By Bill Walker, Investigations Editor, EWG and the EWG Action Fund

Asbestos does not discriminate.

It doesn’t matter who you are – young or old, strong or frail, rich or poor, factory worker or CEO – if you inhale or ingest even one microscopic asbestos fiber, you’re at increased risk of developing a deadly disease whose symptoms may not show up for decades.

Of the estimated 12,000 to 15,000 Americans who die of asbestos-related diseases each year, some groups do bear a disproportionate burden. The death rate is highest for workers in industries in which asbestos is or was extensively used, such as construction, shipbuilding, chemicals and railroads. But though each asbestos death is tragic, the tragedy feels most unfair when it strikes those exposed through their unselfish service to society. Among those more likely than the average American to die from asbestos exposure are two such groups – one who willingly put themselves in harm’s way, another who may have never known they were at risk: firefighters and teachers.

“It’s a risk you accept,” said Battalion Chief J.J. Winn of the Charleston, S.C., Fire Department – the same post held by his father, John Winn, who died in May 2012 at age 59 of mesothelioma, a rare and incurable cancer caused only by asbestos exposure. Although asbestos does not burn, a fire in a building with asbestos sends millions of deadly fibers airborne.

“When my dad joined the department in the ‘70s, we didn’t know much about asbestos,” said Winn. “Now we assume anything built before 1980 has asbestos in it. But every firefighter has always known that every time you go out you might not come home; you might carry something home to your family; you might get cancer. That’s the path we chose, and it sure wasn’t for the money.”

“I taught in the same building for 20-some years, and I never gave a thought to asbestos,” said Roger Hall, 64, a retired high school teacher in Letcher County, Ky., whose mesothelioma was discovered in November 2014 when he went into the hospital for a routine operation to repair a nagging hernia.

“When the doctor told me I had mesothelioma,” he said, “I had no idea where it came from – that school system was the only place I’d ever worked. I started asking my former coworkers and some said yes, that school was just loaded with asbestos.”

In a study of nearly 30,000 firefighter deaths in three major cities from 1950 to 2009, the National Institute for Occupational Safety and Health, or NIOSH, found that the firefighters were twice as likely as other Americans to die of mesothelioma, a malignancy that can strike the lungs, stomach or testicles.

It has long been known that firefighters are more likely to die of lung cancer, for which asbestos is one possible cause among many. But NIOSH’s study of firefighters in Philadelphia, Chicago and San Francisco, published in 2013, was the first to document a higher rate of deaths from mesothelioma, a distinct and much more rare disease.^[1] In 2014 a study led by the Finnish Cancer Registry of more than 16,000 firefighter deaths over 45 years in five Scandinavian nations found firefighters were more than 2.5 times as likely to die of mesothelioma as the general population.[2]

The elevated death rates in these studies are even more striking considering that firefighters, who must be physically fit, are healthier than the general population, with lower death rates from non-cancer respiratory diseases, diabetes, nervous system disorders and alcoholism.

According to a 2007 NIOSH report that analyzed federal cause-of-death records, teachers were also twice as likely to die from mesothelioma as other Americans.[3] The absolute numbers were small – 13 teachers, all of whom taught in elementary schools, died of mesothelioma in 1999, the latest year for which NIOSH has broken down deaths by occupation. In 2004, an EWG Action Fund analysis of government death records reported that 137 elementary and secondary teachers died of mesothelioma from 1985 to 1999. And that’s deaths from only one of the three main diseases caused by asbestos: A 2015 analysis by the Action Fund found that about half as many Americans die of asbestosis, an excruciatingly painful and often-fatal scarring of the lungs, as from mesothelioma and that asbestos-caused lung cancer kills three to four times as many people as mesothelioma.

Judging by the frequency with which asbestos problems continue to arise at schools – in the first half of 2015, more than 50 incidents were reported at schools in 13 states – it’s clear that teachers face increased risk for on-the-job exposure, particularly in the thousands of schools built before 1980, when the dangers of asbestos became widely known. More than 30 years after the Environmental Protection Agency declared that “asbestos in school buildings poses a significant hazard to public health,” how much asbestos remains, and the risk it poses to teachers, staff and students, remains unknown.^[4]

The NIOSH report said that teachers’ death rate from mesothelioma was about half the rate among construction workers, but higher than workers in some industries known for elevated risk, such as chemicals and railroads. The report also said elementary and secondary schools were the 10th most often listed workplaces of victims of asbestosis. That’s on par with electric power plants, where asbestos was widely used in insulation and in workers’ “ protective” clothing – which turned out to be anything but.

