Sacramento Bee Investigative Report: Flavoring agent destroys lungs - sacbee.com

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Investigative Report: Flavoring agent destroys

lungs

Two workers need transplants; threat could be

widespread

By Chris Bowman -- Bee Staff Writer

 

Published 12:01 am PDT Sunday, July 30, 2006

Story appeared on Page A1 of The Bee

 

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By the time Irma Ortiz discovered she had been

breathing toxic fumes on

her job as a mixer at Carmi Flavors near Los

Angeles, she had lost at

least 70 percent of her lung capacity. Ortiz, 44,

a nonsmoker who used

to lift 50-pound bags routinely, now finds

walking so difficult she

spends most of her time indoors. Sacramento

Bee/Hector Amezcua

 

See additional images

 

LOS ANGELES -- Hacking and gasping, Irma Ortiz

could cart her groceries

only so far before she'd catch other shoppers

glaring at her.

 

Mortified, she'd abandon her cart on the spot and

bolt for the door.

 

Frank Herrera could gun his dirt bike only so far

before choking on the

rush of air. Go. Stop. Go. Stop. Exasperated, he

gave up riding.

 

Ortiz, 44, and Herrera, 34, are odd candidates

for lung transplants,

being nonsmokers and having considerable youth on

their side.

 

How they lost 70 to 80 percent of their breathing

capacity is no less

astonishing. They acquired the same rare,

lung-ravaging disease from

breathing the same chemicals on the same type of

job.

 

The two weren't working in a chemical or

pesticide plant. Nor in a

weapons plant. They didn't metal-plate, fumigate,

degrease, demolish,

smelt or weld.

 

They made, of all things, artificial food

flavorings.

 

Harmless as that seems, two big labor unions that

champion ironworkers

and meat cutters are now fighting for the workers

who whip up piña

colada, butterscotch and other flavors that sell

America's snack foods.

Just last week, 40 job health experts joined the

Teamsters and the

United Food and Commercial Workers in urging the

Bush administration to

issue an emergency order restricting worker

exposure to a widely used

butter flavoring -- a chemical called diacetyl.

 

" Although the precise number of workers already

suffering respiratory

effects from exposure to diacetyl is unknown, the

potential magnitude of

the problem is sizable, " the experts said in a

letter to U.S. Labor

Secretary Elaine Chao.

 

" It is now time … to use the scientific evidence

to protect American

workers from debilitating lung disease, " the

group said in support of a

petition to Chao filed by the unions.

 

The lung disease is as bad as its name suggests:

bronchiolitis

obliterans. It's a condition that literally

obliterates the bronchioles

-- the lungs' tiniest airways -- resulting in

drastically reduced

breathing capacity.

 

Ortiz and Herrera are the first Californians

known by state health

officials to have developed the disease from

working in a flavoring

factory, most likely from inhaling diacetyl's

powerful fumes, the health

investigators said.

 

But the search for victims has only just begun.

 

Waking up to the threat

 

Many public health physicians and scientists

believe they are on the

verge of uncovering an occupational health

epidemic among the thousands

of men and women who have worked on production

lines in the nation's

flavoring factories.

 

Neither OSHA, the federal Labor Department's

Occupational Safety and

Health Administration, nor Cal-OSHA, its state

counterpart, has set

limits for worker exposure to diacetyl.

 

In California, state health department staff and

Cal-OSHA regulators are

expanding their investigation beyond the two

plants where Ortiz and

Herrera worked to the estimated 28 other

flavoring companies statewide.

 

Last week, state officials enlisted the help of

physicians at the

National Institute for Occupational Safety and

Health in testing the

breathing capacity of current and former

flavoring workers, beginning

with the Los Angeles-area plant where Ortiz

worked.

 

Some of the same NIOSH doctors found a strong

link between diacetyl and

the lung disease a few years ago among workers at

microwave popcorn

factories in the Midwest. The disease permanently

disabled dozens of

popcorn workers and killed at least three,

according to the doctors.

 

The flavoring industry's largest trade

association also assumed a

leading role in the California investigation. The

Flavor and Extract

Manufacturers Association recently arranged for

its respiratory disease

experts at the National Jewish Medical Center in

Denver to evaluate

workers and inspect operations at companies.

 

The flavor association is bringing health

investigators from all sides

together to share findings for the first time

Wednesday at the medical

center.

 

Consumers who prepare or eat frozen meals,

pastries, candies, coffees

and other foods containing these additives are

not at risk, doctors say.

That's because the chemical concentrations in the

final products are

much lower than those found in flavorings and

snack food plants.

 

Grave risks, uneven protection

 

Without proper protections, workers who make the

flavor mixes in batches

of 50 to 5,000 pounds can inhale highly toxic

fumes as they pour

chemical liquids into huge blenders.

