of the United Steelworkers of America
Westray Mine Public Inquiry Commission
Stellarton, Nova Scotia
INTRODUCTIONThe United Steelworkers of America was the
certified bargaining agent for the underground and surface employees of Westray
Coal through its local union, Local 9332. The Union was in the midst of an
organizing campaign when the mine exploded. It was certified by order of the
Nova Scotia Labour Relations Board on June 10, 1992. On June 29, 1992, the
United Steelworkers of America, Local 9332 was granted general status as a party
to participate in all phases of the Inquiry.
which established the mandate of this Inquiry stated a number of questions.
Having heard seventy-six days of testimony and having reviewed thousands upon
thousands of pages of documents, the Inquiry is about to start putting answers
to those questions. The United Steelworkers of America submits the answers must
be as clear and unequivocal as possible. We owe that to the families of the dead
miners. We owe it to the surviving Westray employees. We owe it to all those who
risked their lives underground in the days after the explosion. We owe it to the
men and women who continue to work in the mining industry in this Province and
beyond and we owe it to all those who expect and deserve to be employed in a
safe work environment.
The first question in the Order-in-Council is the most important because its
answer leads inevitably to the other issues with which the Inquiry must deal.
That question is, was the explosion at the Westray Mine preventable? We submit
that having heard the evidence, the answer can only be yes, the explosion was
The evidence shows:
(1) The explosion on May 9th, 1992 would have been prevented if the operator of the mine had acted prudently and followed widely accepted safe mining practices;
The evidence shows the Westray Mine was allowed to operate in a regulatory vacuum with public officials deferring to mine managers rather than carrying out their statutory responsibilities. The mine operator failed to carry out its primary responsibility to provide a safe, working environment and the
regulators failed to enforce existing standards for safe working practices.
(2) The explosion would have been prevented if the public officials responsible for regulating the mine had enforced the statutes within their authority and carried out their duties diligently.
The evidence does not show that the people who were underground on the
morning of May 9th were themselves engaging in unsafe acts which in any way
contributed to the explosion. They were mining coal and supporting the roof,
following the directions of the mine operator and using equipment supplied by
the mine operator and approved by the inspectors. There was no evidence that the
crews working in the Southwest section that morning did anything other than what
was expected of them and we ask the Inquiry to state this conclusion
However, it is likely that one of those crews created a spark at the heading
in which they were working. In a properly run and properly regulated mine this
would have been an insignificant event. The spark would have gone out without a
fire and without an explosion. But this was Westray and all the elements of a
disaster had been put in place by the time the men of "B Crew" went underground
that Friday evening.
Attempting to individualize the cause of the explosion to the actions of a
single miner or a single crew may suit the purposes of some but this would be a
complete distortion of the evidence before the Inquiry.
The Order-in-Council also asked the Inquiry to determine whether any neglect
caused or contributed to the explosion. We submit the evidence supports the
conclusion that there was neglect on the part of the operators of the mine and
the public officials who regulated the mine and that this neglect both caused
and contributed to the explosion on May 9th.
Throughout the Inquiry, the United Steelworkers of America have cooperated
fully with the Commission and have tried to support the Inquiry in the execution
of its mandate. We made our members available, without reservation, to be
interviewed by Commission Counsel. We made available transcripts of all of the
interviews the miners gave to the Inquiry, to the Department of Labour and to
their own counsel. Finally, we brought to the Inquiry twenty-eight miners and
surface employees whose presence had been requested by the Commission to answer
questions and be cross-examined by all those participating in the hearings.
Their testimony is an important part of the evidence before the Inquiry.
In these submissions, we will review the evidence as it relates to the
actions of three groups, the regulators and public officials associated with the
mine, the men and women who worked at the mine, and the people who ran the mine.
We will ask the Inquiry to make findings on that evidence and we will propose
reforms to regulations and practices to help reduce the likelihood of tragedies
like Westray happening in the future.
It would be difficult to overstate the importance the United Steelworkers of
America attaches to this Inquiry and the report it will produce. It is no
exaggeration to say that the tens of thousands of members of the Union who work
in the mining industry in Canada and the United States are looking to the report
of this Inquiry for a clear, decisive statement that will give them the
assurance that at some time in the future they will not be in the position in
which the employees of Westray found themselves.
From our perspective, the recommendations in the report should reflect four
First, they must say no to the deregulation of health and safety. Instead,
the health and safety of workers must be given the highest priority by all those
who exercise public responsibilities.
Second, the people who represent the public interest must be trained and
professional. They must be the equal of those they regulate.
Third, the regulator must be accountable to workers and to the community at
Fourth, the process of regulation by which the public interest is protected
must be transparent and open to public scrutiny at every level.
If these principles are embodied in the recommendations, the report will be a
milestone in the evolution of occupational health and safety in North America.
From the perspective of the United
Steelworkers of America, the most striking and most troubling feature of the
evidence before the Inquiry is the picture that is drawn of a regulatory system
that failed to work. The failure of a regulatory system is not an abstract
problem for people who work in a mine. In a very real way, they depend on the
regulators, the inspectors, and the government mining engineers. At the time of
the explosion, workers at Westray had no union. They had no functioning health
and safety committee. Their boss, the underground manager, was not the kind of
person they could turn to for support or reassurance. The failure of the
regulators to place effective constraints on the operators of the Westray Mine
left the mine employees without any protection from an employer that did not
place a priority on working safely.
This regulatory vacuum did not arise by accident. It was created by
politicians who valued economic growth over occupational safety and by
bureaucrats who deferred to the mine operators at almost every opportunity.
Evidence about the generous levels of public support
directed to the Westray Mine should be examined closely. The program of support
showed the government valued economic development more than the safety of
workers. It created a political aura around the mine which influenced the public
officials involved with its development and operation. Finally, it created a
conflict of interest for senior bureaucrats who were involved with both the
government assistance and the regulation of the mine.
a) Government PrioritiesThere can be no doubt from the evidence that
the Westray Mine project enjoyed a special place in the hearts and minds of Nova
Scotia's political leaders. For Donald Cameron, the establishment of the mine
was a prime cause. Through his efforts and the efforts of likeminded
politicians, Westray came to life surrounded by government support and
concessions. Indeed, it is clear from the evidence that there would have been no
mine without this support.
Even a cursory review of the support package shows what a good deal Messrs.
Frame, Pelley and Phillips, helped at strategic points by Mr. Cameron, were able
to get in exchange for their investment in this project.
There was the provincial loan of twelve million dollars, on which only
interest had been paid at the time of the explosion. There was the interim loan
of eight million dollars given against the advice of senior public servants and
secured, in effect, by two holes in the ground. There was the federal support, a
loan guarantee on approximately eighty-five million dollars and a direct
contribution against interest rates. There was the guaranteed sale of seven
hundred thousand tons of coal a year to Nova Scotia Power, at the time a
In addition, the Province provided Westray with the unusually generous
take-or-pay agreement, a deal that senior public servants wanted nothing to do
with. The evidence shows that in order to provide further guarantees to the
bank, Donald Cameron persuaded his cabinet colleagues to agree to pay for an
additional two hundred and seventy-five thousand tons of Westray coal a year,
whether or not it was taken from the mine. This was a potential cost to the
Province of fifteen million dollars a year for the life of the deal.
When Westray requested a change to the take-or-pay deal, a change in the
election date that was seen by public servants as not being in the public
interest, the change was made by the Cameron government.
The final item on this list was the permission given to Westray to mine a
200,000 ton so-called "bulk sample" of coal from the surface mine in Stellarton.
Westray needed this coal and it needed it quickly. By calling it a bulk test
sample, Westray was able to avoid mining and environmental regulations. The
evidence is that those in government and in the company knew this was coal
production, not coal testing, even if they didn't admit it publicly.
When you compare the generous treatment the company received to the declining
resources provided to the mine safety division of the Department of Labour, a
clear picture of the priorities of the Provincial Government emerges. The
inspectors in the mine safety division knew they were not ready for Westray and
they asked for help. They asked for a new, engineering position. They asked for
training on the mining method to be employed by Westray. They asked for
permission to hire independent consultants to provide expert advice on roof
control. Each request was turned down. There was no new money to help the
inspectors meet the challenges of Westray. In fact, the staff of the mine safety
division was cut at the same time that Westray was struggling to get into
production. As John Smith testified, perhaps they should have gone to Clifford
Frame for the money.
We submit this Inquiry should find that the Government of Nova Scotia
which generously assisted in the establishment of the mine failed to provide
adequate resources to the public officials who were supposed to inspect the
safety of the mine.
b) Political InfluenceA second point of significance in the
government's support for the mine is the creation of a political aura around the
mine and its operations. This aura inevitably affected the regulation of the
mine. While no public servant testified to having been directly influenced by a
politician, there are several instances in the evidence which show that
regulators carried out their duties fully conscious of the political
controversies surrounding the mine, and were, in fact, influenced by those
Albert McLean finally took steps to talk to safety representatives at
Westray, not because it was something he should have been doing all along, but
because an opposition politician was attacking Premier Cameron over safety
concerns at the mine.
John Smith admitted in his interview with the Commission that the political
sensitivity of Westray may have affected the way he carried out his duties at
Claude White systematically altered minutes of meetings involving government
officials and the mine operators to remove any references which might be
embarrassing to the government, the company, or both.
Don Jones warned Gerald Phillips that the government was coming under
increasing pressure because of the roof falls at Westray and it might be forced
to do something unpopular. Although Mr. Jones has apparently forgotten that he
made that statement, it is recorded in minutes made at the time and was recalled
by other witnesses.
Pat Phalen fretted about the negative "spin" put on Westray controversies by
senior officials in the Federal Government.
John Mullally admitted in testimony that he was aware of the political
significance Westray had for the government and felt it desirable for the
Department of Resources to help Westray meet its production committments.
