When Good Mold Goes Bad

Six-year-old Alex White is sitting restlessly in the waiting area of the HealthSouth Surgery Center and stays close to his mom, Julie Morton. Wearing his favorite NASCAR Jeff Gordon bright-red faux-leather jacket, his nervous facial expression betrays the confident, daredevil aura projected by his clothes. The waiting room is comfortable and seems designed to calm—the soft classical music that is playing complements the framed pastel prints on the walls. A nearby coffee table is stacked with the usual selection of out-of-date magazines, and the September 2001 issue of Reader’s Digest is on the top of the pile. The cover story, “How hospitals are gambling with your life,” goes unnoticed by the handful of waiting patients.

When a surgery assistant walks over to Morton and announces that they are ready to start, Alex’s expression turns to unabashed fear, and he executes a token escape attempt, climbing the back of the chair, putting his back to the wall. Alex clearly isn’t ready to start.

Since this isn’t Alex’s first trip to the surgeon’s table, Morton suggests that this outpatient procedure should be “a walk in the park.” But the statement seems intended more to reassure herself than anyone else, and Alex has to be muscled by the assistant and his mom off the chair and through an adjacent door.

Minutes later, Alex’s cries, which progressively intensify to a near-hysterical level, pierce through the lobby, drowning out the Muzak. The remaining occupants of the waiting area shift in their seats.

“They had to heavily sedate him,” says Morton, returning to the lobby shortly after the waiting room sound level had returned to normal. “He has a lot of anxiety about this.”

It was surgery to mitigate a chronic sinus infection, which followed previous ear tube insertion surgery to address chronic ear infections. In the interim, Alex had two battles with pneumonia, an unusually aggravated asthma condition, and chronic fatigue. According to Morton, the ordeal began shortly after they moved into the Heather Downs apartment complex in Citrus Heights. Initially baffled by her son’s extended run of bad health, she began to suspect that the persistent black mold that seemed to reoccur in parts of the apartment, despite her continual cleaning and disinfecting, may be connected to Alex’s distress.

According to Morton, the property manager resisted her initial request to have a toxic mold test conducted, until she enlisted the help of Alex’s doctor and an attorney. Heather Downs apartment manager Carrie Yanders denies that she needed additional persuasion to conduct a toxic mold test on Morton’s apartment, and said that she agreed to order the test as soon as it was requested by Morton. Yanders hired Action Environmental Management Services to perform the testing, and Morton’s suspicions were validated when the test came back positive for toxic mold. The mold test report noted that “the presence of the toxic black mold Stachybotrys chartarum on the quick-swab sample from the shower enclosure could eventually pose a significant risk to the health of the occupants of Unit 138. … Stachybotrys is a saprophytic fungus with the potential for producing severe allergic, respiratory, and/or immunological symptoms. Persons with a history of allergies and respiratory ailments, the elderly, persons with a suppressed immune system, children and infants are especially susceptible if exposed to airborne spores and mycotoxins that are produced by this mold.”

Yanders declined to comment on the test results, or any other issues related to Morton and her apartment, and referred additional questions to the attorney for the complex. Gerry Larrea, the attorney for Heather Downs, confirmed that the apartment tested positive for toxic mold and was remediated, but points out that the test results also noted that the level of airborne mold spores inside the unit was lower than the level of airborne spores measured outside.

It turned out that the mold was mostly concealed behind a wall in the bathroom, and likely caused by water incursion at the base of the shower enclosure, which was also noted in the test report. Mother and son were required to relocate to a hotel while the mold was eradicated from the apartment, and the bathroom repaired. But like most instances where serious health problems occur during or after exposure to toxic mold, it is extremely difficult to definitively prove that Alex White’s illnesses were caused by the toxic mold found in his home. And the issue of proof is the unstable nucleus of the escalating toxic mold debate.

