Pollutants in the air are a serious environmental issue today. We, as an industrial society, have become far too familiar with terms like smog, radon, lead, asbestos, ozone, and carbon monoxide. We have also seen on the news, read in the newspaper, or experienced in our own lives some of the harmful consequences that result from these pollutants -- perhaps as allergies or congestion from exposure to smog or more dangerous carbon monoxide poisoning. Regulations have been established in an attempt to minimize these harmful air pollutants. For example, we have vehicle emissions testing and standards for pollutant emitting facilities.
Federal involvement began in 1970 with the introduction of the Clean Air Act. In the nearly 30 years it has been in effect it has undergone some changes, but the purpose has remained the same: " to establish and enforce air quality
standards that protect public health with an adequate margin of safety" (Huebner and Chilton). The standards outlined in the Clean Air Act state that the "Environmental Protection Agency (EPA) must promulgate secondary National Ambient Air Quality Standards
(NAAQS) necessary to protect the public welfare. "Public Welfare" includes effects on soils, water, crops, animals, weather, visibility, economic values, and personal comfort and well-being (Env Law). Being protected from harmful pollutants under a federal statute should bring comfort -- but are we really protected?
Yes, it is comforting that there are outlined standards regulating the pollutants that are being emitted into our environment. The air that we breathe should be our life sustenance, not the cause of harm or illness. These standards were established to protect public health, but there is a large fault within them. The Clean Air Act only applies to outside or ambient air. There is no federal statute regarding air pollution
Should this be of serious concern to you? Can you get sick breathing indoor air? Can you die? What can you do to protect yourself? Can you get retribution in a court of law? Would you even have any legal standing?
The federal Clean Air Act is so committed to its incomplete purpose that it does not consider cost in the efforts to approve our air quality. "In pursuing this standard of perfection, The Environmental Protection Agency (with the support of courts) has determined that costs or other economic factors may not be considered in standard setting" (Huebner and Chilton). The idea that we will all be protected from the dangers of air pollution sounds wonderful. We can stand up and salute our government for taking such drastic action where our health is concerned. "But because ozone can cause some effects in individuals even at naturally occurring levels, this goal is impossible, at least with respect to this pollutant" (Huebner and Chilton). The failure to include indoor air in the federal effort to control air pollution makes this goal even less obtainable. Lack of attention and understanding of indoor air quality (IAQ) can lead to serious and even fatal health problems.
Health problems resulting from poor indoor air quality occur very frequently. "The term "sick building syndrome" (SBS) is used to describe situations in which building occupants experience acute health and comfort effects that appear to be linked to time spent in a building, but no specific illness or cause can be identified." "In contrast, the term "building related illness" (BRI) is used when symptoms of diagnosable illness are identified and can be attributed directly to airborne building contaminants" (Indoor). The number of buildings that fit the "sick building syndrome" and "building related illness" description is alarmingly high. "According to the World Health Organization, approximately 30% of all commercial buildings have significant indoor air quality (IAQ) problems" (Byrd).
The causes of sick building syndrome include: inadequate ventilation, chemical contaminants from indoor sources, chemical contaminants from outdoor sources, and biological contaminants. In the case of sick building syndrome, symptoms usually cease upon leaving the building. In cases of building related illness, biological contaminants are usually the culprit. "Physical symptoms related to biological contamination include cough, chest tightness, fever, chills, muscle aches, and allergic responses such as mucous membrane irritation and upper respiratory congestion" (Indoor). These physical symptoms can be more than allergic responses and may even be showcasing a harbored disease. "One indoor bacterium, Legionella, has caused both Legionnaire's Disease and Pontiac Fever" (Indoor).
Legionnaire's disease is a form of pneumonia. If you do not have pneumonia, then you are not suffering from Legionnaire's. Legionnaire's disease is spread through Legionella bacteria present in airborne water particles that are inhaled by susceptible individuals. The disease was first discovered in 1976 and is now very common. "There are an estimated 25,000 deaths per year in the U.S. from it. Most cases are never diagnosed as being Legionnaire's disease, but are simply recognized as a case of pneumonia. It is believed that most cases of Legionnaire's disease are caught in hospitals" (Byrd).
