The time has come for the UK Government to bite the bullet and recognise CTE
as a prescribed industrial disease in order that workers may be justly
compensated, by Alan Care
On 10 December 1999 European policy-makers and medical specialists met in
Delft in the Netherlands to discuss chronic health damage caused by solvents at
work. European medical experts were assessing and exchanging views of
standardisation of diagnosis and criteria for solvent-induced chronic toxic
enceph-alopathy. CTE is brain damage caused by solvent exposure (without a
lesion) and is usually evident on neuropsychological testing.
Most European countries except the UK and France now accept that high dose
and/or long-term occupational exposure to solvents (between 5 and 10 years’
duration) will cause permanent brain damage – that is CTE or post-organic
syndrome. Solvents are universally accepted as causing health, damage
particularly by high-dose acute poisoning.
Personal injury claims for solvent exposure
I became involved in personal injury claims caused by solvent exposure when
pursuing claims against Rentokil, Cuprinol and other wood treatment
manufacturers in the late l980s and early 1990s. These resulted in dozens of
claims for workers and consumers for damage to health caused by exposure to
wood treatment products being settled out of court.
Wood treatment chemicals then (and maybe still) contained a 5 per cent
active ingredient – pesticides such as Lindane (gamma HCH), pentachlorophenol
(which may be contaminated with dioxins) and tributyltinoxide. However, the
products also contained 95 per cent organic solvent. This was probably
responsible for acute (either sudden onset or intensely perceived) injuries
rather than the pesticides in some cases. This is particularly so for short-term
ill health effects such as flu-like symptoms and headaches.
After this string of claims including Yates v Rentokil, which settled for
£90,000, I began to receive more claims that were solvent-based. Barry Yates’
claim resulted from using 22,000 litres of PCP and the development of a rare
cancer, a soft tissue sarcoma, probably due to dioxin impurities in PCP.
There was also a settlement for Llwyd Nichols who died as a result of
complications following aplastic anaemia (either "following or arising
from anaplastic anaemia"). Rentokil had treated his parents’ home and
their insurers settled this claim but fought a subsequent case of Geskill v
Rentokil in the High Court. This claim failed because Mr Justice Otton (as he
was then) took the view that the latency period for aplastic anaemia was too
long after the exposures.
The next claim of note concerning solvents was for 17-year-old Simon
Freeman, who died from taking a drugs overdose after having been exposed to the
solvent trichloroethylene (Trike) at the factory where he worked in the West
Midlands. The allegation was that his exposure to Trike had "disturbed the
balance of his mind" leading to him taking a fatal overdose. His mother,
June, campaigned after her son’s death for restrictions on solvent work use
(particularly for young people) and achieved success in the European
parliament. Some years on, June is now a member of a government expert
committee and has the task of assessing the regulatory safety of chemicals.
For many years it was the Scandinavians who spearheaded CTE and
solvent-induced chronic health damage. It was quietly whispered in the UK
condescendingly as, "Oh, that Scandinavian disease". This was a
cynical condemnation by those who should have known better.
Acute and long-term exposure
I then began to be involved in claiming damages for personal injuries for
those affected by both high-dose acute and long-term solvent exposure.
The first claim among others was for a former watchmaker from Sussex who
suffered CTE. His claim was settled out of court for substantial damages. His
case had been the subject of a television documentary prior to settlement. He
could no longer work as his concentration and memory were "shot". In
his spare time he had kept the books for a local charity but due this loss of
cognitive ability and memory problems he could no longer do so. He also
complained of a loss of peripheral vision.
The journal Hazards reported the £280,000 settlement of a legal claim for
solvent injury to Tony Bradshaw. Bradshaw had worked for the Ministry of
Defence at Portsmouth where he had been extensively exposed to MEK. His
solicitors, Thompsons, with the backing of his union AEEU, pursued his claim.
Occupational disease specialist, Professor Seaton, provided supportive
medical evidence for his case. Professor Seaton had earlier published two
articles on major neurological disease and occupational exposure to solvents,
and organic solvents and the nervous system in the Quarterly Journal of
Medicine in 1992.