Finally, there is Donald Cameron. Judging by his testimony, Westray was all
about politics from the start to the finish and even today he is unable to
distinguish political posturing from objective reality.
We submit this Inquiry should find that the Public officials
responsible for regulating the Westray Mine were affected in the performance of
their duties by political controversies surrounding the mine.
c) Conflict of Interest
The third reason for looking closely at the
government support given to Westray is because in significant instances, the
people who helped put together the package of assistance to make Westray happen
were the same people who were responsible for regulating the mine. This created
a serious conflict of interest at the highest level of the Department of Natural
Resources, a conflict which was recognized at the time by the department's
In November and December of 1991, Pat Phalen, the Director of Mines, had
reached the conclusion that Westray was breaking the Mineral Resources Act by
not following approved mine plans, something that could lead to the loss of the
company's mining permit. At the same time, Pat Phalen was helping Westray get an
amendment to the take-or-pay deal that Westray wanted but which put the Province
at a disadvantage. Also at the same time Pat Phalen was helping Westray get
access to the coal in the strip mine, the 200,000 ton sample that was no sample
at all, in order to help the mine meet its production targets. The Deputy
Minister of Natural Resources, John Mullally, was candid enough to admit in his
testimony that it would be fair to conclude the Department gave Westray
preferential treatment in order to help the project succeed. That appears from
the evidence to have been the main concern of the Department.
There was the appearance of conflict, if not a direct conflict between Mr.
Phalen's duties as a mine regulator and his role as a mine promoter. No public
official involved in industrial promotion should support proposals that threaten
the health and safety of the public or employees and we reject the suggestion
that there is an inherent conflict between the creation of jobs and safety.
We submit this Inquiry should find that the involvement of public
officials responsible for regulating the Westray Mine in measures intended to
promote the success of the mine created a conflict of interest for those
officials which influenced them in the exercise of their statutory
The structure of the regulatory system in
which Westray operated can be divided into two main areas, the planning and
approval process in the Department of Resources (formerly the Department of
Mines) and the operational regulation carried out by the Department of Labour.
The evidence clearly shows that both failed.
We recognize there was a third area of regulation involving the Westray Mine,
that carried out by the Department of the Environment. However, because of the
minimal evidence introduced on the role of this Department, we will not comment
Department of ResourcesThe Nova Scotia Department of Resources failed
to enforce key provisions of the Mineral Resources Act in relation to the
Westray Mine and it failed to carry out its statutory duty to ensure that
Westray engaged in mining that was both safe and efficient. It deferred to the
mine operator instead of fulfilling its statutory responsibilities.
(a) Mine ProposalThe Department's initial review of the Westray proposal
did not recognize challenges posed by the Foord seam and the means by which
Westray planned to mine it. The Department was satisfied the proposal conformed
to general engineering principles and would employ a standard mining method to
extract the coal. It presumed the operators were competent people who would
perform the detailed engineering and planning that was necessary before the
development phase began. The only voice of caution, that of geologist Robert
Naylor, was largely ignored during the approval process.
The position of this Department stands in sharp contrast with the view of the
Westray project that developed in the Federal Government. After a brief
technical review of the proposal, officials of Canmet concluded that while the
project was feasible, the combination of features it presented would create an
unusually complex mining environment which would stretch the limits of existing
technology. The Canmet review also noted that the mining sections in the
feasibility study on which the project was to be based were brief and general in
content and that much more detailed engineering work should be done before the
project began. The evidence of Dr. Thomas Brown was that any experienced mining
engineer or regulator should have come to the same conclusion.
We submit this Inquiry should find that the officials in the
Department of Resources who reviewed the Westray proposal should have recognized
the serious challenges facing the operator and should have required more
detailed and comprehensive mine plans before approving the project. Had
they done so, they might have forced the operator to confront problems that were
to bedevil the mine during its short life.
(b) Mine Permit
The Department's approach of deferring to the mine
operator rather than carrying out its statutory responsibilities is illustrated
by the issuance of a mining permit in August of 1991. The permit was required
under the new Mineral Resources Act. Under the new Act, a permit would be
automatically issued to any mine that held a lease and was producing saleable
coal by the date on which the Act came into effect, March 6, 1991. The evidence
is that Westray had a lease but was not producing coal for sale by the required
date. Kevin Atherton, whose job it was to trace the production of coal at
Westray, was absolutely certain in his testimony. The earliest Westray started
producing coal that could be sold was June, not March 6th.
The person who recommended that the permit be issued was Don Jones. He
testified that he did so on the basis of assurances from Gerald Phillips that
the mine qualified. However, he took no steps to verify Mr. Phillips'
If Westray had been required to apply for a permit under the new Act it would
have had to meet the more rigourous requirements of the new legislation and
would have had to submit detailed engineering studies on mining methods,
ventilation, and ground support for each phase of development in the mine. This
is the work several witnesses testified should have been done by Westray but was
We submit this Inquiry should find that Westray was not entitled to
receive the mine permit that was issued to it in August of 1991 and that by
granting the permit the Department of Resources allowed Westray to proceed with
development without having done the engineering and planning required by law.
(c) Mine Plans
There was much testimony about the changes to Westray's
mine plan that were approved by the Department of Resources as the mine began
development. Also of significance is the proposed change that was not approved
by the Department, the plan submitted in October of 1991 and the process that
followed the rejection of that plan.
The evidence is that on October 3, Gerald Phillips submitted a proposed mine
plan that was significantly different from the approved plan. This submission
triggered a searching re-analysis of Westray Mine planning within the
Department. On November 20, Don Jones produced a highly critical assessment:
(1) Westray had made revisions to its main tunnels without fully realizing the implications of the changes.
Don Jones' analysis was endorsed by his superior, Pat Phalen. Mr.
Phalen passed on the Jones critique to the Deputy Minister of Natural Resources
and added his own assessment; Westray was clearly in violation of the Mineral
Resources Act, was making important decisions on its mine plan without
sufficient input from experienced professionals, and could lose its mining
(2) The company had rushed into the Southwest block to get coal early and changed the original alignment of the section, exacerbating ground control problems.
(3) It proposed penetrating the barrier pillar around the Allen mine without doing any geotechnical work.
(4) It realigned other mining blocks without providing justification.
(5) It changed the mine design under the Trans Canada Highway, increasing the danger of subsidence under the Highway.
(6) It failed to show how depillaring operations were to be conducted without endangering the safety of miners.
At this point, it appeared that the Department had recognized serious
deficiencies in the planning of the Westray Mine and was determined to bring the
operation back into conformity with the Mineral Resources Act. However, instead
of maintaining its resolve, the Department capitulated. Gerald Phillips simply
denied criticisms of Jones and Phalen. He submitted new plans, one showing the
mine consisting of main tunnels only, the other showing a plan for the Southwest
section that was unusual, difficult to execute, and potentially dangerous. Both
There has been no credible explanation in the evidence for the dramatic
change in the position of top officials in the Department of Resources during
this period. Their resolve was clear in November. The Department's solicitor
believed they were about to stop the mine and this is consistent with the
During their testimony before the Inquiry, both Mr. Phalen and Mr. Jones
tried to lessen the impact of their written words by suggesting they now believe
they had exaggerated their concerns. Their memoranda speak for themselves and
they stood on the record for almost five years without being withdrawn or
amended. That is the evidence the Inquiry should accept.
In the end, we are left to speculate about what happened in the Department of
Resources in these weeks. Was Gerald Phillips able to persuade John Mullally or
Pat Phalen to back off? There is evidence that Gerald Phillips was in touch with
John Mullally during this period and that Pat Phalen was aware of their
conversations. Did anyone else intervene? Were the regulators hobbled by the
work they were doing to support the mine and keep it in production?
What we do know is that after this episode the operators of the Westray Mine
acted as if they could develop the mine as they saw fit regardless of the
approvals issued by the Department. The ink had barely dried on the approval for
the plan for the Southwest section when Westray began developing a different
area of the section with a different pillar design.
d) Southwest Section
We submit this Inquiry should find that the
failure of the Department to enforce the Mineral Resources Act in relation to
the Southwest section in the months leading up to the explosion is one of the
most serious lapses in the exercise of regulatory authority that emerges from
The explanation, given in testimony, is that even though they were
underground several times in this period and even though they participated in
discussions about problems being encountered in the Southwest section, neither
Don Jones nor his colleague, John Campbell, realized the company had abandoned
the approved plan and was mining a different area with a different plan. Both of
these men are mining engineers. Mr. Jones claimed he didn't know what the actual
mining was and Mr. Campbell did not know what the approved plan was.
We submit that this is not acceptable performance of the important public
duties held by these men and we ask the Inquiry to find that they were derelict
in not determining how Westray was mining the Southwest section in relation to
the approved plan.
We submit further that there are serious issues of credibility concerning the
testimony of Don Jones and John Campbell which suggest they did know what was
going on in the Southwest section but, for some reason, did nothing about it.
There is evidence before the Inquiry in Mr. Jones' statements to the RCMP and
Nancy Ripley-Hood's statement to Commission counsel that as a result of the
experience with Westray in October and November of 1991 the Department had
decided to keep a closer watch on the mine to ensure that it was following the
approved plan. That would be a reasonable reaction to the events of that fall.
Seen in that light, the idea that Mr. Jones or Mr. Campbell noticed nothing
amiss in the series of visits they made underground is even harder to accept.
As well, there is direct evidence that the Department of Resources knew how
Westray was mining the Southwest section before the explosion. Trevor Eagles
testified that on April 10th Don Jones was at the mine and requested Westray's
current mine plans. Mr. Eagles gave him three plans, two of which clearly showed
how the Southwest section had been mined to date and the plans for further
mining. Mr. Eagles' testimony is supported by a memo he wrote to David Waugh on
April 10th advising him that the plans were given to Don Jones. Mr. Jones was in
Stellarton on April 10th to visit the strip mine.
