Charges sought against two over safety at drowning site

The long-awaited report from District Attorney C. Samuel Sutter accused two Department of Conservation and Recreation supervisors of endangering children by opening the pool when it was unclean and unsafe.

“It was a sad saga from the moment they started to put the water in the pool, and it became a tragic saga once Marie Joseph went under,’’ said Sutter, who described a systemic failure of DCR employees to make sure the Vietnam Veterans Memorial Pool in Lafayette Park in Fall River was safe for swimming when it opened on June 25.

Troopers assigned to Sutter’s office filed applications for criminal complaints yesterday in Fall River District Court against DCR district manager Jeff Carter and DCR regional director Brian Shanahan. After a show-cause hearing, a clerk magistrate will decide whether the misdemeanor complaints will be issued. If convicted, they would face up to 2 1/2 years in jail.

Shanahan has already resigned, and Carter was placed on paid administrative leave after the drowning, state officials said.

It is unusual, but not unheard of, for prosecutors to seek criminal charges against public employees for failing to do their jobs, said a spokesman for the district attorney’s office.

Joseph, who could not swim, drowned in the deep end of the pool June 26, but the water was so murky that lifeguards did not find her body for two days.

“If the water clarity was as it should have been, the chances of a lifeguard seeing her go under would have been exponentially increased,’’ said Sutter, who did not bring felony charges in connection with her death because no individual acted in a “wanton and reckless’’ manner.

Using video, investigators determined it took only seven seconds for Joseph to sink, the report said. She apparently did not struggle.

DCR Commissioner Edward M. Lambert Jr. issued a statement last night saying the agency “takes this entire report and investigation very seriously and intends to use the DA’s report to inform future safety measures of our facilities.’’

A number of policy changes have already been made, he said. The agency, which undertook its own investigation, will use the district attorney’s findings to complete its own investigation, said DCR spokeswoman S.J. Port.

In the 20-page report, Sutter described a failure that extended beyond Carter and Shanahan, though they were most directly responsible.

No lifeguards were to blame, Sutter said. Prosecutors could not substantiate statements by a 9-year-old boy that he told two lifeguards Joseph had drowned and that they did not respond.

Investigators could not corroborate the boy’s statements that when he tried to alert the lifeguards, one left to go on a break without checking what he said he had told them, and the other told him not to worry because it was almost time for the pool check.

One lifeguard remembered being approached by a boy and being asked if she had seen his aunt or mother. “The boy gave no further information to the lifeguard,’’ Sutter wrote.

A friend of Joseph’s said yesterday that she was stunned by the report’s findings.

“I’m in shock at what you’re telling me,’’ said Candela Matta, 22, who was also Joseph’s neighbor. “How many people were there? How many days was she in the pool? How did no one notice her body in that pool? . . . The pool shouldn’t have been opened when there was somebody floating in the pool.

“Nobody is being held responsible for what they were responsible for,’’ she said.

In the days leading up to the opening of the pool on June 25, Carter ordered workers not to chlorinate or filter the pool, apparently to save money, the report said. A vacuum was also not working. Left untreated, the pool became populated with algae and became “essentially a swamp,’’ Sutter wrote.

A maintenance worker, returning from a week’s vacation on June 20, saw the “pea soup green’’ water filling the pool and complained to Carter, who only then, five days before the pool would open, agreed to chemically treat the pool.

By the time the staff started adding chlorine, Sutter wrote, it was too late. When the pool opened for the season on June 25, the water was still cloudy.

The next day, unable to correct the problem, managers closed the pool’s deep end at 3:30 p.m., but Joseph had drowned 15 minutes earlier.

The next day, as Joseph’s body lay on the bottom of the pool, staff reported no problems.

“Good opening weekend,’’ a DCR operations report stated. “No incidents or issues reported, and facility looks great.’’

After Joseph’s body was found, a water sample was sent for lab testing. Visibility in the pool was only a fraction of what was required under Department of Public Health Regulations, whose rules require that any operator “immediately close the pool until the pool water conforms with those standards.’’

But the pool was never inspected by the Department of Public Health, Sutter wrote.

Shanahan contradicted Carter when he told investigators that he did not know the filtration system was not working during the week of June 12. Carter said he had notified him.

Shanahan also told investigators he did not think it was his responsibility to ask the Public Health Department to inspect the pool.

“He likened his approach to driving a car without a current inspection: You drive the car and wait to be pulled over; only then do you get an inspection sticker,’’ wrote Sutter. But Shanahan conceded he did not think safety was up to par at the time of the drowning.

Sutter’s findings, he said, “catalogue a series of poor decisions, errors compounding errors, and disregard for regulation.’’

At least two other public employees lost their jobs after the drowning including a Fall River health inspector, who issued a permit approving the pool for use even while Joseph’s body was at the bottom. That inspector, Roger Casavant, inspected the pool two days after the drowning, noting that the water was cloudy. But he did not notify authorities or recommend that the pool close.

Bill Baker of the Globe Staff contributed to this report. Andrea Estes can be reached at estes@globe.com.