Investigative Report: Flavoring agent destroys lungs

CHRIS BOWMAN, SACRAMENTO BEE, JULY 30, 2006
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By the time Irma Ortiz discovered she had been breathing toxic fumes on her job as a mixer at Carmi Flavors near Los Angeles, she had lost at least 70 percent of her lung capacity. Ortiz, 44, a nonsmoker who used to lift 50-pound bags routinely, now finds walking so difficult she spends most of her time indoors. Sacramento Bee/Hector Amezcua
LOS ANGELES — Hacking and gasping, Irma Ortiz could cart her groceries only so far before she’d catch other shoppers glaring at her.
Mortified, she’d abandon her cart on the spot and bolt for the door.
Frank Herrera could gun his dirt bike only so far before choking on the rush of air. Go. Stop. Go. Stop. Exasperated, he gave up riding.
Ortiz, 44, and Herrera, 34, are odd candidates for lung transplants, being nonsmokers and having considerable youth on their side.
How they lost 70 to 80 percent of their breathing capacity is no less astonishing. They acquired the same rare, lung-ravaging disease from breathing the same chemicals on the same type of job.
The two weren’t working in a chemical or pesticide plant. Nor in a weapons plant. They didn’t metal-plate, fumigate, degrease, demolish, smelt or weld.

They made, of all things, artificial food flavorings.
Harmless as that seems, two big labor unions that champion ironworkers and meat cutters are now fighting for the workers who whip up piña colada, butterscotch and other flavors that sell America’s snack foods. Just last week, 40 job health experts joined the Teamsters and the United Food and Commercial Workers in urging the Bush administration to issue an emergency order restricting worker exposure to a widely used butter flavoring — a chemical called diacetyl.
“Although the precise number of workers already suffering respiratory effects from exposure to diacetyl is unknown, the potential magnitude of the problem is sizable,” the experts said in a letter to U.S. Labor Secretary Elaine Chao.
“It is now time … to use the scientific evidence to protect American workers from debilitating lung disease,” the group said in support of a petition to Chao filed by the unions.
The lung disease is as bad as its name suggests: bronchiolitis obliterans. It’s a condition that literally obliterates the bronchioles — the lungs’ tiniest airways — resulting in drastically reduced breathing capacity.
Ortiz and Herrera are the first Californians known by state health officials to have developed the disease from working in a flavoring factory, most likely from inhaling diacetyl’s powerful fumes, the health investigators said.
But the search for victims has only just begun.
Waking up to the threat
Many public health physicians and scientists believe they are on the verge of uncovering an occupational health epidemic among the thousands of men and women who have worked on production lines in the nation’s flavoring factories.
Neither OSHA, the federal Labor Department’s Occupational Safety and Health Administration, nor Cal-OSHA, its state counterpart, has set limits for worker exposure to diacetyl.
In California, state health department staff and Cal-OSHA regulators are expanding their investigation beyond the two plants where Ortiz and Herrera worked to the estimated 28 other flavoring companies statewide.
Last week, state officials enlisted the help of physicians at the National Institute for Occupational Safety and Health in testing the breathing capacity of current and former flavoring workers, beginning with the Los Angeles-area plant where Ortiz worked.
Some of the same NIOSH doctors found a strong link between diacetyl and the lung disease a few years ago among workers at microwave popcorn factories in the Midwest. The disease permanently disabled dozens of popcorn workers and killed at least three, according to the doctors.
The flavoring industry’s largest trade association also assumed a leading role in the California investigation. The Flavor and Extract Manufacturers Association recently arranged for its respiratory disease experts at the National Jewish Medical Center in Denver to evaluate workers and inspect operations at companies.
The flavor association is bringing health investigators from all sides together to share findings for the first time Wednesday at the medical center.
Consumers who prepare or eat frozen meals, pastries, candies, coffees and other foods containing these additives are not at risk, doctors say. That’s because the chemical concentrations in the final products are much lower than those found in flavorings and snack food plants.
Grave risks, uneven protection
Without proper protections, workers who make the flavor mixes in batches of 50 to 5,000 pounds can inhale highly toxic fumes as they pour chemical liquids into huge blenders.
The level of worker protection in the flavoring business varies from company to company as with other industries where job safety is largely self-policed.
