Final city water report: Richmond's water crisis worsened by miscommunication

• Both are from HNTB Corp., the Kansas City-based infrastructure firm the city hired, which visited the Richmond plant over three days in late January.

State of play: HNTB makes clear in its final report that the lack of emergency protocols inside the plant, plus poor planning, training and communication, turned an equipment failure issue into a full-blown crisis.

Zoom in: "There were several communication deficiencies," both internal and external, throughout the day on Jan. 6, according to the report, including:

• A failure to "adequately convey" to the counties the severity of the issues at the plant until sometime between 1 and 2pm, 8 hours after the initial outage.
• There was no clear communications structure for staff responding to the issues at the plant, which caused workers to only communicate in small groups.
• The poor communication led to plant staffers incorrectly reporting to the city that a backup generator had been started and was operational.
• It wasn't, and the HNTB says they couldn't trace the origin of the claim, only noting that it was widely shared.
• "A misrepresentation like this likely caused a false sense of security by City and regional leaders early on in the crisis," per the report.

Other notable findings:

• There was "little proactive action" taken by staff at the plant to prepare for the storm or a possible power outage, despite the state and city being under a state of emergency.

• The lack of storm planning included a failure to test backup equipment that could be needed in the event of a power outage.
• The plant's internal organizational structure at the time added to staff's confusion because it was unclear which department should've been responding to what became multiple failures inside the plant.

What's next: The city is working to implement the report's recommendations, Mayor Avula said in a statement.