Wake-Up Call For Walkerton

Walkerton Scandal: Sequence of Events (2000)

May 17: Residents complain of bloody diarrhea, vomiting, cramps, fever -- classic symptoms of Escherichia coli (E. coli) bacterial poisoning.

Tests of water sampled May 15 reveal E. coli contamination. Water manager (Stan Koebel) fails to notify public or public health office. First signs show up in children (many fail to attend school and two are admitted to hospital with bloody diarrhea)

May 19-21: Hundreds fall ill; Koebel fails to report knowledge of elevated E. coli levels in water to health authorities.

Public utilities commission reports to public that water is safe (based on information supplied by Koebel)

2000

May 21: Public health unit begins independent water testing, issues boil-water advisory.

May 22: First death directly linked to E. coli.

May 23: Health unit tests reveal water contaminated with deadly E. coli O157:H7. Two-year-old girl dies, more than 150 people seek hospital treatment, another 500 complain of symptoms.

May 24: Medical officer of health, Dr. Murray McQuigge, declares E. coli outbreak Canada's worst. Two more die.

2000

May 25: Fifth person dies. At least four children in critical condition. McQuigge declares tragedy preventable. Outside agency takes over water system. Stan Koebel leaves town, goes on sick leave.

May 26: Tory Premier Mike Harris denies government cuts to blame for tragedy, points finger at changes made by previous NDP government. Proposed class-action lawsuit launched. OPP begin probe.

May 29: Sixth death. Province admits knowing for six years water system flawed; announces new rules to protect drinking water.

May 30: Seventh death.

2000

May 31:Under opposition pressure, Harris orders public inquiry.

June 2: Federal, provincial governments announce financial aid for those affected by outbreak.

Aug. 26: New drinking-water laws take effect.

Oct. 16: Public inquiry under Justice Dennis O'Connor begins.

Nov. 15: Water utility's secretary-treasurer tells inquiry that Stan Koebel believed townspeople had food poisoning or flu.

Nov. 16: Province says Walkerton's water clean, but leaves it to health unit to lift boil-water advisory.

2000

Nov. 17: Koebel resigns with $98,000 severance package.

Nov. 30: Mayor David Thomson bursts into tears at inquiry, recalling when he learned Stan Koebel withheld crucial information that might have curtailed the tragedy.

Dec. 6-7: Frank Koebel, water foreman and Koebel's brother, stuns inquiry with testimony about drinking on the job and routine falsification of safety tests (including falsification of water sample locations), failure to properly monitor chlorine levels in water.

Dec. 18-20: Stan Koebel testifies about his reasons for falsification of safety tests and records, and why he didn't alert authorities to E. coli in water (partly in response to public complaints about “chlorine taste” in water- but may have been more to do with knowledge of a broken chlorinator at well 7).

Year 2001

Jan. 15: Court begins hearing request to certify class-action suit.

March 27: Province picks up $15 million tab for fixing town's water.

April 23: Walkerton council agrees to pay Stan Koebel $82,000 for severance and vacation plus $5,000 in legal costs.

June 25: Dr. Richard Schabas, former medical officer of health, testifies he repeatedly told the government that funding cuts would compromise public health.

June 26: Brenda Elliott, former environment minister, tells inquiry that the government acted as a team when making decisions around funding cuts.

2001

June 27: Norm Sterling, also a former environment minister, testifies he was assured by his senior bureaucrats that any risks to public health caused by layoffs and budget cuts were manageable. June 29: Premier Mike Harris testifies he was never warned of risks to human health posed by funding cuts to the Environment Ministry.

July 3: Inquiry faces first challenge when three local Environment Ministry officials argue judge has no right to find fault with their conduct. Judge dismisses challenge.

Aug. 15-27: In closing submissions, lawyers defend their clients, with government blaming Stan Koebel for tragedy and Koebel saying blame must be spread to individuals at higher levels.

Year 2002

Jan. 14: O'Connor hands report to government.

Jan. 16: Some details of the report are leaked to The Canadian Press.

Jan. 17: The Ontario government announces it will release the first part of the report on Jan. 18, 2002, four days ahead of schedule, because of the leak.

Jan. 18: The report is released in Walkerton. It says the chain of events that led to the disaster began Stan and Frank Koebel, two brothers responsible for the town's water, and was compounded by government budget cuts that undermined the ability of the Ministry of the Environment to pick up on the brothers' shortcomings.

Significant localities in case

(Toronto Star, May 2000) Well #5 (contaminated well)

Public utilities commission(where water was tested)

Well #7 (chlorinator broken, but luckily,Water uncontaminated)

After first signs of outbreak reported, authorities at PUC assured public that water was safe (based on info from Koebel)

What is Known ?: EvidenceWater sampled immediately downline from well 5 on May 15, 2000 tested positive for E. coli (as mentioned previously, Koebel failed to report this)

Most likely source of E. coli contamination: cattle manure

Water sampled on May 23, 2000 from “well 5” consistently tested positive for E. coli (strain O157:H7) whereas other the wells negative (so contamination sourced to one location)

DNA typing indicating a match between strains of bacteria (C. jejuni and E. coli) in contaminated water supply and at a farm near “well 5.”

Torrential downpours between May 8 and 12, 2000 washed bacteria from cattle manure into well 5. Most people probably infected on May 12 when rainfall was highest and E. coli had reached critical concentrations.

Note: Farmer who owned farm near well 5 was deemed innocent of any wrongdoing as he followed accepted

guidelines for spreading of manure

How did contaminated water get into the town water supply in the first place ?

Long before scandal, geological circumstances indicated that Walkerton water supply was at great risk of contamination.

Government-approved wells 3, 6 and 7 lie on thin, permeable deposits of sand and gravel atop very permeable limestone (also, well 5 near a high-risk area).

Recent Developments

   

Frank and Stan Koebel, the two brothers at the centre of Walkerton's water tragedy, pleaded guilty to “common nuisance” on Nov. 30, 2004.

“Common nuisance” = failure to carry out a legal duty and endangers the lives, safety, health, property or comfort of the public.

Judge O'Connor also stated that Ontario's Conservative government was partly to blame for failing to properly assess the risks attached to its cost-cutting measures in the area of ensuring acceptable water quality .

December 20, 2004 - Sentencing

Stan Koebel sentenced to 1 year in jail (received greater blame on account of delaying boil water advisory).

Frank Koebel was sentenced to 6 months house arrest and 3 months night curfews.

April 8, 2005 – Koebel Granted Parole

Stan Koebel granted parole (serving less than 4 months of 1 year sentence). Parole granted early parole on grounds that Koebel was a first-time offender and had shown remorse.

So…

Aside from the wrongdoing of Koebel, and Conservative government greater care should have been taken to choose water well sites. Wells drilled into areas underlain by permeable soil, sediment and bedrock are highly prone to surface contamination.

Rudimentary knowledge of geology can go a long way in preventing disasters like this!

And yet…as of November, 2005

Following evacuations of Kashechewan in northern Ontario in late 2005 (due medical problems associated with water contamination), it has been found that 37 native reserve communities (out of a total of 123) are currently on boil water advisories in Ontario.

Many of the medical problems (including skin disorders) are related to the huge amounts of chlorine used to treat bacteria in the contaminated water (and the treatment plants tend not to run efficiently).

Conservative Leader Stephen Harper called Indian Affairs Minister Andy Scott "incompetent“ for his slow action on the matter (here we go again) .

END OF LECTURE