“Shame on them all”

In response to their members’ heightened risk, firefighters’ and teachers’ organizations have registered opposition to proposed federal legislation that could delay or deny justice to asbestos victims and their families.

A bill that could soon reach the floor of the House – H.R. 526, the so-called FACT Act, introduced by Rep. Blake Farenthold (R-Texas) – would require anyone seeking compensation for an asbestos-caused illness to disclose sensitive personal, financial and medical information publicly. Under the guise of “transparency,” the bill would erect needless and invasive bureaucratic hurdles that would hold up payments to victims from the private compensation trusts set up by companies with asbestos liability.

Some victims could die before seeing money to pay their staggering medical bills – Roger Hall’s hospital stays for chemotherapy cost $70,000 a night, more than twice what the average asbestos victim recovers from the trusts[5] – or provide for their families after they’re gone. The typical mesothelioma victim survives less than a year after diagnosis.^[6] Battalion Chief John Winn made it four months.

In an October, 2015 letter to members of Congress, the International Association of Fire Fighters, the National Education Association and the American Federation of State, County and Municipal Employees said the legislation, which would require the trust to file unnecessary reports and other paperwork, would also “drain critical resources that have been set aside to secure justice for victims of asbestos diseases.” The letter said: “Our nation’s first responders [fire fighters and other emergency personnel], teachers and public employees dying of asbestos diseases deserve more respect and better treatment from Congress.”

Roger Hall has already survived longer than the eight months the doctor gave him. In that time, his wife, Evelyn, has learned all she can about asbestos, including the companies who exposed millions of Americans and the members of the House Judiciary Committee who approved the FACT Act. Federal records show that since 2010, those 19 members received almost $3.3 million in campaign contributions from political action committees tied to asbestos interests.

“Shame on them all,” Evelyn Hall said.

“The companies that did it, they knew,” she said. “They knew asbestos was killing people, and they allowed it. They might as well have taken a gun and shot you with it. They should be put out of business, not allowed to pay out a little bit to people who are going to die, so they can get on with the business of killing people. As for the ones on that committee, I’d ask them, ‘Why are you trying to hold up the few dollars we may have coming? Is it not enough that my husband has to die?’”

“I hope I’m wrong”            

On Sept. 11, 2001, the terrorist attack on the World Trade Center claimed nearly 3,000 lives. It also created what a panel of public health experts called “the largest acute environmental disaster that ever has befallen New York City.”[7]

According to the panel assembled by NIOSH, the plume from the collapse of the twin towers carried 1,000 to 2,000 tons of pulverized asbestos, among other toxic substances, putting hundreds of thousands of firefighters, other emergency responders, recovery workers, volunteers and residents at risk. The World Trade Center Health Registry estimates that on and after 9/11, more than 400,000 people were exposed to asbestos, including 90,000 firefighters and rescue or recovery workers.

Because asbestos-triggered diseases can take decades to develop, the total death toll from that day may not be known for 40 years, but it is already mounting. The first confirmed 9/11 asbestos victim was Deborah Reeve, a New York City Fire Department paramedic assigned to identifying bodies in a Ground Zero morgue, who died of mesothelioma in March 2006.[8] She was 41.

“We’ve just scratched the surface,” Dr. Raja Flores, chief of thoracic surgery at Mount Sinai Medical Center, in New York, told Asbestos.com in September 2015. “Between 15 and 20 years out, we’ll start seeing [asbestos-related disease] in individuals one by one, but by 25 years out, it will be real obvious what has happened. I hope I’m wrong, but I think I know how this is going to turn out.”[9]

Some first responders have received compensation for asbestos-related illnesses through the James Zadroga 9/11 Health Compensation Act. But both the 9/11 Victims Compensation Fund, established by Congress in the aftermath of the attacks, and the fund created under the Zadroga Act will expire over the next two years, unless Congress re-authorizes funding for both. Beyond that, the only prospect for compensation for those who have not yet been diagnosed may be through the asbestos liability trust system or in court.

Even those uncertain avenues may be closed to most firefighters and other first responders.

Under common law, the so-called firefighter’s rule bars first responders from seeking compensation from property owners or other private parties, for injuries sustained in the line of duty because they have assumed the risks inherent to the job. Many states have passed legislation that qualifies or abolishes the firefighter’s rule. In others, first responders’ only choice is to file for worker’s compensation from the city or other jurisdiction they worked for.

In some states a firefighter’s cancer is presumed to be job-related, making it easier to file for worker’s comp. But a firefighter’s employer may appeal, arguing that the asbestos exposure occurred off the job – a bitter truth Charleston Battalion Chief John Winn learned after his diagnosis of mesothelioma.