Trevor Eagles' evidence is credible and believable. There is no reason for
him not to tell the truth. In the absence of any explanation from Don Jones we
can only conclude that Mr. Jones did not tell the truth when he denied knowing
about Westray's mining activities in the Southwest section until the morning of
May the 9th. Mr. Jones knew by April 10th, at the latest, that Westray had
abandoned the approved plan for the Southwest section, had implemented a plan
for extracting coal that had failed and had started another development that was
contrary to the approved plan. The question then becomes, why did he do nothing
This is important because Don Jones testified that if Westray had submitted
the plan for the Southwest section as it was executed, he would not have
approved it. That means that if the Mineral Resources Act had been followed and
enforced in relation to the Southwest section, one of the key factors in the
explosion, a large body of gas in the failed district, might not have been
Second, by not acting when Westray had deviated significantly from the
approved plan for the Southwest section, senior officials in the Department of
Resources failed entirely to meet the statutory duties imposed on them by the
Mineral Resources Act.
We submit this Inquiry should find that Don Jones was not truthful
when he testified about his knowledge of the mining being carried out in the
Southwest section of the mine. We submit further this Inquiry should find Mr.
Jones was derelict by failing to act when he learned Westray was mining the
Southwest section contrary to approved plans.
We submit this Inquiry should find that officials in the Department of
Resources displayed neglect in their regulation of the Westray Mine and that
this neglect contributed to the explosion.
e) Failures Acknowledged
After the explosion, The Department of Resources implicitly acknowledged the failure of its regulation of the Westray
Mine. On the advice of its solicitor, Nancy Ripley-Hood, the Department rejected
Westray's request to resume mining operations without first filing a new mine
plan for approval. Ms. Ripley-Hood's advice to Don Jones highlighted the
Department's failings in its dealings with the mine before the explosion:
(1) Document everything.
It was all good advice, but it was a course that should have been
followed by the Department of Resources before the explosion.
(2) Don't assume anything about what the company is doing. Require a written explanation.
(3) Make the company update you constantly about any change, small or large, to its operations and tell it that approvals will be withdrawn if the information on which they are based turns out to be incorrect, incomplete, or false.
(4) Make sure any change in the plan is approved in advance.
(5) Above all, enforce the Act. Monitor the operation, document all site visits and if the company changes its mine plan without approval, stop the mine until approval is given.
Department of Labour
The other major area of regulation of the Westray
Mine with which we are concerned was the operational regulation carried out by
the Department of Labour.
We submit this Inquiry has abundant evidence before it to conclude that the
responsible officials in the Department of Labour failed to carry out their
statutory duties. They did not enforce the Coal Mines Regulation Act. They
condoned obvious breaches of the Act. They ignored or overlooked serious safety
hazards. They did not enforce the Occupational Health and Safety Act. Rather,
they used the shared responsibilities that underlie the Act as an excuse for
inaction. Moreover, their lax regulation of the operation of the Westray Mine
allowed conditions to persist that were directly linked to the cause of the
explosion on May 9th.
The Coal Mines Regulation Act confirms a broad mandate on a mine inspector.
He is empowered to do whatever is necessary to ensure the health and safety of
miners and anyone else employed in or about a mine. That is the duty of the
inspector and it is against that mandate that the actions of the Westray
inspectors must be judged.
Their failures are well catalogued in the evidence; overlooking the absence
of a barometer and water gauge at the mine; doing nothing about the illegal,
twelve hour shifts; failing to enforce conditions on the use of non-flame proof
diesel equipment; failing to enforce reporting requirements for mine officials;
doing nothing about the storage of fuel underground and the use of torches and
welding equipment; failing to monitor the training of miners.
There are three areas of particular concern in the Department of Labour's
dealings with Westray. These are coal dust, ventilation, and the Department's
response to warnings about safety that came from the work force.
(a) Coal Dust
Some basic facts emerge from the evidence about the failure
of the inspectors to deal with the dust problem at Westray. From the beginning
to the end of the mine, the operators had no program to remove coal dust from
the mine or to apply stone dust. Efforts that were made were ad hoc and
sporadic. The dust problem grew as the mine developed. It was obvious to miners
The inspectors were aware of the problem and began documenting their concerns
in July of 1991. In September they exacted a promise from the operator that a
program for the control and inerting of coal dust and the sampling of dust would
be in place by the end of the month. As we know, that promise was never kept.
Instead it was renewed regularly by the operator until the coal dust exploded.
It was not as if the hazard of coal dust was a newly discovered danger in
coal mining. The explosive potential of coal dust has been recognized since the
last century. Techniques to reduce the hazard are well understood.
We submit this Inquiry should find that the repeated failure of the
Department of Labour to follow through on its request for a program to control
coal dust at Westray was a fundamental lapse in the exercise of its
responsibilities under the Coal Mines Regulation Act.
Despite Claude White's tortured attempts to obscure the obvious meaning of
what he and his inspectors were saying on this issue, there can be no doubt that
they were asking for a stone dusting program in the months leading to the
explosion. They knew the difference between a stone dusting program and a dust
sampling program. That is why they were asking for both. We submit that this
Inquiry should reject Mr. White's explanation on this point and give the words
he and his inspectors used their obvious meaning.
Nothing better illustrates the incompetence with which the inspectors dealt
with the dust problems at Westray than their actions after the coal dust orders
were issued on April 29th. The order had four parts:
(1) The coal dust was to be removed immediately.
The company was to notify the Department, in writing, when it had
complied with each part of the order. As we know from the evidence, nothing was
done. Mechanics were directed to begin installing a sprinkler system on the main
slopes but there was no removal of coal dust and no application of stone dust.
(2) Stone dusting was to be done immediately.
(3) Within fifteen days, a stone dusting plan was to be developed and filed.
(4) Within fifteen days a dust sampling program was to be developed and filed.
What is worse, nothing was done by the Department to monitor compliance.
Albert McLean planned to come back a month later. Claude White considered
sending him back in a couple of weeks.
The evidence shows that Albert McLean actually visited the mine property on
May 6th. He was there for about four hours but he did not go underground, even
though he knew the Department had not received any communication from Westray
notifying it of compliance with the order. He made no inquiries about what was
being done about the order. If he had bothered to go underground on May 6th, he
would have found the mine much as it was on April 29th.
We submit this Inquiry should find that by not taking any action to
monitor compliance with the orders of April 29th, the responsible officials in
the Department of Labour failed in their statutory duties. Implicit in
the orders of April 29th was the recognition that the coal dust problem at
Westray was a threat to safety that required urgent attention. The failure of
the Department of Labour to act accordingly is, in our submission, indefensible.
We submit this Inquiry should find that the inspectors in the
Department of Labour neglected their duties concerning the coal dust in the
Westray Mine and that this neglect contributed to the explosion.
The inspectors also failed to respond to a serious threat
to the safe ventilation of the mine that was obvious on April 29th. That threat
was posed by the plywood barriers to the abandoned Southwest 1 section of the
The evidence shows that the mine inspectors lacked the capacity to deal with
mine ventilation an anything but the most rudimentary level. During his
testimony, Albert McLean admitted his lack of knowledge about ventilation. He
was able to take gas readings in the general air body but that was it. He didn't
understand the phenomenon of methane layering. He did not check air volumes or
velocity. He did not review the company's ventilation surveys or its ventilation
plans. Indeed, during his testimony, Mr. McLean showed that he did not
understand the ventilation route in the Southwest section as it was when he was
in the mine on April 29th. Albert McLean was responsible for inspecting the
Westray Mine in relation to ventilation issues. We submit he was not capable of
carrying out that responsibility.
The inspectors knew methane gas was being produced by the crushing of pillars
behind the barriers to the Southwest 1 section. They knew plywood barriers could
not keep gas from coming out. They knew the air intake to the Southwest 2
section flowed past the barriers, and the barriers were leaking. Westray
employees recorded methane readings of anywhere from 1.25 to 9% within ten feet
of the barriers. The barriers had buckled from the weight of the roof above. By
April 29th, the holes were big enough to allow a person to stick their head
through if they were so inclined. On that date, three inspectors toured the mine
and had a look at the barriers. As a result of their inspection, they learned
gas was escaping from the barriers.
There is conflict in the evidence on this point. We submit Albert McLean's
testimony that he recorded no gas at all when he checked the barrier on B road
is not believable. That same day Trevor Eagles recorded readings of between 1.25
and 2.5% methane ten feet from the barrier. Claude White testified Mr. McLean
told him he recorded some gas that day but Mr. White did not ask how much. After
the explosion the Department recommended charges under the Occupational Health
and Safety Act against Westray based on Mr. McLean recording a reading of 4.0%
methane at the barrier on April 29th. Those recommendations were reviewed by Mr.
McLean and Mr. White before they were passed on. The reading could not have been
made on March 30th as was suggested during the hearings because on March 30th
there was no barrier.
It is likely that the gas from the Southwest 1 section played a significant
role in the explosion on May 9th. Inquiry experts agree that conditions were
right for the gas to layer at the roof of the roadways leading to the working
faces. This gas became the fuel that ignited the coal dust.
We submit this Inquiry should find that Albert McLean recorded
significant levels of methane at the barrier to the Southwest section on April
29th and that this constituted a serious violation of the Coal Mines Regulation
Act. This Inquiry should find that Mr. McLean and Mr. White were derelict in
their duty under the Act in taking no action after inspecting the barriers on
We submit this Inquiry should find that the responsible officials in the
Department of Labour neglected their duties in relation to the ventilation of
the Westray Mine and that this neglect contributed to the explosion.
(c) Concerns of the Miners
The third area in which the exercise of
regulatory authority by the Department of Labour broke down involved the safety
concerns of the miners themselves. The claim, made by Albert McLean and others,
that the miners never told them what was going on, is not supported by the
evidence. The evidence shows Mr. McLean and his colleagues were fully informed
about the concerns of the miners through direct and indirect contact. The
evidence shows further that Mr. McLean and Claude White deliberately
misrepresented the concerns of miners in two significant instances.
