Medical experts call for independent oversight in nuke worker program

Imagine being sent to get a second medical opinion about your fatal lung disease from the same doctor you went to the first time. Then imagine having the differences of opinion between multiple doctors about your fatal condition resolved by someone who is not a doctor.

It happened to Michael Fellinger, a former worker at the Ames Laboratory whose widow, Bo Fellinger, is struggling to get compensation from a Department of Labor program intended to help those sickened by their work in our nation’s nuclear weapons program.

Occupational health specialists around the country who work with claimants say they routinely have their opinions trumped by medical consultants with too little expertise and too much authority. They are calling for an independent oversight board to be established, either by congressional legislation or by the Department of Labor itself, to improve the claims process.

Fellinger’s case is one of many under the Energy Employee’s Occupational Illness Program. The program was started in 2001 and is supposed to provide former nuclear workers with medical benefits and monetary compensation for radiation and toxin related illnesses. But almost from the beginning, frustrated claimants say red tape and unnecessary bureaucratic hurdles stand between those who are sick and the benefits they were promised for their years of service. A languishing piece of legislation, the Charlie Wolf Nuclear Worker’s Compensation Act, and a recent Government Accountability Office report, both target the program for improvement. But in the meantime, bureaucratic struggles continue, and only a third of claims filed nationwide see any payment.

Michael Fellinger worked as a graduate student in high energy physics at the Ames Laboratory in 1960s and early 1970s. He produced lab equipment both for the Ames Laboratory and another Department of Energy site, Argonne Laboratories in Illinois. He became ill in 1996, and his health rapidly deteriorated into lung disease, lung infections and constant hospitalizations. He contracted esophageal cancer, another illness linked to toxic metals exposure, in 2003. The first letter from the EEOICP denying his claim arrived the day he died, in April 2008.

Administrator as medical referee

This April, two years after his death, the EEOICP has rendered a final decision to close Michael’s claim for good, unless more new medical evidence can be found.

“Upon review of the objections and the evidence on file, I find that the case is not in a posture for reopening at this time,” stated Rachel Leiton in her letter of final denial to Mrs. Fellinger dated April 22. “Should you or your doctor have viable medical evidence of a convincing and compelling nature that contradicts the findings in this case, the DEEOIC will reconsider its position.”

The problem, according to several medical experts, is that Leiton isn’t a physician. She is a high-level administrative director in the Office of Worker’s Compensation Programs, overseeing the EEOICP.

While a medical decision would be more appropriately rendered by a medical director, the EEOICP hasn’t had one since the departure of Eugene Schwartz, who resigned his position last year. In piece published by ProPublica last August, Schwartz told the media he had been “muzzled,” and said he had warned the Department of Labor that it is ignoring established medical knowledge about the dangers of bomb work.

Dr. Laurence Fuortes, director of the Former Worker Medical Screening Program at the University of Iowa and the advocate for Michael Fellinger’s claim, said he is deeply troubled that an administrator is assuming the authority of a medical referee.

“They are defending the Department of Labor process rather than a rationalized medical opinion,” he said.

According to the Department of Labor, Leiton is not rendering final medical oversight, and it expects to name a new medical director within weeks. The Labor department stressed that the system of independently contracted district medical consultants had been in place for years, with qualified medical specialists rendering medical findings based on the evidence submitted.

Fuortes has gathered the medical opinions from four other doctors with relevant medical backgrounds, including one who is a pulmonary pathologist with Mayo Clinic.  They all dispute the Department of Labor’s own findings that Michael Fellinger’s lung disease was “idiopathic” or of unknown origin. They also support a wealth of accepted medical literature Fuortes provided to prove that Michael Fellinger’s lung failure was not just a fluke, but likely a result of his exposures.

But instead of sending the case file out to yet another medical consultant for another independent review, the Department of Labor sent it back to the same doctor who reviewed the Fuortes’ objections and the case file the first time. Not once, but twice, and unsurprisingly, that doctor upheld his own decision.

“It is outrageous that they sent this case review back to the same district medical consultant. Nobody likes to admit they made a mistake—of course he’s going to defend his previous statement.“ said Fuortes.

‘Prejudicial bias’

Dr. Maureen Merritt, an occupational health physician based in New Mexico, assists claimants and was one of the four doctors contributing opinions to Fellinger’s claim. She has seen repeated examples of inappropriate medical decisions in the program.

“The prejudicial bias on this case is pretty clear by now,” she told the Iowa Independent. “This is something that should have been compensated long ago.”

Merritt considers this lack of objective review typical in her experience with the Department of Labor’s administration of the program, and that cases under her own advocacy have also been reviewed more than once by the same district medical examiner.

The Department of Labor disputes this, saying claims are only returned to the same district medical consultants for clarifications, and that a third party physician or referee is appointed to review the claim and render a decision.

Both Merritt and Fuortes said this contested decision prove the need for an independent medical oversight board for the program.

“There has not been enough vetting of these (district medical consultant), not enough assurance they have the appropriate certification and background to qualify them to make decisions, and not enough oversight of the process,” said Merritt.

Which was exactly the recommendation made by the Government Accountability Office in a report released in March. The GAO suggested that medical processes and scientific information databases used by physicians to determine cases be subject to outside review. It also suggested, in absence of the Department of Labor’s improvements, legislative action should be taken.

In an attempt to find a second medical opinion that might carry weight with the Department of Labor, Fuortes requested the Fellinger case be reviewed by a pulmonologist that worked inside the Department of Labor. An administrator refused to put him in contact with the in-house expert, even though she previously assisted — or perhaps because she assisted — Fuortes years ago getting the program to recognize certain lung conditions as indicators of occupational lung disease.

“It was totally inappropriate and unprofessional,” said Fuortes of the department’s effort to block contact.

Merritt believes getting outside the administration is now the best possible course.

“With the Fellinger case, there should be an independent medical opinion provided by an unbiased third party, who is without knowledge of prior decisions.” Whether that request will be granted is anybody’s guess.

Bo Fellinger herself isn’t holding her breath.

Suffering from bouts of depression and ill health since her husband’s death, she says she tries to keep herself emotionally removed from the four years of red tape.

“If it works, it will be wonderful. But I’m not totally convinced it will.”

Laura Millsaps will discuss this story and her series of reports on nuclear workers struggling for medical compensation Thursday night at 7 p.m. on 98.3 WOW-FM’s “The Fallon Forum.” The show can also be downloaded here.