Cold War, hellish consequences

Ex-nuke weapons workers caught in medical crossfire

By Laura Frank, Rocky Mountain News - April 7, 2007

Harold Hinton is dying.

He is slowly suffocating from incurable lung disease that the government acknowledges is linked to his work making nuclear bomb fuel during the Cold War. Harold Hinton, 76, gets an insulin shot from his full-time nurse at his Cortez home. Hinton - as a young man he ground up uranium ore that became the feedstock for atomic bombs at a plant in Utah - fears he may lose his around- the-clock health care because the Department of Labor wants to reduce it. Hinton, of Cortez, is eligible for medical care through a federal program designed to compensate ill nuclear weapons workers who weren't fully warned by the government of the dangers they faced. His physician said Hinton needed around-the-clock nursing care at his home in southwestern Colorado, but a government worker reduced the doctor's orders to eight hours a day. Hinton is not alone, says the president of a Denver-based company that provides nursing care to Hinton and about 60 other former nuclear weapons workers across the country.

The U.S. Department of Labor is disregarding doctors' orders and approving less care than doctors say is medically necessary, said Greg Austin, president of Professional Case Management. Department officials have also called family members and doctors, pressuring both to agree to lower levels of care, he said. Labor Department officials said they are simply trying to be good stewards of public funds while getting ill workers the help they need. Assistant Deputy Labor Secretary Shelby Hallmark, who oversees the program, said Professional Case Management is pressuring doctors to prescribe 24-hour home nursing care when less costly care would do. " I think what's going on here is (PCM) wants to maximize cash flow," Hallmark said, adding that he has referred PCM's cases to the Labor Department's Office of Inspector General for review. Austin says the Labor Department's decisions are dangerous. "If we do what the Department of Labor says instead of what the doctors say, literally, lives could be put at risk," he said.

Crying himself to sleep

Verna Keaton, of Ohio, said her husband, Addison, cried himself to sleep Wednesday night after learning that the Labor Department was trying to take away the nursing care that keeps him home with his wife of 44 years. Addison Keaton is dying of cancer that the government says was caused by exposure to radioactive uranium at the Portsmouth Gaseous Diffusion Plant in Portsmouth, Ohio. His colon cancer has spread to his lungs, heart and esophagus.

PCM has served more than 100 ill weapons workers in 11 states during the past five years. The total bill for those five years has approached $30 million, Hallmark said. Austin said Labor Department officials have created such an "adversarial culture" toward ill workers that it is affecting workers' already fragile health. The company is considering assisting some patients with a class-action lawsuit against the Labor Department. The suit would ask a judge to stop officials from ignoring medical directives. On Wednesday, a Labor Department doctor called Addison Keaton's doctor to question his home health-care order, Verna Keaton said. Unbeknownst to the Keatons, the government doctor had already contacted a hospice-care company, which would be less expensive than full-time nursing care, to open a case on Addison Keaton. "I think they want him to hurry up and die because it's costing them too much money," said Verna Keaton. "How can a doctor in Washington, D.C., determine what kind of help my husband needs?"  She said the Labor Department doctor was relying on reports from case managers without medical degrees. "I don't know what's going to happen next because I haven't gotten hold of DOL to answer my questions," she said. "They won't return my calls."

The Labor Department runs the program that Congress created in 2001 to compensate nuclear weapons workers whose toxic exposures made them ill, including those from the now-defunct Rocky Flats weapons plant northwest of Denver. The program includes coverage of medical bills for illnesses linked to those exposures. The Labor Department and the White House have come under fire recently from the ill, their advocates and several federal lawmakers. The critics say recently released internal communications show the Bush administration has been more concerned about containing costs than helping the ill workers, whom they call Cold War veterans. "These brave Americans are suffering, and in some cases, dying, because of the hazardous service they performed for their country," said U.S. Rep. Zoe Lofgren, D-Calif., who heads the congressional committee with oversight of the Labor Department program. "These people deserve better, and I will work with my colleagues in Congress to ensure that they receive the benefits that they were promised."

