Job-related infections hard to prove

When hepatitis C ruined Mike Coghlan's liver, the Department of Veterans Affairs helped him get a new one. Then it paid for expensive medications to help him recover.

But when the 45-year-old Philadelphia man got too sick to work and asked for disability benefits, the VA told him no. He couldn't prove he got the disease while he was in the service, so he was jobless and finally out of luck.

That's not unusual.

Many people with hepatitis C suffer from a double whammy: They have a potentially deadly virus, which can simmer undetected for decades -- and that makes it hard for them to prove how they got it.

As a result, veterans, health-care workers, firefighters and others who think they got hepatitis C by being exposed to blood on the job can't easily trace it.

Advocates have been pushing for laws that make disability automatic or "presumptive" for hepatitis C-positive veterans and high-risk workers.

But so far, they have had limited success. Only a few states consider hepatitis C a presumptive illness for public-safety and health-care workers, and Congress has at least twice in recent years declined to change the law for veterans.

Veterans

Two-thirds of all hepatitis C-positive veterans who seek disability benefits from the Department of Veterans Affairs are denied. That added up to more than 4,000 claims rejected in a recent 38-month period.

"I don't know how I got it, and they don't know how I got it," Coghlan said. "I am not a drug user. I've been married to the same woman for 25 years."

But VA officials require evidence that any illness or injury directly results from military service before approving disability payments.

It's not that veterans have a shortage of known risk factors, including exposure to blood during combat and battlefield transfusions before 1992.

Many veterans say injector guns once used to vaccinate recruits also may have spread hepatitis C. The needleless guns pierce the skin with a high-pressure stream of medication, which they say can contaminate the end of the gun with blood that then can infect the next recruit in line.

That was the way Coghlan, who died March 25 of complications from the disease, thought he got infected.

Indeed, government studies have shown the guns probably spread hepatitis B, and many vets recall seeing blood on the guns and on the arms of other recruits.

Pentagon officials quit using the guns in 1998 but continue to insist they were safe.

The VA is not so sure.

"We need to look at the air gun," said Anthony Principi, a Vietnam-era veteran who heads the Department of Veterans Affairs.

Lawrence Deyton, who directs VA public health programs, said it's possible the devices could transmit hepatitis C: "I am sure that, with the right degree of misuse, the devices could become contaminated."

But VA officials would be more inclined to grant disability if there were more proof that veterans have special risk factors that increase their rate of infection.

So far, studies don't help. Some show veterans are infected at high rates; others show their infection rate is actually below the general population.

"We don't know how many there are," said Teresa Wright, who leads a hepatitis research program at the San Francisco VA Medical Center.

In the workplace

Hepatitis C is emerging as one of the most common and severe workplace hazards.

Kathleen Flor, a Hawaii hygienist, got it sterilizing dental equipment. Nellie Crane, a Washington state deck hand, probably contracted it from an infected needle discarded on a ferry boat she was cleaning.

Both workers were initially denied benefits and had to take their cases to court to win their claims. Tens of thousands of other workers didn't bother, union officials say.

The likelihood of contracting hepatitis C from a single, contaminated needle stick is small, perhaps 2 percent or lower. But the number of accidental needle sticks and other skin punctures each year is high -- 380,000 to 600,000, according to the Occupational Safety and Health Administration.

Still, many workers have little hope of getting their treatments or doctor visits covered -- much less lost wages when hepatitis C renders them disabled.

The problem: a patchwork system of state workers' compensation laws that were created to deal with broken bones, not hepatitis C.

"The worker compensation system does not effectively deal with occupational illness," said Bill Borwegen, safety director for the Service Employees International Union. "It needs to be totally reformed."

Firefighters

Philadelphia fire service paramedic Mary Kohler probably got hepatitis C treating accident victims. Her fight for benefits included a 15-day sit-in outside the mayor's office in 2000.

Ten states (but not Missouri and Kansas) have passed laws making hepatitis C a presumptive illness for firefighters, said Harold Schaitberger, president of the International Association of Fire Fighters. The union is fighting for presumption in 21 more states, including Missouri.

"Unfortunately, the Centers for Disease Control has not been very helpful at all," Schaitberger said. He said a "flawed" CDC report found that emergency workers do not have a higher rate of the disease than the general public.

Cities are using the report to deny disability payments to HCV-positive firefighters, he said.

CDC officials say the study was valid. Emergency workers are indeed exposed to blood, they say, but no research shows they have a higher rate of contracting the virus.

In Kansas City, the union's Local 42 negotiated contract provisions last year just to deal with hepatitis C.

The contract offered an unusual 60-day amnesty window during which firefighters could be tested for the virus without fear that the city would demote or fire them. Ten of the about 850 uniformed members of the fire department were positive.

Under the contract, firefighters who become disabled can get fully paid leave for up to a year -- if they have no previous diagnosis of hepatitis C. The city also agreed it would not automatically challenge firefighters who claim they got the virus at work.

"I am glad to see here in Kansas City that our local and the city have been able to understand the importance of testing our members," Schaitberger said during a recent visit.

Firefighters in other cities have attacked the problem in different ways.

In Chicago, where 87 firefighters and paramedics are thought to have the disease, the union is pushing for changes in state law. The union has said it also plans to pay for testing firefighters.

In Orlando, city officials tested firefighters but never shared the results, prompting union officials to file lawsuits and grievances. The two sides are negotiating.

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