F-1: Toxic Spill

Statement of the Case: Engineer A was Chief Engineer of a plant that processed raw ore. The

refining process involved several dangerous chemicals, which were re-captured and recirculated;

however, careful operation was essential to prevent these chemicals from escaping

into the wastewater. Engineer A worked alongside the Operations Manager, and both of them

reported to the Plant Director. Engineer A was responsible for technical matters, such as design,

maintenance, and safety. The Operations Manager was responsible for hiring, scheduling, and

meeting production targets. Both the Operations Manager and the Plant Director were older than

Engineer A, but neither was a Professional Engineer nor a Professional Geoscientist.

During the first few months on the job, Engineer A reviewed, updated, and improved the plant

Operating Manual prepared by the previous Chief Engineer. Engineer A ensured that copies of

the manual were available to the plant operating staff and personally conducted several training

sessions for key operating staff. In spite of these efforts, however, Engineer A observed many

infractions of the Operating Manual throughout the plant, and he could see that the toxic

chemicals were possibly escaping into the wastewater. Engineer A considered this lax attitude

toward safety to be very risky. Tests of the wastewater effluent showed wide variations of the

escaping chemicals, with concentrations that occasionally reached the legal limits. On several

occasions, Engineer A initiated disciplinary measures against operating staff, but these were

dealt with lightly by the Operations Manager, for whom the staff worked. Engineer A eventually

came to understand that the Operations Manager put production ahead of safety and was casual

about enforcing the safety provisions in the Operating Manual.

Finally, Engineer A warned the Operations Manager about these unsafe practices in writing and

demanded that infractions be disciplined more severely. As a last resort, Engineer A went

directly to the Plant Director and explained the problem, but the Director simply said, “Work it

out among yourselves.”

Question: If you were Engineer A, what would you do at this point?

Outcome: Engineer A was unhappy with this lack of leadership, but felt that he had reported the

problem up the “chain of command” so the problem was no longer his responsibility. A few

weeks later, while the plant was operating at maximum capacity, local news media carried

reports of a devastating fish-kill in a neighbouring creek and poisoned birds in a downstream

marsh. An investigation, carried out by scientists from a government ministry, placed the blame

clearly on the lax operating procedures in the plant. The ministry charged the company and

Engineer A with violations of environmental regulations. A rancher, who had to pipe safe water

to his livestock, sued the company and Engineer A for damages. A lengthy series of legal and

disciplinary actions followed.

Authors’ Comments: Obviously, Engineer A tried to do a good job by updating and distributing

the Operating Manual, by educating staff, and by informing the Operations Manager and the

Plant Director of hazards. However, when they failed to respond adequately, the responsibility

then fell back on the engineer, as the only technically competent professional, to insist that the

plant personnel follow adequate safety measures. In a difficult situation such as this, Engineer A should have informed the Plant Director that unsafe practices were unacceptable, and if the Plant
Director refused to co-operate, Engineer A should have consulted the Association for guidance.
If a solution still could not be found, Engineer A should have reported the unsafe practices to the
appropriate ministry.
When senior management refuses to act on clear dangers to the public or to the environment,
professionals cannot defend themselves by saying they were “only following orders.” As
professionals, engineers and geoscientists are usually the ultimate authority in the industrial
workplace and must insist on protecting the environment and the public when, in their
professional opinions, hazards are likely to cause injury or damage. Failure to do so can lead to
disciplinary action; every Code of Ethics requires the practitioner to put public safety first.