According to several authorities intimately familiar with the issue, toxic mold is at the same place where asbestos and tobacco-related health problems were at years ago—a link with serious illness was suspected, but not yet scientifically established. And similar to the early asbestos and tobacco health debates, a substantial amount of disinformation is being disseminated by corporate, government and other interests that would not benefit if a meaningful connection between toxic mold and illness is confirmed, they say. Sacramento attorney John Miller, doctors Vincent Marinkovich and William Duffy, and local toxic mold writer, lecturer and educator, Doug Haney, all say it is time to expose what they believe is the truth about toxic mold.

About a month before Alex White was dragged through the door of anxiety, Doug Haney was standing in a conference room at the Reno Hilton Hotel and Casino. Haney’s one-man Sacramento-based company, the Environmental Health Research Group, was hosting a day-long, multi-speaker seminar titled “Indoor Mold Contamination: Universal Policies and Procedures Manual & Training Package for Administrators & Key Decision Makers.” The State Bar of California certified the course for continuing education credits. But in addition to attorneys, the 45 attendees, who paid $495 each to learn more about fungus, included real estate brokers and property managers, environmental safety consultants and a toxicologist. They came from throughout California and from as far away as Texas and Michigan. Haney’s first seminar, held in a small Sacramento office a year and a half earlier, drew only half a dozen lawyers. Interest in the subject seemed to be growing and, after expenses, the impresario of toxic mold made a small profit on the latest seminar.Haney began adulthood as a combat medic in Vietnam and now makes a living as an environmental health research writer and consultant. The desk in his home office is topped with a scientific microscope, and copies of Gray’s Anatomy and Mosby’s Medical Dictionary are within arm’s length of the chair. His computer hard drive is packed with academic, medical and health research documents from around the world and he has written several books, including Toxic Mold—Toxic Enemy! He utilized writing and research skills developed as a senior publications writer in the space shuttle program while employed by Martin Marietta Aerospace Corporation. Haney discusses the mold issue with intensity and outrage over what he sees as a public health scandal. He perceives a virtual epidemic coming, “a tidal wave,” that he feels is not being adequately confronted by the mainstream medical community and the government agencies responsible for public health oversight.

Haney has come a long way in a short time—it was just three years earlier that he first began to develop a serious interest in the mold issue. At that time, he was living in a different Citrus Heights apartment complex from Julie Morton and her son, but Heather Downs and Haney’s buildings were only a short walk apart.

Haney was a tenant at the now infamous Fairways apartment complex. The 636-unit, resort-style project developed serious mold problems in the mid-1990s, and the owner has since spent immense amounts of money on mold eradication and remains embroiled in ongoing lawsuits by former tenants (one of whom has a Web site: www.thefairways.com).

When he was a resident at the Fairways and first heard about the mold problems, Haney was skeptical. “I thought it was a hoax, and that people were just trying to bilk insurance companies,” he said. Although he remained healthy, he knew other residents who did get sick, and after attending a mold education program designed to ease local hysteria at the height of the Fairways debacle, he began to work full time researching the issue.

After scouring medical texts, academic and scientific research papers and other sources, Haney became convinced that toxic mold was for real, and presented a serious public health problem capable of causing a range of debilitating illnesses. Haney has since changed careers in order to write, speak and disseminate information about toxic mold. With the enthusiasm of a new believer who has just had a religious conversion, he is a now a man with a message. And Haney’s sermon can be condensed to this: if we, as a community—the public and private sectors—don’t mobilize and take a coordinated, aggressive, proactive approach to address the issue of toxic mold, there are going to be more Alex Whites. A lot more.

Even though he is not a university or medical school-trained researcher, Haney’s work has been endorsed by several physicians involved in the toxic mold issue, including William P. Duffy. Last year, Dr. Duffy was selected by the California Medical Association to be the legislative medical adviser on SB 732, the Toxic Mold Protection Act. Duffy provided Haney’s book to legislators and other consultants involved with the bill. “I think Doug Haney is very reputable, and he is rocking the boat enough to bring about some changes,” Duffy said.

