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Davis-Besse admits it put production before safety

08/16/02

John Funk and John Mangels
Plain Dealer reporters

Chicago

- A chastened team of FirstEnergy nuclear division officials yesterday admitted to federal regulators that the Davis-Besse plant in the last three years slid into a routine in which electricity production mattered more than safety.

Teamwork declined, clues to major equipment problems were overlooked, and managers rarely went into the reactor build ing.

The result was an unprecedented corrosion hole in the reactor lid that has crippled the plant and shaken the nuclear industry. In a four-hour presentation, the new Davis-Besse leaders described to Nuclear Regulatory Commission members how the former management failed. And they detailed the steps the reformers are taking to overhaul the plant's culture and rebuild its commitment to safety and excell- ence.

The presentation and report are a required step in gaining the NRC's permission to restart the plant.

"As an organization, we're very humble and, in fact, embarrassed," said FirstEnergy nuclear's chief operating officer, Lew Myers.

When it came to diagnosing the problems that hinted at the corrosion simmering on Davis-Besse's reactor lid, "we often jumped to the first conclusion, that was in many cases production-oriented," Myers said.

While NRC officials overseeing repairs at the plant said the inch-thick management analysis seemed at first glance to hit the right themes, they were not yet ready to judge its adequacy. And they had strong words about the need for change at Davis-Besse.

"I think you might be beyond humble, you might be into humiliation," said Jim Dyer, who heads the NRC's regional office in Chicago. "Maintaining that humble outlook is going to be critical to going forward. This cannot happen again."

The management changes are crucial to the NRC's decision on when to restart the plant, said Jack Grobe, who heads the special panel overseeing FirstEnergy's restoration of Davis-Besse.

"This is the most complicated and difficult area to get your arms around," Grobe said.

FirstEnergy earlier had analyzed and reported to the NRC the technical reasons why the milk jug-size hole formed undetected for six years, corrosion eating its way through the 6-inch-thick lid that covers the reactor core. Only a thin, stainless-steel liner, bulging from the strain, kept the high-pressure coolant from spewing out of the reactor vessel and causing a major accident.

Workers found the hole in March while fixing cracks that had formed in nozzles on the lid. Leaks from those cracks and elsewhere formed the caustic sludge that eroded the lid.

The management troubles at Davis-Besse began after top officials who had helped the plant near Toledo achieve a good operating record in the late 1980s left during the next decade for opportunities at other utilities.

They also occurred while the NRC office responsible for overseeing Davis-Besse was stretched thin, its inspection efforts focused more on serious problems at several other nuclear plants in the Midwest.

From 1997 to 2000, "we provided a minimal amount of inspection" at Davis-Besse, Dyer said, "and as a result of that, the quality [of oversight] degraded."

Plant officials knew of the potential for the boric acid used in the reactor's coolant water to cause damage if it was allowed to build up in powdered or solid form on the hot reactor lid. They also knew of the potential for the hollow nozzles in the lid - which serve as pathways for the reactor's control rods - to crack under high temperature and radiation, and for those cracks eventually to leak coolant.

But plant executives didn't take the appropriate actions to keep the lid clean and to stop other sources of coolant leaks so that inspectors might have easily and quickly spotted the residue from leaking nozzles, the analysis says.

Also, Davis-Besse workers at all levels wrongly assumed that there was little chance of nozzle-cracking at the plant because it was relatively young compared with other reactors.

"Low probability meant low concern," said FirstEnergy's Steve Loehlein, who led the 11-member management review team of outside consultants and the company's engineers from its Davis-Besse, Perry and Beaver Valley nuclear plants.

Davis-Besse workers repeatedly found clues that should have helped them and their bosses figure out that the nozzles were leaking. Machinery inside the reactor building was being coated and fouled by airborne acid from the leaking coolant. There was an unexplained jump in the leakage rate that the plant's instruments were recording.

But plant personnel at all levels didn't put the puzzle's pieces together, the report says.

Top managers weren't directly involved in plant problem-solving, relying on subordinates to notify them of concerns rather than recognizing them firsthand. The managers allowed Davis-Besse to run for long periods with degraded machinery and parts. Workers had the philosophy that problems weren't serious until they were proved to be.

The plant's efforts to police itself declined at the same time that the threat of damage to the reactor lid increased, because of its age and high operating temperature of 605 degrees.

Workers cleaning the reactor lid during each refueling shutdown weren't adequately trained, the report says. The lid inspection program didn't take into account that it might be the nozzles, and not less critical parts, that were leaking. Reports detailing the individual problems that pointed to nozzle leakage were left unresolved by managers for long periods while damage occurred unchecked.

"It was a site loss of focus," Loehlein said.

To address the problems, the company has replaced many of its Davis-Besse managers. It is retraining its new ones and those who remain. Managers are reconnecting with the plant, joining with personnel from many departments to "walk down" the reactor from top to bottom while repairs are under way.

"In summary, we're committed to doing the job right the first time," Myers said. "We know we have a lot of work to do."

Just meeting the NRC's standards to get the plant restarted won't be enough, the agency's Dyer said. "You cannot base your get-well program on what you expect the NRC to inspect. You need to set your own standards. It's going to be quite a challenging period for both you and us."

For complete coverage of Davis-Besse go to www.cleveland.com/davisbesse/

To reach these Plain Dealer reporters:

jfunk@plaind.com, 216-999-4138

jmangels@plaind.com, 216-999-4842


2002 The Plain Dealer. Used with permission.
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