Science has yet to catch up to case law

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http://sacramento.bizjournals.com/sacramento/stories/2002/07/01/story6.html

June 28, 2002

Mold Rush

Science has yet to catch up to case law

Kathy on Staff Writer

Glenda Reager knew the news was bad when workers opened the closet wall in

her master bedroom. The inside was wet and black. An overwhelming smell

brought on a wave of nausea. Her eyes and throat burned. Her head throbbed.

Unsure what it all meant, the Sacramento attorney spent a couple more nights

in her dream home before someone suggested she call in an air expert. She

did -- and the expert told her to get out.

Reager is one of perhaps hundreds of Americans across the country who have

sued to recover damages they say they've suffered from mold. It's an

exploding new type of litigation. But the science remains blurry, and

objective health data are hard to come by.

Reager left her home almost two years ago. This spring, Reager says she

continues to feel fairly miserable. She still gets throbbing headaches,

despite prescription medicine to ease allergies that never used to bother

her. Her health might improve over time. It might get worse; her doctor

can't tell.

Last year, Reager settled a construction defect lawsuit she filed against

one of the largest homebuilders in the area. Her suit asserted that faulty

concrete work caused water damage and mold that forced her out of her home.

She trashed most of her furniture and belongings, including a collection of

dolls and teddy bears from around the world.

Reager has just bought a new house, but says she is still too upset to drive

by the old one to see what happened to it. She has changed jobs. A former

partner at the Sacramento law firm of Hardy h Brown & , she now

works for the state Attorney General's Office.

A lawyer, she's trained to stick to facts. When it comes to mold, she knows

only how she feels. " We don't know enough about this stuff ... and I don't

know where all this is going, " Reager says. " But if I had a small child and

I found mold in my house, I'd get out of there. "

`The new asbestos': Mold has been around forever, but now it's being called

" the new asbestos. " Figuring out what kinds of mold cause problems for what

sorts of people -- and what to do about it -- has become a whole lot harder.

With jury verdicts in the millions and lots of people running scared, a

debate has emerged as to whether mold is one of the major health crises of

the decade or junk science that has got plaintiff attorneys in a feeding

frenzy.

The problem is that science has yet to catch up with case law. While judges

and juries have been convinced by anecdotal arguments of cause and effect,

various scientists and medical experts claim there's still no credible,

peer-reviewed study or clear environmental standards on mold.

With thousands of varieties that affect each person differently, depending

on the individual's sensitivity and length of exposure, coming up with

permissible exposure limits to mold is tough.

" A number of scientific groups have attempted to address whether (exposure

limits) are feasible and have not been able to come up with any, " says

McNeel, a research scientist with the California Department of Health

Services. " We have reviewed some of the literature -- and that is our

feeling as well. "

Science doesn't have all the answers for why people get sick in damp or

moldy buildings. Exposure can include everything from live mold spores to

dead ones, toxic mold, allergens and volatile organic compounds. There is no

linear relationship between the " dose " people are exposed to and their

response.

Without the science, observers say it's impossible to cap mold-cleanup costs

or stem the flow of mold-related lawsuits.

" Litigators are more up-to-speed than toxic folks, " says

Stwora-Hail, an attorney at the Sacramento firm of Downey Brand Seymour &

Rohwer. " It's so new an area, insurance companies and litigation firms are

driving it. "

Mold requires a new way of thinking -- and a lot of public education.

Thousands of types, maybe 100 hurt: More than 100,000 species of fungi exist

naturally in our environment. Fungi need moisture to germinate -- and when

they do, they become mold.

Small and light, mold spores can travel through the air. They can remain

dormant for months or even years, and some species can withstand extremely

adverse conditions. Like tiny seeds, they germinate in damp places.

Outside, molds help break down leaves and dead trees. Molds can grow inside,

too, if spores land on something wet. Under natural conditions, most are

harmless to people.

People eat some fungi, like mushrooms. Molds flavor stinky cheeses. And some

antibiotics, including penicillin, are derived from mold.

Mold loves modern living, where spores propagate like gangbusters in

airtight houses locked up all day while the residents work or go to school.

An estimated 50 to 100 common types of indoor molds have the potential for

creating health problems, according to a report by Healthy Indoor

Environment Inc. in Fair Oaks.

The most common indoor molds are cladosporiam, penicillium, aspergillus and

alternaria, but stachybotrys gets the most attention these days. It is a

black, slimy mold found in an estimated 15 to 20 percent of homes, including

the one owned by Reager.

Penicillium, the mold from which the popular antibiotic is derived, is most

commonly seen as the blue-green or green mold growing on oranges.

