Westminster Asbestos Seminar
Mesothelioma, like other asbestos-related diseases, is characterized by a long latency period. As little can be done to prevent the onset of disease once hazardous asbestos exposures have occurred, it is essential that people who contract these illnesses receive the support and care which is needed. Recognizing the regional variations in the availability of medical treatment and compensation, this year's House of Commons' asbestos seminar assessed the status quo in Scotland, Northern Ireland, Wales and England. The May 19, 2004 session: Asbestos Round-Up, held under the auspices of the Asbestos Sub-Committee of the All Party Parliamentary Occupational Safety and Health Group and chaired by Michael Clapham MP, was opened by the Rt Hon Jane Kennedy MP, Minister of State for Health and Safety, who spoke of the misery caused by the UK's asbestos legacy; pledging to further lower the control limits of asbestos in 2006, she was optimistic that new provisions of the Control of Asbestos at Work Regulations (CAWR) would reduce the frequency of occupational asbestos exposure.
|Jane Kennedy MP, Minister of State for Health and Safety.|
Introducing Councillor Andy White, leader of West Dunbartonshire Council (WDC), and Tommy Gorman, a WDC Welfare Rights Worker, Scottish MP Tony Worthington highlighted progress made on asbestos issues by the Scottish Parliament including the streamlining of litigation in fatal disease cases such as mesothelioma.
|Councillor Andy White with Tony Worthington MP (left).|
Councillor White outlined the parameters of the research undertaken by the Convention of Scottish Local Authorities (COSLA) Working Group on Asbestos; the comprehensive COSLA report, published in 2001, examined:
Scotland's asbestos legacy of ill health, social and economic problems;
local government's asbestos responsibilities including the duty to manage asbestos as stipulated under new provisions of the CAWR 2002;
examples of local authority best practice in asbestos-related matters;
the need for and availability of external funding to enable Scottish local authorities to meet asbestos-related financial burdens imposed by health care, social needs and economic problems in their areas.
It is noteworthy that five out of the ten COSLA recommendations deal with support for asbestos victims; the need for up-to-date and accurate information on welfare benefits and compensation and the importance of victims' groups are acknowledged. Councillor White stressed that all advice givers must be properly trained and accredited. Other Scottish developments, including a proposal that the Scottish Executive work more closely with COSLA on asbestos, a forthcoming asbestos seminar in Clydebank and the need for international cooperation were discussed by Tommy Gorman.
Due to the May 20 re-launch of the Northern Irish Group: Justice for Asbestos Victims (JAV) in Stormont, a JAV spokesperson was unable to attend the Westminster session. In place of a presentation, a letter addressed to the Sub-Committee was read by Tony Worthington. The letter described JAV's formation in 2002, its membership, and problems such as the lack of appropriate medical treatment and the dearth of social services and information for asbestos victims and their families in Northern Ireland. After the death, in October 2003, of JAV's Founder and Chairperson Robbie Brown, the group entered a testing period. In January, Robbie's widow June took up the reins as Chairperson; on May 20, two years after Robbie first lobbied Northern Irish politicians, the group was re-launched at an event sponsored by all the main political parties: the Alliance Party, Sinn Fein, the Social Democrat and Labour Party and the Ulster Unionist Party.1 With this cross-party backing, JAV will continue: to push for legislative change, more palliative care, quicker compensation, wider prescription of disease for benefits and address the problem of asbestos in domestic as well as commercial properties.
In the introduction to the next segment of the agenda, asbestos issues in Wales and England, Lawrie Quinn, MP for Scarborough and Whitby, explained that in his constituency many of those contracting asbestos-related diseases were retired railway workers; having worked for British Rail as a civil engineer for nearly twenty years, Mr Quinn was aware of the occupational risks asbestos posed and supportive of the work done by the Asbestos Sub-Committee. Before beginning his presentation, Welsh Solicitor Jeffrey Parsons introduced his four female colleagues as the founding members of the Cardiff-based asbestos victims' support group: Asbestos Awareness Wales (AAW); each of the women had lost her husband to asbestos disease.2
Significant progress has been made in expediting asbestos litigation in the Welsh courts over recent years; changes which have increased judicial consistency and expertise, fostered cooperation between parties, led to early identification of issues and settlement of cases and lowered costs include:
the appointment of designated judges for asbestos cases;
the introduction of a 'fast track' system for living mesothelioma claims and expedited hearings for surviving relatives;
the establishment by the Court of 'Standard Directions' for issues such as expert evidence.
