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Judgment
The proceedings have been initiated in the matter on the basis of the captioned media report to the effect that six persons have died and twelve injured in a fire incident in a pharma company at Akkireddygudem in West Godavari District in Andhra Pradesh. The fire incident is said to be due to reactor blast, on account of gas leak. The Chief Minister has announced compensation for the heirs of the deceased and also for the injured. OA 45/2022 (SZ) was also directed to be taken up with the suo motu matter in which order dated 20.4.2022 had already been passed seeking factual report.
As already mentioned, vide order dated 20.04.2022, the Tribunal sought report about the status of compliance of safety norms and steps required for prevention of such incidents in future. A joint Committee comprising of CPCB, State PCB and District Magistrate, West Godavari was constituted for the purpose. Operative part of the order is reproduced below:
“2. Media report gives rise to a substantial question of environment about the compliance of safety norms in operation of the unit, particularly the Manufacture, Storage and Import of Hazardous Chemical Rules, 1989 and the Chemical Accidents (Emergency Planning, Preparedness and Response) Rules, 1996. It is necessary to ascertain whether on-site and off-site Plans have been prepared and mock drills conducted, as required. Though compensation for the victims has already been announced, the status of payment in pursuance of announcement also needs to be found. Further, it is necessary to examine what precautions should be taken to avoid recurrence of such incidents.
Accordingly, we constitute a joint Committee comprising of CPCB, State PCB and District Magistrate, West Godavari to ascertain the cause of incident, extent of damages caused, remedial measures taken for restoration, status of compliance of environmental safety norms, status of payment of compensation, steps required to be taken for restoration and to prevent any such incident in future. CPCB and State PCB will be the nodal agency for coordination and compliance. The joint Committee may take into account reports furnished in respect of similar incidents, in pursuance of orders of this Tribunal, in recent past, available on the website of CPCB, on the pattern of orders in O.A No. 272/2022 and O.A No. 143/2022. 1Order dated 12.04.2022 in O.A No. 272/2022, In re: News item published in The Times of India dated 12th April, 2022, titled “Six killed in chemical factory blast in Gujarat” The Committee may undertake visit to the site, interact with the stakeholders and after verification of facts, furnish a report to this Tribunal within three months by e-mail at [email protected] preferably in the form of searchable PDF/ OCR Support PDF and not in the form of Image PDF.” Order dated 08.03.2022 in O.A No. 143/2022, In re: News item published in The Tribune dated 22.02.2022 titled “7 killed in blast at firecrackers factory in Himachal Una”
In pursuance of above, report of joint Committee has been filed on 17.08.2022. It undertook visit to the site, interacted with officers of the management, ascertained the compliance status, cause of accident and compensation paid. Recommendations have also been made for further steps in the matter, including steps for preventing incidents in future. Relevant extracts from the report are:
“VI. a. Sequence of events and causes of accident
The sequences of events are described as follows:
13.04.2022
4.30 P.M.
In the reactor SSR-D01 of 3 KL capacity in Block-D Phthalic Anhydride flakes of 2625Kgs was charged through manhole of the reactor and the process was started with heating Phthalic Anhydride flakes using the steam in the reactor jacket to melting temperature of 136OC.
13.04.2022
6.30 P.M.
Passing of Mono Methyl Amine (MMA) gas was commenced through 4inch MS Pipeline with manual valve arrangement.
The reaction between MMA gas and Phthalic Anhydride is an exothermic reaction thereby the temperature of reaction is expected to increase. As per the process design, the temperature has to raise up to 180OC and it will be maintained in that range of 150 to 180OC by controlling the flow of MMA gas manually by operating the valve on MMA gas inlet line on the said reactor.
For a batch 600Kgs of MMA gas has to be passed into the said reactor with a flow rate of 30 to 40kgs/hour, which takes the reaction time of 14 hours on an average. As the reaction was commenced at about 6.30 P.M., it was expected to continue up to 8.30A.M on 14.04.2022.
13.04.2022
9.00 P.M.
Shift-II was completed and Shift-III was started. Sri Udrapati Krishnaiah, Chemist took charge of Shift-III in the 1st Floor of
the reactor (Block-D).
13.04.2022
10.20 P.M.
Workers were enquiring about Sri U. Krishnaiah, Chemist who was responsible for operation of the reactors. However, he was not available till 10.40 P.M. in the 1st Floor i.e., reactor floor.
13.04.2022
10.50 P.M.
Workers noticed Sri U. Krishnaiah, Chemist in the reactor floor. He was unavailable from 10.20 P.M.to 10.50 P.M. in the reactor floor and not monitored the operation of the reactors. During his absence, the process parameters (Temperature, Pressure etc.,) might have increased in the reactor SSR-D01 beyond safe limits.
