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SUMMARY OF
MACONDO INQUIRIES
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SUMMARY OF
MACONDO INQUIRIES
Background
DNV GL is one of the largest advisory, verification and certification companies serving the global
oil and gas, energy and maritime industries. Our corporate purpose is to safeguard life, property
and the environment and one way we do this is to distill diverse information of importance and to
share this publicly. This report which summarizes the many Macondo investigations is an example
of this. There have been over 20 major inquiries and many have quite different key lessons and
recommendations. It can be difficult for people in the industry to have an overview of what
recommendations were made and by whom. This report provides a short summary of each
investigation and highlights important points it makes. Further investigation reports are likely,
especially on the long-term environmental impacts, but DNV GL feels that this current summary
would be timely.
The Macondo Event and Major Investigations
Given the significance of the event and the potential for other
events associated with deepwater drilling where response
is difficult, there have been multiple investigations and
lessons-learned exercises. DNV GL has reviewed 21 major
investigations and this report attempts to summarize these
impartially but there was necessarily some selection involved
and we apologize in advance to the many authors if we might
have inadvertently missed some points. Clearly no single
investigation provides a full overview of needed actions.
Transocean
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Title
Release Date
1
DWH Commission
National Commission on the BP Deepwater Horizon Oil Spill and Offshore Jan 2011
Drilling Main Report and multiple topic papers
DWH Commission
Feb 2011
BP
Sep 2010
Transocean
Jun 2011
5
USCG
Report of Investigation into the Circumstances Surrounding the Explosion, Apr 2011
Fire, Sinking and Loss of Eleven Crew Members Aboard the Mobile
Offshore Drilling Unit DWH Vol.1 (MISLE 3721503)
BOEMRE
Sep 2011
Republic of the
Marshall Islands
Aug 2011
Oct 2010
9
DNV GL
Mar 2011
10
Jun 2014
11
Mar 2011
12
National Academy
of Engineering
2012
13
2013
14
US District Court
Eastern Louisiana
Court Judgment
Sep 2014
15
Norway Petroleum
Safety Authority
Jun 2011
16
Norway Petroleum
Safety Authority
Feb 2014
17
OGP
Getting it Right
Jan 2013
18
OLF
Jun 2012
19
SINTEF
May 2011
20
UK HSL
Apr 2014
21
US Transportation
Research Board
2012
Table 3 in the Conclusions summarizes the topic areas addressed in the findings and recommendations of each inquiry.
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Recommendation summary
1A
1B
1C
1D
1E
1F/G
2A
2B
2C
2D
2E
3A
might have failed to recognize the kick, the later flawed drill
floor response, and the failure to activate the emergency
disconnect system which would have actuated the shear rams.
Possible ignition sources were discussed.
The reasons for the BOP failure to seal the well referred mainly
to the DNV GL Forensic examination (9). BP company policies
were a contributing factor.
BOEMRE did review regulatory processes and how these may
have contributed to the event. However in most instances they
concluded these had no contribution to the blowout event.
A final section provided 41 recommendations and was divided
into six sections (with recommendations counts in each): wells
(6), kick detection and response (8), ignition source (4), BOP (6),
regulatory agency (11), and OSC Companies (6).
Some of the more significant recommendations included:
require the negative pressure testing of wells where
appropriate
require at least two barriers (one mechanical and one
cement barrier) for a well that is undergoing temporary
abandonment procedures, and to clarify that a float collar/
valve is not to be considered to be a mechanical barrier.
revise the incident reporting rule at 30 CFR 250.188 to
capture well kick incidents
enhance BOP operation and intervention
expand 30 CFR 250.446 to include documentation and
record keeping requirements for major (3-5 year) inspections
as required by BOEMREs adoption of API RP 53
Note, there was no recommendation regarding safety and
environmental management systems as BOEMRE had already
decided by this time to require adoption of SEMS based
on API RP 75.
