In May 2016, two bottles tumbled off a poorly supported shelf and broke, leading to a chemical spill in a Sacramento State University lab.
The liquid got onto one student's legs and soaked another's feet.
Five employees cleaned up the mess, even though no one knew for sure what it was and whether it was dangerous. They called fellow employee Kim Harrington, their union representative, to let her know what happened.
The spill initially was thought to be all acetone — a solvent used in many nail polish removers that can irritate the nose, throat, eye and skin at moderate to high levels of exposure. The campus did not identify the liquid until the next day, when staff determined that the broken bottles contained not only acetone but another more harmful solvent called dimethylformamide, a known liver toxin that can cause abdominal pain, dizziness, skin problems and nausea.
"No one knew exactly what it was so they cleaned it up the wrong way," Harrington said. "Two students were burned, and our staff was exposed to it. That started us down the road of trying to figure out … how safe is this environment?"
Harrington's ensuing inquiry eventually led to a state audit, released Tuesday, that looked into Cal State's safety measures in the handling of hazardous materials.
The Cal State Chancellor's Office, the audit concluded, "has not provided effective leadership to ensure that its campuses address health and safety concerns related to the presence of hazardous materials." The office hasn't ensured that campuses consistently report on safety or that they convene required committees to discuss such concerns, auditors said.
The audit, requested by Assemblyman Jim Wood (D-Healdsburg), examined four campuses — Channel Islands, Sacramento, San Diego and Sonoma —between July 1, 2014, and June 30, 2017 — and surveyed lab techs systemwide.
The audit recommended developing a "uniform health and safety reporting template" by November and the creation of a systemwide safety committee. The Chancellor's Office, the audit states, should require campuses to report on safety inspections each year.
Toni Molle, Cal State's public affairs director, said the Chancellor's Office agrees with the recommendations. "The university takes seriously the health and safety of all of our employees and students and the Chancellor's Office plans to conduct health and safety audits at all 23 of the campuses beginning in 2019," she said in a statement. She said Cal State already has convened task forces and lab safety training work groups.
After the spill, Harrington started questioning her colleagues about safety in their labs. "Door handles are rusting. Rubber bands are dissolving," said Cathy Hutchinson, a biology technician at Channel Islands. "They're exposed eight hours a day. That's where their office is, where they eat lunch."
Hutchinson said her co-worker was losing his taste buds — and would often find red bumps on his skin. Some workers, according to the audit, filed complaints saying that their work had damaged their health. Molle said the university had no records of workers' compensation claims for such injuries.
Campuses haven't made sure that lab equipment designed to prevent injuries is fully functional, the audit found. State regulations require that eyewash stations and shower equipment be flushed monthly to make sure they are working properly. But only Channel Islands kept to this schedule. San Diego let nine months pass between flushing the eyewash stations. Sonoma let nearly two years pass between checking its showers. An audit in 2001 had found similar problems.
In a Sacramento printmaking lab, if a student needed to shower, he or she would have to leave the building, cross a campus common area and enter a lab in which people work with acids.
According to a systemwide survey, 18 of 193 employees — from 13 campuses — said they had needed safeguards that were not always available.
People in labs handle noxious chemicals by placing them in fume hoods, to try to ensure that noxious chemicals don't penetrate the air or anyone's lungs, but Sonoma hadn't inspected some of those hoods for three years, the audit found.
Three campuses didn't post required signs about asbestos at the entrances of mechanical rooms.
Of 193 lab techs in art, chemistry, biology, engineering and physics departments, 36% said their lab training was ineffective or missing important information. One said she had last had training 20 years ago.