13.04.2022
10.55 P.M.
Explosion took place inside the reactor SSR D01 resulting into manhole opening and agitator gear box got separated and the hot reaction mass spilled out on floor and after getting oxidized caught fire and immediately the SSR D01 reactor fell- down to the ground floor due to pressure resulting rampant fire. There were 18 workers working in the Production Block-D in Shift III. 5 workers were in 1st Floor and 13 workers were in Ground floor discharging duties.
13.04.2022
11.15 P.M.
As a result of this incident, 5 workers died on spot and 13
workers injured. 1 worker died on the way to hospital and 12 workers were admitted in hospital. Immediately plant people started fire-fighting operations by using their fire hydrant system and it was informed to Fire Station, Nuzvid.
13.04.2022
11.40 P.M. & In early hours of 14.04.2022
00.10 A.M.
A.P. State Disaster Management & Fire Services Department deployed 2 nos. of fire tenders along with the crew from Nuzvid and Vissannapet.
14.04.2022
00.24 A.M.
The Department of Factories was informed by NDRF, Guntur about the incident.
14.04.2022
01.15 A.M.
Fire was brought under control.
14.04.2022
02.00 A.M.
Fire was completely extinguished.
VI. b. Probable cause of the accident
It was informed by the workers during the 10.20P.M. to 10.50P.M Sri U. Krishnaiah, Chemist left the reactor during that period and no one was available to monitor the reaction in the SSR:D01 reactor. For the process of step 1 reaction for production of N-Methyl Phthalimide, the reaction temperature should be maintained in the range of 150 to 200OC.The reactor is attached with digital temperature gauge to monitor the temperature of the reaction. Once the temperature of the reaction reaches to 180OC the addition of MMA gas should be cut down to maintain temperature of 200OC. During the absence of the Chemist, the reaction temperature could have been crossed the safe limit of 200OC. After returning to the reactor the Chemist might have noticed the raise in temperature and closed the valve of the MMA gas. Due to which, the reactor manhole lid got separated and the reaction mass in the reactor spilled on the ground, which caused the fire in the 1st Floor. Due to the built up of pressure inside, the reactor fell-down and the reaction mass inside the reactor gushed out causing the immediate fire in the ground floor.
Continuous addition of MMA gas and not maintaining the desired temperature and absence of effective cooling system has led to a runaway reaction. Since there were no reaction terminators, due to runaway reaction the temperature and pressure has escalated, which caused the pressure built up in the reactor causing the bulging inside the reactor and tear of the reactor shell. Due to which, the reaction mass was forced out of the manhole causing explosion of the reactor and fallen from the first floor to ground floor. The entire reaction mass was spilled outside the reactor. On the first floor of the Block D, there was 3000kgs of Phthalic Anhydride, 1600kgs of N-Methyl Phthalimide was kept for charging into the reactor. Phthalic Anhydride is highly reactive substances and incompatible with strong oxidizing agents, strong bases, moisture, strong acids, dust may form an explosive mixture with air. Due to presence of Phthalic Anhydride and N-Methyl Phthalimide on the floor, the reaction mass reacted and fire broke out immediately. Lack of automation, Lack of comprehensive standard operating procedure on maintaining the desired reaction temperature & on rate of addition of chemicals, lack of training of employees, not checking the safety of the reactor, absence of alarm system in the reactor to alert the personnel on not maintaining desired temperature, lack emergency preparedness are all the causes of accident.
It was further informed that the process of stage 1 production of 4-NPI involving Phthalic Anhydride was not manufacturing in the unit from April 2020 and was procuring the materials. It was started manufacturing from February 14, 2022 without any safety audit by third party. The Hazard and operability study (HAZOP) was carried out by third party in May 26, 2017 for this stage 1 drug intermediate and recommendations such as interlocking of temperature with MMA gas feed, provision of pressure relief systems, provision of alarm systems with regard to high temperatures etc. were made for the safety operation of the stage 1 products. However without compliance of HAZOP recommendations and Pre Start-up Safety Review (PSSR), the unit restarted the production of 4-NPI causing explosion and fire break out. Had these systems been provided, the excess pressure/temperature in the reactor would led to alarms, auto cut off of MMA gas addition, release of pressure thereby this accident would have been averted.
The reactor may not have been designed to withstand any deviations in the load and shell of the reactor was weakened. It is essential to carry out third party assessment to verify the safety of the reactors once in two years. The unit has carried out internal check of the reactors (copy of the internal test report is enclosed as Annexure-IV) but safety of the reactor was not ascertained through any certified agency. Further it was reported that the reactor was around 6 years old. Under such circumstance, the committee opines that it is essential to assess safety of the reactor to withstand deviations in the load.
