Incident Report

Subject:         Inadequate "Confined Space" Programme for Tank led to Fatality

Date of Email report: Tue 02/08/2011   

Report Detail:

The JOIFF Guideline on Confined Space Entry was recently completed and circulated to Members. It is available for download from the JOIFF website. The JOIFF Guideline provides the essentials required for safe confined space entry recognising that every entry is unique and must be risk assessed to ensure safeguards are taken during entry.

Amongst the detail covered in the Guideline is

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A US pharmaceutical company has been cited for failing to operate a compliant confined space programme, which led to one fatality and two other workers being seriously injured. A technician entered a tank where, as part of a protein extraction process, air had been displaced by nitrogen gas. No prior atmospheric testing was undertaken on the oxygen-deficient tank. When the man collapsed two other workers were sent in, again without any atmospheric testing of the tank, nor proper equipment and other safeguards necessary for a safe rescue.

Baxter Bioscience is facing 11 citations totalling $371,250 for deliberate and wilful workplace safety violations which resulted in the death of one technician and serious injuries of two other workers, Cal/OSHA officials said.

“We will not tolerate employers who intentionally sacrifice the safety of their workers,” said California Department of Industrial Relations (DIR) Acting Director Christine Baker. “Our goal is to prevent these needless tragedies and ensure employers live up to their responsibility of protecting their workers.”

Additional Documentation:

Worker Dies in Oxygen-Deficient Tank, Pharmaceutical Firm Fined $371,250

“The hazards of working in confined spaces are well-documented and this is a classic example of the kind of injury that occurs when employers fail to adequately protect their employees,” said Cal/OSHA Chief Ellen Widess.

Cal/OSHA has issued 11 citations totaling $371,250 to Baxter Healthcare Corporation dba Baxter Bioscience for deliberate and willful workplace safety violations which resulted in the death of one technician and serious injuries of two other workers.

“We will not tolerate employers who intentionally sacrifice the safety of their workers,” said DIR Acting Director Christine Baker. “Our goal is to prevent these needless tragedies and ensure employers live up to their responsibility of protecting their workers.”

On Jan. 21, Baxter technician, Henry Astilla, collapsed when he entered a 7-foot deep, 6,000-liter tank in which nitrogen gas was being bubbled through plasma as part of a protein extraction process. Air in the tank had been displaced by the nitrogen gas resulting in an oxygen-deficient atmosphere in the tank. Cal/OSHA regulations require employers to have special protective procedures in place prior to the entrance by employees into these types of confined spaces. In this case, the employer had not tested the atmosphere prior to entrance to ensure there was sufficient oxygen, which led to Astilla’s death.

Cal/OSHA’s investigation further revealed that when Astilla was discovered, a supervisor ordered two other employees to enter the tank and retrieve him, without testing the atmosphere of the tank or providing proper equipment and other safeguards necessary for a safe rescue. As a result, Astilla died and the two employees sent to retrieve him were seriously injured. One remains hospitalized since January.

“The hazards of working in confined spaces are well-documented and this is a classic example of the kind of injury that occurs when employers fail to adequately protect their employees,” said Cal/OSHA Chief Ellen Widess. “When confined space operations are not properly planned, it is unfortunately common for other employees to be injured or killed while attempting impromptu rescue of the initial victim.”

Cal/OSHA determined that Baxter’s confined space program failed to comply with all requirements, including appropriate atmospheric testing, protective equipment, and rescue equipment and procedures.

Baxter Bioscience is a multinational pharmaceutical company with a Los Angeles plant located in Atwater Village. The facility uses advanced technology to produce plasma proteins.

The citations issued by Cal/OSHA include one general and 10 serious, four of which were classified as willful.

Source: OSHONLINE via EEMUA. http://ohsonline.com/articles/2011/07/27/worker-dies-in-oxygen-deficient-tank-pharmaceutical-firm-fined-371250.aspx?admgarea=new