A Growing Sensitivity to What's in the Air
By DENNIS M. BLANK
Chronic headaches are among the many symptoms cited by workers with a vague condition known as "multiple chemical sensitivity." What is clear, however, is that defining the workplace malady -- or even agreeing that it exists -- is becoming a big headache for the legal and medical professions.
Because MCS cannot be defined as easily as a broken leg or asbestosis and because symptoms and causes can vary, it is being debated by workers, employers, landlords and health agencies in a growing number of workers' compensation cases and lawsuits.
"In chemical exposure cases, there is not an objective test that you can definitely say yes or no," said Administrative Judge Richard S. Thompson, who oversees workers' compensation cases in Orlando, Fla. "The problem is very, very difficult. The medical community is so divided."
Symptoms of multiple chemical sensitivity can include dizziness, memory loss, rashes, chronic fatigue, food allergies, breathing difficulty and eye and sinus irritations as well as headaches. The conditions can vary depending on body chemistry and the amount of exposure to chemicals, contaminated air or pesticides.
What also happens, experts say, is that once victims have been afflicted -- even if their health improves -- exposure to certain chemicals or products can prompt a relapse even if the patients were not previously sensitive to them.
Many cases are linked to "sick building syndrome," which most commonly occurs in poorly ventilated buildings where formaldehyde gas is trapped after being released from new carpeting, glues or furniture. SBS can also be caused by mold and mildew in air-conditioning.
"Nationwide, indoor air pollution costs tens of billions of dollars annually," wrote Nicholas Ashord and Claudia Miller in their book, "Chemical Exposure" (Van Nostrand Reinhold, 1997). "MCS cases are part of this costly burden and exact a significant financial toll on patients, building owners and employers."
James Woods, a consultant on indoor air pollution from Herndon, Va., estimates that $60 billion in income and productivity is lost annually because of employees' falling sick from MCS and other problems linked to sick-building syndrome.
Based on his surveys and other assessments by private corporations and federal agencies, he estimates that sick-building syndrome is found in 20 percent to 30 percent of the 4.5 million commercial structures in the United States and that it is undetected in an additional 10 to 15 percent.
The Occupational Safety and Health Administration has estimated that it would cost $8.1 billion to bring all commercial structures into compliance with its proposed indoor air quality standards.
How many people have multiple chemical sensitivity and how much can be attributed to sick-building syndrome is unclear. Dr. Albert Robbins of Fort Lauderdale, Fla., who specializes in treating such cases, contends that the condition is a "silent epidemic." He bases that conclusion on the growing number of patients that he and other environmental physicians are treating.
Even so, only Alaska, Connecticut, Delaware, Maryland, Massachusetts, New Mexico, New York and Ohio officially recognize the condition for workers' compensation claims, and none track the number of cases. Dr. Grace Ziem of Baltimore, who specializes in environmental occupational medicine, says 19 federal and 22 state agencies, other than workers' compensation departments, recognize the condition as a legitimate illness.
In West Virginia, employees with MCS-related disability claims had a setback in November. The state's Workers' Compensation Division endorsed its health advisory panel's recommendation that MCS should not be a recognized medical condition.
Dr. Alan M. Ducatman, who served on the panel, said that although he treats patients diagnosed with multiple chemical sensitivity, it is difficult to verify it as a medical condition. "MCS has to be based upon objective findings," he said.
Dr. Ziem, however, said she believed "it would be morally, medically and legally unjustified for West Virginia's agency to now single out MCS claims for a higher burden of proof."
Elsewhere, the Ohio Industrial Commission recently awarded Joann Taylor $400,000 from her former employer. Ms. Taylor, 48, said she was afflicted in 1994 with serious asthma and respiratory problems from fumes from new carpeting in her office at Centerior Energy, now a unit of First Energy.
Now confined to her home, she had been required to continue working in the newly carpeted office after she had been hospitalized with severe vomiting and chest pains, she said.
Ms. Taylor says the condition has made her highly sensitive to exposure to chemicals and products that did not adversely affect her before. "I am very allergic to fragrances," she said. "My sensitivity to smell has heightened more than 10 times. Even the smell of certain foods cooking makes me nauseated. I don't remember as well as I used to, and I become very depressed."
The Ohio Industrial Commission said in its final ruling that Centerior could have "avoided the legal action that resulted when it refused to continue to accommodate her sensitivity to the new carpet."
A corporate spokesman would not comment on the specifics of the Taylor case except to say that the company had not implemented any new policies to accommodate MCS or asthma-prone employees because of the case.
Other employers, including Levi Strauss in San Francisco, have made special accommodations for workers with the condition. Ed O'Masta, a human resources executive at the company, said it had set up a special office with no carpeting and with portable air filtration and had kept irritating chemicals and pesticides out of the area.
Arvin Maskin, a New York lawyer who heads an American Bar Association committee dealing with this problem, said many corporations had improved ventilation and tried to avoid certain paints and chemicals. "Most companies want to do the right thing," he said.
Yet, new research by the University of Cincinnati medical school found that workplace conditions were cited in 15 percent of all asthma cases and that employees were exposed to more than 240 offending chemicals -- led by latex gloves and chemical coatings.
And a survey of 4,000 California adults two years ago by the state Health Services Department said that 6.3 percent had been diagnosed with MCS. In the same survey, 15.9 percent were chemically sensitive and had multiple reactions.
Data from the Equal Employment Opportunity Commission show that 386 formal complaints were filed in the last four years by workers who said they had MCS. These workers contended that they were dismissed because they couldn't continue to work or were not provided with an adequate environment. Since 1992, 1,542 employees filed discrimination complaints over asthma, often a related condition.
More of these cases are showing up in the courtroom. Recently, the federal district court in Springfield, Mass., opened the door to Social Security disability payments for Heidi Creamer, a Massachussetts resident who has been confined to her home after being exposed to urethane fumes during a remodeling in the office where she had worked.
It marked the first federal court case in which MCS was accepted as a "medically determinable impairment," said Catherine M. Hancock, Ms. Creamer's lawyer. Ms. Creamer won her case and is now receiving the disability payments.
And despite the reluctance of some agencies to acknowledge MCS, the Public Health and Science Office of the National Institutes of Health is spending $800,000 this year to study possible links between MCS and veterans afflicted with Persian Gulf war illness.