One of the most troubling stories to emerge from the evidence is the story of
Carl Guptill. This miner, an experienced health and safety representative at
another mine, was injured at Westray in December of 1991. He complained to the
Department of Labour about his injury and about a series of other safety hazards
in the mine, including unsafe work practices, excessive dust and methane, poor
ventilation, and unqualified mine officials. Before anything was done, Claude
White went to the mine manager, told him about the complaints and identified Mr.
Guptill as the complainant. The Department's investigation was compromised
before it began.
Then Mr. Guptill was interviewed by inspectors McLean and Smith. For some
reason, they each took separate statements about the injury but recorded nothing
about the other complaints even though they were much more serious. Mr. McLean
closed his investigation after meeting briefly with three of the men on Mr.
Guptill's crew and gathering statements about the accident that had been taken
by the company. He produced three versions of the report on the incident dealing
with the injury but nothing about the other complaints. In the meantime, Westray
terminated Mr. Guptill's employment.
We submit the evidence points strongly to collusion between the
Department of Labour and Westray over the Guptill case. How else are we
to explain the immediate disclosure of the complaints to Gerald Phillips, the
failure to investigate serious safety issues, or the distortion of those
complaints in the reports produced by Albert McLean. And what else would explain
Claude White's decision to change the minutes of a meeting with the company to
make it appear as though a lengthy discussion of the Guptill case had never
taken place. While there may be no direct evidence that the Department and
Westray conspired to silence the Guptill complaints, there is reason for deep
One thing is clear. If the Department's intention had been to discourage any
other miner from coming forward with concerns about safety at Westray, it could
not have handled the Guptill case any better.
About six weeks after Carl Guptill came forward, Albert McLean had another
opportunity to hear directly from Westray miners about safety concerns in the
mine. One evening he met at the mine with three employee safety representatives.
They talked for about an hour about many of the same hazards Carl Guptill had
warned about; excessive gas, dust, diesel equipment that travelled throughout
the mine, the use of torches and welding equipment underground, untrained
miners, and unqualified supervisors.
Instead of taking any action, Albert McLean produced a memo for Claude White
that hid the fears of the miners. The memo contained no reference to the
concerns that had been expressed by the safety representatives. It made it
appear as if they had engaged Mr. McLean in a general discussion of a number of
topics without any mention of actual conditions in the mine. We submit this
Inquiry should find Albert McLean's memo to Claude White was another deliberate
attempt to distort the record of discussions of safety problems at the Westray
The mine inspectors got other warnings about how bad things were at Westray.
Bud Robinson called Albert McLean at home and spent an hour voicing his
concerns. Bob Burchill left a union organizing meeting to tell Mr. McLean the
concerns he was hearing. There is evidence of other, brief encounters between
the mine inspectors and miners underground or on the surface.
If they really wanted to know about safety concerns of the miners, the
inspectors needed to look no further than the reports of the safety walks which
took place in the mine. The record contains reports on five such safety walks
between October 7, 1991 and April 6, 1992. The reports covered the full range of
known safety deficiencies in the mine:
(1) The men reported excessive coal dust and inadequate rock dusting.
Many of the deficiencies they recorded were direct violations of the
Coal Mines Regulation Act. These reports were circulated to the mine inspectors
and Albert McLean, John Smith and Claude White testified they reviewed some of
them. However, the evidence is that no action was taken by anyone in the mine
safety division as a result of information acquired from the safety walk
(2) They noted problems with gas detection equipment and the use of non-flameproof diesel vehicles.
(3) They recorded men working in headings that had not been checked for gas.
(4) They reported that diesel fuel and oil were being stored underground.
(5) They noted the mine was working without a barometer or water gauge.
Having reviewed the evidence, the question that emerges is not, why didn't
the miners tell anyone about the conditions in which they were working. The
question is, why didn't the inspectors in the Department of Labour respond to
the wealth of information they were receiving about conditions underground at
One reason for the paralysis of the inspectors may lie with the dominant
philosophy in the health and safety division of the Department. It was, and
apparently still is, a philosophy of non-engagement that in this case encouraged
blind deference to the decisions of the mine operator. The concept of shared
responsibility became a means by which the regulators evaded responsibility.
They deferred to internal safety organizations without first determining that
those organizations were in place and functioning properly. The result was a
void that left Westray employees unprotected.
We submit this Inquiry should find the public officials responsible
for inspecting the Westray Mine were made aware of significant safety concerns
on the part of employees in the mine and were derelict in not responding to
those concerns in an appropriate manner.
(d) Recognition of Failure
As with the Department of Natural Resources,
the proposal by Westray to resume mining in 1993 caused the Department of Labour
to acknowledge its failures in regulating the operation of the mine before the
explosion. In March of 1993, Claude White sent the operators a list of questions
he wanted answered before he would approve the re-opening of the mine. He
requested information on a series of basic safety issues:
(1) Was there a mine evacuation plan?
These were all questions that should have been asked and answered
before May 9th.
(2) How were employees to be trained?
3) What qualifications would mine officials hold?
(4) What roof support methods would be employed?
(5) How would the mine be ventilated?
(6) How would the performance of the ventilation be monitored?
(7) What was the plan and schedule for stone dusting?
(8) How would the health and safety committee operate?
Submissions of the Province
In oral submissions at the conclusion of the public hearings of the Inquiry, counsel for the Department of Justice of Nova Scotia attempted to explain away the failures of the regulatory system by attributing most of them to inherent conflicts between the Coal Mines Regulation Act and the internal responsibility system embodied in the Occupational Health and Safety Act. The United Steelworkers of America submits there is no conflict between a system which recognizes the need to promote safety starts in the workplace and one which requires inspectors to monitor decisions made by mine operators and enforce regulations. We reject the suggestion that such an inherent conflict exists.
The United Steelworkers of America has been closely involved in the development of the internal responsibility system. We were a participant in the 1971 Royal Commission in which James Ham first recommended internal responsibility as a framework for the regulation of occupational health and safety. Internal responsibility has always required a vigorous public regulator to enforce minimum standards and ensure the mechanisms of the system are working. The role of the regulator is essential.
Internal responsibility did not prevent Albert McLean from inviting an employee representative on a mine inspection. It didn't prevent him from reviewing statutory reports, from following up on orders and approvals, from responding to the complaints of miners or from enforcing the law. Nor did the Department of Resources fail to respond to Westray's deviations from the approved mine plans for the Southwest section because of some underlying conflict between two approaches to regulations.
Moreover, we reject the claim that a system which provides for prior approvals by regulators and gives inspectors the duty to monitor and enforce those approvals is inconsistent with the recognition that both parties in the workplace should promote safety. Other jurisdictions, such as British Columbia, have successfully applied internal responsibility in a regime which also contains a detailed code of mining practices and which provides for significant powers of enforcement for inspectors.
The two principles, internal responsibility and strong, effective regulation, only come in conflict if the real purpose of internal responsibility is to promote the deregulation of health and safety. Otherwise, there is no reason why internal health and safety committees cannot function successfully in a climate where inspectors play an active role in monitoring compliance with approvals and regulations.
In his presentation, counsel for the Department of Justice made the surprising assertion that the regulatory system failed to protect the health and safety of Westray employees because inspectors intervened too much and assumed too great a role in operational issues. This claim rests upon the false conflict between responsibility and regulation. It also distorts the evidence given before the Inquiry.
The regulators failed because they did not enforce laws that were directed to the very safety hazards that caused the explosion. The evidence shows inspectors assumed little if any role in operational matters. They consistently deferred to the employer. They never questioned its handling of ventilation and even after they issued orders about coal dust, they presumed the orders would be followed without taking any steps to monitor compliance.
The system didn't fail because Westray was required to obtain permits and approvals from the inspectorate. It failed because monitoring of approval was haphazard and incompetent.
The "straw man" created by counsel for the Department of Justice serves only one purpose, to support an argument for the deregulation of occupational health and safety.
Twenty-six of the employees of Westray Coal died in the explosion and many more of the employees have suffered as a result of the disaster. Evidence at the Inquiry shows the surviving miners are still affected by the fears they felt in the mine. Some suffer the guilt that comes from knowing fate selected them to live and their colleagues to die. Others are tortured by nagging doubts about whether they might have been able to do something to prevent the disaster. A significant number of the surviving miners have received and continue to receive psychiatric counselling as a result of their experiences at Westray.
On one point there should be no doubt. The employees of Westray Coal wanted the mine to succeed and they did their best to see that that happened. For many, this was the first chance that they had to work at a good paying job close to home. The promise was 15 years of employment with a young, forward looking company.
The reality of Westray, they soon learned, was quite different. Their bosses were more concerned with production than safety and were not competent to run a modern, underground coal mine. The miners worked in an atmosphere of intimidation, were subjected to abuse from the underground manager, and were threatened with their jobs if they complained about working conditions.
When the miners testified here about conditions underground there were suggestions that they were exaggerating, that it could not have been that bad, that the Inquiry was getting a distorted picture of life in the mine. After seventy-six days of evidence, we submit the testimony of the miners has not been contradicted on any significant point. In fact, their description of working conditions in the mine has been corroborated by their supervisors, by second level supervisors, by the engineering staff, and by senior executives of Curragh.
It has been suggested that if things were as bad as the miners said they were, there should have been more complaints inside and outside the company. We have already dealt with the series of complaints that were made by the miners to the Department of Labour. The evidence is there were numerous complaints inside the company as well. The men took their concerns to their supervisors and their overmen. They complained to the engineers and to Curragh executives such as Graham Clow. Some went to Roger Parry and Gerald Phillips. Given the circumstances, it is not clear what more they could have done to draw attention to their concerns.
Because there has been no challenge to the evidence the miners gave about their working conditions, there is no need to review it in any detail. However, there are a number of specific issues that arise from the testimony of the miners that should be reviewed.
