Abstract: At approximately 1:00 p.m. on January 31, 2001, Employee #1, part of a barge cleaning crew, appeared incoherent and fell from the barge into the river. The cleaning crew was cleaning the "Sarah B.", the largest crane barge on the Mississippi River. The barge was moored approximately 20 ft from the shore of the Mississippi River. Employee #1 started working at approximately 8:00 a.m. performing various tasks: remove boxes and trash from inside the crane pedestal and the work shed; and washing down the deck using a water hose and shovel to clean the deck. As the day progressed the site supervisor noticed that Employee #1's work performance deteriorated. Employee #1 appeared to be walking and working very slowly and as the morning progressed he became less and less coherent. The supervisor called the main plant around lunchtime and asked that Employee #1 be removed because of the way he was acting and responding to directions. The supervisor did not reach anyone at the main office so Employee #1 continued to work. At approximately 1:00 p.m. the supervisor went to get Employee #1's timecard and came back to find that Employee #1 had removed his work vest. The supervisor spoke to the Employee #1 but by this time Employee #1 was incoherent and non-responsive. As the supervisor approached Employee #1, Employee #1 fell back off the edge of the barge into the Mississippi River. It was a 4.5 ft drop to the water from the edge of the barge. The barge crew went to get a long retrieval pole and tried to fish Employee #1 out of the water. The crew attempted for 15-20 minutes before rescuing Employee #1. The deck at the edge of the barge had the usual rope anchor points attached to the deck and a large rubber tire was attached to the side of the barge directly below where Employee #1 was standing prior to the incident. There was a ramp on the shore next to the barge where oil deliveries are made to the barge. There was no measurable wind, no river surge and no measurable current. When Employee #1 fell into the water, he made no attempt to stay afloat or to save himself. When Employee #1 was recovered from the river, an insulin bottle was found indicating that he was a diabetic and may have experienced diabetic shock. In the official autopsy, the medical examiner also leads toward the insulin factor although the primary cause of death cited is drowning. Employee #1 was killed.