‘Don’t tell them there’s nothing wrong’

Workman’s compensation doctor says the concerns at Casey go well past the irritation of hydrogen sulfide

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Hydrogen sulfide may not be the heart of the problem at Casey Middle School, says Dr. Sander Orent, medical director of Arbor Occupational Medicine and the workman’s compensation doctor who has treated the teachers who believe they have health effects from working in the school. Carbon dioxide building up in classrooms due to poor air circulation may be compounding the problem, and increasing the effects of volatile organic compounds and irritants that do exist in the school, he says.

The community response shows mounting, not dissipating concern, and Orent says part of that is in how Boulder Valley School District has responded to the questions raised about whether the air quality is safe at Casey.

“I just think that people [with the school district] need to really dedicate themselves to, number one, paying attention to what’s being said by these folks and giving them a realistic appraisal. Don’t blow them off. Don’t tell them there’s nothing wrong. Because, first of all, I don’t believe that and, second of all, I think that’s a recipe for people getting even more concerned,” he says. “I feel like the intentions are good. I do feel that it’s important to share all information in an open fashion in situations like this, and to be sure that people’s concerns are addressed in a considered, thoughtful and soundly based way — in other words, based on data and information and what people are actually experiencing. Data and information only go so far. We have to listen to what people are saying, and I think that’s really important.”

Orent reiterates much of what the Boulder Valley School District has said about the school — breaches in sewer pipes and dried out traps in pipes allowed gas into the school, and testing shows that hydrogen sulfide is found in Casey, but at low enough levels that it should not be expected to cause any long-term health effects.

“That is not to say that I find it acceptable that there is hydrogen sulfide in that building. I don’t,” he says. “I think it’s a significant distraction. And the other thing it induces is significant fear, because people don’t know — and this is common in toxicology. When there’s a question of an unknown irritant, question mark toxicant, in the air, people get very concerned. That’s the way humans are, and it’s understandable, because they can’t see it but they can smell it, and we all know about the toxins that surround us in this world and it does create a lot of anxiety. So they have to get rid of that smell.”

Boulder Valley School District Superintendent Bruce Messinger says mostly, they have.

“There’s a little bit of misinformation around this — we’ve had one event this year where there was actually an odor in the building. That was the last [sewer pipe] breach that was found and it happened to be on a pipe near the air handling system, so it pushed [sewer gas] into a part of the building,” he said in a March 31 interview with Boulder Weekly. “So we really have not had occasions during this school year where we’ve had — like we did early on — when there were multiple sources.”

School board members have mentioned that based on the information they’ve received from teachers and parents in the Casey community, the odor has been noticeable on several occasions this year.

Orent has been meeting with teachers and staff at Casey since shortly after the school was reopened in August 2010 and initial complaints of sewer gas smells began. In a February 2011 letter to Casey staff, parents and children, he explains that the problem appeared to have come from dried-out water traps, those that prevent sewer gas from reentering a building. He explains that while hydrogen sulfide is easily absorbed by the lungs, and exposure can cause headaches, nausea, eye and throat irritation and increased issues for asthmatics — symptoms teachers have since expressed experiencing — the substance metabolizes quickly through the body and is excreted.

He thought the problem was solved, he says, and didn’t hear anything until about six months ago.

“I started getting complaints from patients, specifically teachers in the school, that there were ongoing issues,” he says.

The district has been asking teachers to go to the workman’s compensation doctor with any symptoms believed to be related to their working environment, whether from hydrogen sulfide or something else, since March of 2014. At last count from the Boulder Valley School District superintendent, seven teachers had seen the doctor for health issues they believed to be related to their work environment at Casey.

“We have several — now two — teachers who have continued to see the workman’s comp doctor around symptoms they believe could at least be related to something with the school, but we’re still working through that,” Messinger says.

Messinger has received updates on their cases, though he has not spoken directly with the doctor, Orent says.

“I don’t want to speak for the doctor, although he has communicated to us in general terms that they’ve eliminated hydrogen sulfide as being any potential source in his assessment and that they are continuing to identify, is there an environmental variable that’s affecting their health and does it have anything to do with Casey Middle School or it might be something else in their environment, because obviously you don’t spend your whole day in the school,” Messinger says.

While Orent acknowledges that based on the data he’s seen from the school on the levels of hydrogen sulfide present and the patients he’s seen, he would anticipate no long-term health effects, and no abnormalities have appeared on the tests he’s run, that doesn’t mean the air quality in the school isn’t irritating to those who have to spend their days there.

“The irritant smell of poop while you’re trying to teach or eat or learn I think is a problem, but I have not found medical consequences in terms of any sort of organ damage in the people that I have seen,” Orent says.

But he adds, that’s not the whole story, in more ways than one.