The reactions involved in the stage 1 process are as follows:
It is the responsibility of the Unit (Factory Manager) to comply with all statutory, regulatory, safety clearances stipulated by various concerned departments. Equal responsibility also lies with employees to comply with operational procedures stipulated by the unit, careful attitude & dedication towards work. In this particular incident the committee observed that both the Unit (Factory Manager) and its employees are responsible for the accident.
VI. d. Qualification & experience of deceased/ injured employees
18 employees were present during shift-3 in the production block D at the time of the accident, details are depicted in table 1 below:
Table 1: Details of deceased and injured persons due to accident
S.
No.
Name of the deceased
Age
Designation
Qualification
Experience in the unit (in years)
Remarks
1
Sh. Udrupati Krishnaiah
34
Chemist
B.SC.
5.5
Died on the spot
2
Sh. Karu Ravidas
40
Loading/ unloading worker
3rd Class
3
Died on the spot
3
Sh. Monoj Mochi
25
Loading/ unloading worker
2nd Class
2
Died on the spot
4
Sh. Subhas Ravidas
32
Loading/ unloading worker
3rd Class
2
Died on the spot
5
Sh. Awadesh Ravidas
27
Loading/ unloading worker
5th Class
2.5
Died on the spot
6
Sh. Boppudi Kiran Kumar
42
Loading/ unloading worker
8th Class
7
Died on the way to hospital
7
Sh. Munark Paswan
47
Loading/ unloading worker
4th Class
2.8
65-75%
(expired on 19-04-2022)
8
Sh. Kancharla Joseph Kumar
26
Loading/ unloading worker
4th Class
7
81%(expired on 22-
04-2022)
9
Sh. S. Nageswara Rao
36
Loading/ unloading worker
9th Class
7
99 %
(Expired on 21-04-2022
10
Sh. Raushan Mochi
29
Loading/ unloading worker
5th Class
2
73%
(expired on 30-04-2022
11
Sh. Mullapudi Nagaraju
37
Loading/ unloading worker
9th Class
7
65-70%
12
Sh. Shaik Subani
36
Loading/ unloading
8th Class
7
10%
13
Sh. Ravi Kumar
19
Loading/ unloading
5th Class
2
28%
14
Sh. Bhikari Ravidas
28
Loading/ unloading
7th Class
2
40%
15
Sh. Sudhir Kumar
27
Loading/ unloading
7th Class
2.7
20%
16
Sh. Varun Das
31
Loading/ unloading
5th Class
2
60%
17
Sh. Sudhir Ravidas
42
Loading/ unloading
4th Class
2
30%
18
Sh. Ch. Rajeev
38
Sr. Executive
B. Tech
6.2
5% (Discharge
VII. Damage Assessment and Calculation of Compensation
The accident was restricted to production block D where 16 reactors were housed, the explosion occurred only in reactor SSR:D01. The other reactors were intact, no impacts observed outside the production block D or outside the unit. The damages that occurred due to accident are as follows:
VII. a. Loss of life and status of award of compensation
On the day of accident, 18 employees were present in the production block D, out of which, 5 employees died in the accident spot, one died on the way to hospital and four employees died in the hospital. The death of the employees is due to accident in the unit and is liable to be compensated.
To ascertain the adequacy of compensation, the committee has calculated compensation by two methods, first as per the Judgement dated 16th August 2019 of Hon’ble Supreme Court of India in Civil Appeal No. 6339 of 2019 and judgement in the matter of Sunita Tokas Vs New India Insurance Co. Ltd. & Civil Appeal No.3483 of 2008 and second as per Employee Compensation Act, 1923 and the highest among two is taken to determine whether compensation of ₹50.00 lakhs paid by the unit& State Government of AP to the dependents of the deceased is adequate or not and assessment of calculation is explained in table 2 and table 3. The unit & AP State Government has already paid compensation of ₹50,00,000/- (Rupees Fifty Lakhs only) to each deceased family.
