The Paducah Sun
The Paducah Sun
Paducah, Kentucky
Sunday, February 16, 2003

Seeking coverage for larynx cancer

By Joe Walker
BARKLEY THIELEMAN/The Sun USEC Early workers lacked protection: The C-400 cleaning and decontamination building has been the workplace of thousands over the years.

Robert Pierce paused repeatedly to gather enough breath to whisper and keep from coughing or choking. That is his way of life after having malignant vocal cords removed five days after terrorists destroyed the World Trade Center.

The 48-year-old Paducahan said he is one of at least five men, all in their late 40s and early 50s, diagnosed with larynx cancer in the past five years after working together in Paducah Gaseous Diffusion Plant locations now known to have been heavily contaminated with radiation and chemicals.

All but Pierce have had voice-box removals and speak with a resonating device they hold against their throats. He was the one lucky enough to undergo a unique, experimental surgery at Vanderbilt University Medical Center in Nashville, Tenn., to save enough of his voice box to allow him to whisper.

Despite the cluster of unusual malignancies, normally seen in elderly people who have abused alcohol and cigarettes, larynx cancer is not one of 22 cancers for which sick Paducah plant workers are eligible for $150,000 lump-sum benefits and ongoing payment of medical costs.

Cancer of the pharynx, the other fork of a "Y" a half-inch away from the larynx, is on the list.

The Department of Labor is trying to determine how much radiation Pierce was exposed to in order to determine his eligibility. His case was forwarded to the National Institute for Occupational Safety and Health in September 2001.

It is among about 11,000 backlogged as NIOSH develops guidelines and beefs up staffing to meet demand.

Had the sickness not robbed him of his livelihood, he would be working at the plant as a utilities supervisor while half its 1,250 workers are on strike. Before joining management, Pierce was a union man, laboring beside many of the middle-aged pickets who now worry about getting sick and not having having enough retirement income to offset soaring health-care costs.

"They call us heroes of the Cold War," he said. "We weren't heroes; we were victims. A hero knows what the risks are and takes the risks. A victim thinks everything is fine."

Pierce started at the plant in March 1975 when the plant's cavernous buildings that enrich uranium for nuclear fuel were being upgraded. Massive pieces of equipment were being cut out, dismantled, cleaned, degreased, rebuilt, tested and put back into service.

What the men didn't know was that recycled material from nuclear power plants had been fed earlier into the system, contaminating it with traces of plutonium and other highly radioactive substances that, if ingested, wreak havoc with cell structure in lungs and other vital organs.

"Many of the people on the picket line now were hired during the upgrade. Because of their hard work, that equipment is still running today at Paducah," Pierce said. "They have seen many co-workers get sick like me, and many die. They were lied to and misled. They should be taken care of medically."

The younger men, like Pierce, did much of the cleaning without protective equipment, monitoring or asking questions. Pierce spent considerable time in a building called C-400 where liberal amounts of the now-banned degreaser trichloroethylene washed the equipment in a huge vat. Radiation-laced spills from the equipment washed down a drain, and now cleanup workers are trying to extract almost 180,000 gallons of the chemical from groundwater beneath the building, some at concentrations more than 20,000 times greater than the federal safe drinking water standard.

Pierce and many of his buddies also worked without protection in a building where ash from feeding the highly contaminated material into the plant was pulverized. He remembers scraping gold from what he now believes were secretive parts from dismantled nuclear weapons.

One day when he arrived at work, he was told he had to submit to a "body counter" to determine the level of radiation in his body.

"I had to take four showers and scrub as hard as I could to keep the monitor from going off from radiation on my skin," he said. "I had just come from my bed at home. I thought I was clean."

In the 1980s, when radiation training and health physics evolved, workers began to understand what they had been exposed to and how much damage ionizing radiation causes when it gets into the body, Pierce said. Buildings that people had worked in were isolated and radiation monitors installed. Chairs in the plant theater, known as the Roxy, were disposed of because of contamination from employees' clothing.

"Then we started getting uneasy," he said.

A fitness buff, Pierce practiced martial arts, lifted weights and got into biking. By 1998, he was regularly riding his bicycle 50 miles "and hardly breaking a sweat." But a prolonged hoarseness caused him to see a doctor. That April, at age 43, he underwent supposedly routine surgery to remove a benign node.

"I went to sleep and woke up with cancer," he said.

Refusing surgery to remove his larynx, Pierce consulted Dr. James Netterville, a world-renowned surgeon in Nashville, Tenn. Netterville said the cancer was "unusual" for a man Pierce's age, even one who had smoked occasionally as he did. "We were quite surprised at the aggressiveness of this lesion," the doctor later wrote.

Pierce underwent rounds of chemotherapy and radiation treatment and was pronounced cancer-free in June 1998. But by the following February, he underwent another operation for throat changes that had Netterville worried, saying the development was "extremely unusual for a patient whose carcinoma was only caused by cigarette use."