“Just because I don’t find abnormalities in laboratory tests or x-rays or other things, and I have looked, that doesn’t mean that these people aren’t suffering irritating effects that don’t show up in laboratory tests and don’t show up on an x-ray,” he says. “When someone comes in to work in the morning after a weekend and feels really good and by the end of the day their throats are hoarse, their eyes are irritated, some of them have headaches, they go home, they feel better when they go home, they feel worse when they come into work these are the kinds of things we just can’t ignore, and say that they don’t exist. They do exist. There’s just no MRI that’s going to show it. There’s no blood test that’s going to show it, but we have sincere individuals who are telling me this, and I’ve actually seen some signs of irritation in people’s mucous membranes when I’ve examined them. So there have been some physical signs. This isn’t made up. These people aren’t trying to create a problem that doesn’t exist. I really don’t see it that way. I see these as good sincere people that just want to get their job done, that’s how I see it.”

Blood and urine tests of thiosulfate levels, a metabolic product of hydrogen sulfide, can indicate hydrogen sulfide poisoning. He’s looked for that, Orent says, but has not found elevated levels.

Without having air quality monitors present to measure the hydrogen sulfide levels, he says, thiosulfate found in the blood can’t be directly tied to exposure at Casey. He would have to look for other sources. The district has tested air quality in the school on roughly 40 of the days since the school re-opened in August 2010 after being closed for extensive remodeling. The school board passed a motion in March that called for ongoing air quality monitoring, but so far the superintendent has announced plans to monitor intermittently through the coming year, based on the recommendations of Indoor Air Diagnostics and the Colorado Department of Public Health and Environment.

Orent argues against getting caught up in the thiosulfate levels and other issues tied to hydrogen sulfide.

“I think to some degree the hydrogen sulfide is a distraction here,” he says. “Yes it’s there, yes it stinks, yes it’s intermittent, and somebody needs to figure out where it’s coming from. I think the bigger issue is the ventilation.”

A marker for how well air is circulating in a building is the level of carbon dioxide found in the building’s rooms and how quickly that carbon dioxide clears from the rooms. Carbon dioxide is generated by humans as they breathe, and so it’s not toxic, but leads to a stale feeling in the air.

BVSD environmental technicians tested for carbon monoxide and carbon dioxide at several locations in the school in December “in response to specific complaints,” according to a letter from Messigner to the Casey community sent Jan. 22, and “results of the test were well within acceptable OSHA and ASHRAE standards.” To bring those levels lower still, the air handling units for those areas were adjusted. A second round of tests completed in January by Quality Environmental Services & Technologies, Inc. (QUEST), showed reduced levels of carbon monoxide and carbon dioxide from the December results, although they were still slightly elevated, ranging during occupied hours from 270 parts per million to 1,565 parts per million. Monitors had been placed in five locations, including three classrooms. During the same period of time, QUEST also tested the school for volatile organic compounds in a single location.

“What we’re finding at Casey school is that the carbon dioxide levels are no where near toxic, but they’re indicative of the fact that there is inadequate ventilation of the building,” Orent says. “We expect to see carbon dioxide levels in an occupied building of 1,000 parts per million or less — that’s considered reasonable, decent indoor air. It means that there is adequate air exchange with fresh air from the outside removing carbon dioxide and other contaminants or irritants that build up in a building. … When carbon dioxide levels are high, the irritants may reach increasing concentrations.”

People who are sensitive — and kids have especially sensitive noses, he says — may experience increased irritation from the various and common substances and contaminants that surround them.

“Instead of trying to figure out exactly what the irritant is, because it can be different for different people, the better solution is to make sure the building is adequately ventilated so that the concentration of those irritants is low and they will not bother people,” Orent says. “That’s the goal and that’s why we have modern HVAC systems is to clear out these contaminants and irritants. It’s not because there are toxins being generated in the building — there aren’t, as far as I know — but just daily living, electronics, human beings, breathing, eating, there’s a lot of cooking that goes on in that facility … [and] any time that you’re cooking things, you’re letting off a variety of different compounds, so I don’t know what the irritants are. And it could take the most intensive industrial hygiene survey, and you still might not figure it out because like I said, what’s irritating to one person may not be to another, so the trick is make sure the ventilation is good, make sure there’s plenty of fresh air coming in the building, so these normal irritants are at very low concentrations and people do fine.”

There are people concerned about whether the testing was done well — some who are even looking into the qualifications of the president of QUEST, Inc., which have been contested during several previous court cases.

Orent raised some questions in how the carbon dioxide tests were conducted at the school and whether the way they were conducted may have recorded carbon dioxide levels that are “falsely low.” Monitoring should be stratified in a room — some monitors up high, some about head-height for children and some near the floor, he says. In a well-ventilated room, the carbon dioxide levels found by all those monitors should be close to the same.

How testing for carbon dioxide is done depends on the objectives of the measurement, says Caoimhín P. Connell, a forensic industrial hygienist with Forensic Applications Consulting Technologies, Inc.

“If I’m looking at carbon dioxide in a school, I’m probably going to be looking at the return air. That’s a really good indication of what’s coming out of that room,” he says. In that case, he would put the air quality monitor inside the return air vent, or dangle it in front of the vent.

