No “single factor” led to the devastation caused by the Lahaina fires that killed 102 people, left thousands homeless and decimated the visitor industry, according to the second phase of findings from the state Department of the Attorney General’s investigation of government’s management of the disaster.

“The report reveals no single factor led to the devastation. Instead, a complex set of factors including weather and its impacts, risk and preparedness, decades-­old infrastructure, organizational structure and incident management and coordination created a historic disaster,” according to a statement from the Attorney General’s Office.

The official cause and origin of the Aug. 8, 2023, Lahaina fire has not been determined, more than 13 months after the historic West Maui town burned.

The U.S. Department of Justice’s Bureau of Alcohol Tobacco, Firearms and Explosives and the Maui Department of Fire and Public Safety have yet to finalize their findings, and no timetable is set for public release.

Maui firefighters have a meeting scheduled for 8 a.m. Tuesday with representatives from the ATF.

“But at this time we have no timeline on when we will receive the finished report from them,” according to a statement to the Honolulu Star-Advertiser from the MDFPS.

Separate from that investigation into the official cause, the state hired the Fire Safety Research Institute to conduct an investigation of government agency actions up to and during the first 24 to 72 hours of the fire.

FSRI’s contract is currently capped at $4 million, a $2.5 million increase from the initial $1.5 million. The increase was approved March 19.

Derek Alkonis, FSRI research program manager, speaking to reporters Friday, explained that Maui firefighters and ATF agents will tell the public exactly how the fire started, where it sparked, how it spread, and detail how it spread through Lahaina.

“We pick up the fire at the moment it hits structures. We pick up not only the fire, but all of the events that go into that, the evacuation effort … even before that, the prevention piece, the preparedness piece, the interactions with other agencies,” said Alkonis. “So our report is a comprehensive report in the way of looking at prevention and preparedness. The actions of the Fire Department, the Police Department, the emergency managers and other emergency responders.”

Hawaii has a “very high risk of wildfire” — higher than 88% of other U.S. states; and Lahaina has a 98% higher risk than the rest of the country, according to the findings.

“I think the risk (of wildfires right now) is real, is a present danger, and climate change will only make things worse,” said state Attorney General Anne E. Lopez, speaking to reporters in the basement of a state office building, noting the need for immediate action on the findings in the report. “We need to understand what a red flag warning means. We need to know what it means when we park our cars on both sides of the road in front of fire hydrants. We need to understand what it means when we keep all of our stuff, and we all have it, in our garages, inside of our house and next to our neighbors’ … that kind of complacency. … We have to bring an urgency to the fact that we have a lot to learn.”

The 518-page Lahaina Fire Incident Analysis Report makes 84 unique findings and 140 recommendations for improving preparation, vegetation management, communications, collaboration between stakeholders, and other policy and operational issues.

“Accurate and comprehensive data for every component can sometimes be lacking and can potentially lead to intermittent and/or unintentional gaps in the analysis. Some of the data gaps are due to the County of Maui being unable to produce the data requested, or difficulties experienced extracting usable data from some file formats provided by the County of Maui,” cautioned FSRI. “Known data gaps will be identified throughout the report. The clear framework of the Cohesive Strategy ultimately helps focus and define the boundaries of the analysis.”

Maui County responds

In a statement, Maui Mayor Richard Bissen said officials continue to “stand in steadfast support of the firefighters, police officers, emergency response personnel, and its residents who heroically sacrificed their personal safety to assist our community.”

“We continue to regard their efforts in August 2023 — to suppress four simultaneous fires amidst extreme weather conditions across both wildland and urban conditions — as the highest form of service to our people,” said Bissen.

“The County remains committed to a transparent and thorough investigation that will help us identify and implement best practices — many that have already been established to protect the health and safety of our community.”

He said most of the information used in the attorney general’s report “came from the County and its hard- working and resilient public servants.”

“To date, the county has delivered to the state over 50 separate productions of documents (containing over 23,000 distinct files, including approximately 8,000 video and audio files; more than 85,000 pages; and approximately 125 GB of data) and has made its personnel, directors, deputies, and employees available for over 150 technical interviews and numerous site visits into and around the affected areas. Technical interviews continue to this day, with another scheduled for next week,” said Bissen.

These technical interviews were compelled by the Attorney General’s investigatory powers, and the interviewees were “not offered immunity from subsequent civil or criminal prosecution in exchange for their testimony,” he said.

“The interviewees were not notified that their recorded interviews would be released by FSRI as part of a public media presentation,” said Bissen.

The only Maui official who declined to be recorded for technical discussions was Bissen, who followed legal advice given by Maui’s corporation counsel, Victoria J. Takayesu. Bissen sat for an interview but asked that it not be recorded.

Recommendations

According to the report, the perception of the risk associated with wildfires needs to be emphasized at the county, state and federal levels in cooperation with the community.

One recommendation is to improve “decades-old infrastructure standards,” including community planning, codes and standards, public utilities and vegetation management.

All “were key contributors to the widespread fire destruction in Lahaina. Lahaina’s dense urban layout turned tragic as the fire’s initial impact hit the most populated area, rapidly spreading through closely packed structures and creating severe evacuation obstacles,” the report concluded.

