Source: http://www.nytimes.com, April 22, 2006
By: Kirk Johnson
As W. R. Grace & Company prepares for a major criminal trial over widespread asbestos contamination here, doctors at the clinic that has treated hundreds of asbestos victims accuse the company of trying to discredit them and force the clinic to close.
The doctors are scheduled to be important witnesses for the prosecution when the federal criminal trial gets under way this fall in Missoula. They testified at several civil trials involving the contamination; Grace lost those cases.
The nonprofit clinic, the Center for Asbestos Related Disease, widely known as CARD, has been a sanctuary here for hundreds of sick and dying people as this former mining town’s extraordinary battle with asbestos unfolded over the last six years.
The treatment records and investigations by the clinic’s doctors have been crucial, medical experts around the country say, to understanding one of the worst cases of asbestos contamination in the nation’s history.
Grace, a producer of chemicals and building materials, voluntarily pays for most of the medical treatment at the clinic. In recent months, the company’s medical plan administrator imposed new rules that have made reimbursement more lengthy and involved, and pushed the clinic, its administrators say, into a cash-flow crisis. And the administrator said that a review it commissioned of past medical diagnoses in Libby found flaws in more than a quarter of the cases.
LeRoy D. Thom, who worked at Grace’s vermiculite mine for 17 years as a foreman and is the vice chairman of the clinic’s board, said he thought legal strategy and trial preparation could explain the company’s actions.
“If they can put out the fact that people are being overdiagnosed, then they reduce the credibility of the doctors,” he said.
Dr. Alan Whitehouse, a consulting pulmonologist at the clinic, is even more blunt.
“It’s a go-to-jail issue,” he said.
Grace dismisses such talk. Dr. Jay Flynn, the medical director of the Libby Medical Plan, which is operated for Grace by HNA/Triveris, a company based in Eatontown, N.J., said the tighter financial rules were imposed because of concerns that the company was being billed for services that had not been performed.
Dr. Flynn also said the medical review of past cases had been under way for years. It looked at the first 719 asbestos cases and, he said, found that 27 percent of the diagnoses, not counting the 69 people who had died, could not be substantiated as linked to asbestos.
“A lot of the things getting diagnosed at the CARD clinic as being caused by previous asbestos exposure just can’t be documented,” Dr. Flynn said.
Grace and seven of its executives were indicted last year by a federal grand jury on charges of conspiracy, wire fraud, obstruction of justice and violations of the Federal Clean Air Act in connection with the company’s mining operations in Libby. All the defendants, who face huge fines and lengthy prison terms if convicted of the most serious charges, have pleaded not guilty.
Grace is also trying to emerge from bankruptcy, for which it filed in 2001 as it was pummeled by tens of thousands of personal injury claims from all over the country by people exposed to asbestos in the company’s products.
Asbestos occurs naturally in the soil here and got mixed into the vermiculite, which Grace sold for insulation and gardening uses. Asbestos was also spread through town by Grace’s mining and milling operations. The Environmental Protection Agency has already spent upward of $120 million on cleanup efforts, including work on hundreds of homes. Most people who have gotten sick here never worked for the company, according to prosecution documents in the criminal case.
A spokesman for Grace, Greg Euston, said that because of a court order, the company could not comment on the criminal trial. Prosecutors would also not comment.
So far, more than 1,400 people in the Libby area, which has a population of about 8,000, have received diagnoses — many but not all, at the CARD clinic — of lung abnormalities related to asbestos exposure. And people are still coming forward.
“We see about 20 new patients a month, and that is ramping up,” said Kimberly Rowse, a nurse and clinical coordinator at CARD. “We’re seeing more and more people, and younger people, but our clinical resources are the same.”
Medical experts around the country who support the clinic say there is more at stake than the patient care itself.
“These doctors stood up in the face of considerable pressures, including from some people in the town, and said, we have a real problem here,” said Stephen M. Levin, the medical director of Mount Sinai School of Medicine’s center for occupational and environmental medicine in New York. “To close this clinic would prevent us learning some very important things about this disease and what we might do about it.”
Doctors at the clinic said that Mr. Arlt, 79, who worked for the company very briefly as a crane operator, had a thick layer of scar tissue around his lungs, probably a result of the 10 years in the 1960’s and 1970’s when he and his wife, Marjorie, lived downwind from a vermiculite processing plant.
But the peer review panel retained by Grace said that what might have looked like scarring at the clinic was really a layer of fat. The company’s medical administrator sent Mr. Arlt a letter last fall formally telling him that he was not a victim of asbestos. The medical administrator said it would continue to pay for treatments at the clinic since Mr. Arlt was already a patient, but not for the oxygen he uses every day.
The clinic sent Mr. Arlt’s records for its own peer review by radiologists around the country, who confirmed its diagnosis of pleural thickening, according to the clinic’s medical director, Dr. Brad Black.
Both sides agree that asbestos-related disease can be tricky to read on X-rays and C.T. scans, and that fat deposits around the lining of the lungs can sometimes look like scar tissue. The Libby Valley also has high levels of particulate pollution, mainly from the smoke of wood-burning stoves, which Dr. Flynn said can compound respiratory problems.
But an equally important problem is the local geology.
The amphibole asbestos in the soil here is very different from the more common chrysotile asbestos that many homeowners might see wrapped around their basement pipes. Amphibole asbestos does not attack the lungs in the same way, and is less often the cause of the classic asbestos-related disease, asbestosis.
The effects of the amphibole asbestos are more insidious, according to health experts around the country. A common manifestation, they say, is so-called pleural scarring on the outer tissue of the lungs. Some people with pleural scarring then develop additional symptoms, while others do not. Dr. Black said that it took experience to even see the pattern that amphibole exposure left on the body, and that Libby was one of the few places in the world where that experience had been developed.
“You have to know how to look,” he said. “Unless you’re very suspicious, you could miss the disease.” Other medical experts say that any good diagnosis also depends on knowing a patient’s history. The Grace review panel examined only X-rays or C.T. scans, or in some cases both, Dr. Flynn said, and did not physically examine or interview any patients.
In addition, the effects of asbestos often do not manifest themselves for years, or even decades. “Even if the clinic did overread their X-rays,” said Dr. Jacqueline Moline, an associate professor of occupational and environmental medicine at Mount Sinai, “people are still at risk for developing disease, and that risk is not going to go away.”