Producing yellowcake

As a young man during the Cold War, Harold Hinton ground up uranium ore and moved it from one chemical solution to another until it was a fine yellow powder that became the feedstock for atomic bombs. His bosses at the mill just over the Colorado border in Utah told him the radioactive ore was safe. His only protective gear was a hard hat, as he toiled at the mill, coming home covered in yellow uranium dust. The product of the mill - uranium 308, or yellowcake as it was known for its appearance - was shipped to nuclear facilities at Oak Ridge, Tenn., and later to Portsmouth. Hinton knew that Portsmouth workers such as Addison Keaton were turning the yellowcake into fuel for atomic bombs. But he and his fellow workers didn't know the yellowcake itself was radioactive. "We were never warned," he said. Oak Ridge workers recalled being told in the 1950s that yellowcake was safe enough to eat. "Remember, at that time, they were trying real hard to get the warheads on the missiles," Hinton said. "They needed it real bad to protect the nation."

In 1986, two decades after he left the mill, Hinton began having trouble breathing. The radioactive uranium dust had scarred his lungs. He developed pulmonary fibrosis, a disease with no cure and no effective treatment. "I have anywhere from six months to two or three years (to live)," Hinton said. "To me, believe me, (the home health care) is a godsend. I have thanked God for it many times." On the last Friday of February, Hinton's doctor was ready to discharge him from the hospital after a particularly severe episode of breathing difficulty. But there was no one to care for Hinton once he got home. His wife is on oxygen and struggles to care for their son's children, a teenager and a disabled 21-year-old. The Hintons' son is in a Tulsa, Okla., hospital fighting lung cancer. Harold Hinton believes his wife's and son's lung problems resulted from contamination he brought home from the uranium mill. At the request of Professional Case Management, Hinton's doctor delayed his discharge until the next Monday in hopes of getting quick approval for Hinton's home care. But the Department of Labor took two weeks to approve the care and reduced the order to eight hours a day instead of the 24 hours ordered by the doctor.

E-mail and voice-mail messages provided by PCM indicate a case manager in Denver made the decision to offer less care without consulting Hinton's doctor.

Dr. Leonard Cain, Hinton's doctor in Cortez, said ordering 24-hour nursing care is not an easy decision. "It's complicated," Cain said. "If I put a home-health aide (instead of a nurse) in the home and the patient has a medical need during the night, that can't be handled by a home-health aide." Such aides, known as certified nursing assistants, are qualified to help patients bathe or move from a bed to a chair, PCM's Austin said. But they legally cannot administer medications, draw blood, change oxygen levels or do many other things that these patients might require at any time. "Yes, this program covers more than Medicare or some other social safety net," Austin said. "But this isn't a social program - it's a compensation program. These workers' illnesses were caused by their work for this country. They can never get their health back, but they can get some relief and be with their families until they pass away."

Caught in the middle

As a doctor, Cain said he feels caught between Professional Case Management advocating for patient care and the Labor Department trying to save money. "I'm going to err on the side of providing the most care for the patient," Cain said. "This level of care is not provided to anyone else in our health-care system. But (the law creating the workers' compensation program) says we're going to provide this level of care for these people who need it."  Cain said he resents being put in the middle. "There should be negotiation and communication on this," he said. PCM's Austin agreed, saying his company has requested that the Labor Department participate in discussing patients' care with health professionals. "They have said they are not interested," Austin said. Hallmark said he was not aware that PCM had asked the Labor Department to participate in patient case conferences. However, he said, PCM complained when the department talked directly with the physicians. Austin said PCM nurses should always be involved in decisions because they see the patients more than their doctors do. Meanwhile, PCM has been providing full-time nursing care to Hinton since Feb. 26 with no guarantee of payment. "There would be a huge liability for us if we didn't do what the doctor ordered," Austin said. "But we can't afford to do that forever."

How it happened

At the height of the Cold War, thousands of Americans were busy at urgent work they couldn't discuss with their neighbors: building atomic bombs for the arms race with the Soviet Union. At the Rocky Flats plant northwest of Denver - and at scores of other sites across the nation - workers were exposed daily to myriad poisons. Radiation. Exotic heavy metals. Chemicals in uncommon variety and quantity. The government routinely withheld information about the risk workers faced. Records of exposures were often incomplete; others were later destroyed. Today, more than 60,000 former nuclear weapons workers are ill and believe that their ailments are linked to their Cold War work. The government denied almost all such links until 2000. The next year, Congress created a compensation program to give lump-sum payments and medical coverage to workers whose illnesses were likely caused by workplace exposures.