BARADRIL-N 4-6 Panorama general 4-

The Laboratory’s initial remedial actions largely took place within the confines of DNAUI and were implemented under the supervision of Richard Guerrieri, the DNAUI Unit Chief. By April 15, 2002, Guerrieri was convinced that the lack of negative control data in Blake’s work was not the result of equipment failure or other accident. Effective that day, he implemented a new policy requiring DNAUI STR case documentation to include hard copies of the electronic raw data files for all casework samples that depicted a negative result. In addition, the new policy provided that the STR documentation must be reviewed by the reporting Examiner and confirmed by a second Examiner. The decision also was made to limit the scope of the Laboratory’s initial inquiry to the testing that Blake had performed as a PCR Biologist and not to examine her serology and RFLP examinations.51 _{The DNAUI collected all the electronic}

raw data from Blake’s STR tests and the training program files that she had completed.

By April 30, all of Blake’s STR casework for Giusti and a second

Examiner had been identified and was being categorized through the following priority system: reported inclusions (i.e., matches with known DNA samples), reported exclusions (i.e., elimination of match possibility with known DNA samples), and inconclusive results. This analysis led to the creation by early summer 2002 of a database of Blake’s STR cases, which included information such as whether a DNA report had been issued from the DNAUI and the case status (i.e., phase of DNA testing). In all, Blake’s STR analyses were identified

51 _{In October 2003, the OIG asked the FBI what assessment the Laboratory had}

conducted of the risk that Blake had also committed misconduct while employed in the DNAUI as a Serologist and RFLP technician. The Laboratory replied that it was not prepared to offer a response at the time and thereafter interviewed Blake’s former supervisors about her early work in the DNAUI. The same month the DOJ Criminal Division wrote to the Laboratory Director and recommended that the FBI “formulate a strategy to determine if Jacqueline Blake violated any protocols in her previous work assignments in the FBI laboratory,” and that “[t]he FBI should work with the Criminal Division to design a plan for a preliminary inquiry . . . .” The Laboratory responded by letter dated January 28, 2004, that its risk assessment was completed and that it “is not aware of any outstanding technical issues that would potentially compromise the testing results previously generated by Ms. Blake in the areas of serology and RFLP analysis.” The Laboratory reached this conclusion based on the facts that: 1) the analysis of her STR casework had not identified any “procedural departure[s]” other than her failure to process the negative controls; 2) the methodologies used in serology and RFLP work do not involve the use of amplified products from negative control samples; 3) any irregular control performance would have been detected through the quality assurance program and promptly addressed; and 4) the Laboratory’s quality assurance controls, including proficiency testing programs and the direct supervision of Examiners, were in place when Blake was performing her serology and RFLP work. In short, the FBI Laboratory has expressed that it does not believe that an examination of Blake’s work from August 1988 to March 2000 is warranted because Blake’s primary failing was her aversion to processing STR negative controls – something that was not part of her serology and RFLP duties - and it is confident that its quality assurance controls would have caught her if she engaged in misconduct.

in 103 cases. Of these, no DNA had been identified in 11 cases, Blake failed to process the negative controls and reagent blanks in 90 cases, and she properly performed the tests in 2 cases. Out of the 90 cases in which Blake failed to process properly the controls, DNA analysis reports were sent to evidence contributors from the DNAUI in approximately 45 cases.

Guerrieri also developed a sampling plan to determine whether other biologists in the DNAUI failed to conduct the negative control tests. Ten active case files from each DNAUI PCR Biologist were scrutinized by the Unit’s

Examiners. All files, except those for Blake, indicated that the negative control specimens had been processed. Based on this evidence, the Laboratory

concluded that the omissions in question were limited to Blake.