Unfortunately, medical care for asbestos victims in Wales is patchy and inconsistent; there is no process guaranteeing a minimum standard of medical care for sufferers.
In a thorough analysis of UK compensation for asbestos-related lung cancer, Solicitor Sally Moore reported:
There are very few reliable statistics concerning the numbers of casesof asbestos-related lung cancer. In 1998 there were only 40 cases ofprescribed disease D8 lung cancer accepted by the Benefits Agency,in 2001 the figure increased to 43. Legal cases for compensation are ararity.Scientists predict that for every case of mesothelioma there areone and possibly as many as two cases of asbestos-related lung cancer.With the present annual death ratefrom mesothelioma creeping to 2,000 that indicates a staggering level of cases that are not being recognized let alone compensated.
Ms. Moore concluded that:
A significant level of asbestos-induced lung cancer claims are not being identified or pursued and the present requirements set for receipt of government benefits are too onerous; furthermore, they are out of step with current statistical, medical and legal thinking as illustrated by: papers published by Pohlabeln (2002), Martinschnig (1997) and Gustavsson (2000), the Helsinki Criteria3, legal decisions in Australia, the Fairchild ruling (UK)4 and a move towards a general consensus amongst UK medical experts that asbestosis and pleural thickening are not precursors to asbestos-induced lung cancer.
The presentation: The Queen's Bench Division 'Fast Track' for Mesothelioma Claims by Master Steven Whitaker,5 a procedural judge of the Supreme Court, detailed the pragmatic response by the Royal Courts of Justice to the UK mesothelioma epidemic. Mentioning recent decisions in the Barker and Maguire cases, Master Whitaker strongly expressed his determination to streamline the system so that claims for living plaintiffs are settled within four months from issue of the claim form and for their surviving relatives within seven months; early admission of liability and the use of joint expert witnesses to reduce litigation costs and expedite settlement are encouraged. Defendants are expected, Master Whitaker said to demonstrate to me that they have a real prospect of success on at least one liability issue before I will allow a liability trial. Largely due to a more realistic approach by lawyers on both sides, progress is being made: The majority of claims in England and Wales are settled before they reach a trial. Unfortunately, however, lengthy delays in obtaining government records of National Insurance or tax payments can prevent the timely disposition of urgent cases; it is not unusual for the Inland Revenue to take 13 weeks to respond to solicitors' requests. MPs were requested to call for urgent action to speed-up disclosure of employment records in mesothelioma cases. Master Whitaker was also dismayed by procedural rules which prevent the interim payment of damages in a personal injuries case brought by any claimant where liability is admitted; even when the defendant is a wealthy corporation, if it was not insured or was not a public body, the Judge is not permitted to order an interim payment of damages. Consultation by the Department of Constitutional Affairs on this issue is on-going and support from MPs would be welcomed.
|Master Steven Whitaker (left).|
Speaking about a UK Mesothelioma Strategy, Dr. Jeremy Steele, a Consultant Medical Oncologist from St. Bartholomew's Hospital, confirmed the inconsistency of UK medical treatment; while palliative care has become more widely available, chemotherapy and surgery have not. Dr. Steele proposed that a mesothelioma reference consultant be designated in each cancer network in England and Wales; this individual would review all mesothelioma referral letters and clinical decisions. Regarding UK mesothelioma research, Dr. Steele warned that should the Human Tissue Bill be enacted as originally drafted, the essential use of tissue samples, obtained from the national tissue bank, would become illegal as the pleural biopsy material on the slides could have been obtained without the consent of the patients or their relatives.