Training of Miners
One of the most obvious features of the work force as a whole is that it was largely inexperienced and untrained. Only a small minority of the miners had any experience in underground coal mining. Of those, fewer still had worked in a mine like Westray. Most of the miners were from a hard rock background or were new to mining altogether. That is why the training they were to receive would be so important.
We submit there is ample evidence before the Inquiry to support the conclusion that the underground employees of Westray were not adequately trained by the company to do the work required of them. Some received a brief introduction, via video tape, to coal mining. Others were sent underground without knowing how to operate basic pieces of safety equipment such as a self-rescuer.
Westray had a training program on paper. But, like so many things at that mine, it did not correspond to reality.
The cavalier attitude Westray management had toward training was illustrated in the evidence of Matthew Sears, the young man who had his leg caught in the conveyor belt and was almost dragged into the main drive. He had never been in a mine before Westray. His first day on the job he was led to the portal by Roger Parry and directed inside and down the slope. The next thing he knew, the door closed behind him. At this point, all he could think about was how dark the place was. He had never been shown how to turn on the light on his helmet.
There is no evidence that untrained miners created additional dangers beyond those already present in the mine or contributed to the circumstances which caused the explosion. However, training of employees is a basic health and safety issue, especially in an environment such as an underground coal mine. Sending an employee underground without providing him with training is the same as sending him down without a helmet or a self-rescuer. The fact that this happened repeatedly stands as a condemnation of the company and the authorities that were supposed to monitor its operation.
We submit that as part of its recommendations, the Inquiry should propose a minimum training period for all miners to be completed before they go to work underground, followed by a graduated certification process. The provision of this training should be legally enforceable.
Another issue that arose during the Inquiry was the suggestion that underground employees deliberately engaged in unsafe acts that endangered themselves and their fellow workers. Some of those allegations came inside this hearing and others have come from outside, from someone who has refused to do what my clients did, that is voluntarily agree to testify. We submit there is no evidence that the underground employees of Westray Coal carelessly or wantonly engaged in unsafe conduct. Rather, as Jay Dooley testified, the underground employees did their best to work safely in the circumstances in which they found themselves.
It has been alleged that some continuous miner operators developed a practice of overriding the automatic shutoff on their mining machines to continue mining the coal face. There was a lot of testimony on this point and the evidence is clear. There was no such practice in the mine. No one saw it done and no one admitted to doing it. It is not even clear if it was possible to do what was alleged, that is cut coal by simultaneously riding the reset button, operating the cutting heads, and cutting into the coal. We submit that issue has been put to rest.
Another area of testimony concerns the blocking of ventilation tubing. The evidence is that this was done on the instruction of supervisors in order to increase air to the mining machine and maintain production. There is not one instance in the evidence where the miners did this on their own initiative. There are cases where they would ignore the request or take the screen and plastic blocking the tube down after the supervisor had left the area.
The management at Westray had a policy of blocking ventilation tubes to increase air flow to the mining machines and the miners were in no position to prevent that policy from being implemented.
There is evidence that some miners operated non-flameproof diesel equipment beyond the restrictions that had been imposed by the Department of Labour. In assessing that evidence the following should be kept in mind. The employees were never shown the conditions. Some knew parts of them, others apparently did not. The non-flameproof equipment was the only way of delivering necessary supplies to the face. The scoops, which could have done the job, were generally fully occupied with roof control. Also, it appears from the evidence that the diesel conditions were breached by supervisors, overmen, the underground manager and perhaps even the mine inspector.
We submit this Inquiry should find that the employees of Westray did their best to work safely. They had to cope with roof conditions that were horrendous. They had a manager who was, to put it mildly, not supportive. They did not have the internal protections the law calls for and they could not rely on the mine inspectors. The fact that no one was killed or seriously injured before May the 9th is very much a tribute to their safe work practices.
Labour Standards Claim
During testimony by the witness Randy Facette, reference was made to an outstanding claim on behalf of the former Westray employees under the Labour Standards Code of Nova Scotia. The claim is for unpaid wages in the form of severance.
Section 72 of the Labour Standards Code requires an employer to give twelve weeks notice when laying off between 100 and 300 employees unless the employees are laid off for a reason beyond the control of the employer and the employer has exercised due diligence to foresee and avoid the cause of the layoff.
More than 100 employees of Westray Coal were laid off in June of 1992 and they did not receive twelve weeks notice. The Labour Standards Tribunal heard the claim of the Westray employees on September 13, 1995. The hearing had been delayed because of the bankruptcy of Curragh.
On September 26, the Tribunal issued an interim decision in which it decided to hold the claim in abeyance. The Tribunal stated that the question of the due diligence of the operator was covered by the mandate of this Inquiry, particularly paragraphs (b) and (c) of the Order-in-Council, that is whether or not the explosion was preventable and whether any neglect caused or contributed to the occurrence.
We submit this Inquiry should advise the Labour Standards Tribunal as soon as possible of its conclusion to the questions posed in paragraphs (b) and (c) so the Tribunal may determine the complaint of the former Westray employees.
The claim of the Westray employees is against the assets of the bankrupt company, Curragh Inc. These assets are now held by the principal creditors, the governments of Canada and Nova Scotia. There is therefore little likelihood that the labour standards claim will be satisfied when it is decided on its merits.
We submit this Inquiry should recommend that if the complaint of the Westray employees is upheld by the Labour Standards Tribunal, the governments of Canada and Nova Scotia should pay any deficiency in the amount of money obtained from the Curragh assets to satisfy the claim.
There can be no doubt that the direct responsibility for the working conditions in the Westray Mine rested with the management of the mine. In practice, the on-site management of Westray Coal was two people. One was stretched beyond his limits and the other was unfit to perform the job he held.
The mine manager and the underground manager controlled most of what happened in the mine. They established priorities, they hired the staff, they planned the mine and they directed the operations. The public face of Westray was Gerald Phillips. He dealt with head-office, the media, the politicians, and regulators. Underground, the face of Westray was Roger Parry. Together, they were responsible for creating the working conditions that were described so graphically by the miners in their testimony.
Gerald Phillips and Roger Parry were supremely confident in their abilities to manage a modern coal mine. They did not need an experienced engineering department and it didn't matter that their chief engineer had never worked in a coal mine before, that their geologist had never been in a coal mine, or that their other engineers were right out of school. The most experienced coal man in the office, the surveyor, Ray Savidge, left in disgust. His replacement didn't have enough experience to be certified under the Coal Mines Regulation Act.
When they needed help with roof problems, they hired a potash geologist who had never worked in coal. As a training officer they hired someone who had never worked as a trainer, or in mining, but who knew politicians and who had been on television as a wrestling announcer.
It was as if Gerald Phillips believed he could will the mine to success by the sheer force of his personality. Of course, he couldn't do it. He was adept at producing slogans and policies but he could not turn them into reality. Of the three main hazards in coal mining, the roof, gas, and dust, he did not control any of them.
Decision-making power was limited to a few members of senior management. Supervisors spoke of the "four horsemen" who actually ran the mine, Gerald Phillips, Roger Parry, Glyn Jones, and Bob Parry. They were the only people in the mine with the authority to make operational decisions. According to testimony, other supervisory employees were subjected to the same kind of intimidation as the miners.
While Gerald Phillips attended to corporate business, Roger Parry maintained a close watch on every aspect of the underground operation. Jay Dooley testified that Roger Parry was present for almost every shift change, both morning and night. He would give instructions directly to the mining crews rather than to the supervisors.
Even though the engineering and technical staff was inadequate for the demands of running a mine such as Westray, senior management did not use those resources that were available to them. Kevin Atherton testified he was not asked to provide engineering input into operational issues and was not instructed to do any mine planning as the development proceeded. Trevor Eagles was not consulted about ventilation in the mine. Arden Thompson, the geologist, was not consulted about changes to the mine design. When he did offer advice to Gerald Phillips about the characteristics of the coal seam, it was rejected.
We submit this Inquiry should find that the senior management of Westray Coal failed to hire adequate engineering and technical support and failed to properly utilize the resources that were available to them.
Pressure for Production
The mine was under production pressures from the beginning. It started behind schedule and never caught up. Although work was suspended for eight months because of financing delays, no attempt was made to reschedule the production committments in the contract with Nova Scotia Power. This put the operation under severe pressure, and it failed to meet any of its production committments. Adding to the pressure were roof conditions which were apparently much worse than anticipated. The frequent roof falls endangered employees, slowed development, and filled the conveyors with waste rock.
Planning was ad hoc, day to day. They never took the time to develop a full mine plan beyond the general intentions described in the feasibility study. The witness Harry Rogers, who had a long and distinguished career in industry and in government, was incredulous that this was allowed to happen.
The pressure of production committments led to the decision to change the mine plan in the feasibility study and make an early entry into the Southwest section. The decision to enter the Southwest section appears to have been made hastily without full appreciation of the conditions that would be encountered there. The inability to control the roof in the Southwest section led to the adoption and abandonment of a series of mine plans and ultimately an attempt to implement an unusual, if not radical pillar design in the district. The decision to persist in the Southwest section after the narrow pillars had failed led to the development of the Southwest 2 area. Each of these decisions appears to have been made in haste, under pressure for production.
The same factors, haste and a priority for production, were behind other decisions in the mine:
(1) The direction to refuel diesel equipment underground instead of on surface;
These were all operational decisions made by Westray management that reflected the assignment of a higher priority to production than to safety.
(2) The routine use of welding equipment and cutting torches underground;
(3) The absence of preventative maintenance;
(4) The blocking of ventilation tubes;
(5) The dangerous efforts to remove equipment from the Southwest 1 panel when it had failed;
(6) The refusal to assign production personnel to stone dusting;
(7) The decision not to take steps to remove or contain the gas in the Southwest 1 section.
