The Mitigating Role of the Health Professionals
After the flurry of mold/health claims following the 2000 Ballard decision, mold/health litigation appears to be changing and, perhaps, decreasing.1 These claims have not been very successful in the courts, and for good reason — many of these claims are not scientifically supportable.
For example, numerous health claims of mycotoxicity are inconsistent with basic toxicological principles. They have also come under intense medical/scientific scrutiny with numerous critical review articles and consensus papers. It is not that mold never has a health impact; rather, the personal injury claims explosion far exceeded the provable illnesses.
Property evaluations and remediation following water events, by contrast, remain a robust and expensive legacy of mold and health. Moreover, although these activities are presumably guided by health concerns, they are often chaotic and unfocused. Today, facilities damaged by water are often probed, prodded, tested, examined, explored and remediated in ways determined by whoever is hired rather than by what is needed.
This leads to an important question: If the health issues drive evaluation, testing and remediation costs, why isn’t there more health criteria standardization and consistency? Why do these associated costs continue to rise when health claims are declining? Facility management has taken on a new intensity with its own life, its own standard-of-care, with few questions asked, such as: Why are we doing these things? Why are we doing as much as we are? Why is remediation so expensive? The unspoken assumption is that why, whichever the why is depending upon the provider, is needed to protect occupant health. The cost of a why is driven as much by fear as by health-based realities.
Many of the testing, probing, prodding, examining and remediating costs are, from the health standpoint, unfocused at best, unnecessary at worst, and costly in either case. Absent the presence of health professionals, evaluation and remediation plans may be incomplete.
Even more problematic and more risky are the regular remediation activities which take place behind plastic, but in plain view of employees and other occupants. Employees who yesterday were working in the very spot where people are today covered in respirators and Tyvek suits, are invariably distressed. Their normal concerns are: Why do the workers need this protection when I had no protection? What health risks threaten me? Thus, health-based risk communication emerges as one of the first and most essential requirements.
Someone with health expertise, environmental (i.e., mold) knowledge, communication skills and believability must be an integral part of a remediation team, if one hopes to prevent panic, sick-building symptoms, illnesses and workers compensation claims. Answers for these worried employees are available. Remediators are constantly exposed to mold and exposure levels are much higher during tear outs. In their case, these precautions are warranted. But to be believable and to answer medical questions like, “Why was I coughing last week?”, risk communication must come from a medical doctor, not from facility management, maintenance staff, building engineers, industrial hygienists or other testing companies.
A number of other issues are driven by health, at least in part. Do people need to be removed from the space? How much remediation is required? When can they return? What levels are safe? Do furnishings, equipment and other belongings pose a health risk, or can they be cleaned? The full scope of these answers cannot be covered here as individual circumstances vary in every situation. However, let’s take a look at a few case studies.
Case Study 1
A child developed bronchopulmonary aspergillosis (a serious, mold-induced lung disorder) and the school was found to have some Aspergillus contamination. The parents and faculty were panicked, certain that the school was the source and a pervasive threat. The community demanded the school be closed immediately. Several physicians concurred with the community, fueling the panic. A more in-depth evaluation of the child and his medical records by the medical doctor revealed two critical facts: first, this child had cystic fibrosis, making him susceptible to this fungal disease; second, he had been playing in a mulch pile all summer, providing the near certain source of his infection. Effective medical communication with the school and its occupants explained these facts and why the school was not causal in this case. The actual threat to others was minimal. The school was successfully reopened following limited, focused remediation.
Case Study 2
An atopic (one with multiple environmental allergies) instructor reported asthmalike symptoms when working at a school. He complained of toxic mold in his classroom and formaldehyde off-gassing from furniture as the cause of his problems. Others in the building were also concerned. A comprehensive health evaluation was performed, and a visual inspection revealed signs of an old water leak with no obvious evidence of mold amplification. The furniture was also inspected. There was an ongoing renovation of the building occurring in nearby offices. A pathway with enough air pressure differential was also found to be exposing this instructor to allergens probably carried on the construction dust/debris. The occupants were so advised and the instructor was temporarily transferred to an existing trailer classroom for the duration of the renovation. Dust control modifications were recommended to the construction team to prevent widespread distribution. The instructor returned to his classroom after the renovation without a medical incident. Health-based management of the situation by trained health professionals identified the root cause of the problem, addressed the fears of the occupants through effective risk communication, mitigating potential problems.
Case Study 3
Following the flooding of an assistedliving facility, significant mold growth, Stachybotrys included, resulted. Decisions had to be made about the occupants, their accommodations and their possessions with respect to the extent of remediation required. Several town meetings with physician communicators revealed that the residents were more fearful of being forced to vacate their rooms than they were of the potential health risks associated with the mold. Although ambient levels of mold were higher than customary, the medical doctors concluded that the health risks were minimal. It was determined that the healthbased remediation plan could take place with no resident relocations, and the remediation plan was communicated to the residents. Remediation went forward with medical oversight, and the occupants remained in place with minimal inconvenience. The cost was reasonable and everyone remained healthy.
These assisted living residents were quite immune to mold fears. This raises a key element of psychology. The misperceptions of mold hazards are often more important solution drivers than the risks themselves. These fears can be very expensive and may lead to evacuations, building material deterioration, property damage, breaking of leases and lawsuits or workers’ compensation claims. They can also be, and often are, exacerbated by thoughtless or unknowledgeable professionals. Witness the scientifically inaccurate statement often used by testing groups, building engineers, remediators, and even some health professionals, “We just don’t know about mold-health risks.” That common, but erroneous, refrain alone can drive up the costs.
Active participation by the right environmental health medical experts can make a dramatic difference in the risks and costs of water damage or mold-related evaluations and remediation. Health issues do drive much of today’s remediation costs following water damage and mold growth. But they do so erratically and with little health input or oversight. The result is an unfocused, misdirected system, wasteful of resources and contributing to unnecessary remediation costs, personal fears and claims risks. The goal should be a medically driven investigation appropriately addressing and resolving the health risks, as illustrated by the previous examples.
A blend of the right medical and scientific knowledge, as well as practical experience, will help ensure that moldrelated health risks and building health risk cost drivers are properly addressed. The result: fewer personal injury and workers’ compensation claims; less worker downtime; lower physical and psychological health risks, and reduced remediation costs.
Ronald E. Gots, M.D., Ph.D., is chief scientist at Building Health Sciences, Inc. in Rockville, Md. He has focused on the scientific methods for assessing causation of diseases allegedly associated with chemical and biological agents.
Hung K. Cheung, M.D., M.P.H., F.A.C.O.E.M., is a principal and chief medical officer at Building Health Sciences, Inc. His subspecialization is Indoor Environmental Quality/risk communication/medical advisory services. He also served on the Maryland governor’s task force on indoor air quality.
Allan E. Burt, MBA, is vice president of field operations and a construction executive at Building Health Sciences, Inc. He is developing “medical engineering” means and methods with the medical doctors of the International Center for Toxicology to resolve indoor environmental matters when occupant health complaints have been received.
Donald E. Franklin, C.P.A., is president and a construction executive at Building Health Sciences, Inc., and has extensive experience in the construction industry.
1 Ballard v. Fire Insurance Exchange, 2001 WL 883550 (Tex. Dist.) (Unpublished opinion).
Read the full article in Cleaning & Restoration.