Judges’ comments:
This series achieved the perfect balance of human emotion and investigative findings. Carol Smith grabbed us with the personal tale of a nurse whose death was likely caused by the chemotherapy drugs she gave to her patients, then shocked us with the news that the government does not regulate the administration of these drugs or monitor the health problems they can cause. Each piece was so clear and well organized that the message became a drumbeat: This shocking situation must be remedied.
1. Provide the title of your story or series and the names of the journalists involved.
“Lifesaving Drugs, Deadly Consequences” reported and written by Carol Smith. Edited by Rita Hibbard. Photos by Paul Joseph Brown. Video by Mike Kane.
2. List date(s) this work was published or aired.
This story was published on our website on July 11, 2010. It was simultaneously published in The Seattle Times, and on MSNBC.com. An investigative report based on our reporting that we co-produced with public broadcast station KCTS-9 ran on July 9. (Note, the public broadcast version of our report was produced by Carol Smith of InvestigateWest with Ethan Morris and Enrique Cerne of KCTS-9 Connects.) Versions of the story subsequently ran in multiple regional outlets as well as on NPR, CNN and a variety of websites aimed at healthcare workers.
3. Provide a brief synopsis of the story or stories, including any significant findings.
This story looked at a critical worker safety issue affecting the nation’s healthcare providers. In “Lifesaving Drugs, Deadly Consequences”, InvestigateWest showed that the federal Occupational Safety and Health Administration does not regulate exposure to chemotherapy in the workplace, despite multiple studies documenting ongoing contamination and exposures and their potentially lethal implications for human health. Chemotherapy agents are descendants of mustard gas used in WWI to kill soldiers, and studies as far back as the 1970s have linked increased rates of certain cancers to nurses and physicians. Occupational health experts believe that’s because when nurses, pharmacists, technicians and increasingly, even veterinarians, mix and deliver the drugs, accidental spills, sprays and punctures put them in close, frequent contact with hazardous drugs. These are drugs that can save lives of cancer patients, but ironically, are also human carcinogens themselves. This was an untold story potentially affecting more than 2 million health care workers who handle chemo on the job. Yet no one — not the federal government, not the unions representing them, not their employers, was tracking exposures and subsequent illnesses. The result — victims themselves often did not realize their own practices on the job were putting them at risk for cancers that could kill them. The report documented, through FOIA’s, that the federal government had cited a workplace for lax handling of chemotherapy agents only once in 10 years, despite ongoing and repeated studies that revealed workplace contamination was pervasive throughout the health care industry. Smith’s reporting resulted in calls for legislative change at both the state and federal level. Washington Sen.’s Karen Keiser and Jeanne Kohl-Welles have confirmed they plan to introduce legislation to improve tracking of occupational exposures to hazardous chemotherapy drugs and other carcinogens in the workplace as well as strengthen safety standards to protect workers.
4. Explain types of documents, data or Internet resources used. Were FOI or public records act requests required? How did this affect the work?
A critical element of this story was to determine whether OSHA ever actually checked whether workplaces were following safe handling practices with regard to chemotherapy. Smith submitted a FOIA request to OSHA for all citations where OSHA used its General Duty safety clause to cite a healthcare workplace for its handling of hazardous drugs. The FOIA took months and required repeated requests. Ultimately it revealed OSHA had only used the General Duty standard one time in 10 years to cite a healthcare workplace. In addition, Smith submitted a FOIA for similar information from the Washington State’s Labor & Industries department. That FOIA was responded to in a much more expedited manner, and produced documents related to a recent investigation of a health care clinic. Much of the background reporting for this report relied on extensive reading of academic studies that showed the depth of concern scientists had about the potential mutagenic effects of these drugs on workers. Smith also searched for documents on OSHA’s website related to public hearing testimony, Congressional Record entries, and correspondence between OSHA and employers regarding compliance questions and disputes.
5. Explain types of human sources used.
The reporting for this story relied on tracking down pharmacists, technicians, nurses, veterinarians and others who had handled chemo on the job — both historically and currently — who could talk about their workplace conditions. It also relied on a variety of scientists and academicians, including occupational health specialists, toxicologists and geneticists, both in the U.S. and in Europe. Smith also spoke with regulators and investigators, and published a transcript of her Q&A with Deputy Asst. Secretary of Labor Jordan Barab responding to InvestigateWest’s findings.
6. Results (if any).
The report found that the federal government is not regulating hazardous drugs, including chemotherapy agents, in the U.S. workplace, despite widespread indication that workplaces are routinely contaminated and workers are being exposed. The report also found that no organizations, including unions and cancer registries, are tracking health effects of chemo exposure on the job in the United States. Canada and Europe, where many of the early studies of these hazards were reported, have taken more aggressive stances in monitoring and regulating these hazards, while the U.S. has lagged behind. As a result, two Washington senators are proposing new legislation to address both these issues. Two bills are expected to be introduced during the 2011 Legislative session: one to require occupations to be reported to the cancer registry along with disease data, and a second one that will establish an enforceable workplace exposure standard for health care workers handling chemotherapy on the job.
7. Follow-up (if any). Have you run a correction or clarification on the report or has anyone come forward to challenge its accuracy? If so, please explain.
We did a follow-up story on the legislative changes being proposed as a result of our earlier reporting. That story was published on our website on January 4 and is scheduled for publication in The Seattle Times on January 16. No corrections or challenges to accuracy.
8. Advice to other journalists planning a similar story or project.
One of the most difficult aspects of this story was finding victims who would be willing to disclose their medical conditions publicly. Doing so required persistence and gaining the trust of the individuals involved. Smith got the word out to potentially affected populations in part by asking various professional organizations, unions and occupational safety advocates to circulate her contact info to health care workers who handled chemo. Smith also had a number of other access issues. She encountered a pervasive culture in the medical community of not wanting to believe that its professional practices might not be safe enough. HIPAA laws also made access to medical records and medical facilities difficult. Breaking through both these barriers required cultivating relationships with patients, families and facility managers.