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Plan to Pay Sick Nuclear Workers Unfairly Rejects Many, Doctor Says
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Magnu-@aol.com
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Aug 21, 2009 07:00 PDT
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_http://www.propublica.org/feature/plan-to-pay-sick-nuclear-workers-unfairly
-rejects-many-doctor-says-731_
(http://www.propublica.org/feature/plan-to-pay-sick-nuclear-workers-unfairly-rejects-many-doctor-says-731)
_Health & Science_ (http://www.propublica.org/topic/health-science/)
Plan to Pay Sick Nuclear Workers Unfairly Rejects Many, Doctor Says
by Laura Frank, Special to ProPublica - July 31, 2009 11:00 am EDT
Dr. Eugene Schwartz (Andrew Greto/ProPublica)
Carla McCabe spent a decade building nuclear bombs at the sprawling Rocky
Flats complex near Denver. When she developed a brain tumor and asked for
help, federal officials told her that none of the toxic substances used at
the top-secret bomb factory could have caused her cancer.
Now, on the eighth anniversary of the federal program created to help sick
nuclear weapons workers, the man who until recently was the program's top
doctor says that McCabe, now 55, and many others like her are being
improperly rejected.
The doctor, Eugene Schwartz, _recently resigned_
(http://s3.amazonaws.com/propublica/assets/docs/schwartz_resignation_letter_20090417.pdf) [1] (PDF)
and in his first interview since quitting, he said many of the complaints
that workers, advocates and lawmakers have leveled at the controversial
program are valid. For instance, Schwartz said he repeatedly warned the U.S.
Department of Labor that it is ignoring established medical knowledge about
the dangers of bomb work.
"I was muzzled," said Schwartz, a Harvard-trained doctor with a master's
degree in nuclear engineering, whose job was overseeing medical decisions at
the federal compensation program.
The Labor Department took charge of the program, the Energy Employees
Occupational Illness Compensation Program, at its creation on July 31, 2001.
Today, it boasts that it has paid $5 billion in compensation and medical costs
to more than 52,600 former workers or their survivors. That averages to
$95,000 each.
But sick workers, who have banded together in multiple advocacy groups
across the nation, point out that the Labor Department has denied nearly three
out of four claims — 127,000 filed on behalf of sick nuclear weapons
workers or their survivors in the past eight years.
The sick workers and their advocates say they feel vindicated that Schwartz
confirms many of the complaints they've raised previously about waste,
bias and bad science within the program.
"He is saying what we've been saying is true," said Harry Williams, a sick
worker from Oak Ridge, Tenn., who helped found the national Alliance for
Nuclear Workers Advocacy Groups and has spent more than a decade trying to
help others. "With his credentials, the people in power will definitely have
to pay attention."
Schwartz said Labor continues to incorrectly tell weapons workers with
multiple diseases — including cancers of the brain, breast or bones — that
radiation and other toxic substances that permeated the bomb factories could
not have made them sick.
"That's madness," said Dr. Daniel Teitelbaum, a nationally recognized
toxicologist who helped review cases when the federal government began
compensating its sick nuclear weapons workers in 2001. In addition to working for
the government, Teitlebaum also has testified on behalf of sick workers in
other industries.
Teitelbaum and Schwartz said that multiple studies have found links between
brain, breast and bone cancers and exposure to toxic substances such as
plutonium, PCBs, and mixtures of chemicals and radiation — all key bomb
ingredients.
Those studies were subjected to scrutiny by other experts, what is known as
"peer review," before they were published in scientific journals.
But it has not been enough for the Labor Department.
When an official punched McCabe's diagnosis into the Labor Department's $11
million database of nuclear-related illnesses, nothing came back, her
records show.
A Labor Department document regarding her case reads: "The research did not
identify any toxic substances at the Rocky Flats Plant which are linked to
... any form of brain tumor."
The database did not include several peer-reviewed studies that have linked
glial brain tumors like McCabe's to radiation and chemicals known to have
been used at Rocky Flats. At least one of those studies, Teitelbaum said,
was done on workers at the now-demolished Rocky Flats site itself. McCabe
said she knows of at least eight coworkers who suffered similar brain tumors.
Program officials said they would send her case to another agency for
analysis of her radiation exposures. But she's not holding her breath. That
process takes on average two years, and none of her coworkers with brain tumors
— most of whom are now dead — have been compensated through that process
either.
The Labor Department declined to answer questions about its database or
make public the grounds on which it includes some diseases and excludes
others. It could not be learned how much consideration the peer-reviewed studies
of brain cancers received.
"Somebody needs to do something about this," Teitelbaum said.
Schwartz said he tried but failed.
The McCabe case, he said, illustrates the flaws he tried to address.
Schwartz said he began documenting his concerns shortly after he began work as
medical director at the compensation program in March 2008.