Table 2: Assessment of compensation
Name of the deceased
A*
Amount of compensation in INR as per Hon’ble Supreme Court Judgement in civil appeal No. 6339 of 2019 and civil appeal No.3483 of 2008
OR
Whichever is
more is
considered by the committee to ascertain the
adequacy of compensation
B
As per Employee Compensation Act, 1923 Compensation= fifty percent of the monthly wages of the deceased x relevant factor&
Sh. Udrupati Krishnaiah
₹ 57,27,240/-
₹ 14,95,500/-
Sh. Karu Ravidas
₹ 17,06,764.8/-
₹ 13,81,275/-
Sh. Monoj Mochi
₹ 17,06,764.8/-
₹ 1626825
Sh. Subhas Ravidas
₹ 17,06,764.8/-
₹ 15,28,875/-
Sh. Awadesh Ravidas
₹ 17,06,764.8/-
₹ 16,01,775/-
Sh. Boppudi Kiran Kumar
₹26,08,320/-
₹ 13,38,675/-
Sh. Munark Paswan
₹ 17,06,764.8/-
₹ 12,23,025/-
Sh. Kancharla Joseph Kumar
₹ 31,01,702.4/-
₹16,14,600/-
Sh. S. Nageswara Rao
₹ 30,45,120/-
₹14,59,800/-
Sh. Raushan Mochi
₹ 17,067,64.8/-
₹15,74,400/-
* àA calculation is explained in table-3.
& à As per EC Act, 1923 the Central Government has specified `15,000/- as monthly wages with effect from 03.01.2020. The relevant factor as per EC Act, 1923 is (the completed years of age on the last birthday of the workman immediately preceding the date on which the compensation fell due).
Table 3: Amount of compensation in INR as per Hon’ble Supreme Court Judgement in civil appeal No. 6339 of 2019 and civil appeal No.3483 of 2008
Name
Age at the time of death
Salary per month for permanent employee
Future prospect s (40% of the income)
less tax if any as per the prevailing tax slabs
Salary after deducting tax
Deduction towards personal expenses
Loss of monthly income to the dependen ts
Annual income
loss of future income
Expense s for shifting mortal remains and Loss of estate & funeral expenses (approx. cost)
Loss of Love and affection
Compensation
A
B
C
D
ET=50% of D
F=D-E
G=F*1 2
H#
I$
J&
L=(F*G*H) +I+J
Sh. Udrupati Krishnaiah
34
46150
18460
-
64610
32305
32305
387660
6202560
100000
200000
6502560
Sh. Karu Ravidas
40
10467
4186.8
-
14653.8
7326.9
7326.9
87922.
8
1318842
100000
200000
1618842
Sh. Monoj Mochi
25
10467
4186.8
-
14653.8
7326.9
7326.9
87922.
8
1582610
100000
200000
1882610
Sh.
Subhas Ravidas
32
10467
4186.8
-
14653.8
7326.9
7326.9
87922.
8
1406765
100000
200000
1706765
Sh. Awadesh Ravidas
27
10467
4186.8
-
14653.8
7326.9
7326.9
87922.
8
1494688
100000
200000
1794688
Sh. Boppudi Kiran Kumar
42
17175
6870
-
24045
12022.5
12022.5
144270
2019780
100000
200000
2319780
Sh.
Munark Paswan
47
10467
4186.8
-
14653.8
7326.9
7326.9
87922.
8
1142996
100000
200000
1442996
Sh. Kancharla Joseph Kumar
26
20846
8338.4
-
29184.4
14592.2
14592.2
175106
.4
2976809
100000
200000
3276809
Sh. S.
Nageswara Rao
36
20425
8170
-
28595
14297.5
14297.5
171570
2573550
100000
200000
2873550
Sh.
Raushan Mochi
29
10467
4186.8
-
14653.8
7326.9
7326.9
87922.
8
1494688
100000
200000
1794688
T Deduction towards personal expenses varies @50% for age of the deceased 20yrs to 50yrs and @40% for age of the deceased more than 50yrs. # Depending on the age, the factor is fixed. 18 for age group 21-25 years, 17 for 26-30 years, 16 for age group
31-35 years, 15 for 36-40 years, 14 for age group 41-45 years and 13 for 46-50 years
$ Entire responsibility taken by unit for shifting mortal remains
& The committee fixed the amount as ₹2,00,000/- for loss of love and affection
@ The committee fixed the amount as ₹1,00,000/- for loss of estate, funeral expenses and for shifting mortal remains
VII. b. Status of award of compensation to burn injured employees
Eight employees were injured during accident and sustained burns. Soon after the accident, the unit has shifted the injured to the nearby hospital and expenditure incurred towards their treatment and hospital stay is borne by the unit. All the injured employees were discharged from the hospital and are in good conditions. Government of A.P has announced compensation of ₹5.00 lakhs each to the injured employees and the amount is deposited in their respective back account.