Haney asserts that the current mainstream medical and government approaches to the issue—to essentially deny or discredit the prevalence and adverse health effects of toxic mold, leaving the lawyers and the courts to sort it out—is patently irresponsible, and will only create additional human hardship and misery. His views on the issue are unsettling and controversial.

“This is way out of hand. People are dying, and a lot of people are not talking,” he said, citing several reports of fatalities linked to toxic mold exposure, including a still debated Centers for Disease Control and Prevention study of infants in Cleveland, 10 of whom essentially bled to death in their lungs after toxic mold exposure.

Haney and other medical authorities claim a whole host of serious ailments can be caused by exposure. Respiratory problems, such as wheezing, difficulty breathing, shortness of breath, and persistent coughing; ear, nose and throat irritation and congestion; nosebleeds; blurred vision, watery or red eyes, and light sensitivity; central nervous system problems, such as constant headaches, memory problems and mood changes; aches, pains and fever; skin conditions; hair loss; miscarriages; hard-to-diagnose conditions such as chronic fatigue syndrome and fibromyalgia; certain types of cancer, including breast; and arthritis can all occur, or be aggravated by exposure to toxic mold.

Although most molds are relatively harmless, it is generally acknowledged that the strains of Cladosporium, Penicillium, Aspergillus, Fusarium and Stachybotrys chartarum, all of which have been identified in home infestations, produce mycotoxins, a carcinogenic substance, as a byproduct of their fungal metabolism. In sufficient quantities the toxins trigger one or more of the health ailments associated with mold exposure, giving these strains the somewhat inexact, but generally accepted “toxic” moniker. The molds can enter the body by being inhaled, touched or eaten (such as by consuming mold-contaminated food). Depending on the level of exposure, anyone is potentially susceptible to health problems. But particularly vulnerable are infants, elderly persons, immune-compromised patients (people with HIV infection, undergoing cancer chemotherapy, liver problems and similar conditions that weaken the immune system), pregnant women, and individuals with existing respiratory conditions such as allergies or asthma.

“This is why it is so important that policies and procedures be implemented by the government and the private sector to preserve and maintain uncontaminated environments at home and work,” Haney said. He and a small but growing group of medical and legal experts believe that there is an obvious cause and effect link between toxic mold exposure and serious health problems.

They also express the opinion that the link is suspiciously not as clear to powerful special interest groups and government agencies with a financial stake in the issue. Haney maintains that insurance companies, health maintenance organizations, government programs such as Medicare and Medi-Cal, rental property owners and property management groups, and the real estate and construction industries all stand to avoid significant monetary outlays as long as any link between toxic mold and health problems remains inconclusive. He explains that the costs to treat mold-related illnesses, and abate and fix mold-infected buildings, are potentially astronomical, given the extent of the problem. As a result of the political influence exerted by these groups, other government agencies responsible for protecting the public health, such as the Centers for Disease Control and Prevention, the Environmental Protection Agency and the California Department of Health Services are under pressure to maintain the status quo, said Haney. “It’s all about politics and money,” he concludes.

While the conspiracy theory is essentially impossible to prove, Haney and others embroiled in the issue cite what is at least compelling circumstantial evidence, such as the current status of the California Toxic Mold Protection Act. Passed by the Legislature last year, SB 732 directed the California Department of Health Services to assess the seriousness of the toxic mold problem by convening a task force. The task force was supposed to come up with permissible exposure limits for toxic mold, adopt standards to assess mold threats, and adopt guidelines for the identification and the remediation of toxic molds, by July 1, 2003.

But the governor’s new state budget failed to provide any funding to implement the measure. “Calling the task force will require resources we don’t have at this point,” confirmed Sandy McNeel, a research scientist with the department. But there are additional ramifications resulting from not funding the task force. Among other provisions, SB 732 also requires landlords and homeowners to disclose the presence of excessive mold when selling or renting property. But the disclosure requirement isn’t triggered until at least six months after the task force comes up with exposure limits. Until the currently nonexistent task force completes its work, landlords and property sellers don’t have to tell renters and buyers about prior mold problems.