A former epidemiologist for the World Health Organization, the physician
and nuclear engineer from South Hadley, Mass., spent more than 30 years
working in his field, which assesses the effects of industrial processes on
workers. His research has focused on the causes and prevention of cancer and
occupational diseases.
But Schwartz said his bosses at the Labor Department largely ignored the
issues he raised, and then tried to silence him.
"The program needs scientific oversight," Schwartz said. "I was told
they're not going to do that — repeatedly."
Sen. Mark Udall, D-Colo., answers a reporter's question during a news
conference. (Chip Somodevilla/Getty Images)
U.S. Sen. Mark Udall, a freshman Democrat from Colorado, helped push for
the program as a congressman in 2000. This year, he introduced legislation
to reform it. He said Schwartz's statements confirm what he and others have
long believed.
"It is what I've suspected all along — an attempt by the agencies to delay
and deny benefits to workers of nuclear facilities," Udall said.
The most serious allegations Schwartz raised involve what are arguably the
two most important steps on the path to compensation and medical care.
One involves the very first step: Determining whether a worker was exposed
to toxic substances that could have caused the disease in question. The
other involves what is often the last step: Seeing whether a government-hired
doctor agrees that the worker's exposures did, in fact, cause his or her
disease.
In the first step, the Labor Department is supposed to use its database of
diseases and exposures to screen which cases deserve further investigation.
That initial screening is performed by a Labor Department employee, not a
doctor.
Sick workers have previously complained that some cases are wrongly
rejected for compensation because the database, created in 2006, is missing
information about both exposures and their links to disease.
Schwartz said they have a point.
"Claims are being denied because of these problems," Schwartz said.
Labor Department rules say the database should be used for guidance and
that the claims examiners should dig deeper if they suspect an illness arose
from work at a bomb factory.
Schwartz, however, said some claims examiners told him they had used the
database to decide cases without further review.
"The issue is how it is used — or misused," Schwartz said.
According to Schwartz, the disease-exposure links in the database were
decided by one doctor: Jay Brown, an occupational medicine physician from
Tacoma, Wash., who has a background in family medicine.
While the database has "this aura of scientific validity," Schwartz said,
it has never been peer reviewed and does not take into account the combined
effects of low-level radiation and toxic chemicals.
When asked about Schwartz's concerns, Brown replied via e-mail: "I don't
work on SEM," the Labor Department's acronym for the database, called the
Site Exposure Matrix. He referred all further questions to the Labor
Department.
Labor Department officials would comment only through a spokeswoman, who
said in an e-mail that Schwartz's concerns "were reviewed, discussed, and
addressed appropriately."
The agency spokeswoman added that Labor pays Brown to conduct "independent
research to identify established chemical-disease links specifically
focused on materials used in the Department of Energy complex." Brown puts the
links into a database he developed, called Haz-Map. He began compiling
Haz-Map in 1991 as a way to identify and prevent occupational disease, according
to his Web site. Haz-Map is published there and on the National Library of
Medicine Web site.
The Labor Department says Haz-Map automatically feeds its information into
the Labor database. Beyond that, Labor has released very little information
about it. Officials there declined to release Brown's contract or give
details about it.
Schwartz said that, before he resigned, he learned that the Labor
Department was poised to remove from the database more than 100 toxic exposures it
previously considered linked to disease.
"I asked about a half-dozen times to see the more than 100 links being
removed," Schwartz said. "I was rebuffed." He added, sardonically: "Talk about
scientific validity and transparency. Based on what science?"
More than half a million people have worked to build the nation's nuclear
arsenal since World War II. Less than 15 percent of them have filed claims
for aid, but that's still more than 180,000 former nuclear weapons workers —
or their survivors — and they are from every state in the nation.
The compensation program was created after the federal government admitted
that nuclear weapons workers had been exposed to dangerous levels of toxic
substances at more than 300 weapons sites across the country.
But only 29 percent of those who applied have been approved for aid, and
many of those received aid only after years of appealing.
The Labor Department, citing national security, has declined to provide the
entire database to sick workers who've asked for it.
As for the government-contracted doctors who help decide who gets
compensation, Schwartz said he examined the cases handled by doctors who review
claims and found a pattern in the denials from some high-volume doctors. But he
says Labor never investigated potential bias among these so-called
"district medical consultants."
Labor has never checked the credentials of these 80 or so medical
consultants, Schwartz said. He also says Labor was overstating the expertise of
some doctors.
"This is no small issue," Schwartz said. "If a doctor were being hired by a
hospital, his name would be checked through the National Practitioner Data
Bank, state licensure and board certification would be checked, and he'd
be asked to provide information on malpractice claims and Medicare
sanctions.
"This program hasn't done that."