In addition to work within the DNAUI, Guerrieri promptly notified other units within the Laboratory of the Blake situation. On April 15, he spoke with John J. Behun, Chief of the FSSU and NDIS Manager. Behun concluded that all DNAUI specimens that Blake processed through STR analysis that were entered into NDIS should be identified and removed and placed into a temporary target batch file until the matter was resolved. This work was completed by early May 2002, and 29 profiles were removed from NDIS. DNAUI agreed to notify the FSSU of any confirmed NDIS matches involving DNA profiles generated by Blake and other NDIS contributors, to inform those contributors of the problem, and to attempt to reanalyze the negative control specimens and/or the remaining physical evidence. The DNAUI subsequently identified a single match through NDIS that had been generated by an external lab prior to the removal of Blake’s profiles.52

Guerrieri also met with the DNAUII Unit Chief. In addition to her

casework, Blake had performed STR analyses on some reference blood samples from incarcerated individuals within the Federal Convicted Offender Program managed by a DNAUII Examiner. Guerrieri and the DNAUII Unit Chief agreed

52 _{The NDIS match was generated from a convicted offender sample. The underlying}

criminal case involved an investigation of extortion, and the evidence tested was a letter. The FBI Laboratory, through the local FBI field office, requested a blood sample from the

incarcerated offender to verify the match. After Blake’s misconduct was discovered, the Laboratory also requested the return of the original evidence sample for retesting. The Laboratory never received the requested blood sample and the evidence was not returned for retesting. Follow-up contact by the Laboratory subsequently disclosed that prosecution was declined in the underlying criminal action. In another matter, the DNAUI generated a match in NDIS between one of Blake’s profiles and an incarcerated offender. After Blake’s misconduct was discovered, the profile was removed from NDIS and retesting performed. The newly generated profile matched the DNA profile of the same offender that previously was identified by NDIS. In addition, the Laboratory identified matches in a local DNA database from two of Blake’s profiles. In one case, the FBI obtained resubmitted evidence and issued a new report. The profile from the retested evidence matched a profile in NDIS. The FBI is still waiting to receive evidence in the second case despite repeated requests to the contributor to resubmit its evidence.

that these samples should be located and retesting performed where appropriate.53

The Laboratory also sought guidance from FBI Headquarters, including the FBI’s OPR and OGC. In mid-April, Adams met with Michael DeFeo,

Assistant Director for OPR, and agreed that the Laboratory would forward documentation describing Blake’s conduct to OPR for review. DeFeo advised Adams that the matter would have to be referred to the OIG. Guerrieri and DiZinno subsequently met with an OPR Unit Chief to brief him on the Blake matter. DiZinno said that the Laboratory hoped to receive guidance on what corrective actions should be implemented, including whether the Laboratory needed to evaluate Blake’s serology and RFLP work. The OPR Unit Chief told them to furnish him with a written report outlining the misconduct allegations and the actions taken by the DNAUI in response to the discovery of the

misconduct. On April 30, 2002, the Laboratory provided a 6-page

memorandum to the FBI Director, with a copy to OPR, that described Blake’s actions.

On May 7, 2002, OPR forwarded Guerrieri’s April 30 Memorandum to the OIG, which began an investigation. As mentioned earlier, over the next five weeks OIG staff interviewed Laboratory personnel, examined documents, and met with representatives of FBI OGC. At a meeting on May 21, 2002, OGC explained that it would be heavily involved in the FBI’s notifications to

prosecutors, including providing legal guidance, and that the Laboratory would manage the Bureau’s response to the Blake matter. The OGC and OIG agreed that the OIG would not be involved in managing the FBI’s activities, though information would be shared to ensure that there was no interference with the OIG’s investigation. The FBI OGC also explained that a management plan would be developed.

Following these developments, the DNAUI focused some attention on its operating procedures. In July 2002, as part of the Unit’s annual review of its protocols, Guerrieri requested that DNAUI program managers take into

account Blake’s misconduct when formulating proposed protocol revisions. However, other than the requirement that GeneScan® _{data be included in the}

case file for review by the Examiners, Guerrieri did not receive any suggested modifications to the protocols from his staff. In addition, later that year Guerrieri initiated a project to map case processes in the DNAUI to facilitate communications and decision-making. See generally Chapter Five, Section III.A.2 (describing need for decision aids).

53 _{Blake processed 105 offender samples. The Laboratory has retested 75 of these}

samples and expects to complete retesting of the remaining 30 by the end of March 2004. The Convicted Offender Program currently has a backlog of 24,000 samples waiting to be

B. Identification and Processing of Cases That Required