Certain toxic types of mold can cause serious reactions. They secrete

mycotoxins, chemicals which can seep into the body through the nose, mouth

and skin.

While cladosporiam can cause allergy problems, penicillium, aspergillus,

alternaria and stachybotrys all produce some mycotoxins. The degree of

reaction to mold depends on the species, the metabolic products it produces,

the amount, frequency and duration of exposure -- and the specific

susceptibility of those exposed.

" Just because you see a mold that is black doesn't mean it is toxic, " says

Hugh , president of HTA Science & Engineering Inc. in Fair Oaks. The

local company tests for mold and advises clients on how to fix the problem.

Five factors have to be considered to determine whether a particular mold is

toxic to a particular person, he explains.

People with poor immune systems and respiratory problems, as well as

children, the elderly and pregnant women, have the biggest risk.

Symptoms: While mold lore includes horror stories about people losing their

memory or coughing up blood, most common symptoms are similar to the ones

associated with hay fever. An estimated 10 percent of the population is

allergic to mold (see illustration at left).

People who experience any of these symptoms after being exposed to what they

think is mold, the agency advises, should contact their doctor.

Headaches, memory problems, mood swings, nosebleeds, body aches and pains,

and fevers are occasionally seen in mold-related cases, but their cause it

not understood, according to the state Department of Health Services.

" The thing that gives it away is that (the symptoms) keep coming back, " says

Dr. Marinkovich, an allergist, immunologist and professor of

pediatrics at Stanford University. " It's not like a single cold that goes

away. It can take months or years. My patients come in saying, `I can't

understand why I keep getting sick.' "

The best treatment for mold is to avoid it, Marinkovich says. Everybody gets

exposed to some mold at some time, but extensive mold inside a house means

the residents may breathe in trillions of spores. That can cause extreme

gastrointestinal upset and other ailments.

" It's like eating a tablespoon of mold, " Marinkovich says, " and that's

generally not a good idea . "

Biggest verdict in the U.S.: It certainly wasn't a good idea for Bryce

Mazza, a Sacramento 8-year-old whose family was awarded a $2.7 million jury

verdict last November after they experienced health problems related to mold

in their Partridge Pointe apartment on Watt Avenue. The defendant in the

case appealed, and a confidential settlement was reached a couple months

ago.

The verdict is believed to be the largest U.S. personal injury award related

to mold, says , the plaintiff's attorney from Sacramento-based

Charter & who handled the case.

For Bryce, severe stomach cramping was the first sign something was wrong,

his mother Marcie says. " He kept crying, `Mommy, why does it hurt so bad?' "

Bryce was eventually hospitalized for five days for gastrointestinal

problems. Doctors didn't know why. Maybe cancer?

Bryce had a colonoscopy, feeding tube and five CT scans before anybody

thought of mold. He missed 32 days of school the first year that the family

lived in the apartment; 39 days the second. They moved out last September.

Darren Mazza, Bryce's father, started noticing symptoms about a year after

the family moved to the apartment. He was hospitalized for a week with a

respiratory infection and developed heart problems while in the hospital,

Marcie says. An array of tests couldn't pinpoint the problem, and Darren,

the sole supporter of the family, left the hospital for financial reasons.

" He went home and got worse, " says Marcie. His steroid medication was

increased to get swelling under control. He missed 26 days of work. Marcie

began to wonder what raising Bryce on her own would be like.

A former smoker, Marcie attributed her own breathing problems to cigarettes.

She'd never had asthma, but began waking up in the middle of the night

gasping for breath, ready to call 911. Darren, an emergency medical

technician, calmed her down, but the scare became a nightly ritual.

When a vent was removed, showing where water had been leaking, the family

" put two and two together, " Marcie says. " Black-looking mold. We were sick.

We need to move. "

They did, and life is now " livable, " Marcie says. She's gained 60 pounds and

Darren gained " at least 40, " she says, because of the medications they now

take.

" Are you ever away from mold? No, " she says. " We are extremely sensitive to

it due to our exposure. When mold is high, we are miserable. "

The defense argued that the Mazzas' health problems stemmed from allergies

to their three cats. The verdict, although later appealed and settled,

sends a message that mold-related health problems are real, says.

`Junk science': Plaintiff attorneys are simply using the power of suggestion

to sway public opinion, says Lees-Haley with Health Education Services

in Huntsville, Ala. The theory that harm exists unless you disprove it, he

says, is " junk science. "

There's lots of speculation but no scientific basis for saying that

breathing mold spores causes harm, he writes in " Mold and Neurotoxicity:

Validity, Reliability and Baloney. "

Most people ignore fleeting aches and pains, temporary fatigue or stress as

" symptoms of life, " but there's much to the power of suggestion, he says.

