‘Care providers are not asking, what caused the disease?’
Occupational disease kills more Canadians every year than any other work-related injury, accident or disorder. With no national strategy to prevent or even monitor these diseases, the death toll grows
HAMILTON —
It was supposed to be routine knee surgery for Stoney Creek’s Don Buckley, who expected to go into the hospital in early 2012 and be back on his feet in a few days.
The steelworker was a millwright who repaired the big electric arc furnaces at Dofasco, where he had been working since 1981. He spent years working next to the coke ovens, where coal is heated as part of the iron and steel manufacturing process in the sprawling plant that towers over Hamilton’s waterfront.
It was a physically demanding job that took its toll on his body. During presurgery blood work for his second knee replacement, a low white blood cell count was flagged. Buckley was feeling tired all the time, but
had no obvious answer for his chronic exhaustion. An oncologist took a bone marrow sample, found nothing wrong, and told him not to worry.
But something was wrong. The physician had missed the early signs of MDS, or Myelodysplastic syndrome, a bone marrow cancer that affects the blood cells. The rare disease is often associated with Vietnam War veterans who were exposed to the defoliant Agent Orange — or workers in industries that expose them to benzene and heavy amounts of hydrocarbons.
“The oncologist said, ‘There’s nothing wrong with you. Go home, I don’t need to see you,’ ” said his widow, Cindy Buckley.
Too often, family doctors and health-care providers in Canada overlook the signs of occupational disease. They don’t ask enough questions about a patient’s work history and they fail to identify links to potential workplace exposures. Often, cancers and other workrelated diseases aren’t properly identified until it’s too late — and that causes problems for everything from prevention to treatment.
“It’s a problem across the country,” said Paul Demers, director of the Occupational Cancer Research Centre, who was hired by the Ontario government to conduct a sweeping review the province’s occupational cancer policies. His report has not been released publicly yet.
“Most of our primary care providers are not asking about, and are not thinking about, what caused the disease. Their primary concern is taking care of the patient, but it’s supposed to be part of the process, thinking about what caused this?”
It wasn’t until February 2018, six years later, when Buckley’s white blood cells plummeted, that doctors became alarmed and finally diagnosed the millwright with MDS. Once they had a diagnosis, Cindy Buckley said the physicians immediately drew a link to his job at the steel plant.
“Every number was off the charts. It was all wrong,” she said. “Once they knew where he worked, all the specialists said it was work-related.”
Buckley underwent a bonemarrow transplant, but never left hospital and never recovered. His body rejected the transplant, and he eventually succumbed to pneumonia in October 2018. He was dead at 58 years old, within nine months of diagnosis.
More than 3,500 people still work at Dofasco, a plant owned by Luxembourg-based ArcelorMittal, a $76-billion (U.S.) multinational and the largest steelmaker in the world. Cindy Buckley knows there are other tradespeople like her late husband who are sick, and she wants answers about what they may have been exposed to in their jobs. And she wants doctors to be able to identify the warning signs earlier.
Buckley long believed his work exposed him to a toxic soup of harmful chemicals, from benzene to heavy metals dust. For years, he and other millwrights at the plant used a chemical degreaser called trichloroethylene to wash their hands and clothes after a dirty shift. The chemical is now banned in Canada and is a known human carcinogen.
Dofasco says trichloroethylene was never approved to be used to clean skin, and the company maintains its health and safety protocols all meet the standards of Ontario’s Occupational Health and Safety Act.
Steelmaking remains dangerous work. The company says it employs a team of occupational physicians and nurses who monitor employees who work in the most problematic areas of the plant — using Xrays, blood work, urine and lung exams to check their health. But that system only protects workers who are currently employed, not retired employees who may only begin to show signs of disease after they leave their jobs.
Although Canadian medical schools spend more time training students on occupational disease than they used to, doctors still often have little information available about a patient’s work history and potential exposures. In places like Denmark, they have a lot more to work with — including an occupational exposure tracking system, so when someone is diagnosed with cancer, the physician already has their work history available and can flag potential connections.
“The first step is really being aware of where patients work,” Demers said. “We don’t really have enough information on exposure to workplace carcinogens. We need basic information around what they were exposed to, and what levels they were exposed to, and that kind of information is hard to come by in Canada.”
Other countries do a better job of tracking workplace exposures to carcinogens, and making that information available to doctors. In Italy, for example, a pipe fitter can apply to a government program that funds their transition into another job when their exposure to asbestos surpasses acceptable levels.
