Deadly toll of lung disease
Work-related lung disease takes a heavy toll in America. The National Institute for Occupational Safety and Health — NIOSH, part of the Centers for Disease Control and Prevention — estimates that nearly 39,000 people die each year of COPD, lung cancer, pneumoconiosis (dust-induced lung disease), mesothelioma (an asbestos-linked malignancy usually found in the covering of the lung) and asthma related to on-the-job exposures. By comparison, 31,672 people were killed by guns in 2010, according to the CDC.
Millions more workers annually are thought to contract these diseases, though a doctor may not always make the connection between, say, a case of COPD and a patient’s dusty or fume-laden workplace.
In James Sawyer’s case, the tie was fairly easy to see. Hard-metal disease, a type of pneumoconiosis, is quite rare. Characterized by giant cells with multiple nuclei in the air sacs of the lung, it is found in workers exposed to cobalt through the production and processing of diamond-hard, tungsten carbide metal, or through the inhalation of dust or fumes given off by grinding or cutting.
“Pretty much anybody who gets hard-metal disease wouldn’t have gotten it unless they had a workplace exposure,” said Dr. David Weissman, director of NIOSH’s Division of Respiratory Disease Studies.
Sawyer started in the machine shop at the 550-acre Newport News shipyard — now known as Newport News Shipbuilding, a division of Huntington Ingalls Industries — in 1980. Twelve years later he became a pipefitter, a job he held until he left the shipyard in 2011.
Sawyer used a hand grinder with a 4-inch cutting wheel to cut pipe on aircraft carriers and tankers being built for the U.S. Navy. The cutting gave off dust and sparks. “You could see little flakes of metal floating in the air,” he said. The dust, a doctor at Duke wrote, included tungsten, nickel, copper, brass, carbide steel and galvanized steel.
Welders and painters working nearby contributed to the noxious fog, Sawyer said, and on many occasions he wasn’t provided a respirator. “Sometimes I would walk out of the work area, because you had to let the smoke go down,” he said.
Sawyer began having breathing difficulties in the early 1990s and was diagnosed with asthma late in the decade. By the early 2000s, he said, the attacks had become more frequent and severe. In 2008 he was transferred to his first submarine, the USS California. Ventilation in the tight quarters of the sub was poor, and his condition worsened. “I just got to the point where I couldn’t make it through a full day of work,” Sawyer said.
He was bent double by coughing spells. When he blew his nose, the discharge would come out black.
Sawyer was referred to a pulmonary specialist in mid-2010 but for six months resisted having a lung biopsy that could pinpoint the nature of his illness. “I didn’t want to miss work,” he said. His condition continued to deteriorate, however, and his last day at the shipyard was March 3, 2011.
He had the biopsy done about two weeks later. The pathologist found “marked granulomatous inflammation” in the tissue samples, which, he said, could be consistent with cigarette smoking (Sawyer didn’t smoke), pneumoconiosis or some sort of infection.
In April 2011, Sawyer found his way to a Newport News law firm, Patten, Wornom, Hatten & Diamonstein, which handles toxic torts. He weighed about 100 pounds. The receptionist rang lawyer Gary DiMuzio, who handled mostly asbestos-exposure cases and had seen his share of skeletal mesothelioma victims. Even by this standard, Sawyer stood out.
“He was wraithlike,” DiMuzio said. “He was thin as a rail and could barely breathe while speaking. I thought he might die within days.”
DiMuzio filed a Longshore claim with the Labor Department on Sawyer’s behalf in May 2011. Newport News Shipbuilding contested.
That June, a physician for the shipyard, Dr. Andrew Churg, reviewed the slides and records from Sawyer’s biopsy. The evidence “fits best for what is referred to as ‘hard metal disease,’ ” Churg concluded.
The strength of Sawyer’s claim was put to its first test at an informal Labor Department conference that September. It passed: The claims examiner found that Sawyer had established a prima facie case that his disease was work-related.
Sawyer gave a sworn deposition in his Longshore case in December 2011. Lawyer Christopher Hedrick, representing the shipyard, probed for evidence that Sawyer’s troubles originated elsewhere.
Did his wife smoke? “Yes, but she smokes outside,” Sawyer testified. Had he ever welded outside the plant gates? “Very, very little,” Sawyer said. The last time had been three years earlier, when he’d helped his son-in-law build a canoe rack for his truck.
In February 2012, Dr. Carrie Redlich, a professor at the Yale School of Medicine, reinforced Churg’s conclusion, writing in a report to DiMuzio, “There is no other more likely diagnosis than hard metal lung disease.” The ailment, she warned, “can progress away from exposure, and can lead to end stage pulmonary disease.” In short, Sawyer could die.
Three months later, Sawyer settled with the shipyard. He received a lump-sum payment of $170,219. The settlement papers included the following language: “Future medicals are to remain open.”
Sawyer, who was bracing for the first of two transplant operations at Duke, assumed that was the end of it. It wasn’t.
The shipyard refused to pay for his new right lung in January 2013. It refused to pay for his new left lung in August.
Before the transplants, “Jimmy looked like he was at death’s door,” Linda Sawyer said. “Personally, I think they agreed to all of this thinking he wasn’t going to live.”
Shipyard lawyer Hedrick suggested in a March 2013 letter to a Labor Department claims examiner that there might be a condition other than hard-metal disease “necessitating … the lung transplant.” In a letter to DiMuzio, the doctor who wrote the report accused Hedrick of cherry-picking from it and affirmed that Sawyer’s lung transplant “was due to his Hard Metal Pneumoconiosis.”
After an informal conference between the parties in April, claims examiner P.R. Hodgson sided with Sawyer, finding that “the claimant is entitled to authorization and payment of related medical treatment.” This was only a recommendation, however. The shipyard still wouldn’t pay.