Echoing many of Haney’s warnings is Sacramento attorney John Miller. Last November, Miller won the largest toxic mold personal injury judgment in history. After a two-and-a-half-week jury trial, the 12 Sacramento County citizens that heard the evidence agreed that Darren and Marcie Mazza and their 6-year-old son, Bryce, were made seriously ill, and will suffer lifelong complications from the toxic mold found in their Watt Avenue apartment. The jury awarded the family $2.7 million in compensation. According to Miller, the defense team in the Mazza case argued that allergies to the family cat were primarily responsible for the family’s health problems—which included the hospitalization of Darren and Bryce—but the jury was not persuaded. In legal terminology, Miller said that he was able to prove to a reasonable degree of medical probability that the toxic mold caused the family’s illnesses, and to a reasonable degree of medical certainty that the family will continue to be susceptible to asthma, respiratory problems and mold hypersensitivity for the rest of their lives. Rick Rodgers, the defense attorney in Mazza, said that the case will be appealed, but declined to comment further on the litigation.

As one of the few toxic mold injury cases to reach a jury, it would be hard to exaggerate the significance of the Mazza decision, and the verdict has sent shockwaves throughout the insurance, real estate and construction industries nationwide. Nearly all toxic mold cases are quietly settled out of court. “Most settlements are required to be confidential by the insurance companies—they don’t want people to know about them,” said Miller.

Like Haney, Miller has immersed himself in the study of toxic mold, and he lectures nationwide on the subject. His office has over 600 toxic mold cases pending, but he doesn’t represent only tenants injured by toxic mold exposure. He also represents defendants, including landlords, property managers, and some of the largest insurance companies in the world. And working both sides of the issue may lend his conclusions on the subject more credibility. Miller said that he has “no question” that illness caused by toxic mold exposure is a much more prevalent and serious problem than the medical community and the government is willing to acknowledge, and that the substantial costs to identify and treat toxic mold illness is much of the reason. Miller points out that the link between toxic mold exposure and health problems has been documented by a small number of doctors specializing in allergy and immunology, but that the majority of doctors, and especially general practitioners and those employed by HMOs, are either unable or unwilling to acknowledge the connection. “It’s in medical literature, it’s in the medical textbooks, and it’s what they teach in medical school, but people don’t recognize it,” he said.

One of the doctors who does seem to recognize it is Vincent Marinkovich. Marinkovich is a Bay Area pediatrician who is board-certified in allergy and immunology, and is also a clinical faculty member at Stanford University Medical School. At age 69, Marinkovich has been treating mold health problems since the 1970s, and is regarded as one of the country’s leading authorities on toxic mold, treating patients who come from across the country. Marinkovich is encouraged that awareness of the issue is growing, but agrees that doctors are part of the problem. “A lot of them are closed minded and don’t want to be aware. They often write off a [toxic mold] patient and say they’re psychiatric, when they’re not.” And Marinkovich also concurs that political pressure is playing a role in keeping the connection between toxic mold and health problems inconclusive. “The only way to prove [the connection] beyond a shadow of a doubt is to [expose people to toxic mold] and watch them die. And you can’t do that.”

Finding reassurance that the claimed negative health effects of toxic mold are exaggerated, inconclusive or outright fraudulent isn’t hard. The EPA provides concerned consumers an information sheet that begins, “Molds can be found almost anywhere,” and goes on to note that, “Outdoors, many molds live in the soil and play a key role in the breakdown of leaves, wood, and other plant debris. Without molds we would all be struggling with large amounts of dead plant matter.” In its publication “Questions and Answers on Stachybotrys chartarum and other molds,” the Centers for Disease Control and Prevention concludes that, “Stachybotrys chartarum and other molds may cause health problems that are nonspecific. At present there is no test that proves an association between Stachybotrys chartarum and particular health symptoms.”