Referring to Uphaar tragedy victims case, MCD Vs. Uphaar Tragedy Victims Association – (2011) 14 SCC, and in other NGT case, the amount was calculated as Rs. 15 lakhs for persons who have burns in excess of 50%, Rs. 10 Lakhs for persons who have burns from 25-50% and ₹5 lakhs for persons who have injuries between 5 to 25%. Victims who were treated as outpatients and who had but minor degree of burns or other forms of simple injuries shall be paid Rs. 2 lakhs. The amounts shall be directed to be paid within the time the Tribunal may set and direct a further liability of interest at 12% p.a. for default of payment. The unit has paid the following compensation to the injured employees:
Table 4: Details of compensation to injured employees
Name of the injured
Percentag e of burn injuries
Date of admission to Hospital
Date of Discharge
Compensation amount paid by the unit
Compensati on to be paid
Remarks
Sh. Mullapudi Nagaraju
65-70%
13.04.22
13.06.22
Rs. 5 Lakhs
Rs. 15.00
Lakhs
Unit shall pay remaining amount of Rs. 10.00
lakhs
Sh. Shaik Subani
10%
13.04.22
07.06.22
Rs. 5 Lakhs
Rs. 5 Lakhs
-
Sh. Ravi Kumar
28%
13.04.22
30.05.22
Rs. 5 Lakhs
Rs. 10.00
Lakhs
Unit shall pay remaining amount of Rs. 5.00
lakhs
Sh. Bhikari Ravidas
40%
13.04.22
20.05.22
Rs. 5 Lakhs
Rs. 10.00
Lakhs
Unit shall pay remaining amount of Rs. 5.00
lakhs
Sh. Sudhir Kumar
20%
13.04.22
20.05.22
Rs. 5 Lakhs
Rs. 5 Lakhs
-
Sh. Varun Das
60%
13.04.22
30.05.22
Rs. 5 Lakhs
Rs. 15.00
Lakhs
Unit shall pay remaining amount of Rs. 10.00
lakhs
Sh. Sudhir Ravidas
30%
13.04.22
08.06.22
Rs. 5 Lakhs
Rs. 10.00
Lakhs
Unit shall pay remaining amount of Rs. 5.00
lakhs
Sh.Ch. Rajeev
05%
13.04.22
19.04.22
Rs. 5 Lakhs
Rs. 5
Lakhs
-
VII. c. Contribution of Emissions into the atmosphere
Around 3000kgs of Phthalic Anhydride on the floor, 2625kgs Phthalic Anhydride & 160kgs of MMA gas in reactor and 1600kgs of N-Methyl Phthalimide was burnt causing emissions into the atmosphere. Due to high pressure, the portion of the civil structure where reactor SSR:D01 was housed had collapsed. From interaction with employees, it was understood that huge noise was heard when the reactor collapsed. The adjacent 15 reactors were housed in first floor but were intact and no explosion occurred. During inspection, there were no accumulated waste materials in production block D and all waste materials was disposed to Transportation, Storage, Disposal Facility (TSDF), at Visakhapatnam as per the directions of APPCB. The committee did not observe any other physical damages during the visit. The environmental prices for the material wasted are not available. To account for the damage cost due to the material wasted, the committee has assumed the market price of the material is equal to the opportunistic cost. The committee opines that presently restoration measures or clean-up or remediation is not required as all the materials have been disposed to TSDF, Visakhapatnam.
Damage cost = Market price+ opportunistic cost+ treatment cost
Damage Cost
=
Market price
+
Opportunistic cost
+
Treatment cost
=
Actual cost of the material lost
+
The essential product which could be beneficially used in treatment of ailments is wasted. The committee has assumed the market price of the product is considered as opportunistic cost
+
Nil
The injured employees have recovered and informed that they are not facing any health issues. The cost of treatment is already borne by the unit. Hence presently no additional treatment cost is required for injured employees but unit shall carry out health monitoring of injured employees for two years.
Since the entire reaction mixture in the reactor and 3000kgs of Phthalic Anhydride and 1600kgs of N-Methyl Phthalimide were burnt in the fire, the remaining waste materials was disposed to TSDF. Hence treatment cost is taken as Nil.