Several companies declined to give The Bee an inside look at their operations. Western Flavors and Fragrances, however, opened the doors of its Livermore plant for a tour at the encouragement of the flavoring industry.
By all appearances, the factory appeared to be a model of industrial hygiene, with workers fully suited in protective gear, with meticulous storage, handling and labeling of hazardous chemicals, and worker safety training that goes beyond the law.
“This plant is typical of those in our association,” said John Hallagan, the flavor association’s chief spokesman and attorney.
Yet the stories of Ortiz and Herrera provide fresh and powerful evidence that some of the estimated 3,700 flavoring production workers nationwide continue to be exposed to highly toxic fumes.
Their experience also exposes serious disconnects in job safety surveillance and enforcement that allow workers with little or no knowledge of the potential dangers to slip through the safety net and lose most of their capacity to breathe, according to interviews with several health experts and regulators and a review of Cal-OSHA inspection records on flavoring plants in Southern California.
Few of the flavoring workers are unionized. Many of the estimated hundreds in California are immigrants like Ortiz and Herrera, and primarily speak Spanish.
The two worked 60 miles apart in Southern California, which hosts most of the flavoring factories on the West Coast — Herrera at Mission Flavors & Fragrances Inc. in Orange County, and Ortiz at Carmi Flavor and Fragrance Co. near Los Angeles.
“They never said nothing to us about the chemicals there, the kinds of dangers or give us a warning like, you know, ‘This is bad for you guys, protect yourselves better,’ ” Ortiz said of her former employer. “They never say nothing to us like that.”
Eliot Carmi, the company’s president, did not return phone messages for comment. State job safety regulators declined comment on their ongoing investigation of conditions at the Carmi plant.
Airways narrowed in matter of months
The swiftness and severity of the disease alarmed Barbara Materna, California’s chief of occupational health.
“When you have young people on a lung transplant list and unable to work, it’s a very serious problem,” said Materna, whose staff interviewed Ortiz in May and inspected the flavor blending room where she worked for eight years.
Breathing the toxic fumes can drastically lower breathing capacity in a matter of months. The vapors inflame the bronchioles, crucial airways branching like twigs at the ends of the respiratory tree where oxygen enters the blood. Scar tissue builds up in the inflamed bronchioles, shrinking or completely blocking the tiny air tubes.
“It’s the difference between a Jamba Juice straw and a cocktail straw,” said Michelle Fanucchi, a UC Davis researcher in respiratory disease. “Have you ever tried to drink a milkshake out of one of those really skinny straws? It takes a lot of effort.”
Materna and other health scientists said a much broader worker population may be at risk: Those who manufacture chemicals supplied to the flavoring factories where mixers like Ortiz and Herrera labored, and the bakers, candy makers, beverage formulators and other who use the flavoring mixes.
And, while diacetyl is the leading suspect, health and industry officials are warning companies that other vaporous flavoring agents may be damaging workers’ lungs: the already regulated acetaldehyde (common in citrus flavorings) and benzaldehyde (common in cherry and other fruit flavors), among others.
“These chemicals are still in use in industries that we haven’t even begun to look at,” Materna said.
For now, though, the spotlight is on flavoring workers. Ortiz and Herrera came to the attention of Cal-OSHA in the past two years by sheer serendipity and happenstance, said Dr. Philip Harber, a UCLA occupational health expert who is treating them both.
“If I’m randomly seeing a couple of cases, there’s likely to be a lot more out there,” Harber said.
Indeed, just in the past two weeks, doctors conducting breathing tests identified three more potential victims of bronchiolitis obliterans. Two worked at Carmi Flavor, Ortiz’s former employer, and a third worked at the nearby Mastertaste plant in the City of Commerce, just outside Los Angeles, Materna said.
The flavoring industry cases, together with the sickened popcorn workers, provide “compelling scientific evidence linking occupational exposure to diacetyl to bronchiolitis obliterans,” the health experts said in the letter sent Wednesday to Labor Secretary Chao.
Industry doctors in California began looking for that evidence a year ago by screening workers. Companies later struck a deal with Cal-OSHA to continue evaluating employees and to conduct their own safety inspections — in exchange for avoiding visits from agency enforcers and possible citations. The catch was, the companies would then have to share the results with regulators, who would follow up on-site to make sure that the plants were safe.