One operational decision that was not implemented shows the lack of consideration senior management had for the safety of its employees. In order to deal with the problem of transporting workers from the underground, Gerald Phillips devised a plan to have men ride the conveyor belts out of the mine. The belts would run at their normal speed, men would roll on and roll off, and would have to lie flat to avoid hitting various obstacles hanging from the roof. This "system" would have threatened the safety of any miner who tried it. The idea was vetoed by Colin Benner as soon as he became aware of it.
We submit this Inquiry should find the management of Westray Coal was preoccupied with meeting production committments and gave little consideration to the safety of the people who worked in the mine.
Dust and Methane
The extent of the coal dust problem should have been no surprise to the operators. The coal floor and the vehicles selected for use in the mine were bound to add appreciably to dust levels in the mine.
Yet the evidence shows that Westray management did not take stone dusting and the removal of coal dust seriously. The stone dusting that was done was largely cosmetic and served to hide the coal dust rather than deal with the problem. Don Dooley was under direct orders from Roger Parry not to take men from production in order to stone dust. Fraser Agnew believed that he would have been fired if he had assigned production crews to stone dusting.
Even when the Department of Labour issued its order on April 29th, Roger Parry was still determined not to sacrifice production for dust control. Instead of directing miners to stone dust he had a mechanic work on the sprinkler system, something which was of questionable effectiveness but which did not take men away from production.
Mine management didn't take methane seriously either. They never produced a ventilation plan for the mine and never asked for help from the engineering department to solve ventilation problems. Elements of the ventilation system were added haphazardly without considering how the pieces fit together as a whole. Particular problems such as leaking stoppings or cavities which trapped pools of methane in the roof, were simply not addressed. No consideration was given to methane layering or to the impact changes in barometric pressure had on the movement of gas in the mine.
The gas in the Southwest 1 section was largely ignored. Initially, nothing was done about the abandoned area. It was a week before even a rope was put up. In the meantime, methane gas was building to high concentrations. After two weeks, plywood barriers were erected. They were completely inadequate to control gas. They were not sealed to the ribs or roof and in a few days they had buckled, leaking gas into the intake air for the Southwest 2 area. These facts were known at the time. Underground officials were taking readings at the barriers. Trevor Eagles was taking regular ventilation surveys and sending them to Roger Parry.
Jay Dooley became so alarmed about the situation that on May 5th he went over Roger Parry's head to Gerald Phillips. He got a promise that the problem would be dealt with. However, before anything was done, Phillips and Parry had gone to the United States to study roof control. It seems clear from the evidence that Westray management was preoccupied with ground control problems in the mine and neglected the threat of methane and coal dust.
We submit this Inquiry should find that in failing to deal with coal dust and in failing to control the methane in the Southwest 1 district, Westray management ignored obvious hazards to the safety of people in the mine. These hazards were direct factors in the explosion on May 9th. The decisions of Westray management were conditioned by a belief that they would not be interfered with by regulatory authorities.
We submit this Inquiry should find that the management of the Westray Mine displayed neglect in their operation of the mine and that this neglect was directly related to the cause of the explosion.
Management by Intimidation
There was a sinister side to the management of the mine beyond the incompetence and the neglect. Experienced coal miners were lured to the mine by a false promise of a solid sandstone roof. When they learned of the reality, it was too late for most of them to leave. Inexperienced men who sometimes didn't know better were assigned to the dangerous job of bolting the roof and if they didn't meet performance targets they were subjected to abuse by the underground manager. If they questioned what was going on they were reminded of all the people looking for jobs in the mine. Anyone who complained was threatened with dismissal. Direct threats were made against anyone who went outside the company and complained to the Department of Labour about working conditions.
Evidence shows front line supervisors were also subjected to abuse. They were under continual pressure to increase production from their crews, regardless of the conditions in which they were working. They were extremely vulnerable to such pressure because they were isolated from the employees and from upper management. They had no operational authority and any supervisor who acted on his own put his job at risk.
It would be wrong to suggest that Westray or Curragh were rogue companies that can be set aside as anomalies. They were part of the Canadian mining industry. Their executives were leading figures in thatindustry. In a sense, the industry as a whole must bear some responsibility for what happened. We regret the fact that both the Coal Association of Canada and the Canadian Institute of Mining, Metallurgy and Petroleum refused the invitation of the Commissioner to participate in these hearings.
The Institute was the body which awarded Westray the John T. Ryan Trophy for mine safety a few weeks before the mine blew up. On the basis of the evidence heard at the Inquiry, including evidence of falsification of accident reports by Westray, we submit the Institute should withdraw that award.
It is also wrong to suggest that Gerald Phillips and Roger Parry were off on their own in Nova Scotia making decisions without the knowledge and support of the parent company, Curragh Resources. The evidence is that Clifford Frame and Marvin Pelley were very much involved in the critical decisions about the Westray Mine. This close involvement arose because of the nature of the positions they held and because of the way they conducted business.
Clifford Frame effectively owned the company. As Chairman of Curragh Resources, he had ultimate control over corporate decisions. He established the priorities of the company, hired the senior executives and determined their responsibilities. He had a direct relationship with Gerald Phillips and his involvement with the mine extended to the approval of a detailed mine design for the Southwest section.
Marvin Pelley was President of the Westray Coal Division of Curragh for all but the last month of the life of the mine. Gerald Phillips reported to him. He was responsible, as chief executive officer, for all aspects of the mine planning and operation. He dealt with the company's banks, with politicians and with senior bureaucrats.
Each of these men had important responsibilities in relation to the mine and both should be accountable for what happened at Westray. The fact that they have refused to voluntarily give evidence at the Inquiry is a sad reflection on their sense of duty and on the Canadian mining industry of which they are prominent members. The United Steelworkers of America strongly supports the efforts of the Inquiry to compel their attendance at a hearing.
THE IGNITION AND EXPLOSION
The conditions that caused the
explosion were not created by the men who were underground on the morning of May 9. They were not responsible for the excessive coal dust or gas. The evidence suggests that the ignition was caused by sparks created by one of two pieces of equipment working in the Southwest section, a continuous miner or a roof bolter. It is clear from the testimony of the miners that sparks were caused during the normal operation of both machines. Ordinarily, they amounted to nothing.
However, the methane gas and coal dust were present in dangerous levels that morning. Gas from the abandoned Southwest 1 district was being drawn along theroof towards the working faces of the Southwest 2 area, following the upward incline of the tunnels. Because of inadequate auxiliary ventilation, gas produced at the face was not being mixed and was also layering at the roof. Coal dust had built up in many areas of the mine, especially the belt-lines and travel roads. It was well above the legal limits of explosibility.
These were the conditions in which the 26 miners were working.
The evidence is that some time close to 5:18 in the morning one of two chines working at the face, the continuous miner on Southwest 2 road or the bolter in the adjoining left-hand heading, threw a spark into this lethal mixture. The spark ignited methane which was pooling in explosive levels in the ceiling.
While it will never be known for certain which of the two machines caused the spark, it appears the most likely source of ignition was the bolter working in the left-hand heading next to Southwest 2 road. The continuous miner was on but it was pulled back two or three feet from the face. Most of the coal on its conveyor had run through, suggesting the operator was not cutting coal at the time he decided to leave the machine.
The bolter appeared to be in operation, in the process of fixing a section of screen to the roof. This would involve a process which, from other testimony, is known to have produced sparks at roof level when metal in the drill pressed against the screen.
The behaviour of the miners in the two crews is also significant. The three men working at the continuous miner took the time to open and put on their self-rescuers before heading out of the section. Two apparently took their gloves off and placed them by the shuttle car. The men who were near the bolter were not so deliberate. None had opened his self-rescuer before he collapsed. This suggests the mining crew may have had a warning something was wrong while the others were reacting to flames erupting over their heads.
The creation of sparks by one or other of the crews in no way suggests the miners were not working safely. The evidence is that sparking was a normal and unaviodable occurrence in both the mining and bolting operations. The explosion was caused by the excessive dust and gas, not by a spark from a single machine.
There has been no evidence that challenges the expert testimony from Reg Brookes and Malcolm MacPherson about the propagation of the explosion once the methane fire was ignited. The fire travelled along the roof until there was a methane explosion which triggered a coal dust explosion. The eleven men in the Southwest section were poisoned by carbon monoxide from the methane fire.
The expert evidence of Dr. McPherson and Westray's own ventilation surveys show that the ventilation at the face of these headings could not prevent the layering of gas produced there. It is also likely that the gas leaking from the Southwest 1 section was also layering and was being drawn to the headings. This process would have been increased by the steady drop in barometric pressure in the seventy-two hours preceding the explosion.
We submit this Inquiry should find that conditions were right for the layering of methane gas in the roadways leading to the working headings of the Southwest section in the hours preceding the explosion.
The coal dust explosion began somewhere in the main entries to the Southwest section. As it left the section it gathered speed and force. Fueled by more dust in the main tunnels, it travelled simultaneously toward the Number One portal and into the North Mains. It destroyed the remainder of the mine and killed the 15 men working there.
We submit this Inquiry should find the coal dust exploded because it had been allowed to accumulate to excessive levels and had not been treated with stone dust to reduce its combustibility.
We submit this Inquiry should find both factors, the gas and the dust, were the result of neglect on the part of the operator of the mine.
The United Steelworkers of America submits the Westray disaster has proven the need to replace the existing Coal Mines Regulation Act. It has also shown weaknesses in the current Occupational Health and Safety Act which was revised in 1996. This Inquiry should make detailed proposals to correct the deficiencies in the Statutes. It also should review the fundamental principles upon which health and safety legislation is based.
Deregulation and Internal Responsibility
The phrase "internal responsibility" was heard often in testimony and in submissions to the Inquiry. At times, the phrase was used to describe a common sense proposition that the primary focus of the concern for safety must be in the workplace and the employees and employers who occupy the workplace. At other times, the concept was used as a justification for regulators evading the responsibility to enforce safety laws. On still other occasions, "internal responsibility" was used as amask for deregulation and as a way of facilitating deregulation.