The report also found that incident management and coordination during the wildfires “consisted of a siloed command structure that contributed to a lack of communication both to the public and responding agencies.”

In more than 600 civil actions that are part of a proposed $4 billion dollar deal to settle all legal claims, plaintiffs nearly always blamed the fire on live power lines from Hawaiian Electric Co. that were downed by strong winds from a passing storm, the flames being fueled by dry vegetation on land owned by the state, Maui County, Kamehameha Schools and West Maui Land Co. Additionally, Spectrum Oceanic LLC and Hawaiian Telcom, which share infrastructure with Hawaiian Electric, are defendants in many cases.

Weather warnings

The report was critical of state and county first responders and emergency operations officials for ignoring several dire warnings about fire conditions from the National Weather Serv­ice in the four days leading up to the fatal fires.

An Aug. 4, 2023, email sent by a NWS forecaster to fire managers was “above and beyond” NWS’ typical notification process, according to the report.

“Due to the exceptional certainty of the forecast models, and the obligation to inform emergency managers of the wildfire risk, the email was sent to provide unprecedented advance warning of the approaching fire weather due to arrive late August 7, 2023, and strengthen into August 8, 2023,” read the report.

The Hawaii Emergency Management Agency held a statewide briefing Aug. 4, 2023, and “several more high fire danger forecasts” followed the Aug. 4 email.

The email included language “not typically used” by a forecaster: “There is higher than normal confidence in the forecast track,” “there is significant concern that strong trade winds will develop sometime Monday and peak Tuesday,” “critical fire weather on Tuesday,” and, “NWS conditions this many days away is quite rare,” according to email excerpts quoted in the report.

“The strongly worded nature of the email, had it been communicated to fire managers in other states with better developed severity preparedness strategies, could have gained attention and prompted discussion and operational planning,” the attorney general’s investigators wrote. “It was a call for State of Hawaii fire managers to prepare for the impending extreme weather. Although MFD chief officers discussed the forecasted weather well before August 8, 2023, no evidence of pre-event preparedness plans by the MFD were produced.”

The state Hawaii Emergency Management Agency, county Department of Water Supply, Maui Police Department and Hawaiian Electric Co. were “also aware of the impending weather, but did not provide evidence of pre-event preparedness planning.”

The Maui Emergency Management Agency responded by partially activating the Emergency Operations Center with two people on the night of Aug. 7, 2023.

“It is surprising that the MFD and MPD did not prepare more for these Red Flag conditions, especially given the advance warning provided by NWS Honolulu and having previous experience with the 2018 Lahaina Fire,” wrote the state’s investigators. “This lack of preparation could be related to the lack of attention wildfire preparedness and prevention receives statewide. Based on our findings, it does not appear that any consideration was given to adding resources in advance of the Red Flag days, or planning responses to various ‘what- if’ scenarios, from a strategic and resource deployment perspective.”

2018 fire lessons

An ongoing point of contention between state investigators and Maui County officials is what, if anything, was done to improve wildfire management and preparation on Maui in the aftermath of a 2018 wildfire in Lahaina.

County officials have refused to respond to Honolulu Star-Advertiser questions about what they learned, what recommendations were made and what was done in the aftermath of the 2018 West Maui fires.

“We have one report that has been released (on that 2018 fire). … It was a preliminary report, it was not finalized, but we all saw it. We have not seen a report for the Police Department or the Fire Department for the 2018 fire,” said Alkonis. “We are going to learn more about that fire. We have an interview with the incident commander … next week to hopefully learn more details. I can’t really comment on what we can learn because we don’t know enough about that fire. But we’ll know more.”

The 2018 fire, fueled by winds from Hurricane Lane, burned 2,100 acres and destroyed 21 structures and 27 vehicles, with estimated damage totaling $4.3 million, according to the report.

“At the time, it was the most destructive wildfire in Hawaii’s history,” read the findings.

Maui Emergency Management was the only county agency to initiate an after- action review, but it was never finalized and was titled a “preliminary report” with an August 2019 date on the cover. It was not released until news media made a public-records request after the Lahaina tragedy.

“The AAR (after-action review) mostly focuses on MEMA responsibilities and does not address the operational response efforts of the MFD and MPD,” read the state’s findings. “Documenting experiences from previous incidents is essential to understanding where improvements to prevention, preparedness, and operations can occur. An AAR can also serve as an important benchmark for measuring change over time. Knowing the lessons learned from the 2018 fire, and the changes implemented afterwards, can help with tracking improvements over time.”

FSRI investigators requested a “technical discussion” with the 2018 Lahaina fire incident commander, Amos Lonokailua-Hewett, who now serves as MEMA administrator.

The county maintains the state’s investigators do not have the authority to review the 2018 incident, and the attorney general issued a subpoena to compel Hewett’s testimony.

County attorneys filed a motion to quash the subpoena. The state and county stopped their legal wrangling after “the County of Maui agreed to make the incident commander available for an interview with FSRI in September 2024.” “As a result, the analysis of the 2018 Lahaina fire was limited,” wrote the state’s investigators.

Analysis report

For the 518-page report, visit d1gi3fvbl0xj2a.cloudfront.net/2024-09/FSRI_Lahaina_Report__Redactions_09102024.pdf.