Impact of the accident and criticism of Petrobras In terms of lives lost,
P-36 was the worst offshore oil and gas accident in Brazil since the 1984
blowout and explosion on a Petrobras drilling rig in the Enchova field (also part of the
Campos Basin), which caused 36 fatalities, and the worst worldwide since the explosion of a
Mobil platform off Nigeria in January 1995, which killed 13. Total damages from the accident were estimated to be in the region of US$1 billion. The salvage operation alone cost an estimated US$100 million. By July 2001, Petrobras had received a US$500-million (or US$-million counting inflation) insurance settlement for the loss of the platform. The revenue loss was substantial, as the platform was making the company an estimated US$40-million (or US$-million counting inflation) monthly. As a consequence of the accident, Petrobras' insurance premium increased from US$10 million to US$48.8 million (or from US$ million to US$ million counting inflation) for a diminished insured value (US$20.9 billion – or US$ billion counting inflation – compared to US$32 billion – or US$ billion counting inflation – from before the accident). The slow sinking of the platform attracted significant attention from the media. A national debate over the responsibilities for the accident and whether the platform could have been salvaged was sparked in Brazil as a result. Two days after the rig sank, Brazilian oil workers went on a nationwide strike. Petrobras were criticized by trade union organization Unified Federation of Oil Workers (, FUP) for the lack of measures put in place to ensure the safety of their workers, citing the deaths of 81 workers over the three years leading to the accident. The FUP blamed the company for their cost-cutting initiatives (in spite of recent growth in revenue and activities), referring to excessive outsourcing to poorly trained contractors and the substantial downsizing of their own workforce in the decade prior to the
P-36 sinking (from 62,000 employees in 1989 to 34,000). The decision to place the EDTs in the columns has been cited as a direct consequence of the company's focus on financial performance. Both Sindipetro (, Oil Workers Union) and AEPET (, Petrobras Engineers Association) blamed the high number of safety and environmental accidents occurred in the organization on the
neoliberal management approach adopted by chief executive officer . Reichstul resigned in late 2001. Although he cited personal reasons, the string of accidents occurred during his three-year tenure may have played a role in his move. Petrobras received further criticism for operating the platform with systems (such as the production caisson) not yet fully commissioned by the date of the accident. It also transpired that the electronic maintenance management system had not yet been set up and the emptying of the port aft EDT was not supervised. As a direct result of the disaster, the company implemented an
operational excellence program.
Investigations A governmental investigation commission was appointed shortly after the accident by the
Chamber of Deputies. Another dedicated commission was formed by the
National Agency of Petroleum, Natural Gas and Biofuels (ANP) and the (DPC), an agency of the
Brazilian Navy. This included members from both organs and had the mandate to investigate the causes of the accident and propose recommendations for the offshore oil and gas industry. Other independent investigations were carried out by the Rio de Janeiro (CREA-RJ) and the . Petrobras organized their own investigation around a team of internal experts and representatives invited from the Oil Workers Union and the
Federal University of Rio de Janeiro. Certification body
Det Norske Veritas (DNV) was hired to oversee the integrity of the investigation. The ANP–DPC report was published in July 2001. It identified a series of non-conformities that led to the loss of the platform. The first cited in the report is the practice to store large amounts of water contaminated with hydrocarbons in the emergency drain tanks, contrary to the operations manual. Other problems identified were systematic errors in the manual level measurement of the EDT; issues with the discharge of the open drain vessel (possibly due to the malfunction of its pump) that resulted in regular overflow through its vent pipe into the EDT; poor isolation of the starboard aft EDT, in concomitance with the blind flange isolation of its atmospheric vent, which was the factor that allowed backflow in otherwise sealed EDT and ultimately to its failure; the necessity of lining up the EDTs to the high-pressure production header, which caused exposure to backpressure, instead of low-pressure production caisson; absence of adequate supervision of the emptying of the EDT; inadequate
hazardous area classification and absence of
gas detectors in the column internals; ineffective emergency response, in terms of both communication and organizational aspects; failure of the ventilation dampers to close and isolate adjacent column spaces, which facilitated the progressive flooding of the column; multiple manholes to key spaces providing buoyancy, which led to the flooding of a ballast tank and a stability box; ineffectiveness of the flooding containment response and insufficient training of the personnel in charge of this operation; two seawater pumps out of operations, which led the automatic safety system to start the seawater pump in the damaged column, thus causing its flooding. The investigation commission recommended improvements in the operations management system; establishment and enforcement of robust design review processes; improved hazardous area classification; establishment of clear criteria for the selection of which systems may or may not be commissioned after the initial start-up of the platform; reassessment of the size and required skills of personnel; better management of conversion projects; assessment of the need for implementation of the