=
5625 Kgs of Phthalic Anhydride+160 kgs of MMA gas+ 1600 Kgs of N Methyl Pthalimide
+
5625 Kgs of Phthalic Anhydride+ 160 kgs of MMA gas+ 1600 Kgs of N Methyl Pthalimide
+
Nil
=
₹120/- per Kg+
₹145/- per Kg+
₹132/- per Kg
+
₹120/- per Kg+ ₹145/- per Kg+ ₹132/- per Kg
+
Nil
=
₹675000/-+
₹23200/- +
₹211200/-
+
₹675000/- + `23200/- +
₹211200/-
+
Nil
₹ 909400/-
+
₹ 909400/-
Total damage cost
=
₹ 18,18,800/-
Rupees Eighteen Lakhs Eighteen Thousand and Eight Hundred only
VII. c. Environmental Compensation on account of non-compliances
From the available records it is found that the unit started the production of stage 1 -4NPI from February 14, 2022. Since the unit has not complied with safety requirements for the production of 4-NPI causing to a major accident. Hence the committee has calculated EC as per CPCB formula:
EC=PI x N x R x S x LF
Where,
EC = Environmental Compensation in INR
PI = Pollution Index of industrial sector (Red-80)
N = Number of days of violation took place (start of unit operation to date of accident)
R = A factor in Rupees for EC (Rs. 250/- may be assumed)
S = Factor for scale of operation (Medium - 1)
LF = Location factor (the unit is located in Akkireddygudem and >10Km from the municipal boundary and population is less than 10 lakh=1)
i. Pollution Index of industrial sector (PI): Andhra Pradesh Pollution Control Board has categorized this industry into red category of industries and accordingly the Combined consent & Authorisation have been granted. For red category of industries, average pollution index is 80.
ii. Number of days of violation (N): The number of days for which violation took place is considered as the period between the day of violation observed and day of compliance verified by the CPCB/ APPCB. From the available records, it is observed that unit has resumed the production of 4-NPI on February 14, 2022. Based on the criteria, 59 days (from 14-02-2022 to 13-04-2022) is considered for calculation of period of violation for
estimating EC.
iii. Scale of operation (S): The industry is considered as medium. Thus, scale of operation (S) for EC estimation is considered as 1.
iv. Location factor (LF): The industry is located in Akkireddygudem, Eluru district and the total population within municipal boundary and up to 10km distance from the municipal boundary of the city is less than 1 million. Thus location factor (LF) is considered as 1 for EC estimation
v. Factor in Rupees (R) (₹): As per the environmental compensation estimation guidelines, factor of rupees may be minimum of ₹100/- and maximum of ₹500/-. The factor of rupees is considered as ₹250/- for estimating environmental compensation for this industry, considering its pollution potential.
S. No.
Period of non- compliance
PI
S
LF
R (₹)
N
(days)
Environmental compensation (₹)
1
14.02.2022 to
13.04.2022
80
1
1
250/-
59
11,80,000/-
Total EC for violations
59
11,80,000/-
Rupees Eleven Lakhs Eighty Thousand Only
VII. d. Total Compensation M/s Porus Laboratories Pvt. Ltd. liable to Pay
a. The unit and the State Government have already paid ₹50.00 lakhs to the family of each deceased. Total of ₹500.00 lakhs paid towards Compensation to the deceased persons families. However, for the deceased Late Sh. Udrupati Krishnaiah, as per the calculation ₹65,02,560/-has to be paid, hence the remaining amount of ₹15,02,560/-shall be paid by the unit.
b. Referring to Uphaar tragedy victims case, MCD Vs. Uphaar Tragedy Victims Association – (2011) 14 SCC and reports submitted to Hon’ble NGT in other accidents, the total compensation to be paid to the eight injured employees is ₹75.00 lakhs @ of ₹5.00 lakhs to three employees and ₹10.00 lakhs to three employees and ₹15 Lakhs for two employees. However the unit has already paid ₹40.00 lakhs @ ₹5 Lakhs for each of the eight injured employees which is not adequate. Hence, the unit shall pay additional compensation of ₹10.00 lakhs each to two injured employees namely Sh. Mullapudi Nagaraju and Sh. Varun Das and ₹5.00 lakhs each to three employees namely Sh. Ravi Kumar, Sh. Bikari Ravidas and Sh. Sudhir Ravidas respectively.
c. The unit shall pay Environmental Compensation of ₹18,18,800/- to CPCB on account of contribution of emissions into environment.
d. The unit shall pay Environmental Compensation of ₹11,80,000/- to CPCB for violations. The unit shall pay total compensation of ₹29,98,800/- (Rupees Twenty Nine Lakhs Nighty Eight Thousand and Eight Hundred only) to CPCB.
VII. e. Current Status of the Unit
When the accident occurred reactions were in progress in other reactors which were abruptly stopped and also in production Block B. Hence, the unit was permitted to safely shut down its operations. On the day of committee inspection, the unit was under complete shutdown. The reaction mass spilled from the reactor SSR:D01 and 3000kgs of Phthalic Anhydride and 1600kgs of N-Methyl Phthalimide that were burnt in the fire including the reaction mixture in other 15 reactors (total of 50 tons) of chemical wastes were disposed to TSDF, Visakhapatnam. At the time of committee inspection, reactorSSR:D01 which exploded was lying in the block D and is yet to be disposed of. The copy of the manifest is enclosed as Annexure V. During inspection, Effluent Treatment Plant (ETP) was not operational and all the treatment units were empty. 40KL of water was used as fire hydrant to control the fire, the contaminated fire hydrant water was partly collected and part of the water find its way outside the unit. The partly collected contaminated water along with the effluent in the ETP was sent to Common Effluent Treatment Plant, Visakhapatnam and copy of manifest is attached as Annexure VI.