Pontiac Fever is caused by the same Legionella bacteria. Its victims experience flu-like symptoms, so it does not pose as serious a health risk as does Legionnaire's disease. Pontiac Fever is "self-limiting (people get well on their own in a few days) and no one knows why some infections manifest as the one disease and some as the other" (Byrd).
Carbon monoxide poisoning is also a serious building related illness. Carbon monoxide is a colorless odorless gas that is the result of an incomplete combustion of carbon burning in the air. "The most well known symptoms of carbon monoxide poisoning are headaches and nausea, but long term moderate exposure can cause other symptoms, including flu-like symptoms" (Byrd). "Carbon monoxide inhaled combines in the blood stream with hemoglobin - the oxygen carrying chemical in red blood calls" (Byrd). Symptoms and even death can occur when a large enough amount of carbon monoxide is inhaled resulting in the prevention of hemoglobin to carry oxygen throughout the body. "Very high levels of carbon monoxide can kill in a few minutes" (Byrd). It is extremely important to act quickly when suspicious of carbon monoxide poisoning. The area or building should be vacated immediately.
Carbon monoxide can be a problem in any building or home because the items that can produce this gas are quite ordinary. "The most common sources are combustion engines (automobiles, gas-powered lawn mowers, etc.) and fumes from water heaters, gas stoves, unvented heaters, and furnaces. Unhealthful levels of carbon monoxide have been measured at tractor pulls and in ice-skating rinks (from the Zamboli ice making machines)" (Byrd). The best preventative measure against carbon monoxide poisoning is to make sure that any combustion appliances are installed correctly and maintained properly.
Another biological contaminant that can be harmful is Aspergillus fungus. "Aspergillus are ubiquitous fungi, commonly occurring in soil, water, and decaying vegetation. Aspergillus have been cultured from unfiltered air, ventilation systems, contaminated dust dislodged during hospital renovation and construction, horizontal surfaces, food, and ornamental plants" (Aspergillosis). As with Legionnaire's disease, Aspergillus commonly causes pneumonia in its victims called pulmonary aspergillosis or Nosocmial pneumonia. "The primary route of acquiring Aspergillus infection is by inhalation of fungal spores" (Aspergillosis). Cases of Aspergillus are conventional of hospital settings.
Carbon monoxide poisoning, on the other hand, is not common in hospitals but can quickly harm even the healthiest of people. However, healthy people rarely fall victim to Legionnaire's disease, Pontiac Fever, or Aspergillus. These sicknesses are examples of what can occur when already ill people are exposed to indoor air quality problems. It is unfortunate that when hospitalized to get well, we face the risk of the development of an even worse condition due to contaminants in the air.
"Legionnaire's disease is an 'opportunistic infection', meaning that it attacks individuals who are already ill or in generally poor health"(Byrd). Aspergillus is also opportunistic and infects immune-compromised hosts - meaning those who have a weakened immune system. "Risk factors include hematologic malignancies, bone marrow and solid organ transplant patients, and chemotherapy patients" (Gonzalez).
Aspergillus is frequently fatal and difficult to treat. Francoise Meunier, M.D., Ph.D., director of the Central Office of the European Organization for Research and Treatment of Cancer in Brussels, says, "Aspergillus infection is particularly important to prevent by any means necessary, because there are no good treatments" (McCann). According to Meunier, " '5% [of cancer patients who die] have evidence of invasive fungal infection at autopsy.' She estimated that 300,000 of the 6 million worldwide cancer deaths each year result from fungal infections in the bloodstream, also known as fungemia. The more aggressive the treatment, the greater the risk. Some 30% of bone marrow transplant patients show evidence of fungal infection. 'It is clearly a catastrophe for a patient to enter a hospital for a bone marrow transplant and then have to explain that this patient is going to die because of invasive Aspergillus" (McCann).