A substantial claim was settled last year against the MoD for £300,000 for a
solvent (Trike)-induced CTE. To date, as far as I am aware, no solvent CTE case
has gone to trial. This claimant remains anonymous for personal reasons
unconnected with the settlement. His was a fascinating case.
He had been dismissed from the Naval Fleet Air Arm, where he had served as a
mechanic, on ill health grounds. He had used Trike on a daily basis, washing
down Sea King and Lynx helicopters with a rag and bucket of Trike, and working
in confined spaces on board ship. Trike is a highly efficient low-cost cleaning
and degreasing agent.
His diagnosis by Naval doctors was chronic fatigue syndrome. The Naval
medical specialists did not think to consider that his condition could have
resulted from using Trike. This was despite reports of him "bouncing"
off the ship corridor walls after extensive working sessions with Trike. The
Navy seemed to prefer to believe he was malingering and to all intents and
purposes seemed to shut their eyes and fail to investigate any apparent cause.
He had markedly similar cognitive and memory problems to the watchmaker
mentioned previously. He could no longer concentrate or retain any employment
of substance and continues to suffer from debilitating fatigue.
Types of CTE
There are three types of CTE which are helpfully explained in White and
Proctor’s article on solvents and neurotoxicity published in the Lancet (vol.
349 April 26 1997).
"The last category of severe CTE is rare. In this category the worker’s
health has been damaged as in the case of painters who have worked intensively
with solvents (the solvent being in the paint) for many years and having
resultant dementia-like health damage. The UCATT builders union introduced a
campaign of warnings to employers and industry some years ago calling for the
substitution of organic solvents."
Most claimants have suffered what may be described as "borderline"
mild/severe CTE. Nonetheless this is severely debilitating.
The Swedish medical specialists began to report on CTE in the 1980s. For
example, in 1986 Ulf Flodin and his colleagues from the Department of
Occupational and Environmental Medicine Linkoping published a paper on clinical
studies of psycho-organic syndromes among workers with exposure to solvents.
This followed a number of other Swedish, Norwegian and Danish studies.
There has been a substantial amount of literature worldwide acknowledging
the existence of CTE including from the USA’s Atlanta Agency for Toxic
Substances and Diseases Registry. The World Health Organisation produced their
core protocol in 1989. Some aspects of CTE remain controversial even within the
general European acceptance of occupationally derived CTE. This includes
one-off or short-term high-dose exposures (under 5-to-10 years’ duration) and
long-term low dose exposures
However, an interesting and informative paper was published by US
neurologist Robert Feldman in AJIM in 1985 on the long-term follow-up of a
single toxic exposure to trichloroethylene. Here a worker suffered a one-off
exposure. He was followed up 12 and 16 years later by Dr Feldman and still had
health problems.
Indeed, a later paper from the USA, on neuropsychological function in
retired workers with previous long-term occupational exposure to solvents
(Daniell et al, 1999), suggests that even after withdrawal from solvent
exposure the neuropsychological affects may linger for many years. The report
states, "The findings were consistent with residual CNS dysfunction from
long-term exposure to organic solvents persisting many years after the end of
exposure".
What is clear and established beyond doubt is that long-term/high-dose
solvent exposure is an undeniable cause of chronic damage to neuropsychological
health.
CTE is still not formally recognised in the UK
However, in the year 2001 we are still waiting for formal recognition of CTE
by the Health and Safety Executive and the UK Government. Despite the
overwhelming evidence, the HSE continues to review the evidence and effectively
"sit on the fence" as to CTE. It was poignant to note the HSE
representative at the Delft conference was an isolated figure. However, the HSE
says it is making progress through its own reviews and consideration of the
evidence. It has held solvent awareness conferences with industry and other
interested groups.