Finland, meanwhile, has managed to reduce the number of occupational disease cases by nearly half since the early 1990s, using a progressive approach to prevention, including early screening of workers who have been exposed to carcinogens on the job.
Cases of asbestos-related disease and lung cancers peaked in Finland in 1991, while rates in Canada and other industrialized nations continue to climb. Mesothelioma remains a growing problem, but Finland’s emphasis on early detection and treatment gives
patients a greater chance for survival.
Buckley, even before his diagnosis was confirmed, was convinced there was a link between his health problems and his job, and told anyone who would listen.
“He always encouraged me to get out of there. He knew it was a bad environment,” said his son Tanner Buckley, who also worked at Dofasco. “Everybody who worked there knew it was a bad environment, as far as longevity and health concerns.”
When he was diagnosed, Buckley filed an occupational disease claim with Ontario’s Workplace Safety and Insurance Board (WSIB). It took the board 13 months to investigate his case. The board looked at other possible causes for his disease, including his rural address and potential exposure to farm pesticides, and the fact that he used to smoke more than 30 years earlier.
Buckley had hired a lawyer and was ready to appeal the decision. But four months after his death, the WSIB agreed the blood disease was workrelated. Now his widow wants his story told to help other workers, so they don’t have to go through the same battle to get compensation.
“He asked us to fight this because he always knew it was work-related,” said Cindy Buckley, who started dating Buckley in high school. “I want to help other people so they don’t have to go through this same battle … Don wanted this story out there. He wanted people to know what was going on there.”
Buckley’s coworkers at the steel plant say they knew there were risks involved with their jobs, and many admit they worry about their health today.
Former employees believe they breathed in harmful gases and particulate, including graphite dust from iron ore, on a regular basis. Eye protection was mandatory, but they say respirators weren’t — and on some the jobs, workers would take them off when they needed more freedom to move around.
“Some us got out of there unscathed, others didn’t. We’re all ticking time bombs, but we don’t like to think something can happen to us,” said Clint MacKenzie, Buckley’s friend and co-worker who was a millwright at Dofasco for almost 38 years.
“I guess we just became conditioned to the environment. We became complacent. We tolerated it, it’s a job. It’s a job that gave us a life. But ironically it may also take our life.”
Other former steelworkers recalled spitting up black gunk at the end of their shifts. Fine dust coated the plant’s raised platforms so thickly that their footsteps would kick up clouds of it as they walked, they said. Dofasco now uses vacuum trucks to remove the dust before workers do maintenance jobs, but former employees say it used to be an accepted part of a dirty job.
“Sometimes the dust was so thick you could hardly see the other guy in front of you. Any time the sun was shining through the roof, you could see the particulate in the air,” said Dennis Lyons, another former Dofasco employee.
“We knew it wasn’t a perfume factory. You knew going in it was going to be crappy.”
In 1997, the WSIB amended the Workplace Safety and Insurance Act to make it easier for former Dofasco employees with lung cancer claims connected to the foundry unit to get compensation. But former employees say the WSIB is still lagging when it comes to other diseases they believe are linked to their old jobs. Those who worked around the steel plant’s massive electric arc furnaces — used to melt scrap steel into liquid — say they noticed a lot of lung problems among coworkers exposed to the dust produced by the operation.
“There were a lot of guys who had respiratory problems. So we’re going, ‘OK, what’s the common denominator here?’ ” Lyons said. “You’ve got to question it.”
Dofasco says air quality in the steel plant is regularly tested and meets regulatory standards. The company has also invested millions in technology to improve ventilation in the plant and reduce its pollution emissions.
But the problem, Tanner Buckley says, is many workers in the non-unionized plant are afraid to voice their concerns about the conditions they’re working in.
Cindy Buckley, meanwhile, feels companies like Dofasco should do even more to protect their workers. But for many former employees, the problem is what they were exposed to years ago, and how difficult it can be for their doctors today to be aware of those risks.
Without access to old exposure records from previous eras, it can be hard to catch occupational diseases before they kill. Buckley’ wife says she’ll always wonder how things might have been different if his cancer was diagnosed sooner.
“He gave his all for Dofasco. But in the end, it didn’t matter,” she said.
“Most of our primary care providers are not asking about, and are not thinking about, what caused the disease. Their primary concern is taking care of the patient, but it’s supposed to be part of the process, thinking about what caused this?” PAUL DEMERS Director of the Occupational Cancer Research Centre