InvestigateWest’s reporting fuels two worker safety bills to be signed by governor Wednesday

Gov. Chris Gregoire is expected to sign two bills Wednesday  that will help protect healthcare workers from dangerous drug exposures, making Washington the first state in the country to have enforceable safe-handling standards.The lawmaking has gotten the attention of the federal government as well, which this week issued a letter to healthcare workplaces, advising them to update their safety practices. The letter, signed by the National Institute for Occupational Safety and Health (NIOSH), the Occupational Safety and Health Administration (OSHA), and The Joint Commission (the national hospital accreditation agency), highlighted the potential for serious adverse occupational health effects.“This is a victory,” said Dr. Melissa McDiarmid, Director of the Occupational Health Program at the University of Maryland School of Medicine, whose research has shown chromosomal damage in workers who handle chemotherapy.Both bills, which passed unanimously through the House and Senate, were sparked by InvestigateWest’s reporting on hazardous drug handling practices, which showed that lack of workplace regulation was resulting in workplace contamination and worker exposures. Such exposures can result in irreversible effects that include cancer, reproductive harm and developmental problems.SB 5594, sponsored by Sen. Jeanne Kohl-Welles, requires the state to regulate chemotherapy and other hazardous drugs by creating a safe-handling standard for healthcare workplaces. “It is unacceptable that health-care workers risk exposure to deadly chemicals on a daily basis while on the job.  This measure could literally save lives by requiring the development of workplace safety standards for these professionals,” Kohl-Welles said.

Daughter of cancer victim to testify before lawmakers today

Chelsea Crump, daughter of oncology pharmacist Sue Crump, testifies today in Olympia on SB 5594, a bill that would regulate the handling of hazardous drugs by health-care workers. Chelsea’s mother, Sue Crump, died of pancreatic cancer after longtime workplace exposure to toxic chemotherapy, which InvestigateWest Carol Smith covered in a July investigation.On Jan. 17, Sen. Karen Keiser introduced SB 5149, which would require that the state cancer registry capture occupational data from cancer patients.

The story behind “Lifesaving Drugs, Deadly Consequences.”

When InvestigateWest Executive Director Rita Hibbard and I first met Sue and Chelsea Crump, Sue was suffering from cancer that she and Chelsea suspected may have been triggered by her long history of handling chemotherapy. The tip rang a bell for Rita, who recalled mention years earlier of studies indicating oncologists got certain cancers at higher rates. When Rita asked me to look into the story, it triggered a strong association for me as well. My grandmother had served as an Army nurse in WWI near the trenches in France. Many years later, I remember her recounting the horror of treating young soldiers blistered and burned by mustard gas, the precursor of today’s cancer drugs. I understood their power.  Between the four of us, we believed there was at least the seed of a story worth examining. That early conversation led to InvestigateWest’s year-long investigation. The story was widely published and broadcast, receiving strong national attention.  It has triggered discussions at state and national levels of how to improve regulation to keep healthcare workers safe. Through the last two years, Chelsea underwent two profound role reversals. She was a student who became a source, and a daughter who became her mother’s caregiver. Today she is finishing a double major at Western Washington University and learning to live without her mom for the first time. She is the reason we know her mother’s story. This, in her own words, is her own story:My Mother’s Story: A Daughter’s JourneyBy Chelsea Crump

Q&A with Jordan Barab, Dep. Asst. Secretary of Labor for OSHA

Read the whole package here.We asked Deputy Assistant Secretary of Labor for the federal Occupational Health and Safety Administration Jordan Barab what the agency charged with protecting American workers is doing to protect healthcare workers on the job. Here’s what he had to say.Note: These answers, presented in their entirety, were in written response to questions submitted by InvestigateWest after multiple attempts to obtain comment from OSHA for these stories.  Q. Why are there OSHA standards that specifically relate to other healthcare workplace dangers, such as radiation, and other hazardous chemicals, such as sterilizing agents or benzene, but not for hazardous drugs?A. The process of setting regulatory priorities for new standards is always a challenging one for OSHA because there are so many serious safety and health hazards facing the Nation’s workers across all the industries in our very diverse economy.  In determining the best course of action to correct a particular hazard, OSHA must take a variety of issues into account, including resource limitations, because standards promulgation is such an intensive and lengthy process.  The Department of Labor publishes its Regulatory Agenda twice each year to notify the public of its priorities.

The Widow Speaks

By Carol SmithInvestigateWestRead the whole package here.Bruce Harrison had been an oncology pharmacist since the late 1970s. He had seen the evolution – or lack of it – in safety awareness during that time, but he spent much of his career trying to change attitudes toward safe practices through research.Harrison, who for years was a clinical pharmacy specialist with the Department of Veterans Affairs Medical Center in St. Louis, was also one of the authors of the strictest set of voluntary guidelines, issued in 2004 by the National Institute for Occupational Safety and Health, for the safe handling of chemo and other hazardous drugs for healthcare workers.Practices that, had they been in place throughout his career, might have saved his own life.Harrison died at age 59 in St. Louis in August of a rare form of oral cancer. He had never smoked, or chewed tobacco. He had no other known risk factors, except he had mixed a lot of chemo for other people in his career as a pharmacist.He discussed it with his doctor.“There was no way they could prove it, but the two of them decided it could be related,” said his widow, Kathy Harrison. “Bruce absolutely believed it was triggered by his exposure.”She’s grateful her husband had a long career doing something he loved. She’s also sad, and frustrated, that it may have cost him his life.And she worries it will cost others theirs.