|Dr. Jeremy Steele (left).|
The final presentation of the afternoon was by Dr. Greg Deleuil, medical adviser to the Asbestos Diseases Society of Australia. With the use of a wonderful selection of photographs, Dr. Deleuil described the urgency behind Australia's mesothelioma research program. For over twenty years, crocidolite (blue asbestos) was mined in the town of Wittenoom; during that time, more than 6,000 resident children received hazardous domestic and environmental exposures. Data produced by Australian epidemiologists show the following lifetime risks of contracting mesothelioma:
Wittenoom mine or mill worker 16.6%
Power station worker 11.8%
Wittenoom town resident 3.1%
Waterside worker 2.1%
All Australian men 0.39%
All Australian women 0.07%
With the passage of time, many of the Wittenoom children have contracted mesothelioma; many more will die prematurely unless a cure is found. The Australian reaction to the country's worst industrial disaster in our history has been impressive. Commenting on the well-orchestrated and focused national programme, Professor Bruce Robinson, a leading Australian mesothelioma researcher, recently told a UK journalist:
we agreed to throw the best of modern medical research technology at this disease to give us the chance to find something that can help us and the rest of the world As well as a small number of centres of excellence, we have a national co-operative research group, sending tissue and blood samples between centres for different avenues of research; diagnostic methods, new blood tests, and the mechanisms that initiate this disease. We're pretty well co-ordinated over here.6
Dr. Deleuil shared his excitement at some of the latest Australian break-throughs:
||Vitamin A project: results show incidence of malignant mesothelioma (mm) reduced by 30-50%.|
||Early blood test for mm: soluble mesothelin related protein found in the blood is a reliable warning of future mm. The diagnosis of mm when people are relatively healthy, makes them better candidates for treatment.|
||Surgery followed by treatment with vaccine made from patient's excised tumour and chemotherapy: gemcytabine and cisplatin. Although this treatment hasn't cured the cancer, patients are reported to live longer.|
Dr. Deleuil ended his talk by presenting to Michael Clapham, Chairperson of the seminar, a copy of the Australian book Lean on Me,7 by Lorraine Kember.
|Dr. Deleuil with Michael Clapham MP (right).|
The book is a gripping account of the tragic asbestos death of Lorraine's husband Brian, a Wittenoom child. The Kembers' family life was shattered after thirty years by the shocking news that Brian had contracted pleural mesothelioma:
I felt as if I had fallen off the planet, my distress intensified by the reaction of our friends and acquaintances who were shocked over our tragic circumstances, and not knowing what to say or how to act, avoided us.
At the local club, instead of the enthusiastic welcome we were accustomed to, we were greeted with silence, whispers or exaggerated attempts at joviality. It was as if we had lost our identity. They no longer saw us as Brian and Lorraine; we have become the objects of pity, a sad reminder to all of the fragility of life.
Through her painful honesty and touching poetry, Lorraine reveals the physical and emotional traumas endured by mesothelioma sufferers and their families. Having discussed methods of pain management, and their failings, Lorraine segues into rarely mentioned human dysfunctions such as constipation and night sweats both of which have major impacts on quality of life. The personal journey this book documents and the humanity of its author are truly inspirational.
July 23, 2004
1 According to the letter, although the DUP will not formally co-sponsor an event with Sinn Fein, they will be in attendance. So all the parties will be united at our launch, in their support of our fight against asbestos.
2 The group was set up in 2001 and is run by volunteers; AAW has concentrated on helping asbestos victims and raising money for medical research into asbestos-related conditions.
helpline: 07775 815705 9 a.m.-9 p.m.; email: ABaylissHowells@aol.com
3 Proceedings of an International Expert Meeting on Asbestos, Asbestosis & Cancer. Finnish Institute of Occupational Health, Helsinki 1997.
4 The House of Lords accepted in the case of a mesothelioma claimant (Fairchild) who couldn't prove his case on the balance of probabilities that it was enough to demonstrate a contribution to risk. Fairchild was a mesothelioma case - it has not been applied to a lung cancer case. However, in his Judgment, Lord Bingham did not rule out its application in other cases and it must be arguable that it would apply in a lung cancer case.
6 Peter Martin. Dust to Dust. The Sunday Times. May 16, 2004.