At the state government level, the toxic mold issue has been delegated to the California Department of Health Services, and the agency has issued several reports and information sheets on the subject. One consumer report, “Mold in My Home: What Do I Do?” acknowledges a laundry list of possible health ailments that have been reported in conjunction with exposure to toxic mold, but the department also reassures the reader that “Everyone is exposed to some mold on a daily basis without evident harm.”

In the private sector, and perhaps representing the opinion of much of the mainstream medical community, talk-radio medical guru Dr. Dean Edell vents a scathing opinion on the issue in a March 12, 2001, broadcast. “Toxic mold may be what America needs in order to go off on a new health panic. We need something to be upset about because life is just too damn good for us and we cannot handle it!” The talk doc does admit that “There are people who are allergic to mold, but it is not a toxic thing—it’s an allergy,” and implies that the condition essentially constitutes just another “fraudulent disease—like multiple chemical sensitivity … ” Edell also offers a complimentary diagnosis to people who claim health problems from exposure to toxic mold. “We have proven that these people, basically, have a psychosomatic illness.”

The area’s largest HMOs—Kaiser Permanente, Health Net and Blue Cross—offer members scant information on the subject of toxic mold, usually dismissing any effects as allergy related. Dr. Peter Yip, Kaiser’s local mold authority, does say that the number of mold cases he has seen has increased dramatically over the past two years, and he attributes the increase to greater awareness of the subject. Yip said that most patients with mold-related problems are having an “allergic response, just like [with] a cat.” Yip acknowledges that he is aware of anecdotal reports that toxic mold can produce mycotoxins which may be linked to other health problems, but points out that there are no peer- reviewed medical studies on the subject. He advises patients with toxic mold exposure symptoms to avoid the exposure by either moving, or thoroughly cleaning any mold present in the home. “Once the exposure is removed, people recover rapidly,” he said.

Blue Cross spokesman Larry Bryant said that the corporation doesn’t have anyone qualified to comment on the toxic mold issue, but that doctors under their plan are “authorized to do anything that is medically necessary,” and a representative from Health Net parroted the same position nearly verbatim. The managed care plans may be emphasizing their compliance with the “medically necessary” standard as a result of the January 1, 2001, enactment of the Managed Health Care Insurance Accountability Act of 1999. Among other things, the Act makes HMOs liable for any substantial harm caused to patients by their failure to provide medically necessary health-care treatment.

But one of the problems with HMOs, according to Haney, is that by refusing to acknowledge the connection between toxic mold exposure and serious health problems, they are able to avoid having to authorize certain medically necessary treatments for toxic mold-related illness. And Marinkovich describes his own personal experience with the problem. Marinkovich explains that some patients exposed to high levels of especially tenacious strains of toxic mold that will colonize within the body, will require long-term treatment with a relatively costly anti-fungal medication. “That’s where I’ve run into the most trouble with insurance companies. These anti-fungals are very expensive and the insurance companies don’t like to pay for them so they often deny therapy for patients,” he said. Marinkovich explained that in certain cases the indicated treatment is the orally ingested prescription anti-fungal Sporanox, which costs $9.50 per pill. The pills must often be taken twice a day for a full year, which can run over $6,000.

To get around the medically necessary requirement, Marinkovich said that after he submitted a bill to an HMO, they notified him that they couldn’t approve the treatment because there wasn’t medical literature in support of it. “So then I write back a letter saying ‘Here are three articles in the literature that support what I’m doing.’ And they wrote back and said, ‘Well, we showed this to our medical advisory committee’ and they still said no. And you know very well that their medical advisory committee is full of doctors who’ll say no, so it’s stacked against the physician that really cares about his patients. Bad situation.”

