Gots hates it when the disinformation isn't his.

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http://www.claimsmag.com/Issues/aug02/mold_claims.asp

Mold Claims: Recognizing What Is Real

By E. Gots

The recent mold frenzy is the strangest environmental claim issue that I

have seen in 30 years of toxicological and environmental litigation

consulting. Why? Mold is a natural living material, essential for life and

comprising 25 percent of the world's biomass. It has neither become more

prevalent than it was 20 years ago, nor is there much additional support for

any new adverse health effects, despite thousands of active claims alleging

the contrary.

Most allegations are based upon misinformation, so often repeated that it

has garnered an aura of certitude. Among the misinformation: mold and mold

toxins in the indoor environment are not known to cause brain damage,

immunological disorders, bleeding lungs in newborns, fibromyalgia, attention

deficit disorder, cancer, or chronic fatigue syndrome. The alleged chronic

disorder " fungal syndrome " or " bioaerosal disease " is neither accepted in

the medical community, nor known to exist.

Outdoor levels of mold spores in parts of the country (i.e., St. Louis in

summer) are routinely 50,000 m3. People are being told to evacuate homes

which have 5 percent of those levels. The term " toxic " mold makes no sense.

Almost all molds can make mycotoxins, including Alternaria, one of the most

common outdoor molds and always considered non-toxic or benign by

environmental consultants.

One of the reasons for this strange and vast discord between health

realities and health perceptions is the lack of medical expert voices in the

fray. Instead, the din of indoor air experts and air quality experts, few

of whom have any medical expertise and even fewer of whom have read

thoroughly the scientific literature, has coopted this field. Some fringe

physicians also have jumped into this arena. As those of you who handle

claims well know, the growing interest in testing and finding problems

rivals 's interest in keeping Enron healthy. Thus, they are neither

expert, nor impartial.

Notwithstanding the fact that this situation is misdirected, you as claim

handlers still have to contend with the mold issue. Failing to do so is

perilous.

Risk Decision Process

True health risks are generally minimal in most mold contamination

situations. Exceptions may exist, i.e., if contamination is extensive, if

occupants are highly allergic, if residents are immunocompromised. Although

health is the driver for most testing and remediation, however, we must

recognize that perceived health risks are the real driver.

Because of the extensive publicity, people are genuinely worried about mold.

That plus, now common, legal representation are key determinants of your

actions. This is particularly true in high-risk jurisdictions such as

California and Texas. These factors have led to the need for prompt action

and decisions, some of which must be guided by the level of distress of

involved parties.

This presents the claim handler a new challenge: psychological assessment

(and early clinical assessment) of the client or occupants. This, in turn,

must be considered before you deny coverage or permit the claimant to move.

One approach we have used in homeowner matters is requiring a physical

examination of residents who complain of symptoms. After all, the IAQ people

are not qualified to connect symptoms to cause, and if the occupants believe

that their health has been compromised, what could be more reasonable and

supportable than medical confirmation? One caution: use standard, mainstream

physicians, not those who are making a current carrier in mold hype or fear.

Some situations require effective, early health risk communication. This is

particularly true in commercial buildings, municipal facilities, and schools

in which large numbers of concerned workers, parents, or students may be

involved. Communicators must have expertise, excellent communication skills,

and the ability to deal with media and Internet errors in a knowledgeable,

believable fashion. Any good communicator will anticipate the concerns and

be prepared to answer tough questions.

Evacuation or Not

A significant cost driver in the mold arena is relocation. This is

particularly common in homes, but may involve commercial establishments and

municipal buildings. Rarely is immediate evacuation needed. Mold is not like

carbon monoxide or natural gas. An exception may be a situation in which

contamination is unusually severe, i.e., a family returns after three weeks

to a flooded home or a roof blows off a building.

Too many IAQ investigators order evacuation with little appropriate

knowledge to do so and little reason. The finding, for example, of small

amounts of Stachybotrys is not, taken alone, grounds for evacuation. It is

important for the claim handler to discuss this issue with consultants. If

they are too cavalier, they can get you in trouble; if they are overly

conservative (demanding regular evacuation), they can lead to vastly

inflated costs. If occupants are complaining of symptoms, they should be

examined by a non-mold-activist physician at once to see whether medical

findings are consistent with a mold-induced cause.

During remediation a second evacuation decision may have to be made. The

need for this depends upon the amount of remediation and the ability to

reasonably protect the occupants.

Most importantly, these decisions are all matters of judgement. Your job is

to be certain that your consultants have good judgement and valid,

scientifically supportable reasons for their decisions.