The Whistleblower Speaks

By Carol SmithInvestigateWestRead the whole package here.Luci Power was among the first pharmacists in the United States to pressure her employer to take warnings about chemo handling coming out of Europe in the early 1980s seriously.The alarm was triggered by a letter from Finnish researchers published in Lancet in 1979. That study found evidence of exposure in nurses preparing and administering chemo. Their urine contained higher amounts of chemo drugs than control groups.“That was a landmark,” said Power.The Australians had already moved to publish some English-language guidelines. Power learned of them through a friend and colleague. But when she asked for more protective equipment for her staff at the University of California, San Francisco, no one took her seriously, she said. She ended up creating make-shift “personal protective equipment” out of welder’s masks and other scavenged pieces.Then one day, a team from Cal-OSHA happened to be in the hospital monitoring an asbestos abatement project in a room adjacent to where Power and her staff were mixing chemo. The team used her room as a base, so they could observe the asbestos removal from a safe distance.When they saw the pharmacy staff working behind bright red welders’ face shields, they were horrified, she said. They started asking questions.Power told them what she knew of the potential dangers of handling chemo, and her difficulties securing equipment to protect workers from getting it on their skin or in their lungs.

The Veterinarian

By Carol SmithInvestigateWestRead the whole package here.Brett Cordes had been a practicing veterinarian for nearly a decade when he was diagnosed at age 35 with thyroid cancer.One of the first questions his doctor asked him after he gave him the diagnosis was whether he handled chemotherapy agents.“He said they see a link between chemo and thyroid cancers,” Cordes said, who today is healthy four years after his diagnosis and treatment.“It changed my life. I quit my practice and made it my passion to improve oncology safety for vets.”Animal oncology has exploded within the last decade as some of the most common chemotherapeutic drugs became available as generics. Instead of paying $1,200 a vial, it is $12 to $15 a vial, he said. “That opened the flood gates.”Charlie Powell, spokesman for the College of Veterinary Medicine at Washington State University said the number of vets who handle chemo is low, and those who do receive specialized training and take precautions similar to those required for human medicine."It's very safe to say the vast majority of vets in practice will never give a chemo dose, and will refer to cancer specialists," he said. "It's highly unlikely they will try to tackle themselves."Cordes said he sees that changing. He estimated about 4,000 general practices in the United States administer a few doses a month, often with no special precautions in place.With his medium-sized mixed-animal practice in Scottsdale, AR, Cordes would have put himself in that category.

The Patient Speaks

By Carol SmithInvestigateWestRead the whole package here.Karen Lewis knew what the possibilities were when a routine medical exam returned an abnormal white blood cell count on her four years ago.“I worked in a cancer center,” she said. “I knew.”The 57-year-old, long-time hospital pharmacist was soon diagnosed with a pre-cancerous form of blood cancer called Myelodysplastic Syndrome. Her doctor immediately ordered her to stop working with or around chemo agents.“I started working with chemo in 1993,” said Lewis, who has worked for years at the University of Maryland Medical Center. “Back then there were much less restrictive policies (around handling chemo.)”Her attitude then was similar to those of many of her peers.They had been advised to wear “chemo protective gowns” made of heavy paper, with little cuffs, and double gloves.“But nobody really did (wear double gloves) because it made it hard to manipulate needles,” she said. “And no one said if we didn’t follow (the guidelines) we were at any greater risk.”She also doesn’t recall being advised to wear a mask.“My thinking was – if I don’t actually stick myself or spill on skin, I’m OK,” she said. “I never thought of any other way (it could be) adversely affecting me.”In particular, she never realized that the type of “laminar flow hoods” the hospital used – the commonly recommended type at the time – blew potentially contaminated air back in her direction.

Europe and Canada set more controls on workplace chemo

 ‘Contamination is everywhere,’ expert warnsBy Carol SmithInvestigateWestRead the whole package here.In the United States, there’s a lot of discussion about the difficulties of requiring hospitals and clinics to prove they are not contaminating their workers with toxic drugs.But some other countries are already doing that.In Holland, health care workers can choose to be monitored for exposure and work areas must be tested for contamination. Germany, Austria and Belgium also have aggressive safety programs regulating chemo agents. The United Kingdom and France impose strict regulation on veterinary practices handling chemo. In Canada, British Columbian hospitals do monthly safety inspections and a major union there is preparing to track nurses’ health histories to link exposures to disease. “Contamination is everywhere, even at the best organized facilities,” said Paul Sessink, a chemist and toxicologist who has performed monitoring in about 300 hospitals around the world. European countries are moving to make worker safety regulations stronger, he said, while the U.S. appears almost exclusively focused on patient safety.

Lifesaving Drugs, Deadly Consequences

‘Secondhand chemo’ puts healthcare workers at risk Healthcare worker? Take our survey here.  Sue Crump braced as the chemo drugs dripped into her body. She knew treatment would be rough. She had seen its signature countless times in the ravaged bodies and hopeful faces of cancer patients in hospitals where she had spent 23 years mixing chemo as a pharmacist.At the same time, though, she wondered whether those same drugs – experienced as a form of “secondhand chemo” — may have caused her own cancer.Chemo is poison by design. It’s descended from deadly mustard gas first used against soldiers in World War I. Now it’s deployed to stop the advance of cancer.Crump knew she had her own war on her hands. She wanted to live long enough to see her 21-year-old daughter, Chelsea, graduate college.And she wanted something else: She wanted young pharmacists and nurses to pay attention to her story.Crump, who died of pancreatic cancer in September at age 55, was one of thousands of health care workers who were chronically exposed to chemotherapy agents on the job for years before there were even voluntary safety guidelines in place.