Coast Guard to enact sweeping safety reforms in wake of deadly Conception boat fire

Fire aboard the Conception dive boat.
Thirty-four people died in the 2019 Labor Day fire aboard the Conception dive boat off the Channel Islands.
(Ventura County Fire Department)

More than a year after the worst maritime disaster in modern California history, the U.S. Coast Guard said it would enact a sweeping series of rules and other reforms designed to make small passenger vessels safer.

The changes come in response to the 2019 Labor Day fire aboard the Conception dive boat off the Channel Islands, which killed 34 people and exposed a series of serious flaws in boat safety later detailed by a series of Times reports and an investigation by the National Transportation Safety Board.

The Coast Guard told the NTSB this week that it agreed with seven recommendations for major changes, including mandatory checks to make sure roving watches are occurring, better smoke detector systems, mandatory safety management systems and improved emergency exits.


The NTSB found all were lacking aboard the Conception when the 75-foot boat caught fire in the early morning hours of Sept. 2, 2019, killing 33 passengers and one crew member sleeping below deck. The NTSB concluded in October that the boat’s owner, Truth Aquatics, failed to have effective oversight of the vessel and did not operate a required roving watch that probably would have detected the fire sooner and could have saved lives.

And though it placed much of the blame on Truth Aquatics, the agency did not spare the Coast Guard, finding that “contributing to the undetected growth of the fire was the lack of United States Coast Guard regulatory requirements for smoke detectors.”

The Coast Guard, which regulates vessels, also had not implemented the NTSB’s previous recommendations for mandatory safety management systems for small passenger boats — despite a decade of calls by the NTSB — and had allowed older vessels like the Conception to have poor egress.

“I think the Coast Guard, vessel owners and the vessel builders were all grossly negligent for not taking these measures already,” said James Adamic, who lost his sister, Diana Adamic; brother-in-law, Steven Salika; and niece, Tia Salika-Adamic, in the Conception fire. “But it is better now than never.”

Vice Admiral Scott A. Buschman, the deputy commandant for USCG Operations, wrote that he concurred with the recommendations that newly constructed and existing small passenger vessels with overnight accommodation should have interconnected smoke detectors.

The smoke detectors provision, he noted, was included in legislation enacted last fall and the Coast Guard “is making new regulation to require interconnected fire detection equipment in all areas where passengers and crew have access.”


The NTSB determined that the lack of a roving watch and inadequate smoke detectors aboard the Conception allowed the fire, which began from an undetermined source in the back of the middle deck salon, to burn for several minutes before a crew member sleeping in the wheelhouse atop the three-deck boat was awakened by a pop, crackle and the glow of the flames.

NTSB Chairman Robert Sumwalt has said those below deck probably could have escaped if there had been early detection of the blaze.

The NTSB cited the failure by the boat’s captain, Jerry Boylan, and Truth Aquatics to comply with a Coast Guard requirement that it operate a roving watch whenever passengers were below deck. Boylan was charged in November with 34 counts of seaman’s manslaughter.

The Coast Guard, the NTSB board members noted, did not require logs of roving watches, so no vessel operated since the 1990s has been cited for failing to have one.

Buschman concurred with the NTSB that inspection procedures need to be put in place to verify roving patrols are being conducted on such boats. He said the Coast Guard, in the aftermath of the fire, conducted a “concentrated inspection campaign” of vessels with overnight accommodations and is using that to create an inspection program.

Buschman said the Coast Guard has already exercised its existing regulatory authority to mandate the logging of completed night watch patrols, and the provision will be added to boat inspections.

Coast Guard officials also agreed with the NTSB that both new and existing vessels with overnight accommodations must have better means of escape. The NTSB found the escape routes aboard the Conception “inadequate,” since both led into the same area that was engulfed in fire, and it recommended that boats have a secondary means of escape into a different space than the primary exit so that no single fire would trap passengers.

“The Coast Guard agrees that having independent escape routes exit into different spaces would decrease the possibility of one incident blocking both escapes,” Buschman wrote.

He acknowledged current regulation does not require that, but noted that the Elijah E. Cummings Coast Guard Authorization Act passed last December requires vessels to have two independent means of escape, and the agency is now setting new rules.

A Times investigation in the aftermath of the disaster revealed the Conception had been exempted from stricter safety rules designed to make it easier for passengers to escape. It was one of about 325 small passenger vessels built before 1996 and given special exemptions from safety standards that the Coast Guard imposed on new vessels, some of which required larger escape hatches and illuminated exit signs, records show.

In releasing the findings of its investigation, the NTSB also reiterated its recommendation that all U.S.-flagged passenger vessels implement safety management systems. Responding this week, Buschman said he agreed “with the intent of the recommendation” and said the Coast Guard is seeking public comment through April on making such a rule. He did note that a voluntary program is currently in place.

Glen Fritzler, the owner of Truth Aquatics, has denied wrongdoing and insisted that a crew member was awake when the fire was detected.

Coast Guard Capt. Jason Neubauer, chairman of the USCG’s Conception Marine Board of Investigation, informed the victims’ families on Wednesday in an email of the agency’s response and added that his panel’s work on “the incident remains ongoing and my final report of the investigation will provide additional safety recommendations for consideration by our Commandant.”

Kathy and Clark McIlvain, whose son Charles, 44, died in the fire, said they “are encouraged by the Coast Guard’s response” and they “hope these lifesaving recommendations are implemented quickly.”

California Sen. Dianne Feinstein, who worked with Reps. Salud Carbajal (D-Santa Barbara) and Julia Brownley (D-Westlake Village) on a new law mandating some of the changes, said she was “pleased by the Coast Guard’s move to implement the lifesaving changes our bill requires.”

“The Conception boat fire was a horrific accident that never should have happened,” Feinstein said. “Outdated safety regulations contributed to the tragic deaths of 34 passengers.”

NTSB Chairman Sumwalt, in an interview Thursday, praised the Coast Guard’s “quick concurrence and their good intentions.” But, he added, “we have seen this often where a federal agency will indicate they intend to do something and it drags and drags and drags.”

“The real proof in the pudding is actually getting it done, getting it over the finish line,” he said.