7) Marshall Islands Registry DWH Marine Casualty
Investigation Report
The Flag State for the DWH
was the Republic of the
Marshall Islands. Under
international conventions, the
Flag State must report the
causal factors of all serious
and very serious marine
casualties. Therefore the
Marshall Islands issued a report to the IMO on 17 Aug 2011
outlining its findings with respect to the accident. The focus of
this report was to identify non-compliances with relevant
international regulations, including the United Nations
Convention on the Law of the Sea, 1983 (UNCLOS), the
International Convention for the Safety of Life at Sea, 1974, as
amended (SOLAS), and the Code of the International Standards
and Recommended Practices for a Safety Investigation into A
Marine Casualty or Marine Incident.
The report provided a detailed timeline of the incident including
witness statements. The report then addressed the functioning
of the safety and other equipment and human and
organizational factors. There were instances of unclear
command and control, evacuation systems that did not function
well (as power had been lost), and the Emergency Disconnect
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When the drill pipe was sheared on April 29, 2010, using the
CSRs (Casing Shear Rams), the well flow pattern changed
to a new exit point through the open drill pipe at the CSRs
expanded to flow up the entire wellbore to the BSRs and
through the gap along the entire length of the block faces.
Figure 6. Location of drill pipe inside BSR and its effect on BSR
cutting ability
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Conclusions
There have been many investigations into the Macondo
accident and these have addressed several different aspects of
the accident. Some investigations took a purely technical cause
perspective whereas others emphasized more compliance with
regulations or addressed organizational or human causes. Early
investigations provided very detailed tutorials on deepwater
drilling challenges. An indication of the range of
recommendations is shown in Table 3 and a more specific focus
on technical recommendations appears in the OLF Figure 8.
Many of the key recommendations have been adopted in one
form or another. The USA has seen major changes to the MMS
regulator, now BSEE and BOEM, with an updated style of
operation emphasizing goal-based safety and increased
inspector staff to allow greater presence offshore. BSEE has
issued new requirements for drilling safety, for BOP
recertification, negative pressure tests, and professional
engineer sign-offs on casing and cement, and a requirement to
estimate worst case blowout events. API and IADC have worked
on an interface requirement between lessee and contractor, and
several new API standards have been developed. SEMS I and
SEMS II have been implemented with the Center for Offshore
Safety defining the protocols and approving third party audit
service providers. BSEE has provided guidance on safety
culture and is working with another federal agency to
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No. Title
Prevention
BOP Design
& Operation
Contain &
Respond
Management US
& culture
Regulatory
International
Regulatory
1
DWH Commission Main
X X X X X
2
3
BP Investigation X X X
4
Transocean Investigation
X X X
5
USCG
X X X X X
6
BOEMRE
X X X X
7
Republic of the Marshall
X X X X X
Islands
8
Adm Thad Allen Report X X
9
10
Chemical Safety Board
X X X X
11
Center for Catastrophic Risk
X X X X X
Management (UC Berkeley)
12
National Academy of
X X X X X
Engineering
13
National Research Council X
14
US District Court
X
X
Eastern Louisiana
15
Norway Petroleum Safety
X X X X X
Authority Interim
16
Norway Petroleum Safety
X X X X X
Authority Final
17
OGP
X X X X
18
OLF
X X X X
19
SINTEF
X X X X
20
UK HSL X
21
US Transportation X
X
Research Board
Table 3. Range of Findings and Recommendations
Table of Acronyms
ALARP
AMF
API
BAST
BOEMRE
BOP
BSEE
BSR
CFR
CSB
CSR
DOI
DWH
EDS
EPA
GoM
HP
HSE
HSL
IADC
IMO
INPO
ISM
JIP
JIT
MMS
MOC
MODU
NCP
NIC
OCS
OGP
OLF
OIM
OSHA
PSA
PSM
RMI
ROV
RP
SCE
SEMS
SIL
USCG
VBR
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