 

The level of worker protection in the flavoring

business varies from

company to company as with other industries where

job safety is largely

self-policed.

 

Several companies declined to give The Bee an

inside look at their

operations. Western Flavors and Fragrances,

however, opened the doors of

its Livermore plant for a tour at the

encouragement of the flavoring

industry.

 

By all appearances, the factory appeared to be a

model of industrial

hygiene, with workers fully suited in protective

gear, with meticulous

storage, handling and labeling of hazardous

chemicals, and worker safety

training that goes beyond the law.

 

" This plant is typical of those in our

association, " said John Hallagan,

the flavor association's chief spokesman and

attorney.

 

Yet the stories of Ortiz and Herrera provide

fresh and powerful evidence

that some of the estimated 3,700 flavoring

production workers nationwide

continue to be exposed to highly toxic fumes.

 

Their experience also exposes serious disconnects

in job safety

surveillance and enforcement that allow workers

with little or no

knowledge of the potential dangers to slip

through the safety net and

lose most of their capacity to breathe, according

to interviews with

several health experts and regulators and a

review of Cal-OSHA

inspection records on flavoring plants in

Southern California.

 

Few of the flavoring workers are unionized. Many

of the estimated

hundreds in California are immigrants like Ortiz

and Herrera, and

primarily speak Spanish.

 

The two worked 60 miles apart in Southern

California, which hosts most

of the flavoring factories on the West Coast --

Herrera at Mission

Flavors & Fragrances Inc. in Orange County, and

Ortiz at Carmi Flavor

and Fragrance Co. near Los Angeles.

 

" They never said nothing to us about the

chemicals there, the kinds of

dangers or give us a warning like, you know,

'This is bad for you guys,

protect yourselves better,' " Ortiz said of her

former employer. " They

never say nothing to us like that. "

 

Eliot Carmi, the company's president, did not

return phone messages for

comment. State job safety regulators declined

comment on their ongoing

investigation of conditions at the Carmi plant.

 

Airways narrowed in matter of months

 

The swiftness and severity of the disease alarmed

Barbara Materna,

California's chief of occupational health.

 

" When you have young people on a lung transplant

list and unable to

work, it's a very serious problem, " said Materna,

whose staff

interviewed Ortiz in May and inspected the flavor

blending room where

she worked for eight years.

 

Breathing the toxic fumes can drastically lower

breathing capacity in a

matter of months. The vapors inflame the

bronchioles, crucial airways

branching like twigs at the ends of the

respiratory tree where oxygen

enters the blood. Scar tissue builds up in the

inflamed bronchioles,

shrinking or completely blocking the tiny air

tubes.

 

" It's the difference between a Jamba Juice straw

and a cocktail straw, "

said Michelle Fanucchi, a UC Davis researcher in

respiratory disease.

" Have you ever tried to drink a milkshake out of

one of those really

skinny straws? It takes a lot of effort. "

 

Materna and other health scientists said a much

broader worker

population may be at risk: Those who manufacture

chemicals supplied to

the flavoring factories where mixers like Ortiz

and Herrera labored, and

the bakers, candy makers, beverage formulators

and other who use the

flavoring mixes.

 

And, while diacetyl is the leading suspect,

health and industry

officials are warning companies that other

vaporous flavoring agents may

be damaging workers' lungs: the already regulated

acetaldehyde (common

in citrus flavorings) and benzaldehyde (common in

cherry and other fruit

flavors), among others.

 

" These chemicals are still in use in industries

that we haven't even

begun to look at, " Materna said.

 

For now, though, the spotlight is on flavoring

workers. Ortiz and

Herrera came to the attention of Cal-OSHA in the

past two years by sheer

serendipity and happenstance, said Dr. Philip

Harber, a UCLA

occupational health expert who is treating them

both.

 

" If I'm randomly seeing a couple of cases,

there's likely to be a lot

more out there, " Harber said.

 

Indeed, just in the past two weeks, doctors

conducting breathing tests

identified three more potential victims of

bronchiolitis obliterans. Two

worked at Carmi Flavor, Ortiz's former employer,

and a third worked at

the nearby Mastertaste plant in the City of

Commerce, just outside Los

Angeles, Materna said.

 

The flavoring industry cases, together with the

sickened popcorn

workers, provide " compelling scientific evidence

linking occupational

exposure to diacetyl to bronchiolitis

obliterans, " the health experts

said in the letter sent Wednesday to Labor

Secretary Chao.

 

Industry doctors in California began looking for

that evidence a year

ago by screening workers. Companies later struck

a deal with Cal-OSHA to

continue evaluating employees and to conduct

their own safety

inspections -- in exchange for avoiding visits

from agency enforcers and

possible citations. The catch was, the companies

would then have to

share the results with regulators, who would

follow up on-site to make

sure that the plants were safe.