Studies show differences in symptoms among people who sued and those who

have not. There's also a disparity in symptoms reported by people who are

going after money versus those who have not, Lees-Haley claims.

Good scientific studies -- with appropriate control groups -- are needed, he

says. The conclusion, for now: " We don't know. "

In the jam, in the juice: There's a definite link between mold exposure and

health problems, counters physician Marinkovich, whose flourishing private

practice as an allergist and immunologist is proof of growing public

concern.

" Anybody who denies that is ignorant or has a hidden agenda, " he says.

Mold-related illness in humans was documented in the 1930s and '40s, when

fungal exposure was shown to cause farmer's lung disease, a mold-related

infection of the lung, he says.

People react to different amounts of mold, Marinkovich says, just like they

react to different amounts of pollen. Some people become sensitive quickly,

some don't. Any mold, if the quantity is high enough, can cause symptoms.

And there's mold in a lot more substances than most people think.

Mold malt extract is used in bread. There's mold in fruit juice. Aspergillus

enzymes chew up the cellulose in pre-squeezed fruit, upping juice production

as much as 25 percent, according to Marinkovich.

And citric acid -- a fermentation product that comes directly " out of the

aspergillus vat " -- is the most common preservative used in food.

" And we know molds create toxins that can do terrible things, " Marinkovich

says.

Most people aren't bothered: " Yes, mold can cause health problems. It

usually doesn't, however, " says McCurdy, an associate professor in

the department of epidemiology and preventive medicine at UC . " Through

evolution, our bodies have learned to deal with it. We all breathe, eat and

sleep in a sea of mold. "

Most people smell a musty odor when they go into a house with mold. Some get

headaches, which end when they leave.

But there are some special circumstances at play. Certain people with immune

problems from conditions like cancer or HIV, or certain genetic

predisposition, can have severe -- even mortal -- health problems that stem

from exposure to mold, McCurdy says.

Dark-skinned individuals seem at greater risk of contracting San Joaquin

Valley fever, which is caused by certain kinds of mold.

" Bottom line: It's not possible to remove ourselves from mold, and an

overwhelming proportion of the population is not bothered by it, " McCurdy

says. Still, it's important for doctors to keep an open mind. Fifty years

ago, nobody linked cigarette smoke to lung cancer.

Tools for docs: Both patients and their doctors need to learn what to look

out for when a patient suspects mold exposure, says Dr. Frederick Fung, a

physician with the Sharp Rees-Stealy Medical Group who works at University

of California campuses in Irvine and San Diego.

While there is no fail-proof single test for mold exposure, there are ways

to narrow the field, he writes in a paper titled, " What is Mold All About? "

" The presence of symptoms does not in and of itself imply disease, " writes

Fung. Lab tests are not enough. Clinical background isn't either, without

controlled research, he says.

That's where it all gets rather fuzzy.

California plan stalls: In October, California became the first state in the

nation to enact sweeping mold legislation. The new law requires state

officials to develop a uniform mold standard and publish educational

materials to teach the public about the problem.

The Toxic Mold Protection Act also requires that the presence of mold be

disclosed during commercial or residential property sales.

But there's no money in the state budget to do the work. State health

officials estimate that the program would require $400,000 in the first year

and $700,000 in subsequent years. They got zero this year and expect the

same in the future.

In the meantime, the state Department of Health Services is trying to put

together a task force of volunteers to create a database on the issue, says

department research scientist McNeel. One of the budget trailer bills seeks

to set up a fund for voluntary contributions to the effort.

State health officials are looking at how other indoor environmental hazards

such as pest infestations, rodent infestations and smoke are handled without

permissible exposure limits, says McNeel.

" By their very nature and previous experience, we know they are not good to

have indoors, " she said, " but housing inspectors don't have to go around

counting mouse droppings to say there's an OK number of droppings -- or too

many. "

Unlike other indoor contaminants like radon, asbestos or carbon monoxide,

there is no single measure or instrument developed to find out how many

molds are present and what type. " So once you decide to test, it opens a

whole Pandora's box, " says McNeel.

While standards are not possible today, there is enough evidence of the link

between mold exposure and health problems to come up with some kind of " best

practice " guidelines, says Alan Borner, president and CEO of the Durham,

N.H.-based Environmental Hazards Management Institute.

The institute is a sister company to the new Sacramento nonprofit, Healthy

Indoor Environment Inc. The idea behind the new company is a collaborative

effort to raise money, do an epidemiological study of mold and come up with

some national guidelines for how to deal with the stuff.

" We can't create a standard on this soupy stuff called mold, " Borner says.

" At least we can create best practices based on reasonable theory as

something we can all refer to. "