Lead Research Called Unethical Participants Are Sent Technical Reports, But No Clear Explanation Of What They Mean

Charlotte Rieken’s bones ache. At 62, she’s not sure if her symptoms are caused by age or lead.

“Maybe it’s just the way you feel when you get old. But people I know who didn’t work at the smelter don’t seem to have all this trouble,” says Rieken, who worked at Bunker Hill from 1973 until it closed in 1981.

Rieken fears her exposure to lead dust from the Silver Valley mining and smelter operation has led to health problems. The Agency for Toxic Substance and Disease Registry studied 108 women, including Rieken, last summer. In May, officials mailed out technical reports to the women, without any simple explanation of the results.

That amounts to malpractice, some doctors say. The agency’s work suggests the need for immediate medical attention, even though such care is not being offered.

“What ATSDR has done to date (in Kellogg) qualifies unequivocally as medical malpractice,” said Dr. John Rosen, professor of pediatrics at Montefiore Medical Center, a major hospital and training center in New York. As head of the Division of Environmental Sciences, Rosen oversees the largest lead treatment program for children in the country.

The agency that Rosen lambastes was created to stop human exposure to pollution and provide doctors with information about the effects of such exposure. Legally, it has no authority to treat the people it studies.

Consequently, Rieken and some other study participants have been left with the fear of serious health problems with no promise of a remedy.

Rieken’s job at the Bunker Hill smelter was in the baghouse, the community’s main source of protection from airborne lead dust. She replaced bags full of lead dust and other heavy metals with clean bags. Full bags, sometimes so heavy it took two or three people to lift them, were boosted over a railing into waiting dump trucks.

Tall and skinny, Rieken also occasionally climbed into the flues connecting different parts of the smelter to clean out the lead-laden muck that accumulated. And she helped fight a fire that in 1973 destroyed the baghouse.

“We fought it all night. It was so long ago. It’s all a blur,” she says. “I can’t even remember whether I was wearing a respirator.”

Jerry Cobb, an environmental health specialist with the Panhandle Health District, bets she wasn’t. Although Rieken wore a respirator day-to-day on the job, there was less emphasis on wearing respirators in emergency situations.

“I’m guessing she was in the baghouse itself, which was absolutely full of fine particulates. … You really shouldn’t be in a place like that without a sealed mask and supplied air,” Cobb said.

Rieken jumped at the chance to join last summer’s study. To learn more about the consequences of lead exposure after menopause, the agency studied women who had worked at the smelter.

Physicians from the agency also looked at bone lead levels in 281 people who lived in the Kellogg area as children in 1974 and 1975. Study results have not yet been made public.

Rieken’s joints ache. So does her back, constantly. Two or three times a year, she experiences severe bouts of nausea.

“All I can do is sweat and throw up. I can’t keep anything down, even water. It usually lasts about 39 hours,” she said.

After a four-hour series of tests in August 1994, Rieken got her results in May. The six-page report was full of numbers and technical jargon.

“I can’t make heads or tails out of it,” Rieken says.

Dr. Virginia Lee, one author of the study, said 70 to 75 percent of the women studied from Bunker Hill have lead levels higher than those seen in other major studies of people not exposed to lead.

“Ms. Rieken had one of the highest bone leads - not the highest, but in the top 5 percent,” Lee said.

The highest bone lead found in the study was a woman with about 100. A normal bone lead level, measured in micrograms of lead per gram of bone, is about 2.63. Rieken’s count was 63.36.

What does that mean for Rieken’s health?

“Nobody has looked much at lead and osteoporosis, so it’s hard to tell,” said Lee. But Rieken and others with high lead levels need to talk with their doctors about extra estrogen and calcium to prevent osteoporosis, which would release lead from the bone, she said. Breaking a bone also could release lead, further overloading Rieken’s kidneys.

Rieken’s test results suggested consulting a physician, so she went to her doctor in Coeur d’Alene.

“He said it looked all right to him,” she said.

Rieken switched doctors.

She also got in touch with the People’s Action Coalition, a small activist group that has clamored for increased medical services at the Bunker Hill Superfund site.

The group’s leader, Barbara Miller, faxed Charlotte’s results to Dr. Marvin Legator, a Texas lead specialist and physician. He called back immediately.

Legator, director of the Division of Environmental Toxicology at the University of Texas Medical School in Galveston, confirmed Rieken’s fear that the tests show kidney problems. “Something like this should never have been sent out without really good explanation and follow-through.”

Dr. Rosen learned of the Kellogg studies at the agency’s International Conference on Hazardous Waste in June. Results of both studies showed that a large percentage of the participants had markedly elevated levels of lead in their bones, he said.

“Since that information has immediate medical implications, it should have been shared face-to-face with those individuals and their families,” Rosen said. “Not having done so is a departure from good and acceptable medical practice - in other words, malpractice. Unquestionably unethical.”

Rosen contends that medical support and monitoring should also have been supplied for those with elevated bone lead levels. While there is no specific treatment for the problem, its potential risks include kidney disease, elevated blood pressure, neurological disease, and implications for women of childbearing age.

While the agency has no authority to treat the Bunker Hill women it studied, it has spent plenty of taxpayer money in the Silver Valley - about $3 million, said spokesman Mike Greenwell.

Agency dollars pay for the annual blood lead screening for children, as well as follow-through in the form of counseling if problems are found. The agency also pays for prenatal blood screening and a program that attempts to find and educate new residents.

Since 1992, the agency has added money for a community nurse.

The $3 million total also includes last year’s two studies.

Not every woman tested found the results puzzling.

“I thought they were very simple. They were about what I thought they’d be. I always was a healthy specimen,” said Brenda Stinson, a 45-year-old Cataldo resident who worked in the sewing room at Bunker Hill for 11 years.

Sylvia Sjogren, 58, took her results to her doctor in Plummer a few weeks ago.

“They didn’t make any sense to me, that’s why I took them to the doctor,” she said. The Pinehurst woman worked at Bunker Hill from 1974 to 1982. Now, she has kidney problems and takes blood pressure pills.

Lee, the study co-author, said the agency presented the results in the best possible way. “It was logistically impossible to meet, because 30 percent of the women lived more than 120 miles away from Spokane.”

All the women with markedly abnormal results on their tests were contacted by letter or phone in September 1994. Every report included Lee’s phone number.

Rieken said she didn’t call Lee because she was worried about expensive long-distance charges.

After learning of Rieken’s concerns, Lee called her. The doctor explained the importance of guarding against osteoporosis, and warned Rieken that breaking a bone could release lead and further overload her kidneys.

“I know the studies are needed,” Rieken said. “But they should at least let us find out what’s wrong with us before they do more tests.”

MEMO: IDAHO HEADLINE: Legacy of sickness, fear