In another case, to test for increased carbon dioxide levels in a classroom where a teacher believed the levels may be elevated, he wanted the monitor to be placed “as close as we could to the teacher’s breathing zone throughout the course of the day.”

The air quality monitors used by QUEST to measure carbon dioxide, carbon monoxide, relative humidity and temperature in the school were “placed on top of cabinets nearest to return air grilles [sic]”, according to QUEST’s report. A photo included in QUEST’s report suggests that the monitors were well above head-height, or the breathing zone, for children.

Work at the school that took place at the end of March, largely during spring break, was meant to balance air flow in the school to increase ventilation to classrooms. A team worked for almost two weeks going room by room, checking pressure in every duct, according to Messinger. The aim, he says, was to balance the air to adjust the negative air pressure that had existed in the school and could contribute to pulling fumes into the building.

During a community meeting on April 2, Richard Shaughnessy, program director of indoor air quality research at the University of Tulsa and the air quality specialist hired by the district to work on Casey, said that ventilation in most schools is well below desired levels. Poor air circulation in schools can lead to increased fatigue and difficulty focusing. During that same meeting, Messinger said that improving air quality at all district schools will be a goal moving forward, funded by the $576.5 million bond issue voters approved in November.

The Casey community has been asking the district for increased transparency and access to the specialists hired to address Casey’s air quality concerns in addition to answers to a bevy of questions. The sentiment — as expressed in the signs toted by protestors outside the April 2 meeting — is that the school is sick and the district is denying just how severe the problem is. One sign suggested Messinger’s office be relocated to the school.

“I think that one of the most important points is not to discredit or discount what people are experiencing. It’s important to put into context, so they understand that this doesn’t mean that 10 years down the road they’re going to develop lung cancer or other diseases. That’s not why we’re doing this. Because again, the data on long term effects of hydrogen sulfide are very, very minimal in my view,” Orent says. “The worst thing to do, in my view, is to tell people that there’s nothing wrong.”

In a December letter from the Casey Faculty Advisory Committee to the Boulder Valley School District superintendent and deputy superintendent, the committee expressed their concerns about the levels of gas at the school and the negative affects of the school’s air quality, as well as an interest in having more access to Indoor Air Diagnostics’ team, including Shaughnessy. The committee asked that at least two teachers and two parents tour the school with Indoor Air Diagnostics experts during winter break, that committee members be able to speak with or view the research done by Indoor Air Diagnostics, and that the school be given portable parts per billion meters until the hydrogen sulfide levels no longer measure above .11 to .33 parts per billion.

In her response letter, Deputy Superintendent Deirdre Pilch stated that the Indoor Air Diagnostics team would need to focus their attention during their visit to the school on the building and its environment, mechanics and operations, and would not be meeting with staff. A community meeting to be held in late January would give faculty the chance to ask questions and share comments.

That meeting was held in April, and staff, faculty and parents were allowed to submit questions on 3-inch-by-5-inch note cards that were read and answered at the end of the meeting. Unanswered questions were to be addressed online at a later time.

“I have continuously felt that the best way to deal with this is you shine a light on it. Let’s look at all the numbers. Let’s look at the whole picture. Let people ask all the questions they want. Let’s shine the light on it, because I really don’t believe there’s poison in that school at high enough concentrations to hurt people, but I think there are irritants in that school that are really bothering people, and they’re not just doing this to be irritating or for no reason,” Orent says. “Certain people in the district haven’t been as open with the information, and I think that the problem with that is, if they were open with the information, the information is not damning. It’s not. It’s not like ‘Oh my god, this is terrible. We’ve got to get these kids out.’ The information shows that Casey Middle School, in my view, has two indoor air quality issues, neither of which are dangerous but both of which are irritating as heck.”

The side effect circulating the building now, Orent says, is fear. In the academic literature, the term is “toxic panic.”

In the absence of answers, or presented with information that can be misinterpreted, to a certain degree, people have begun to come up with their own answers and theories. They’re turning to their own research and their own testing. He cautions that the variety of compounds toxicological tests can pick up “may or may not be relevant.”

“The more that people deny that there’s a problem, the more you’re going to be confronted with the data that may be obscure or not particularly well studied that might allude to possible chronic effects or things like that. I’ve seen some of this stuff come by,” Orent says. “But if you really look at the mass of information on hydrogen sulfide, what you find is that only when it reaches high concentrations do we see acute effects and there’s no evidence of longterm effects unless somebody had a severe enough chronic exposure to cause them to lose consciousness.”

His goal at this point, he says, is the same as everyone else’s: “It’s to make this thing go away so that students and teachers can go in there and have a great, successful learning experience without irritating odors or irritating concentrations of irritants that some people are sensitive to. That’s all that I want, that’s all that the people at Casey Middle School want and I’m sure that’s all that Boulder Valley Schools wants.”

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