The United Steelworkers of America submits the experience of Westray has exposed fundamental distortions in the internal responsibility system which must be identified and addressed in recommendations for statutory reform. It is not true that the Westray disaster happened because the internal responsibility system was not properly implemented. What is true is that internal responsibility failed to protect the safety of Westray employees because regulatory authorities failed to enforce the law.
What is now called internal responsibility began as an attempt to recognize the rights of workers to refuse to do unsafe work and to participate in decisions which affected workplace safety. The idea did not involve any basic change in control of the workplace. The owner, the employer, retained its authority to direct the operation. Although there was a limited amount of responsibility given to employees for safety matters, the overall responsibility for decision-making, including decisions about safety, rested with the operator. This necessitated a continuing role for the public regulator as an important contributor to health and safety in the workplace.
At the time the idea of internal responsibility was taking hold in health and safety statutes, governments were, for ideological and budgetary reasons, looking for ways to reduce bureaucratic activity and shrink the size of the public service. To accomplish these objectives, the role of the regulator was significantly diminished and employers and employees were separated from the regulatory framework in which they were to perform their roles. This distorted conception of internal responsibility became the path to deregulation of health and safety.
In order to justify the deregulation of health and safety, two myths have been promoted:
(1) The myth that employers and employees have equal power over decisions that affect safety; and
Westray has exposed both of these myths for what they are.
(2) The myth that operators will act in their corporate self-interest.
a) The Myth of Equality
Westray has shown there is no equality between employers and employees over safety issues, especially in an unorganized environment. Many decisions that had a profound impact on safety underground, such as the mine design, the choice of mining method, and the choice of mining equipment were made before the workforce was even assembled. Even if there had been a properly functioning health and safety committee at Westray, it could have done nothing to affect these basic decisions. The most it could have done would have been to react, incrementally, to safety problems over which it had no control.
Because the employees had no decision making authority in the mine, their safety representatives had no power to affect working conditions. They could note deficiencies and they did. But they were powerless to correct those deficiencies or to remedy their root causes. The attitude of their employer and the refusal of the inspectors to intervene gave them few options.
Westray showed that in extreme cases, the "right to refuse" is, in reality, the "right to be unemployed". An individual faced with performing an unsafe task could refuse to do it, but he would know the job would go to someone else and he would be asked to do the same thing next day. The only way to truly refuse to do unsafe work at Westray was to leave the mine.
b) The Myth of Self Interest
A further justification for the withdrawal of government regulators from occupational safety is the presumption the operator of a business will act with prudence to protect its investment without regulatory constraints and will protect the health and safety of its employees in the process. Westray shows this presumption should never be made. The
operators of Westray Coal did not act prudently in their corporate
self-interest. They did not protect their investment. They allowed it to be
destroyed by poor planning and short-term priorities. Because they were
preoccupied with reaching commercial production targets, they took the risk that
gas and dust problems in the mine could wait until production problems had been
overcome. They lost that gamble, the mine was destroyed and 26 people were
killed as a result.
The only way to effectively protect the safety of
employees in the internal responsibility system is to maintain professional
regulatory authorities supported by strong, enforceable statutory mandates. Only
a public authority backed by the law can act as an effective check on an
operator's power to direct the workplace. Only a trained and competent regulator
enforcing a public statute can step in when an operator makes decisions that are
not in its interest or the interest of its employees.
"Generic inspectors" of the kind talked about in evidence and submissions,
could not effectively perform their role in the internal responsibility system.
Inspectors of complex industrial enterprises such as a coal mine, must have the
substantive knowledge to understand the technology and production methods being
used. Otherwise, they have no means to assess the implications of safety
decisions taken by the operator, nor can they properly assess complaints that
may come from employees.
Generic inspectors would not have the ability to exercise a general
discretionary power to see that a mine is run safely or to monitor compliance
with a detailed code of practice.
We submit this Inquiry should find that generic inspectors are not
appropriate for the regulation of mine safety. This Inquiry should call on the
Province of Nova Scotia to retain a trained, professional inspectorate to
enforce safety laws in the mining sector.
In truth, there is no inconsistency between a strong, well-developed
regulatory system and the recognition that safety must begin with those who are
present in the workplace all the time. There is no harm in relating that fact to
"internal responsibility" as long as the limitations of the concept are
understood and provided for in the regulatory system.
Internal responsibility was never intended to support the abdication of
responsibility by regulatory authorities or the general deregulation of health
and safety in the workplace. For that reason, we submit this Inquiry
should call on the Government of Nova Scotia to repeal Subsection (d) of Section
2 of the 1996 Occupational Health and Safety Act, and replace it with language
that better describes the important role regulatory authorities should play in
maintaining safe work environments.
Our regulatory regime for occupational health and safety must take account of
the strong public interest in ensuring safety in the workplace. It is a
community priority that citizens be able to work in an environment that is safe.
It is not simply a private matter between employers and employees. A regulatory
authority, exercising powers conferred by statute in a public fashion, is the
only means of protecting that public interest.
Principles for Change
The United Steelworkers of America has a deep
interest in the recommendations for regulatory reform which will form part of
the report of this Inquiry. We are attaching a Joint Submission on
Recommendations as well as a list of detailed proposals for regulatory changes
to safety in mining regulations as Appendices to this submission. However, we
submit the following principles should be embodied in the recommendations of the
1. The health and safety of people at work must be given the highest priority in all legislation.
2. The regulatory system for health and safety must retain a central role for public officials who are empowered to enforce public statutes.
3. The regulatory system must be transparent and regulators must perform their duties in full view of the public.
4. Regulators must be trained professionals conversant with their statutory mandates and the substance of the operations they regulate.
5. Operators must follow a detailed code of practice enforceable by public authority.
6. Both regulators and operators must be held accountable for their actions.
INQUIRY IN PUBLIC
This Inquiry has taught many lessons
about safety in a coal mine, about the regulation of safety in the workplace and
about the need for regulatory reform. The Inquiry has also demonstrated the
importance of having a full, public airing of all relevant issues when a
disaster such as the Westray explosion occurs. Sadly, the United Steelworkers of
America has appeared as a party at scores of inquests, inquiries, and royal
commissions dealing with injuries and deaths in mining and other hazardous
The Union's experience at the Westray Inquiry has confirmed a basic lesson
learned in those earlier proceedings. The public nature of the Inquiry process
is as important as the specific answers that may be given as a result of the
hearings. A public inquiry is a response to a public need. It demonstrates the
community's interest in health and safety in the workplace.
The Westray Inquiry has shown again that the hard questions which arise after
an event like the Westray explosion must be asked and answered in public. Quite
apart from the final report of the Inquiry, the public nature of these
proceedings will prove to have been of lasting value to the community.
The Lesson of Westray
The Westray Families Group, the Nova Scotia
Federation of Labour, the United Steelworkers of America, and the Canadian Union
of Public Employees and the United Mineworkers are pleased to present the
following joint recommendations to Mr. Justice Richard, Commissioner of the
We bring a wide range of history and experience to the issues of this
Inquiry. We represent workers in all walks of life, including most of the coal
and hard rock miners in Canada and those who work in the smelting industry. We
represent many in the public service who perform similar functions to both the
coal miners and the inspectorate, and we represent the families of those who did
not survive Westray.
This is not the first commission of inquiry on occupational health and safety
in which many of us have taken part.
We will not repeat the arguments which are already set out in our written
submissions. We would ask you to separately consider those submissions and
recommendations, and to then consider these as being recommendations upon which
we all agree and jointly urge upon you.
It is our joint and considered opinion that the circumstances surrounding the
Westray explosion expose a number of very serious limitations in the present
statutes which should be speedily addressed.
1. The current Occupational Health and Safety Act should be amended
to add a purpose or objective clause that clearly states that the goal of the
legislation is to prevent injury and illness due to work.
The most profound lesson of Westray is that tragic consequences flow when
government and its administrative arm put the economic success of a specific
company or industry above the health and safety of the people who work for it.
In order to assure the necessary independence for those whose duty it is to
protect the lives and health of the people of Nova Scotia while at work, the Act
should provide them with clear direction.
We recommend that you consider section 2 of the Manitoba Health and Safety at
Work legislation as an example of a clause setting the purpose of the Act. Such
a clause could read as follows:
The objects and purposes of this Act are:
(a) to prevent illness and injury due to work;
(b) to secure employees and self-employed
persons from risks to their safety, health
and welfare arising out of, or in connection
with, activities in 'their' places of work; and
(c) to protect other persons from risks to their
safety and health arising out of, or in
connection with, activities in places of work.
2. In recognition of the importance of safety and health at work
to the people of Nova Scotia you should recommend that the House of Assembly
create a Standing Committee to address matters of occupational health and
safety. Through this committee, the Department, the Occupational Health and
Safety Advisory Council, and others could publicly report on their activities
and answer questions posed by members.
Public accountability of those charged by legislation to uphold the law and
protect our health and safety at work is essential to regain the public
confidence lost by exposure of what happened at Westray. In addition to the
compelling evidence heard at this Inquiry, the Commissioner can take notice of
what has happened in the press as some evidence of public response and attitude.
To further the process of regaining confidence, the Minister's Occupational
Health and Safety Advisory Council should be strengthened. It can and should
play a valuable role in commenting on the effectiveness of the Department in
carrying out its duties under the Act as well as make recommendations for
legislative amendments. To do so effectively, the Advisory Council should report
to a Committee of the House, and not just to the Minister.
In this way, the ultimate accountability of those elected will be reinforced.
3. Section 2 of the current Occupational Health and Safety Act should
be amended to specify:
(I) That the Government has a shared responsibility with the other
parties described in section 2(a) for protection of health and safety at work.
Westray has made clear the need for enforcement to ensure compliance. Any
failure of the "internal responsibility" was contributed to by the failure of
the Department to act with its existing regulatory authority.
