commission.

The reforms face a daunting challenge: changing the practices not just of regulators and executives who handle protocol and the bottom line, but of a down-and-dirty drill floor culture where key moment-to-moment decisions are made.

"The system depends on the right person watching the information at the right time and having enough knowledge above all other activities to interpret it the right way, and act very rapidly," said Fred Bartlit, the oil spill panel's chief counsel, on Monday. "It depends on one person doing everything right at the time when you have to move fast."

So far, the Bureau of Ocean Energy Management, Regulation, and Enforcement, formerly known as the Minerals Management Service, has implemented new recusal protocols to cut down on conflicts of interest and has ordered reviews of all categorical exclusions during permitting. More tangible changes include ordering permanent plugs on 3,000 nonproducing wells and the dismantling of 650 others. It has also introduced new blowout preventer certification rules. No new deepwater drilling permits have been approved since the Deepwater Horizon disaster.

"This was a wake-up call to my agency and the industry, as well," said Michael Bromwich, the newly appointed director of the agency. "I've had a lot of meetings with companies that tell me that they've taken to heart what happened" to the Deepwater Horizon.