But perhaps an even worse situation is that an HMO has recently filed a complaint against Marinkovich for malpractice. He is convinced that the HMO that has filed the complaint is the same one that he repeatedly battles with to pay for his recommended, albeit expensive, toxic mold treatment. He believes that the HMO is trying to circumvent the medically necessary requirement and stop him from treating patients by complaining to the state medical board on the pretext that, “Look, he isn’t doing what everybody in the medical community is doing,” when their real motive is to cut costs. The soft-spoken Marinkovich is clearly dismayed by the tactic and feels pressured to defend his 30 years of work. “Well, everybody else in the community isn’t treating it because they don’t understand it,” he explains. He believes that, in taking the action against him, the HMO is ultimately trying to “reduce medical treatment to the lowest common denominator.” And Haney submits that, like Dr. Edell, most HMOs would not object to resigning all toxic mold-related health problems to the category of psychosomatic illness.

When Julie Morton and her son moved back into the apartment after the mold had supposedly been eradicated, Alex was still having problems. She also noticed that, despite the recent work in her bathroom, the shower pan still wasn’t caulked properly and mold kept reappearing on the shower door. Morton also noticed that mold kept trying to grow under the rim of the toilet in Alex’s bathroom, and when she lifted the tank lid to drop in a bleach tablet, she discovered mold throughout the tank and on the underside of the lid. “I didn’t touch it, I said ‘I’m not stirring this up anymore,’ ” she said. Heather Downs attorney Larrea said that management promptly cleaned the toilet tank, but that was the last patch of black fungal matter Morton intended to see, and they moved a short time later.

It is too soon to say if Alex has made a complete recovery—his allergist said it could take three to six months to see a noticeable improvement—but Morton said that he doesn’t have to sleep nearly as much as he did at the previous apartment, where he needed up to 14 hours a night. “And he’s not moody, cranky and irritable all the time,” she said. Although the attorney that helped them convince the apartment manager to conduct a mold test of the unit tells her that they have potential grounds for a lawsuit to, among other things, obtain reimbursement for medical costs and time lost from work, he also said they need to find another attorney. Despite the “avalanche of frivolous mold lawsuits” spin disseminated by the real estate and insurance industries and printed in the business sections of daily newspapers, the reality is that very few attorneys will even look at a mold case. Because of the high costs of medical, toxicology and the other expert witnesses required, the few cases that are actually brought to trial are usually taken on a contingency basis by law firms with deep pockets.

Attorney John Miller said that the costs of experts needed to prove the plaintiff’s damages in the event a case goes to trial, “even if you have a family of three living in an apartment complex,” would be somewhere in the range of $45,000 to $65,000. Miller said his office has over 600 active toxic mold cases, virtually all of which will settle without a jury trial. “And we probably get 15 to 20 [toxic mold] calls a day. We now accept maybe one percent of that,” he said.

But despite the inaction and obfuscation by the government and the mainstream medical community, the issue seems to be reaching critical mass in parts of the private sector. Last year, the California Apartment Association took the initiative to convene its own mold task force that, after thoroughly researching the subject, did issue a report, “Mold on Rental Property—Guidelines for Assessment and Remediation of Fungal Contamination.” The report acknowledges that toxic mold exposure can cause serious health problems, and encourages landlords and property managers to take a proactive education, prevention and intervention approach to the issue of toxic mold contamination in rental housing, recommending that all on-site staff and tenants be provided mold education.

Next month, Haney will bring his own 2002 mold education tour to the Holiday Inn in Sacramento where he will have five other speakers, including Melinda Ballard, who won a $32 million jury verdict in Texas for mold-related property damage to her home and bad-faith handling of her insurance claim by her insurance company. And at the end of March, he is back on the road and planning to give a similar course in Houston and one in Seattle in April.

“This is my war on ignorance,” he said. “When I came out of Vietnam, two of my buddies had died, and there was nothing I could do about it. Now they’re on that [Vietnam Veterans Memorial] wall. This is something I can do something about.”