Some see conflict of interest
Some public health experts question whether regulators should be satisfied with information that comes secondhand from an industry with a financial stake in the outcome.
“It’s terrific that industry wants to play a role in solving the problem, but it’s the responsibility of regulators to ensure that employers provide a safe workplace,” said David Michaels, who has studied the Midwestern popcorn workers disease as a public health professor at George Washington University.
An industry-paid doctor, Michaels said, no matter how professional, has an inherent conflict of interest that could taint the process.
“It’s not a question of how honest you are, or how good you are,” Michaels said. “It’s that the financial relationship clouds your judgment. And Cal-OSHA is not there to watch the data being collected.”
The leading industry physician, Dr. Cecile Rose at National Jewish Medical Center, did not return phone messages for comment.
Cal-OSHA acting director Len Welsh said it’s the employer’s responsibility to screen workers’ health and that Rose is highly reputable and renowned in her field.
But, said UCLA’s Harber, Cal-OSHA should have issued an emergency order requiring the state’s flavoring plants to reduce chemical exposures once it learned of Herrera in March 2004.
“Certainly there was enough evidence to justify intervention in time to have prevented injury to Irma, or at least reduced the harm,” said Harber, who diagnosed Ortiz’s disease in March.
Cal-OSHA doesn’t see it that way.
“There was a real question as to whether there was a problem (beyond Herrera’s case), although this second diagnosis (Ortiz) adds some real urgency to it,” Welsh said.
Before ending up at UCLA’s Occupational-Environmental Medicine Clinic, Ortiz and Herrera had visited several primary-care doctors who misdiagnosed their conditions as asthma or bronchitis.
Recalling their initial doctors’ visits, Ortiz and Herrera told The Bee that they were at a loss to account for their illness.
“I just thought I had a bad cough,” Herrera said.
His breathing declined to the point where he slept tethered to an oxygen tank. Still, he didn’t want to lose his job. He shopped around for a doctor who would attest to his job fitness — to no avail.
“My biggest concern was that I couldn’t go back to work,” said Herrera, who was supporting his then-wife and their two young children in Riverside.
Mission Flavors provided Herrera with a breathing mask that filtered out chemical vapors, but, apparently, with no instruction, according to Cal-OSHA records of its 1,050-hour investigation of the company.
“He thought it inhibited his breathing toward the end of his employment, and thought it was safer not to wear it,” an inspector noted after interviewing Herrera.
Mission Flavors also failed to tell authorities about Herrera, who left on medical disability and was hospitalized “due to his illness from diacetyl,” Cal-OSHA records show. The agency instead found out through Harber.
Cal-OSHA fined Mission Flavors $45,575 in January 2005 for several violations, including “failure to report illness.” Moreover, it found that Herrera “became ill because employer failed to implement proper controls and respiratory equipment.”
The company is appealing the enforcement action. Its president, Patrick Imburgia, could not be reached for comment.
Herrera, meanwhile, is suing diacetyl manufacturers. He has lost 70 percent of his breathing capacity, Harber said.
Toxicity known early on
Bronchiolitis obliterans is known to result from extraordinary injury to the lungs. Those suffering the disease, according to the medical literature, include survivors of mustard gas attacks in Iraq and Iran; residents of Bhopal, India, poisoned in 1984 by chemical gases released from a Union Carbide pesticide plant; and those who have had lung transplant complications.
At that level, every breath takes a toll, said Dr. Marc Schenker, an occupational health expert and chairman of the Department of Public Health Sciences at the University of California, Davis.
“People who have that describe it as a living hell,” Schenker said. “Because you are out of breath just sitting.”
Diacetyl’s potent punch was no secret to its manufacturers.
At least one of them, the German giant BASF, had performed experiments in the 1970s showing diacetyl fumes to be extraordinarily effective at killing lab rats.
“That was a big surprise to everybody,” said the flavor industry’s Hallagan. His trade group did not learn of the internal study until October 2001.
But the flavoring group apparently did know as early as 1985 that breathing high concentrations of diacetyl posed a breathing hazard — to humans — according to the association’s “ingredient data sheet” on the chemical.
“Harmful. Sore throat, coughing; may be absorbed,” the report states under the heading, “Human Health Effects Data, Known Effects of Acute Exposure” for inhalation. “High concentrations may cause irritation of respiratory tract; capable of producing systemic toxicity.”