IMO's
International Safety Management Code; and improvement of emergency response plans. The CREA-RJ report was issued in October 2001. It pointed to failures in management as the underlying causes of the accident. In particular, CREA found fault in the failure to complete construction and commissioning works prior to starting production. It also cited failure to shut down production when the platform would have needed it for equipment replacement. The conclusions of the commission appointed by the Chamber of Deputies were published in March 2002. The commission found that it was not possible to pinpoint a single cause or an individual party responsible for the accident. Multiple faults were found with Petrobras as well as regulating and enforcing agencies. The commission pointed out that there were conflicts and overlaps between the government agencies – namely, the ANP, the Navy, and IBAMA – involved in the regulation, control, and law enforcement in the domain of offshore oil and gas activities. These agencies also did not have sufficient capability and competence. Among other recommendations addressed to Petrobras, the commission required that the company provide equal treatment to their own employees and external contractors and clarify their respective responsibilities in case of emergency situations; ensure that only Petrobras staff with sufficient competence and authority be assigned to emergency management duties; improve the training of external contractors; define a limit for the activities that may be executed by external contractors, as opposed to own staff; revise the organization of the field personnel in charge of operations, maintenance, and
ship stability; reduce the bureaucratic workload on field supervisors to ensure they can focus on operations and safety; exclude lagging safety
performance indicators (such as the number of accidents) from the criteria used to decide personnel promotions and bonuses, because this may lead to underreporting of accidents with a negative impact on their investigation and the implementation of
lessons learned within the organization; reduce production targets; and give preference to Brazilian construction and service contractors over foreign companies. Petrobras presented the results of their investigation at the Offshore Technology Conference in
Houston in May 2002, one year after receiving an award at the previous edition of the conference for the innovations put in practice in the execution of the
P-36 project. Petrobras' openness in sharing the details of the accidents was considered unprecedented. Their investigation focused mainly on confirming the source of the flammable gas that exploded. Different scenarios were modeled using
computational fluid dynamics for the gas dispersion and structural response calculations to assess the deformation of the EDT walls and the failure of the seawater pipe.
Legal proceedings and fines The
Federal Public Prosecutor's Office filed a public civil action demanding compensation from Petrobras in the amount of
R$100 million (US$42.6 million, or US$ counting inflation). Petrobras later appealed this decision and managed to reduce the fine by 50%. IBAMA imposed fines for R$17 million (US$7.2 million, or US$ counting inflation) for the environmental damage caused by the hydrocarbon spill and the use of chemical dispersants. Petrobras challenged the decision. In 2023 the
Superior Court of Justice confirmed Petrobras had to pay R$5 million (US$1 million, or US$ million counting inflation) for the environmental damage caused. In July 2005, the Maritime Court ordered Petrobras to pay a fine of R$12,000 (US$, or US$ counting inflation) for negligence in the maintenance of the platform and for placing the EDT in an inappropriate location in disregard of safety standards. The military court also ordered five employees of the state-owned company to pay R$1,200 (US$, or US$ counting inflation). Eleven indemnification lawsuits were filed by the families of the deceased. Petrobras paid the relatives the equivalent of lifetime salaries. They also provided the families' children with fully-paid education scholarships through college. Petrobras and Marítima (through its subsidiaries Petrodeep and Petromec) entered a litigation around the insurance settlement. When the state oil company received the settlement monies (US$500 million, or US$ million counting inflation), they passed on to the trustee in charge of redistribution to the creditors –
Arab Banking Corporation, later substituted by
Den Norske Bank – the amount they would have paid the contractors through the
chartering contract in place, i.e., US$325.6 million, (or US$ billion counting inflation). However, Petrobras retained the balance of the sum. Marítima's chief Germán Efromovich sued Petrobras on the basis that his company should be entitled to the entire settlement. In 2004, Petrobras won the legal dispute in a London court. This was one of several litigations between the two companies, which took place in Brazilian, British, and American courts. Proceedings were brought about concerning different services and contracts, including for the construction of six drilling rigs that had been cancelled by Petrobras and the execution of the projects for the
P-36,
P-37,
P-38, and
P-40 platforms, which Petrobras claimed went over budget and schedule.
Redevelopment of the Roncador field P-36 was replaced by
FPSO Brasil, a ship-shaped floating platform leased from
SBM Offshore. The FPSO started its lease contract with Petrobras in December 2002. It was demobilized in 2014. In November 2007, the semi-submersible platform
P-52, built in
Singapore and Brazil, came into operation to further supplement production. FPSO
P-54, converted from an oil tanker at the
Jurong shipyard in Singapore and the Mauá shipyard in Niterói, followed in December 2007. ==Impact on process safety==