New York state has issued 14 violations to two fire departments regarding the Dec. 19 line-of-duty death of Mount Marion volunteer firefighter Lt. Jack Rose.

The Public Employee Safety and Health Bureau of the state Department of Labor issued the violations in early May. The Times Herald-Record obtained the reports on the two departments through a request under the Freedom of Information Law.

Two key findings in the reports point to possible contributing factors in Rose's death:

n Rose, who was 19, was using someone else’s self-contained breathing apparatus pack — equipment he had not been fitted for and not trained to use — that he grabbed off the truck of a different fire department at the scene of the fire that night.

n Rose and the firefighters with him inside and outside the house failed to stay in contact.

The citations are based on a lengthy investigation, including interviews with those at the scene, done by both PESH investigators and Saugerties police. Safety and health officials issued eight violations to Rose’s Mount Marion Fire Department and six violations to the Centerville Fire Department.

The fire at 11 Fel Qui Road in Saugerties was in the Centerville Fire District and, as such, Centerville was in charge at the scene. It sent one truck and seven firefighters. Mount Marion responded with two trucks and six firefighters, including Rose, under mutual aid, according to the reports.

Fire chiefs of the Mount Marion and Centerville departments did not respond to interview requests.

According to the reports, Rose had second-degree burns on his nose and his lower forehead. “Lt. Rose may have removed his mask in order to obtain these burns,” the Mount Marion investigation report says.

The Centerville investigation report says the burns “are likely from a heated object striking him in the face, such as an open door.” Or, the report said, his face could have struck something as he was being taken from the burning building.

The mask was not the one specifically fitted to Rose. Neither report explains where Rose’s Scott brand SCBA was that night. Both reports quote another Mount Marion firefighter saying that he and Rose “grabbed two SCBA packs off the Centerville fire truck.” He also commented to police that “firefighters, on occasion, will grab SCBA packs from another department’s fire trucks.”

The air pack from the Centerville truck was a different brand.

Rose got separated from the other firefighters. “Why this happened is unclear,” the Mount Marion report says. “Additionally, due to the presence of thick smoke and high-temperature conditions, it is believed that Lt. Rose became disoriented as to his position relative to the exit door and thus began searching for an exit.”

Rose, the reports state, did not tell the two firefighters with him on the hose line in the basement that he was leaving. They did not keep track of him either, nor did those outside the basement who were supposed to monitor firefighters inside the house.

Both department are required to correct the violations, though the time frame for those actions was not detailed in the reports. Failure to correct the violations could result in fines of up to $200 a day per violation.

pbrooks@th-record.com