“Abestos is a danger to everyone”

“He tried to file a worker’s comp claim, but they wouldn’t settle it,” said J.J. Winn. He did qualify for federal and state disability insurance, which paid him a fraction of his former salary. It was approved two weeks before his death.

“My dad was very dedicated to the fire service,” said Winn. “He was stationed downtown most of his career, working in the old buildings – even some of the old fire stations had asbestos. He received a lifesaving award for saving a baby that he rescued from an old low-income apartment building. That child is still living today.”

At one time, firefighters’ protective clothing was often made with asbestos. Today all firefighters wear protective gear that includes face masks and oxygen tanks, although studies have found that too often firefighters remove the uncomfortable equipment immediately after exiting a burning building, when asbestos and other toxins are likely to be in the air.

But when John Winn, known as Big John, became a firefighter in 1977, attitudes were different. “In those days, if you wore a SCBA [self-contained breathing apparatus], you were considered a weakling; you weren’t tough,” said his son.

In January 2012, J.J. Winn was working alongside his father in Battalion 4, Engine Company 6. “We were out training, and my dad came over and said he couldn’t breathe,” he said. “The next night he went to the hospital. They found fluid in his lungs, so they thought it was pneumonia. They tried to pull the fluid out through needles in his back, but when they went in they found the cancer in the pleural cavity.”

In his final months, John Winn launched a crusade to encourage fire fighters to get checked for asbestos disease. On his 59th birthday, two months before his death, another department nearby donated a fire truck that became the foundation of the Big John Project. The truck is pearl white to represent the Minnie Pearl Cancer Foundation, and trimmed in baby blue, a symbol of mesothelioma awareness. Volunteers take the truck to firefighter events, parades and car shows, spreading the message that early detection can save or extend the life of a firefighter or family member.

“The Big John Project is helping firefighters to do the right thing, to think about their health and their family,” saId J.J. Winn. “But not only firefighters. The day he received the truck, my dad said he wanted everyone to become aware that mesothelioma is out there and that asbestos is a danger to everyone.”

Half of U.S. schools built in peak asbestos years

In 1984 the EPA surveyed and took air samples in 2,600 public school districts and private schools and estimated that 1.4 million teachers, administrators and other employees – along with 15 million students – were at risk of asbestos exposure in almost 35,000 U.S. schools.[10] That was the last known attempt to assess the nationwide risk, but the problem clearly remains. In 2013 the National Education Association estimated that about half of the approximately 100,000 U.S. schools were built between 1950 and 1969, the peak years of asbestos use in construction.[11]

The first documented cases of teachers with asbestos-related diseases whose only known exposure was at school are found in two papers published by the New York Academy of Sciences, in 1991.

One study looked at four teachers who died of pleural mesothelioma between 1983 and 1990. In each case the schools where they had worked were known to contain asbestos insulation, but “none of these persons physically handled the asbestos in the course of his or her employment as a teacher.”[12] What’s more, these were the first reported cases of victims who apparently were not exposed by contact with a family member who worked with asbestos. The paper also reported three cases of malignant mesothelioma victims whose only known exposure came while they were students.

The second study looked at 12 Wisconsin teachers who died of mesothelioma between 1968 and 1987. Researchers concluded that for nine of the them, their schools were the only potential sources of asbestos exposure. In eight of those schools, inspections found asbestos that was friable, or easily crumbled by touch and more likely to become airborne. Two findings bolstered the evidence that the victims were exposed on the job: Three of them taught at one school, and two at another. Even more surprising, the latter two victims were sisters, and the researchers noted the world medical literature contains less than 10 reports of family clustering of mesothelioma.[13]

“They did nothing”

“My family was not cancer-prone,” said Roger Hall, “and I’ve never smoked. Because of that, I never thought much about ever having cancer. So when the doctor said I had mesothelioma, my first question for me and my wife was, now where could I have got it?”

From 1976 until he retired, in 2003, Hall taught history and social studies at Letcher High School, in Whitesburg, Ky., a town of about 2,100 near the Tennessee border. Every day, he took his breaks and ate lunch in the school’s boiler room.

According to the negligence lawsuit the Halls filed in September 2015 against the Letcher County school board and three administrators, tests at the school in 1988 found that the boiler was insulated with asbestos. Asbestos was also found in floor and ceiling tiles throughout the building. The complaint charges that the school system failed to remove the asbestos for two to three years, and never warned teachers and other employees of the danger.[14] The school board has yet to respond.

“My mesothelioma was not in the lungs but the abdomen, so I didn’t inhale the asbestos but ingested it,” said Hall. “The boiler room was where all the teachers would go to drink coffee and eat lunch. Pop machines and chip machines were put in. We all sat on a bench within 25 feet of the boiler. That’s the only possible way I could have ingested asbestos.”