By August 2001, the cancer was back. This time, Pierce opted for the new operation to avoid being like his four co-workers.

Besides the others with larynx cancer, Pierce frets about a fellow worker who shaved his head to lend support when Pierce underwent chemotherapy. Pierce didn't lose his hair from the treatments, but the friend later was diagnosed with prostate cancer in his early 50s. Like Pierce's disease, prostate cancer isn't on the list for $150,000, and now the cancer has spread into the friend's bones and elsewhere, Pierce said.

He said a man he worked with in C-400 who cut up equipment scraps with an electric chain saw died of multiple cancers, including the lung. Another man who helped Pierce wash cylinders of enriched uranium is battling colon cancer, he said. "The guy who inspected them died of colon cancer."

Like colon cancer, lung cancer is on the compensation list. In hopes of helping Pierce get compensated, Netterville noted Pierce's working in environment where exposed workers were getting sick from cancer of the lung and pharynx. "Certainly the association between pulmonary cancer and pharyngeal cancer and laryngeal cancer is very strong," his letter said.

Roberta Mosier, deputy director of the Energy Employees Occupational Illness Compensation Program in Washington, D.C., said the list of 22 cancers sprang from previous legislation to help sick uranium miners and millers. The list was derived from studies linking radiation exposure with certain types of cancer, she said.

Mosier said bone and kidney cancer have been added to the list of qualifying cancers for enrichment workers, and it would take another legislative amendment to add other cancers, such as the larynx.

"I do want to stress we have a policy respecting cancer of the cartilage of the larynx," she said, explaining that cartilage is a part of bone structure. "We had an actual case that caused us to investigate the case further. We went to the National Cancer Institute and got guidance. Based on their opinion, we have determined we will consider that (larynx cartilage cancer) as a specified cancer (for compensation)."

Pierce said his larynx cancer is an unusual squamous-cell form similar to skin cancer. Larry Elliott, director of NIOSH's Office of Compensation Analysis and Support in Cincinnati, said larynx, prostate and certain other cancers did not make the list because "the scientific body of evidence" does not support a strong correlation between them and radiation exposure.

The new law does not take into account chemical and metal exposure, or a mixture of those exposures with radiation. For those cancers not on the list, Congress asked NIOSH to establish a method of dose reconstruction. Elliott said the preparatory work was extensive and his office was understaffed, which meant that only 14 reconstructions had been done as of late last month out of about 11,000 claims.

Now that the NIOSH staff has doubled to 43 and more than 100 health physicists are on contract through Oak Ridge (Tenn.) Associated Universities, the process should move much faster, he said. "Our expectation is by March to do 100 (reconstructions) a week and by June, 200 a week."

Elliott said he thinks claims will level at just under 700 a month, which should allow his office to keep pace once it gets caught up.

Citing privacy laws, neither he nor Mosier would comment on Pierce's case. However, Elliott said the NIOSH database is set up to flag groups of similar cancers, such as of the larynx, for further study.

"We'll be able to determine how many cancers of a certain type exist in the Paducah work force as they come forward," he said. "The burden of proof should not be on the claimant population."

Meanwhile, it is a waiting game for Pierce and others who believe they have fallen though the cracks in the system. He frets about the picketing workers, who along with his management friends collected hundreds of dollars when he first got sick to help him with traveling daily to Nashville for many weeks of treatment.

He said his plant insurance has been "wonderful," but only after his Paducah physician, Dr. Kenneth Cook, saw to it that the Vanderbilt care was included in the insurance health maintenance organization (HMO) group.

Pierce, whose fixed disability pays about 30 percent less than his plant income, said he understands striking workers' concerns that rising health-care costs and a fixed pension will leave them in jeopardy if they get sick. He walked the last picket line in 1979, long before he left the union to become a supervisor.

"If I lived to be 65, my pension will be based on my salary when I left the plant, and it will never go up," Pierce said.

The roughly 630 striking members of the nuclear workers' union want plant operator USEC Inc. to increase the pension fund it received from the Department of Energy when the company was privatized in 1998. That concern, and holding down workers' share of health insurance costs, will be critical topics when the two sides meet with a federal mediator Wednesday morning.

"I can see the company's side of it. They're trying to hold down costs," Pierce said. "But they inherited the pension plan and knew what they were getting into."

USEC has run a safe plant and isn't responsible for worker illnesses, but DOE and previous contractors should be held accountable, Pierce said.

He said the strike probably wouldn't have started if the workers hadn't learned so much about their working conditions since a major federal lawsuit in 1999 set off an avalanche of publicity. After that, an Energy Department study confirmed high levels of contamination and potential exposures in certain areas of the plant.

"The main issue of the strike is health care," he said. "People are getting older and getting sicker."