There were “serious breaches” of regulations that led to an Army lab repeatedly shipping out live anthrax spores to 194 labs in the United States and abroad over the course of a decade.

In a heavily redacted report released Friday, the Army acknowledged that a “culture of complacency” was permitted to “flourish” at Dugway Proving Ground (DPG) in Utah, a major production and testing facility for the military’s chemical and biological defense programs.

This included, among other notable lapses, a “failure to investigate and hold personnel accountable for biological mishaps” and commanders who “blamed external entities or downplayed the seriousness of the incidents in reports to higher headquarters.”

The commander who was cited repeatedly in the report is Col. William King IV, who commanded Dugway from 2009 to 2011 and has since been promoted to brigadier general.

Last year, he took command of the 20th Chemical, Biological, Radiological, Nuclear, Explosives Command at the Army’s Aberdeen Proving Ground in Maryland.

“Colonel King repeatedly deflected blame and minimized the severity of incidents,” the report notes. “Even now, Brig. Gen. King lacks introspection and fails to recognize the scope and severity of incidents that occurred during his command at DPG.”

Surveillance cameras at Dugway showed personnel dropping anthrax samples and failing to properly clean up, for example. Personnel also “manipulated and carelessly generated critical documents,” according to the report.

Army officials stressed at a Pentagon press conference Friday that these failures “did not pose a risk to public health,” mostly because the lab workers who handled the anthrax spores “used proper protective equipment at all times,” said Maj. Gen. Paul Ostrowski, who led the review team.

Still, “by any measure, this was a massive institutional failure,” Deputy Defense Secretary Robert Work said in July, when the Army issued its initial report on the breach.

It was last May that a private company phoned the Centers for Disease Control and Prevention (CDC) in Atlanta to let officials know that it received what it thought would be inactive anthrax spores from the Army.

The problem was that they were not inactive. They were live spores that had been shipped across the country from Dugway. One month earlier, the same thing had happened. The incident set off a series of media reports and Pentagon investigations.

The anthrax samples sent out by Dugway are used by companies to run diagnostics in equipment and devices that are meant to detect biological threats that could be used, for example, in terrorist attacks at airports and other public spaces.

The CDC, with Pentagon support, determined that over a 12-year period, samples of viable anthrax had been sent by Dugway to 194 labs.

In August, the CDC formally suspended Dugway’s right to possess, use, or transfer any agents or toxins for failure to comply with safety regulations.

In examining the way forward, Army officials said that there should be more oversight, including inspections that “should not be announced,” said Major General Ostrowski, so “we can see the lab working as it does on a daily basis.”

The Army report also noted that Dugway “often had a difficult time drawing in new highly educated and experienced scientists because of its remote location” – some 90 miles west of Salt Lake City.

The “senior virologist” in its microbiology branch, for one, had only a high school education, and many others “do not have the expertise to ask the questions that due diligence would have required,” noted the report, which posited that perhaps hiring practices at the facility, in which third- and forth-generation workers are often brought on, should be examined.

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Though scientists had complained about safety practices, some Army personnel acknowledged that while they received the complaints, they dismissed them in at least one instance as the “innate tendency of scientists to constantly question the skills of their colleagues as a reason why the accusation did not need to be taken seriously.”

It was, the report concluded, a series of “missed opportunities.”