Workplace Exposures Cause Nurses’ Illnesses
UPdate Spring 2003

Proving workplace injury is difficult at the best of times.  It’s particularly difficult when the cause is low level chemical exposure.

A recent Workers’ Compensation Appeals Tribunal (WCAT) decision made some small but significant progress in recognizing that chemical exposures even below established “safe” levels can cause disability.  The decision found that eight nurses in the Regional Dialysis Unit (RDU)  of Yarmouth Regional Hospital “suffered exposure induced illness which arose out of and in the course of … employment (and) suffered from many severe and at times debilitating symptoms which resulted directly from … workplace exposure.” The nurses’ claim had been denied by the Workers’ Compensation Board in 2000.

The Yarmouth Renal Dialysis Unit had been a source of health complaints since the 1980’s.  The unit was crowded and busy and there were ventilation problems.  Due to inadequate staffing, the nurses worked long hours without breaks and didn’t take sick leave.  A variety of chemicals were used frequently to operate and clean the dialysis machines.  Both staff and patients increasingly complained of symptoms including asthma and other respiratory distress, burning skin, rashes, aching joints, headaches, memory loss, confusion, and other problems.  Eight nurses left work due to illness in 1997.  Six have since returned to work in a newly renovated unit although some continue to suffer health problems from the exposures.  Two remain unable to work.

The three person panel hearing the case referred to a 1999 Ontario compensation decision, which concluded that an office worker suffered an increase of symptoms resulting in disability even though indoor air quality studies did not reveal systems that operated below industry standards.  In this case, the Ontario panel concluded that  “industry standards might not be sensitive enough to adequately measure office-type environments.”

Toxicologist Dr. Torgny Vigerstad, expert witness for the Yarmouth  nurses, provided additional evidence along these lines.  Threshold Limit Values (TLVs) are the levels normally accepted as safe.  Vigerstad stated that there are many agents for which the TLV is set at a level above the level which will effect some people, that  TLV’s  do not address the effects of mixing chemicals, and that there are some chemicals, including ones used in the Yarmouth RDU, for which TLVs are not set.  He referred to the TLV Handbook, published by the American Conference of Governmental Industrial Hygienists, which states: 

"Because of wide variation in individual susceptibility, however, a small percentage of workers may experience discomfort from some substances at concentrations at or below the threshold limit, a smaller percentage may be affected more seriously by aggravation of a pre-existing condition or by development of an occupational illness."

Evidence established that the nurses had been exposed to a variety of chemicals over many years.  The exposures included DRX, a strong germicidal cleaner which contained ethanol which for several years was used full strength and without gloves or masks.  The nurses were not aware that this was contrary to the manufacturer’s safety instructions.  They were also inadvertently exposed to chlorine gas caused by mixing javex bleach and vinegar in cleaning.  Ongoing exposure to low levels of chlorine gas is a documented cause of asthma.  It can also cause headaches and cognitive difficulties.  There were also ongoing exposures to caustic soda, bicarbonate soda dust, carbon monoxide, and intermittent exposures to formaldehyde, all of which have documented health effects. 

Opposing the nurses’claims, was Workers Compensation Board witness Dr. Ronald Gots, a leading spokesperson against physical causes of chemical sensitivity.  As a witness for the Compensation Board against hundreds of Camp Hill workers several years ago, Gots argued that those illnesses were “psychosocial”.  In the Yarmouth case, Gots admitted he did not review the individual workers’claim files before submitting his opinion, nor did he consult Material Safety Data Sheets on the chemicals used in the RDU.  He argued that “reporting bias” was a factor in the case.  He referred to a “Symptoms Book” kept in the RDU where symptoms were recorded, to back up his explanation that people experience symptoms when they believe there is a health threat present.  The Panel rejected this argument, and found d that, “There is nothing in evidence to suggest that the Worker’s symptoms and ultimately her injury, were magnified by virtue of her knowledge of the common reporting of symptoms by her coworkers.”

The panel noted that the nurses had worked long hours in harsh condition, and maintained a high level of dedication and professionalism.

Yarmouth decision: Number 2000-503-AD in the WCAT data base, Ontario decision No. 458/96 (1999, Ontario WSIAT).