There were two bullets each of 22KL capacity containing MMA gas, one bullet was empty and another bullet contained 14.5KL of MMA gas. The entire MMA gas was transported to the sister concern unit. The storage yard of MMA gas is having license from Controller of Explosives, Government of India valid up to September 30, 2024. After the accident, Deputy Chief Controller of Explosives, Visakhapatnam inspected the unit and verified the safety measures at MMA storage yard.
VII. f. Actions taken by various departments
After the accident, Deputy Chief Inspector of Factories vide order dated 16.04.2022 issued “Prohibitory Orders” which states as “Manufacturing process in the premises of the factory are prohibited with immediate effect until further order”. Copy of the Prohibitory orders is enclosed as Annexure-VII. APPCB officials inspected the unit on April 14, 2022 and recommended the disposal of chemical waste to TSDF and contaminated water from fire hydrant to dispose to CETP and issued temporary closure directions until the wastes are properly disposed and Pollution Control Systems are augmented. The copy of the temporary closure order is attached as Annexure VIII. In continuation, Deputy Chief Inspector of Factories, Vijayawada issued Show cause to the unit on May 25, 2022 and copy enclosed as Annexure-IX.
VIII Status of On-site and Off-site Emergency plans and mock drills conducted
The unit has prepared On-site emergency plan and updated in June 2021 and unit is regularly conducting onsite emergency mock drills and latest was conducted on November 18, 2021.
The unit is using Phthalic Anhydride and MMA gas which meets the criteria laydown in the Part I of Schedule-1 and is listed in Part II of Schedule 1. Thus, these two chemicals are hazardous chemicals as per the rule 2(e) of Manufacture, Storage and Import of Hazardous Chemical Rules, 1989.The chemicals used by unit are not listed in Part I or Part II of Schedule 3. Also, the quantity of chemical used by the unit is much less than threshold quantity mentioned in the said schedule 3.It can be inferred that threshold quantity of hazardous chemical used/stored in the unit is less than threshold quantity specified in the column 3 & 4 of Schedule 3 appended to MSIHC Rules, 1989, therefore, rules 7 to15 of said MSIHC Rule are not applicable to the industry. The industry is not a Major Accident Hazard (MAH) unit. The Rules 7 to 15 of the said Rules are:
Approval and notification of sites
Updating of the site notification following changes in the threshold quantity
Transitional provisions
Safety Reports and Safety audit reports
Updating of reports under rule 10
Requirement for further information to be sent to the authority
Preparation to on-site emergency plan by the occupier
Preparation of off-site emergency plan by the authority
Information to be given to persons liable to be affected by a major accident Eluru district off-site emergency plan was prepared in the year November, 2009
IX Suggested remedies to avert such accidents in future
The committee suggests following remedial measures
The units shall manufacture only those products specified in the EC and Consent. If the unit intends to manufacture any additional products or intermediates or restart manufacturing of a consented product after a long gap the unit shall conduct safety test of reactor and impart adequate training to its employees.
The units shall provide interlocking facility for critical parameters with raw material feeding and with reaction terminators.
To provide auto alarm system or siren system to alert the employees in case of any deviations noticed in desired range of process parameters.
To provide dedicated ceiling roof mounted automatic fire detection and suppression system for all blocks where flammable chemicals are stored/used.
The units shall carry out third party assessment through any certified agency or competent person on safety & suitability of the reactors.
To conduct HAZOP (Hazard and Operability) study and Layers of Protection analysis study for all the processes by an expert third party before resuming the production in order to identify and evaluate risks by considering the possible deviations during the reaction, storage, handling, transfer etc.
The units shall carry Hazard Analysis and Risk Assessment (HARA) considering all products, bye-products, intermediates or any other manufactured in the unit.
To prepare comprehensive SOP for all consented products and to impart training to all employees on SOP’s, product process, safety aspects. The employees shall be given hands on experience with the product process under the supervision of senior employees. Overall the industries should be prepared for emergency response readiness & effectiveness in terms of major accidents.
The cooling system of all reactors shall be designed properly based on the evaluation of heat of reactions scientifically in order to withstand the possible deviations of parameters beyond operational limits.