The diacetyl “ingredient data sheet” had taken on a different look by 2001, the year the industry first learned of the cluster of popcorn worker cases in the Midwest. Under the same heading, the new report states, “Not Found” for both ingestion and inhalation.
Hallagan said the industry had not yet gotten around to updating the data sheet, using a “place-keeper” to fill in the blanks.
And the “place-keeper” went by the term “Not Found.”
To this day, the manufacturers’ Material Safety Data Sheet on diacetyl does not mention bronchiolitis obliterans among the potential hazards.
Warning signs misread
By the time Irma Ortiz learned she had been breathing highly toxic fumes on her job, her lungs were all but destroyed.
She enjoyed her job at Carmi Flavor. The plant was a short commute, getting her home to South Gate in time to make dinner for her three boys and husband, an auto-parts salesman.
She took pride in her physical strength, routinely lifting 50-pound cartons, driving a forklift and being the only female on the production floor.
Starting in 1997 at $6 an hour, she prepared secret recipes for about every imaginable flavor — pineapple, pistachio, cappuccino, key lime.
Ortiz worked with four or five others in a room the size of a two-car garage — with no ventilation system, no vapor-tight goggles and — for years — no vapor mask.
As a mixer, Ortiz got the brunt of the fumes. She routinely poured the pungent chemical solutions by hand into a giant electric blender.
“When I pour the liquids into the funnel, you can smell the fumes,” Ortiz said. “They were always there. There is no way to take the fumes out, because we only have one door … that’s it.”
Less than a month into her job, Ortiz began to complain about constant irritation in her eyes. A company doctor said she had developed photophobia — an usually strong sensitivity to light. Ortiz noticed that her co-workers in the mixing room also had red eyes.
Her husband, Victor Mancilla, said he couldn’t help but notice something funny when she came home from work — something coating her eyelashes. That was dust from the chemical powders.
And there was something peculiar about her long, coal-black hair. To the touch, it felt like cotton candy.
“Like she had put a gel on,” Mancilla said. “And it was real thick. You can go ahead and grab her hair, and you could squeeze it together. It would just stay there.”
The flavoring odors also stuck to Ortiz, even after she changed out of her work clothes.
“A couple times she was going to the doctor, and the good thing about it, she was smelling real good, like a strawberry.”
Patients in the waiting room “would go, ‘Ah, you smell good,’ ” Ortiz said.
Carmi Flavor eventually got her a vapor mask — after she developed a nasty, persistent cough.
“I couldn’t even talk with nobody. I just cough, and cough and cough.”
An investigator with Carmi Flavor’s insurance company had to abort his interview with Ortiz. She couldn’t complete a sentence without retching out a ghastly chorus of coughs.
Doctors told her she had asthma or bronchitis. But the bronchodilators and oral corticosteroids didn’t improve her breathing.
Everyday activities had her gasping for air. A walk around the neighborhood park was like a marathon. A flight of stairs — Mount Everest.
“I see the steps, and I think, ‘Oh my God, how many steps do I have to go?’ I say, ‘Wait a minute. Let me get air. Wait a minute.’ ”
The breakthrough in diagnosis came this past spring.
The fourth doctor she visited, Dr. Arthur Gelb of Long Beach, had read about the popcorn workers’ lung problems. That prompted him to ask about the chemicals she used at work.
“Diacetyl” topped her list.
Gelb referred her to Harber, a colleague at UCLA. Following an open-lung biopsy, Harber confirmed that, like Herrera, she had bronchiolitis obliterans.
Ortiz — a nonsmoker and a one-time robust worker — has lost 80 percent of her breathing capacity.
“Before I used to be more healthy, but not no more. I gave all my strength to Carmi, to the company. I leave all my strength there.”
The disease is irreversible. And it could worsen over time.
Already, doctors have deemed Ortiz eligible for a double-lung transplant. She plans to add her name to the waiting list in August.
If Ortiz undergoes the operation, at best she could resume an active life for several years. At worst, she could suffer a known complication of lung transplants:
Bronchiolitis obliterans — all over again.
About the writer: * The Bee’s Chris Bowman can be reached at (916) 321-1069 or cbowman@sacbee.com. Bee researcher Sheila A. Kern contributed to this report.

 

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