The compensation program divides sick workers into two groups. Scientists
assess whether workers were exposed to high enough doses of radiation so tha
t it was "at least as likely as not" the cause of their cancer.
The cases of workers who believe their cancer or other diseases were caused
by chemical exposure — or a combination of chemicals and radiation — are
weighed separately.
Schwartz said this second category is where he found most of the problems.
According to Schwartz, the Labor Department has decided on its own that
radiation exposures can be ignored if they weren't high enough to be the sole
cause of a cancer.
Labor's rule book says "DOL has not found scientific evidence to date
establishing a synergistic or additive effect" between exposure to radiation and
other toxic chemicals.
Schwartz says this flies in the face of known science about how toxic
chemicals and radiation can work together.
"It is generally accepted that the effect of combined exposure will likely
be greater than either exposure separately," he said.
Schwartz showed ProPublica a document he says Labor sent to a medical
contractor who was reviewing the case of a worker with skin cancer that could
not be traced to radiation exposure alone.
The _Feb. 19, 2009, letter_
(http://s3.amazonaws.com/propublica/assets/docs/dol_radiation_instructions.pdf) [2] (PDF) said that in such an instance:
"Radiation should not be considered a toxic substance for any cancer and
should not be a part of the medical opinion that is being requested of you."
Advocates for the sick workers say that instruction is illegal because the
law requires the contribution of all toxic substances be considered — and
that includes radiation.
"It is against the law," said Terrie Barrie, who leads the national
Alliance for Nuclear Workers Advocacy Groups, from her home in Craig, Colo.
"Congress has told them that. But it's like talking to a brick wall."
The Obama administration's new Labor secretary, Hilda Solis, received a
detailed letter recently from Barrie's group complaining about what they see
as "woefully inaccurate" information being used to wrongly deny claims.
One such case was that of Melissa Webb, whose job at the Mound nuclear
facility near Dayton, Ohio, involved taking samples from 55-gallon drums of
nuclear weapons waste at a top-secret facility five stories underground.
Webb was 33 when she learned she had Parkinson's disease. When she filed
for compensation in 2007, she listed exposure to the solvent carbon disulfide
as a possible cause. The Labor Department sent her a letter saying its
records showed she was indeed exposed to carbon disulfide at her Ohio nuclear
weapons site, but that there were no known links between the poisonous
substance and Parkinson's.
However, the Labor Department's own Occupational Safety and Health
Administration recognizes carbon disulfide's link to Parkinson's. And a bulletin
issued by the same program that denied Webb's claim lists carbon disulfide at
the top of its list of toxic links to Parkinson's.
"You'd think mine would be an open and shut case," said Webb, now 48, who
first filed for compensation in 2004.
On Jan. 9 of this year, the same day the Labor Department sent Webb a
letter saying it could find no toxic link to Parkinson's, Schwartz _penned a
memo_ (http://s3.amazonaws.com/propublica/assets/docs/schwartz_memo_jan9.pdf)
[3] (PDF) to his bosses at the Labor Department. One of his top concerns
was the "scientific integrity and validity" of the database because it failed
to find well-known links between toxic exposure and multiple diseases.
In the memo, Schwartz also called for the Labor Department to submit the
program to outside peer review, in which independent experts would validate
the conclusions in the database.
Schwartz said none of his bosses, all longtime program employees, ever
responded.
But after he sent the memo, Labor Department officials put new demands on
his work schedule and, records show, planned to have a manager accompany
Schwartz on training trips to make sure he didn't raise issues about the
scientific validity of the program.
Then, on April 16, Schwartz gave testimony about his allegations to the
Government Accountability Office, the investigative arm of Congress, which has
a continuing probe into problems with the compensation program.
The day after his GAO testimony, Schwartz got a memo from one of his
bosses, policy chief Mike Chance, who had listened in on the GAO call. Chance
told Schwartz that Labor was changing his previous work agreement, which had
guaranteed he would not be sent on the road more than three times a month.
The change was "non-negotiable," Schwartz said he was told.
"My current situation is the response" to his memo, Schwartz said. "I
believe I was forced out."
When asked for a response, Rachel Leiton, director of the compensation
program, sent this statement through a spokeswoman:
"While it is not our policy to discuss personnel matters, in this case we
can emphatically state that Dr. Schwartz was not forced to resign. Rather,
he submitted his letter of resignation on a completely voluntary basis."
When asked for elaboration, the same spokeswoman did not reply. But she did
send out a press release on the amount of money collected so far by
claimants in Colorado, where a bipartisan group of Congress members has
introduced legislation to reform the national program.
The payments — some $400 million — are a lot of money, said Carla McCabe,
the former bomb builder from Rocky Flats suffering from a brain tumor she
believes is linked to her work.
"But they're denying people like crazy," she said. "I don't know how they
keep denying us. I hope finally a whistleblower can help us get some
answers."
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