X Concluding remarks
Major accident occurred at M/s Porus Laboratories Pvt. Ltd., Unit-IV on 13.04.2022 due to explosion of reactor SSR:D01 during the production of Stage 1 drug intermediate 4 NPI. The immediate trigger to the accident is ineffective cooling and deviation in the rate of addition of MMA gas into reactor-SSR:D01 which contained 2625kgs of Phthalic Anhydride and 160kgs of MMA gas causing rise in temperature & pressure beyond safe limit. The unit had valid EC from MoEF&CC and CFO from APPCB for manufacture of 4 -NPI.
Lack of proper automation, Lack of comprehensive standard operating procedure on maintaining the desired reaction temperature & on rate of addition of chemicals, lack of training, not checking the safety of the reactor, absence of alarm system in the reactor to alert the personnel on not maintaining desired temperature, absence of automatic fire detection system and lack of interlocking system are all the causes for accident. Immediate trigger is deviation in adding MMA gas to reactor and not maintaining the desired temperature of less than 2000C in the reactor.
Eighteen employees were present in the production block D during accident, out of which 5 employees died on spot, one employee died on the way to hospital, four employees died in hospital and eight employees were injured. The injured employees have recovered and discharged from the hospital.
To ascertain the adequacy of compensation the committee has calculated compensation using two methods. As per Hon’ble Supreme Court Judgment in civil appeal No. 6339 of 2019 and civil appeal No.3483 of 2008, the compensation paid for the deceased is adequate, however, for the deceased Late Sh. Udrupati Krishnaiah, as per the calculation `65,02,560/- has to be paid, hence the remaining amount of `15,02,560/- shall be paid by the unit. The amounts shall be directed to be paid within the time or the Tribunal may set and direct a further liability of interest at 12% p.a. for default of payment.
Referring to Uphaar tragedy victims case, MCD Vs. Uphaar Tragedy Victims Association – (2011) 14 SCC and reports submitted to Hon’ble NGT in other accident matters, the total compensation to be paid to the eight injured employees is ₹75.00 lakhs @ of `5.00 lakhs to three employees and ₹10.00 lakhs to three employees and ₹15 Lakhs for two employees. However the unit has already paid ₹40.00 lakhs @ ₹5 Lakhs for each of the eight injured employees which is not adequate. Hence, the unit shall pay additional compensation of ₹10.00 lakhs each to two injured employees namely Sh. Mullapudi Nagaraju and Sh. Varun Das and ₹5.00 lakhs each to three employees namely Sh. Ravi Kumar, Sh. Bikari Ravidas and Sh. Sudhir Ravidas respectively. The amounts shall be directed to be paid within the time or the Tribunal may set and direct a further liability of interest at 12% p.a. for default of payment.
The committee did not observe any damage to the surrounding environment and the accident & impacts were confined only to production block-D. The entire reaction mixture was spilled out from the reactor SSR:D01 and burnt along with 3000kgs of Phthalic Anhydride and 1600kgs of N-Methyl Phthalimide. Immediate restoration or remediation is not required in this incident, however the health of the injured employees shall be monitored for a period of 2 years. The unit may tie up with hospitals for health monitoring. The unit started the production of 4-NPI on 14.02.2022 without taking adequate safety measures leading to a major accident. For violations and the damage caused (contribution of reaction mixture into atmosphere) the unit shall pay Environmental compensation of ₹29,98,800/-(Rupees Twenty Nine Lakhs Nighty Eight Thousand and Eight Hundred only) to CPCB.
Eluru District off site emergency plan was prepared in the year November, 2009. Latest onsite emergency plan of Porus Laboratories Pvt. Ltd., Unit –IV was prepared in June 2021. The unit is regularly conducting onsite emergency mock drills and latest was done on November 18, 2021.
The committee humbly submits that all industries have to ensure self-monitoring, self-compliance and comply with statutory guidelines, safety measures issued by MoEF&CC, CPCB, APPCB, Directorate of Factories etc.”
From the above, it is seen that the PP had failed to take necessary measures for preventing the incident. The incident was result of ineffective cooling resulting in temperature beyond safe limits. There is lack of following comprehensive Standard Operating Procedure (SOP). The compensation paid was inadequate, adequate safety measures were not taken and environment compensation was liable to be paid. We see no reason not to accept the report. Accordingly, the report is accepted and suggestions and recommendations in the report be duly complied with which may be overseen by the statutory regulators.
The applications are disposed of accordingly.
A copy of this order be forwarded to the Chief Secretary, Andhra Pradesh, MoEF&CC, CPCB and State PCB by e-mail for compliance.