The HSE’s initial discussion paper for its expert advisory group the Watch
Committee appeared to dismiss any chronic health attributable to solvents of
the CTE type. However, the HSE (after submissions by myself, June Freeman and
Hazards to the HSE and Minister Alan Meale MP) altered the wording of the
discussion paper.
The HSE still maintains that there is no pathological evidence of chronic
solvent poisoning. In effect the HSE maintains there is no scientific evidence
or pathological test to diagnose CTE as there may be for other industrial
diseases. However, the HSE is still assessing the evidence and its official
response to the neuropsychological aspect of CTE.
However, in a previous article for Occupational Health entitled, "Trike
a cause for concern?"(March 1996) I stated, "The scientific and
medical solvent literature is there to be read and observed… The HSE must
stop burying its head in the sand. The Swedish authorities are surely wise to
adopt a precautionary approach and to prefer to protect their workers’ health
when signs are evident. The HSE should know that ignorance of scientific
literature may well be tantamount to ignorance of the law – it is no
excuse."
This article called for a reduction of workplace levels for the solvent
trichloroethylene to be reduced from the present UK level of 100 ppm to 10 ppm
in line with the Swedish regulatory level. The article was published with a
reply from the HSE (at its request) on the same page.
The HSE acknowledged the 100 ppm average over eight hours but stated,
"We believe that HSE’s processes for dealing with substance control are
robust and the most likely way of ensuring that exposure limits are sensible
and reliable".
We are now approaching the fourth anniversary of that article and nothing
substantive has changed and the words of Sylvia Collier in the Health and
Safety Journal (1998) that "Trike proves too toxic" remain perfectly
sound.
There is scientific evidence for acute solvent poisoning levels being
reduced from the UK 100 ppm standard. This appears untenable in view of
experiments carried out by Japanese experts who recommended a 50 ppm limit in
1977 after human volunteer exposure experiments.
They reported their findings in an article on the dose response relationship
for trichloroethylene in man which was published in the International Archives
of Occupational and Environmental Health. They stated, "From the above
results 50 ppm might be suitable for a threshold limit value for trichloroethylene.
This conclusion, however, is based on the appearance of headaches, not the
critical changes in trichloroethylene metabolism at 50 ppm."
The time has come for the UK Government to act to ensure that CTE (or
post-organic syndrome) is recognised as a prescribed industrial disease. This
will enable workers to be entitled to industrial disease benefits "as of
right". Why are these benefits still being withheld? Is it because of
government inaction? Could it be a question of saving money I ask myself?
Surely not.
Alan Care of Russell Jones & Walker solicitors specialises in claims
for chemical poisoning.
Mental disorders arising from solvent exposure
Acute organic mental disorders
Acute intoxication                                Duration:
minutes to hours
Symptoms: central nervous system depression, psychomotor or attentional
deficits
Residua: none
Acute toxic encephalopathy                 Symptoms: confusion,
come, seizures
                       Pathophysiology:
cerebral oedema, central nervous system capillary damage, hypoxia
                       Residua:
permanent cognitive deficit may occur
Chronic organic mental disorders
Organic
affective syndrome                  Duration:
days to weeks
                       Symptoms:
mood disturbance (depression, irritability, fatigue, anxiety)
                       Residua:
none
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Mild
chronic toxic encephalopathy       Duration:
weeks
Course: insidious onset
Symptoms: fatigue, mood disturbance, cognitive complaints, cognitive
deficits: attentional impairment, motor slowing or unco-ordination,
visuospatial deficits, short-term memory loss
Residua: improvement may occur in absence of exposure, but permanent
mild cognitive deficits can be seen
Severe chronic
toxic encephalopathy    Symptoms:
cognitive and effective change sufficient to interfere with daily living
Cognitive deficits: as in mild chronic toxic encephalopathy but more
severe
Neurological deficits: abnormalities seen on some neuro-physiological or
neuronal logical measures (computed comography, magnetic resonance imaging,
electromyography, electroencephalograph)
Course: insidious onset, irreversible
Residua: permanent cognitive dysfunction