 

Some see conflict of interest

 

Some public health experts question whether

regulators should be

satisfied with information that comes secondhand

from an industry with a

financial stake in the outcome.

 

" It's terrific that industry wants to play a role

in solving the

problem, but it's the responsibility of

regulators to ensure that

employers provide a safe workplace, " said David

Michaels, who has

studied the Midwestern popcorn workers disease as

a public health

professor at George Washington University.

 

An industry-paid doctor, Michaels said, no matter

how professional, has

an inherent conflict of interest that could taint

the process.

 

" It's not a question of how honest you are, or

how good you are, "

Michaels said. " It's that the financial

relationship clouds your

judgment. And Cal-OSHA is not there to watch the

data being collected. "

 

The leading industry physician, Dr. Cecile Rose

at National Jewish

Medical Center, did not return phone messages for

comment.

 

Cal-OSHA acting director Len Welsh said it's the

employer's

responsibility to screen workers' health and that

Rose is highly

reputable and renowned in her field.

 

But, said UCLA's Harber, Cal-OSHA should have

issued an emergency order

requiring the state's flavoring plants to reduce

chemical exposures once

it learned of Herrera in March 2004.

 

" Certainly there was enough evidence to justify

intervention in time to

have prevented injury to Irma, or at least

reduced the harm, " said

Harber, who diagnosed Ortiz's disease in March.

 

Cal-OSHA doesn't see it that way.

 

" There was a real question as to whether there

was a problem (beyond

Herrera's case), although this second diagnosis

(Ortiz) adds some real

urgency to it, " Welsh said.

 

Before ending up at UCLA's

Occupational-Environmental Medicine Clinic,

Ortiz and Herrera had visited several

primary-care doctors who

misdiagnosed their conditions as asthma or

bronchitis.

 

Recalling their initial doctors' visits, Ortiz

and Herrera told The Bee

that they were at a loss to account for their

illness.

 

" I just thought I had a bad cough, " Herrera said.

 

His breathing declined to the point where he

slept tethered to an oxygen

tank. Still, he didn't want to lose his job. He

shopped around for a

doctor who would attest to his job fitness -- to

no avail.

 

" My biggest concern was that I couldn't go back

to work, " said Herrera,

who was supporting his then-wife and their two

young children in Riverside.

 

Mission Flavors provided Herrera with a breathing

mask that filtered out

chemical vapors, but, apparently, with no

instruction, according to

Cal-OSHA records of its 1,050-hour investigation

of the company.

 

" He thought it inhibited his breathing toward the

end of his employment,

and thought it was safer not to wear it, " an

inspector noted after

interviewing Herrera.

 

Mission Flavors also failed to tell authorities

about Herrera, who left

on medical disability and was hospitalized " due

to his illness from

diacetyl, " Cal-OSHA records show. The agency

instead found out through

Harber.

 

Cal-OSHA fined Mission Flavors $45,575 in January

2005 for several

violations, including " failure to report

illness. " Moreover, it found

that Herrera " became ill because employer failed

to implement proper

controls and respiratory equipment. "

 

The company is appealing the enforcement action.

Its president, Patrick

Imburgia, could not be reached for comment.

 

Herrera, meanwhile, is suing diacetyl

manufacturers. He has lost 70

percent of his breathing capacity, Harber said.

 

Toxicity known early on

 

Bronchiolitis obliterans is known to result from

extraordinary injury to

the lungs. Those suffering the disease, according

to the medical

literature, include survivors of mustard gas

attacks in Iraq and Iran;

residents of Bhopal, India, poisoned in 1984 by

chemical gases released

from a Union Carbide pesticide plant; and those

who have had lung

transplant complications.

 

At that level, every breath takes a toll, said

Dr. Marc Schenker, an

occupational health expert and chairman of the

Department of Public

Health Sciences at the University of California,

Davis.

 

" People who have that describe it as a living

hell, " Schenker said.

" Because you are out of breath just sitting. "

 

Diacetyl's potent punch was no secret to its

manufacturers.

 

At least one of them, the German giant BASF, had

performed experiments

in the 1970s showing diacetyl fumes to be

extraordinarily effective at

killing lab rats.

 

" That was a big surprise to everybody, " said the

flavor industry's

Hallagan. His trade group did not learn of the

internal study until

October 2001.

 

But the flavoring group apparently did know as

early as 1985 that

breathing high concentrations of diacetyl posed a

breathing hazard -- to

humans -- according to the association's

" ingredient data sheet " on the

chemical.

