Monday, January 21, 2008
Report by all-union panel is said to ignore substance abuse. The Boston Fire Department's internal inquiry into the deaths of two firefighters in West Roxbury last year has been controlled exclusively by members of the powerful firefighters union, leading some outside specialists to question the thoroughness and objectivity of the probe.
Whether the investigation by the seven-member board of inquiry was sufficient has become another flashpoint in a political battle between the union and the administration of Mayor Thomas M. Menino. Details of the official inquiry's draft report, described for the first time by two officials who have read it, shed light on what some city officials have described as holes in the investigation.
The panel did not investigate the potential level of impairment of the firefighters who died in the Aug. 29 restaurant fire, the sources said, and excluded an analysis of autopsy reports showing that one, Paul J. Cahill, was legally drunk, and the other, Warren J. Payne, had traces of cocaine in his system.
The report also gives no indication that the panel examined whether supervisors or colleagues noticed that the firefighters were impaired, or whether they knew of any previous substance abuse by the pair, said the sources, who spoke on condition of anonymity because they didn't have permission to speak publicly.
The issues relating to the firefighters' conditions were "deemed outside of the board of inquiry's level of expertise and in fact may never be ascertained with any degree of certainty," the report says, according to one of the sources, who was reading from the draft.
The panel also did not analyze whether Cahill, Payne, their supervisors, and colleagues - all members of the union - followed proper protocols or were properly trained to face the type of fire they fought at the Tai Ho Mandarin and Cantonese Restaurant, where the seemingly routine grease fire in the ceiling turned deadly.
The report was to have been released last month, but has been delayed by City Hall officials who have criticized it as incomplete.
Specialists who investigate firefighter deaths nationwide say the omissions described by the sources would violate international guidelines for investigating line-of-duty deaths in fires and defeat the main purpose of the inquiry: preventing similar tragedies.
"Was there evidence they were abusing drugs before responding to the fire? When did they come on shift? Was this occurring back at the firehouse? Those things, at a minimum, should have been included," said Hollis Stambaugh, director of the Center for Public Protection at the TriData Division of Systems Planning Corp., whose specializations include firefighter line-of-duty deaths.
The international guidelines, issued by the International Association of Fire Chiefs, are also part of the Boston Fire Department's standard operating procedures. They direct investigators to secure the help of outside experts if needed, and to determine whether firefighters followed proper procedures and were adequately trained. Stambaugh said the omissions raise questions about the objectivity of the investigation.
The panel was convened by Boston Fire Commissioner Roderick Fraser immediately after the fire. It is composed entirely of members of Boston firefighters Local 718, something Stambaugh and others said is unusual when there are multiple firefighter fatalities or complicating factors, such as alleged impairment.
"I'm shocked that a city the size of Boston would permit a post-action investigation, even an internal one, to be conducted entirely by members of the union," Stambaugh said.
Dot Joyce, a spokeswoman for Menino, said the mayor has not seen the report and therefore could not comment. Menino's administration confirmed last week that it had asked the board of inquiry to investigate further because it wanted more information included, but it did not say what it believed was missing.
Fire Department spokesman Steve MacDonald said both the fire commissioner and the board of inquiry members declined to comment, citing the ongoing investigation.
The board of inquiry is composed of three deputy fire chiefs, two district fire chiefs, and two lieutenants. The lieutenants are supposed to represent Local 718 in the investigation. One, Lieutenant Sean F. Kelly, is the brother of the union president. The other, Lieutenant Neal A. Mullane, is the brother of a district vice president of Local 718's parent organization, the International Association of Fire Fighters.
Union officials, through a spokesman, said Friday that union leaders had nothing to do with the investigation.
"In no way did they ever try to influence the outcome or try to put themselves in a position to influence the outcome of the investigation," Local 718 spokesman Austin Shafran said.
The union has fought to keep information about the firefighters' potential impairment out of the public eye, and sought a civil injunction against disclosure in the media of their autopsy information last October. At the time, the union called the disclosure a "heinous and vile public attack."
Last week in a press conference and again on Friday, the union alleged that city lawyers were trying to manipulate the results of the panel's investigation.
"If anyone was trying to exert influence it was the city, who demanded to see the report before it was completed and then offered recommendations before it was completed and released to the public," Shafran said Friday. "The fact that the city made its recommendations in an unsigned, undocumented letter shows their underhanded tactics."
The city's lawyer, William F. Sinnott, said last week that he advised the panel in an informal memorandum to provide "more complete fact-finding, more substantive analysis, and more defensible conclusions" but he did not elaborate, saying the communications were confidential.
The draft report's findings, according to the sources, confirmed the results of a preliminary review by fire officials immediately after the blaze, concluding that cooking grease from a kitchen exhaust system oozed into the ceiling and ignited.
During the fire, Cahill and Payne became disoriented and were "unable to evacuate" the restaurant, the report says.
After stating that impairment affecting fitness for duty was beyond the panel's expertise, the report nonetheless concluded that impairment did not cause the firefighters' deaths.
"The board of inquiry could find no factual indications supporting that alcohol/drug impairment contributed to or caused these two firefighters to become disoriented, or inhibited the ability of them to perform the firefighting duties assigned to them at the fatal fire incident," according to one of the sources, who was reading from the report.
It is not the first time Boston Fire Department line-of-duty death investigations have been conducted solely by members of the union. Nor is it the first time questions have been raised about thoroughness.
After firefighter James A. Ellis apparently fell to his death inside a Roxbury firehouse in December 1996, a board of inquiry composed entirely of union members issued a report saying Ellis fell down a fire pole, but did not say why. The report did not address possible negligence on the part of Ellis or others at the firehouse, even though fire officials who had inspected the scene indicated there was a puddle of water near the pole that could have caused Ellis to slip.
After Lieutenant Stephen F. Minehan died after he was sent into a burning Charlestown warehouse to look for colleagues in 1994, a board of inquiry composed entirely of union members issued a report that did not analyze whether his supervisors made the correct call in sending him into the building. Some national specialists said that the line of acceptable risk may have been crossed when Minehan and his fellow firefighters were sent inside the warehouse, which was empty.
The National Institute for Occupational Safety and Health, a federal agency, often investigates firefighter line-of-duty deaths and is currently probing the deaths of Cahill and Payne. But the federal reviews do not analyze whether firefighters followed proper procedures, and the resulting reports do not include the names of those involved or even the cities where the deaths happened.
In recent years, cities across the nation have been tapping the expertise of outsiders to investigate firefighter deaths.
After nine firefighters died last year in a South Carolina furniture store, Charleston Mayor Joseph P. Riley Jr. convened a team of national experts to conduct an independent investigation. Baltimore Mayor Sheila Dixon also commissioned an outside investigator after a firefighter recruit died last year during a training exercise.
"All over the country, when you have a firefighter death, the fire department has to do an investigation, but . . . there has to be an outside investigation if there's anything that is in any way extraordinary," said Hal Bruno, chairman of the National Fallen Firefighters Foundation, which offers chief-to-chief technical support nationwide following firefighter deaths.
Bruno said outside investigations protect everyone involved from allegations of bias or attempts to cover up mistakes that may have been made.
"It isn't just for the union," he said. "It's for the city."
By Donovan Slack, Globe Staff | January 21, 2008
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