The testing and remediation industry is chaotic and highly variable in

quality. Some of the largest and best known firms over-test and

over-interpret and over-evaluate. That is how they get paid. Working with

the key individuals, reviewing their work, getting recommendations, and,

most importantly, reviewing their reports and recommendations, both for

content and consistency, are the only ways to insure that you are getting

the right people. Inconsistency in your recommendations and your actions can

get you into trouble. You need a standard and medically/scientifically

supportable set of guidelines and standard operating procedures.

Sampling options are another area of enormous inconsistency. Sampling should

always be determined by apparent or highly suspicious water damage and

suspected mold growth. Random tests are uninterpretable and make no sense.

The latest creative, but rarely appropriate, testing extreme involves

mold-smelling dogs, a silly, expensive approach designed to escalate costs.

Since dogs are touted as being able to identify mold at 1,000 times lower

levels that the human nose, they will likely find it everywhere, even when

it is inconsequential to human health.

Evaluation and Remediation

Water incursions must be controlled and damage cleaned up. This is often a

localized activity that does not, and should not, involve an entire

facility. The allegation of widespread mold spore dissemination through the

ventilation system is rarely a meaningful issue. Because spores enter

buildings and homes every time we open doors and windows, they are

everywhere. The concern is not their presence (unless levels are

extraordinarily high), but whether they find wet areas for growth. One study

of normal homes showed mold spore levels during routine activities. A simple

act like changing sheets on beds, for example, has been shown to generate

many thousands of airborne mold spores.

Rarely do contents require destruction or replacement. An exception is

furniture which is water soaked and moldy. This may not be salvageable.

Surface spores, however, on otherwise dry furnishings, drapes, and clothing

can readily be cleaned. Solid surfaces can be wiped down.

Returning occupants to remediated areas generally follows elimination of

water damage and moldy materials. Numbers are unreliable, often

uninterpretable, but commonly used. The commonly-used 1-1 or 2-1 ratios of

indoor to outdoor mold are poor rules of thumb, as levels can vary so

markedly from time to time and as, in cold climates, winter outdoor levels

are almost always lower than indoor levels. The best guidelines are: 1) Has

the damaged area been remediated? Visual inspection answers that question.

2) Are levels consistent with customary indoor levels which have been

reported in the scientific literature?

The only claims that generally are compatible with mold contamination are

respiratory claims, primarily hayfever and, occasionally, asthma. Most of

the rest - brain damage, immune dysfunction, chronic fatigue, etc. - are

nonsense and readily defendable. They simply find no scientific support and

are not generally recognized in the medical community. Symptoms alone are no

measure of personal injury from mold. Symptom reporting is highly unreliable

and non-specific.

To investigate personal injury claims, several steps are essential:

.. Review all past medical records to correlate alleged exposure with

symptoms and findings and to put them in as temporal context with alleged

exposure.

.. Include in the review a medication analysis. Many medications can produce

a host of symptoms.

.. Review contemporaneous (not after mold has been discovered or a lawsuit

filed) medical records to see what complaints and, most importantly,

physical findings existed during exposure period.

.. The former review leads to identification of temporal relationships and

alternate causation.

.. If indicated, review, or have performed, standard allergy skin testing to

see whether the claimants are allergic to the identified mold. If not, they

likely have no valid claim.

.. Force opposing experts to prove that mold can cause the alleged disorders

(using medical and scientific literature).

.. Force opposing experts to prove which mold and when allergies developed,

assuming claimant has demonstrated mold allergies.

.. Show that 20 percent of the population has some allergies to mold and

dozens of other aeroallergens which do not, in general, suggest serious

illness and often do not even indicate a clinical response to those agents.

.. Recognize that there are very few long term illnesses which have ever

arisen from indoor mold exposure.

.. Be prepared to compare mold exposures in gardens, camps, plant stores,

and numerous occupational settings (thousands, even millions, of times

higher than indoor levels even in contaminated facilities) and to show what

ailments such individuals develop and how rarely those occur.

As it is commonly used, toxic mold is a meaningless term. Indoor air mold

has never been proven to produce toxicity, and common allergies are the main

endpoint of mold exposure in sensitive people. Gardening or walking in the

woods exposes people to vastly higher levels of toxigenic mold than do

almost any indoor exposures. The defense of irrational claims depends upon

well prepared defense counsel who understand the known clinical science of

mold and its effects.

E. Gots is a lecturer at town University School of Medicine and

a principal at the International Center for Toxicology and Medicine. He can

be contacted at regots@....