 

" Harmful. Sore throat, coughing; may be

absorbed, " the report states

under the heading, " Human Health Effects Data,

Known Effects of Acute

Exposure " for inhalation. " High concentrations

may cause irritation of

respiratory tract; capable of producing systemic

toxicity. "

 

The diacetyl " ingredient data sheet " had taken on

a different look by

2001, the year the industry first learned of the

cluster of popcorn

worker cases in the Midwest. Under the same

heading, the new report

states, " Not Found " for both ingestion and

inhalation.

 

Hallagan said the industry had not yet gotten

around to updating the

data sheet, using a " place-keeper " to fill in the

blanks.

 

And the " place-keeper " went by the term " Not

Found. "

 

To this day, the manufacturers' Material Safety

Data Sheet on diacetyl

does not mention bronchiolitis obliterans among

the potential hazards.

 

Warning signs misread

 

By the time Irma Ortiz learned she had been

breathing highly toxic fumes

on her job, her lungs were all but destroyed.

 

She enjoyed her job at Carmi Flavor. The plant

was a short commute,

getting her home to South Gate in time to make

dinner for her three boys

and husband, an auto-parts salesman.

 

She took pride in her physical strength,

routinely lifting 50-pound

cartons, driving a forklift and being the only

female on the production

floor.

 

Starting in 1997 at $6 an hour, she prepared

secret recipes for about

every imaginable flavor -- pineapple, pistachio,

cappuccino, key lime.

 

Ortiz worked with four or five others in a room

the size of a two-car

garage -- with no ventilation system, no

vapor-tight goggles and -- for

years -- no vapor mask.

 

As a mixer, Ortiz got the brunt of the fumes. She

routinely poured the

pungent chemical solutions by hand into a giant

electric blender.

 

" When I pour the liquids into the funnel, you can

smell the fumes, "

Ortiz said. " They were always there. There is no

way to take the fumes

out, because we only have one door … that's it. "

 

Less than a month into her job, Ortiz began to

complain about constant

irritation in her eyes. A company doctor said she

had developed

photophobia -- an usually strong sensitivity to

light. Ortiz noticed

that her co-workers in the mixing room also had

red eyes.

 

Her husband, Victor Mancilla, said he couldn't

help but notice something

funny when she came home from work -- something

coating her eyelashes.

That was dust from the chemical powders.

 

And there was something peculiar about her long,

coal-black hair. To the

touch, it felt like cotton candy.

 

" Like she had put a gel on, " Mancilla said. " And

it was real thick. You

can go ahead and grab her hair, and you could

squeeze it together. It

would just stay there. "

 

The flavoring odors also stuck to Ortiz, even

after she changed out of

her work clothes.

 

" A couple times she was going to the doctor, and

the good thing about

it, she was smelling real good, like a

strawberry. "

 

Patients in the waiting room " would go, 'Ah, you

smell good,' " Ortiz said.

 

Carmi Flavor eventually got her a vapor mask --

after she developed a

nasty, persistent cough.

 

" I couldn't even talk with nobody. I just cough,

and cough and cough. "

 

An investigator with Carmi Flavor's insurance

company had to abort his

interview with Ortiz. She couldn't complete a

sentence without retching

out a ghastly chorus of coughs.

 

Doctors told her she had asthma or bronchitis.

But the bronchodilators

and oral corticosteroids didn't improve her

breathing.

 

Everyday activities had her gasping for air. A

walk around the

neighborhood park was like a marathon. A flight

of stairs -- Mount Everest.

 

" I see the steps, and I think, 'Oh my God, how

many steps do I have to

go?' I say, 'Wait a minute. Let me get air. Wait

a minute.' "

 

The breakthrough in diagnosis came this past

spring.

 

The fourth doctor she visited, Dr. Arthur Gelb of

Long Beach, had read

about the popcorn workers' lung problems. That

prompted him to ask about

the chemicals she used at work.

 

" Diacetyl " topped her list.

 

Gelb referred her to Harber, a colleague at UCLA.

Following an open-lung

biopsy, Harber confirmed that, like Herrera, she

had bronchiolitis

obliterans.

 

Ortiz -- a nonsmoker and a one-time robust worker

-- has lost 80 percent

of her breathing capacity.

 

" Before I used to be more healthy, but not no

more. I gave all my

strength to Carmi, to the company. I leave all my

strength there. "

 

The disease is irreversible. And it could worsen

over time.

 

Already, doctors have deemed Ortiz eligible for a

double-lung

transplant. She plans to add her name to the

waiting list in August.

 

If Ortiz undergoes the operation, at best she

could resume an active

life for several years. At worst, she could

suffer a known complication

of lung transplants:

 

Bronchiolitis obliterans -- all over again.

 

 

 

" To be nobody-but-myself in a world which is doing its best, night and day, to

make me everybody else - means to fight the hardest battle which any human being

can fight, and never stop fighting. " -e.e. cummings-

 

 

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