Other statistics also share high mortality rates - especially of bone marrow transplant patients. "Rates have been as high as 95% in recipients of allogeneic bone-marrow transplants and patients with aplastic anemia, compared with rates of 13-80% in leukemic patients (Aspergillosis). Prevention of Aspergillus is the most important factor since the medical treatment available is routinely unsuccessful. "Prevention of Aspergillus infection may mean something as simple as removing plants from a patients' room (the soil can harbor the fungus) or something as drastic as shutting down an entire bone marrow transplant unit as a result of widespread contamination, which Meunier said was done recently as a unit in France where 21 deaths from invasive Aspergillus occurred" (McCann).
Legal recourse is available to those, or the family members of those, who feel their contact with a biological contaminant and subsequent illness or death could have and should have been prevented. The Regulation of Health Facilities and Services states that: "Current federal or state regulations which address quality assurance and quality improvement requirements for nursing facilities, intermediate care facilities, and skilled care facilities shall suffice for compliance with the standards in this section" (Regulation, 383). A case brought before the federal court system may gain a ruling for compliance with standards, but will not grant personal compensation. To sue a health care facility for personal compensation it is usually necessary to go through district court and file a tort claim. A tort claim refers to a civil wrong or a breach of duty. These cases are usually filed as malpractice or negligence against a particular doctor, but must be done so within an established time frame. As stated in the Limitation of Actions: "An action seeking damages for an alleged unskillful and negligent operation by a physician is barred by the one year statute of limitations" (Limitations, 255).
If the statute of limitations has expired then legal recourse will not be productive. Such an example occurred on August 19, 1954: "plaintiff filed action to recover damages from the doctor because of his alleged failure to examine and treat plaintiff with due care and to perform his duties as such physician, the action was not commenced within one year after the cause of action accrued as required by paragraph (e) of subsection (1) of this section" (Limitations, 255). This case did not stand in court because too much time had passed. Legal recourse is available, but even within the statute of limitations success is not certain.
It is so important to be aware of the dangers that we face through air pollution and its biological contaminants. Measures should be taken that could drastically reduce exposure to contaminants created from poor indoor air quality. People also need to be educated, especially in the hospital sense, because awareness is a key factor to prevention.
If there is no cost restriction in the Clean Air Act applying to ambient air, it seems incomprehensible that the same standard is not applied to buildings and hospitals. With the knowledge that is available about Legionnaire's and Aspergillus, patients should be more adequately protected. Doctors who treat cancer patients and other patients with weakened immune systems should be overly cautious of indoor air quality. But too often saving money or time becomes more important than taking morally right precautions that result in added expense.
When faced with a hospital stay and a weakened immune system - talk to doctors, become familiar with the treatment provided, and become informed of construction or other air quality hazards within the hospital. And remember, people receiving immune-weakening treatments such as radiation, chemotherapy, and transplantation should not have or accept live plants or flowers in their homes or hospital rooms. For now, the best defense is to be knowledgeable and be aware.
Indoor Air Facts No. 4: Sick Building Syndrome. Environmental Protection Agency. April 1991. .
Byrd, Richard R. IAQ FAQ Part 1 (untitled).
Huebner, Stephen and Chilton, Kenneth. Is it Time to Rethink the Clean Air Act? National Legal Center for the Public Interest, 1998. Volume 2, Number 6.
Gonzalez, Gabriel. Pulmonary Aspergillosis. June 1996. .
Aspergillosis. Part I. Issues on Prevention of Nosocmial Pnemonia. 26 March, 1996.
McCann, Jean. Hold that Plant! National Institutes of Health March 1996.
Environmental Law Reporter Statutes Statuatory Outline Air Quality: Clean Air Act. November, 1998.
Regualtion of Health Facilities and Services
Limitations of Actions