(II) That the primary responsibility for prevention rests with the
The employer has the authority to manage and to determine how work will be
done. As is standard in legislation across Canada, this should be recognized
by stating that the employer has a primary responsibility that cannot be
shifted. Section 23 should also be clarified to insure responsibility of this.
(III) That the rights of employees set out in section 2(c) should be
stated so as to be consistent with the language of the other subsections and
to emphasize the role which employees have to participate effectively in the
internal responsibility system.
(IV) That the department's responsibility should be clearly stated
to include the enforcement of regulations designed to set minimum standards
and to protect employee's rights in effective decision making in the workplace
to prevent injury and illness.
4. Inspectors should receive training to enable them to
effectively enforce the legislation, including training in basic techniques in
investigation, inspections, measurement (including hygiene), and enforcement.
The curriculum of this training would be designed through a tripartite
process including management, labour, and appropriate representation from
The government should investigate establishing a program for training
comparable to what currently exists in forestry (at the University of New
Brunswick), for police officers, and for game and fisheries officers, for
We need not review all of the evidence before the Inquiry regarding the
performance of the inspectorate. The people of Nova Scotia are entitled to
receive better qualified protection, especially since it can, as it could have
at Westray, make the difference between life and death. Not only do inspectors
need to be trained in the regulations they enforce, they must also be trained to
write orders under the general duty clause to fill gaps that might exist in the
It must be recognized that there are many workplaces in which special
knowledge and training is required because of the nature of the work or of the
equipment being used. Coal mining is clearly one which requires special
knowledge and training. Provision for insuring sufficient expertise in these
areas is required.
The notion of a generic inspector should be decisively rejected since it both
undervalues the level of training which all inspectors need and ignores the
degree of specialization needed for certain tasks and workplaces.
5. The inspector's duties should include the obligation to respond in
person to investigate a written complaint by an employee or their
representatives regarding their health and safety. A report would have to be
made to the employer, the employee, the employees representatives (if any), and
the Department. A copy would be filed with the Advisory Council for review. The
decision of the Inspector could be appealed through newly established appeal
This recommendation is explicitly borrowed from the MSHA legislation in the
United States. In our view, it provides the only effective means of insuring
that the concerns of employees get appropriate attention when they are unable to
resolve a health and safety concern at work. It also makes the Occupational
Health and Safety Division more accountable for their actions. As in MSHA, the
complainant would remain anonymous in order to protect him or her from
6. Occupational health and safety concerns should be explicitly
addressed (along with environmental concerns) in the permit and other approval
Much has been made about the inability of two Ministries – Natural Resources
and Labour – to effectively address health and safety concerns in the permit
and development process.
In our view, it should be made clear that health and safety concerns are to
be considered in the initial permitting process for a mine and in any further
permits that are issued. Perhaps Ministry of Labour health and safety
representatives should be required to sign-off in the permitting process before
the permit is okayed.
How the departments integrate to address those concerns is ultimately
administrative, but this Inquiry should be clear that the purpose of such
integration must be to insure the effective protection of health and safety, and
not just to speed up the process of permitting and approvals as happened at
7. Curriculum should be developed for all levels of education,
including professional schools, to provide that safety and health at work is
routinely taught in order to insure ongoing improvement in the future working
lives of Nova Scotia's school age people. Our health and safety is too important
to not make it a core subject in school.
Health and safety training can no longer be left just to the individual
employer. In addition to whatever worksite specific training is required, there
is a broader responsibility to insure people come to work with a basic
understanding of how to protect themselves. Specific standards should be set for
workplaces today, but, in addition, people still in the learning process should
be introduced to the basics at an early age.
APPENDIX "B"In addition to the joint recommendations
submitted by The Nova Scotia Federation of Labour, the United Steelworkers of
America, The Canadian Union of Public Employees, the United Mineworkers, and the
Westray Families Group, The United Steelworkers of America submits evidence
before the Inquiry shows the need to make the following changes to the Coal
Mines Regulation Act:
1. No non-flameproof diesel equipment should be permitted to operate in an underground coal mine.
2. The methanometers should be installed and operational on all coal-cutting machines.
3. Roof bolting machines should be equipped with a methanometer, or the operator of a roof bolting machine should be provided with a methanometer and trained in its operation.
4. A mine operator should be required to conduct regular sampling of coal dust throughout the mine and maintain a record of sample results.
5. Explosion barriers, certified by a professional engineer, should be erected at the entrances of all production sections and development districts.
6. Inspectors should be required to make a minimum number of inspections of a mine and to enforce a "checklist" of operational practices. Inspectors should also have a general power to order what is necessary to maintain safe working conditions.
7. Inspectors should be accompanied by an employee safety representative on all inspections of a mine and must report to employee members of the joint health and safety committee at the conclusion of every inspection of a mine.
8. Miners should receive training from operators in a program approved and monitored by the inspectorate.
9. The legislation must specify that owners and operators would be liable for any violations of the Act or regulations. Company directors would also be liable unless they could show due diligence to avoid a violation.
10. Variances to a permit, approval, or regulation should only be permitted if the variance furthers the health and safety of employees.
Summary of Submissions
We submit this Inquiry
should find that the Government of Nova Scotia which generously assisted in the
establishment of the mine failed to provide adequate resources to the public
officials who were supposed to inspect the safety of the mine.
We submit this Inquiry should find that the Public officials responsible for
regulating the Westray Mine were affected in the performance of their duties by
political controversies surrounding the mine.
We submit this Inquiry should find that the involvement of public officials
responsible for regulating the Westray Mine in measures intended to promote the
success of the mine created a conflict of interest for those officials which
influenced them in the exercise of their statutory responsibilities.
We submit this Inquiry should find that the officials in the Department of
Resources who reviewed the Westray proposal should have recognized the serious
challenges facing the operator and should have required more detailed and
comprehensive mine plans before approving the project.
We submit this Inquiry should find that Westray was not entitled to receive
the mine permit that was issued to it in August of 1991 and that by granting the
permit the Department of Resources allowed Westray to proceed with development
without having done the engineering and planning required by law.
We submit this Inquiry should find that the failure of the Department to
enforce the Mineral Resources Act in relation to the Southwest section in the
months leading up to the explosion is one of the most serious lapses in the
exercise of regulatory authority that emerges from the evidence.
We submit this Inquiry should find that Don Jones was not truthful when he
testified about his knowledge of the mining being carried out in the Southwest
section of the mine. We submit further this Inquiry should find Mr. Jones was
derelict by failing to act when he learned Westray was mining the Southwest
section contrary to approved plans.
We submit this Inquiry should find that officials in the Department of
Resources displayed neglect in their regulation of the Westray Mine and that
this neglect contributed to the explosion.
We submit this Inquiry should find that the repeated failure of the
Department of Labour to follow through on its request for a program to control
coal dust at Westray was a fundamental lapse in the exercise of its
responsibilities under the Coal Mines Regulation Act.
We submit this Inquiry should find that by not taking any action to monitor
compliance with the orders of April 29th, the responsible officials in the
Department of Labour failed in their statutory duties.
We submit this Inquiry should find that the inspectors in the Department of
Labour neglected their duties concerning the coal dust in the Westray Mine and
that this neglect contributed to the explosion.
We submit this Inquiry should find that Albert McLean recorded significant
levels of methane at the barrier to the Southwest section on April 29th and that
this constituted a serious violation of the Coal Mines Regulation Act. This
Inquiry should find that Mr. McLean and Mr. White were derelict in their duty
under the Act in taking no action after inspecting the barriers on April 29th.
We submit this Inquiry should find that the responsible officials in the
Department of Labour neglected their duties in relation to the ventilation of
the Westray Mine and that this neglect contributed to the explosion.
We submit the evidence points strongly to collusion between the Department of
Labour and Westray over the Guptill case.
We submit this Inquiry should find the public officials responsible for
inspecting the Westray Mine were made aware of significant safety concerns on
the part of employees in the mine and were derelict in not responding to those
concerns in an appropriate manner.
We submit that as part of its recommendations, the Inquiry should propose a
minimum training period for all miners to be completed before they go to work
underground, followed by a graduated certification process. The provision of
this training should be legally enforceable.
We submit this Inquiry should find that the employees of Westray did their
best to work safely.
We submit this Inquiry should advise the Labour Standards Tribunal as soon as
possible of its conclusion to the questions posed in paragraphs (b) and (c) so
the Tribunal may determine the complaint of the former Westray employees.
We submit this Inquiry should recommend that if the complaint of the Westray
employees is upheld by the Labour Standards Tribunal, the governments of Canada
and Nova Scotia should pay any deficiency in the amount of money obtained from
the Curragh assets to satisfy the claim.
We submit this Inquiry should find that the senior management of Westray Coal
failed to hire adequate engineering and technical support and failed to properly
utilize the resources that were available to them.
We submit this Inquiry should find the management of Westray Coal was
preoccupied with meeting production committments and gave little consideration
to the safety of the people who worked in the mine.
We submit this Inquiry should find that in failing to deal with coal dust and
in failing to control the methane in the Southwest 1 district, Westray
management ignored obvious hazards to the safety of people in the mine.
We submit this Inquiry should find that the management of the Westray Mine
displayed neglect in their operation of the mine and that this neglect was
directly related to the cause of the explosion.
We submit this Inquiry should find that conditions were right for the
layering of methane gas in the roadways leading to the working headings of the
Southwest section in the hours preceding the explosion.
We submit this Inquiry should find the coal dust exploded because it had been
allowed to accumulate to excessive levels and had not been treated with stone
dust to reduce its combustibility.
We submit this Inquiry should find both factors, the gas and the dust, were
the result of neglect on the part of the operator of the mine.
We submit this Inquiry should find that generic inspectors are not
appropriate for the regulation of mine safety. This Inquiry should call on the
Province of Nova Scotia to retain a trained, professional inspectorate to
enforce safety laws in the mining sector.
The electronic version of this document is presented
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