The Halls could have chosen to sue the maker of the furnace or the asbestos used to insulate it. But as they learned more, they focused their anger at the school system.

“I requested from the county board all the records on asbestos in the school,” said Evelyn Hall. “I saw that they were written up (for an asbestos violation) in 1988. I kept looking. They were written up again multiple times, in ’88, ’89, ’90. They did nothing. They never shut the room down. We realized that the real problem was not the boiler but the school system, for not telling employees. If that’s not gross negligence, there ain’t such a thing.”

Roger Hall’s multiple surgeries and hospital stays have extended his life beyond his doctors’ expectations. His treatment has cost more than $450,000. So far that’s been covered by insurance, but if the Halls get any money from the school district, they’ll have to pay it back. In June Roger began another course of chemotherapy but had to stop halfway through because his organs were in danger of failing.

“Some days it’s a real battle,” said Evelyn Hall. “He can do nothing a person wants to do. He can’t walk outside by himself. Last night I picked him up off the living room floor. Doctor’s appointments are basically our life. We’re supposed to have some more tests in a few weeks … but we just don’t know.”

[1] Robert D. Daniels et al, Mortality and cancer incidence in a pooled cohort of US firefighters from San Francisco, Chicago and Philadelphia (1950− 2009). Occupational and Environmental Medicine, Oct. 14, 2013. www.cdc.gov/niosh/firefighters/pdfs/OEM_FF_Ca_Study_10-2013.pdf

[2] Eero Pukkala et al, Cancer incidence among firefighters: 45 years of follow-up in five Nordic countries. Occupational and Environmental Medicine, Feb. 6, 2014. oem.bmj.com/content/71/6/398.abstract

[3] National Institute for Occupational Safety and Health, Work-Related Lung Disease Report 2007. September 2008. www.cdc.gov/niosh/docs/2008-143/pdfs/2008-143a-i.pdf

[4] U.S. Environmental Protection Agency, Asbestos-Containing Materials in Schools: Health Effects and Magnitude of Exposure. October 1980. http://1.usa.gov/1AhBIQs.

[5] Lloyd Dixon et al, Asbestos Bankruptcy Trusts: An Overview of Trust Structure and Activity with Detailed Reports on the Largest Trusts. RAND Institute for Civil Justice, June 5, 2010. www.rand.org/content/dam/rand/pubs/technical_reports/2010/RAND_TR872.pdf

[6] Alastair J. Moore et al, Malignant mesothelioma. Orphanet Journal of Rare Diseases, Dec. 19, 2009. www.ncbi.nlm.nih.gov/pmc/articles/PMC2652430/

[7] Philip J. Landrigan et al, Health and Environmental Consequences of the World Trade Center Disaster. Environmental Health Perspectives, May 2004. www.ncbi.nlm.nih.gov/pmc/articles/PMC1241968/pdf/ehp0112-000731.pdf

[8] Dorian Block, Closure eludes EMT’s kin. Daily News (New York, N.Y.), March 12, 2006. www.nydailynews.com/new-york/bronx/closure-eludes-emt-kin-article-1.290442

[9] Tim Povtak, Asbestos Diseases Still Looming After 9/11 Attacks. Abestos.com, Sept. 10, 2015. http://www.asbestos.com/news/2015/09/10/september-11-world-trade-center-asbestos-diseases/

[10] U.S. Environmental Protection Agency. Fact Sheet: Asbestos Hazard Emergency Response Act of 1986, H.R. 5073. Oct. 23, 1986. www2.epa.gov/aboutepa/signing-asbestos-hazard-emergency-response-act.

[11] Cindy Long, NEA Health Information Network Surveys Schools on Indoor Air Quality. NEA Today, Jan. 8, 2013.  neatoday.org/wp- content/uploads/2012/01/Southernmiddle-e1326221666621.jpg

[12] David E. Lillienfield, Asbestos-Association Pleural Mesothelioma in School Teachers: A Discussion of Four Cases. Annals of the New York Academy of Sciences, Dec. 31, 1991. www.ncbi.nlm.nih.gov/pubmed/1809159

[13] Henry A. Anderson et al. Mesothelioma among Employees with Likely Contact with in-Place Asbestos-Ctinaining Building Materials. Annals of the New York Academy of Sciences, Dec. 31, 1991. www.ncbi.nlm.nih.gov/pubmed/1809169

[14] Roger Hall and Evelyn Hall vs. Tony Sergent et al. Civil Action No. 15-CI-00159. Commonwealth of Kentucky, Letcher Circuit Court, September 2015.