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Hep C Infected Firefighters, Paramedics Battle on
Hepatitis C Infected Firefighters, Paramedics Battle on Two Fronts
Continue to Fight the Virus, and City Hall
Dec. 29, 2000 (Philadelphia)--Philadelphia firefighters and paramedics
infected with hepatitis C virus are fighting two battles -- one against
virus, and the other against the mayor. These "first responder"
workers contend their disease is work-related and the city should
sick leave for it. The mayor says the city can not afford such a policy.
Philadelphia Local 22 of the International Association of Fire Fighters
(IAFF) estimates that more than 200 active or retired members of the
department, including paramedics, are infected with hepatitis C virus (Hepatitis C Virus).
This figure amounts to about a five-percent infection rate. The federal
Centers for Disease Control and Prevention (CDC) puts the number of
Philadelphia fire personnel at about three-percent, still far above the
percent infection rate among the general United States population.
One paramedic, Lt. Mary Kohler, an eleven-year veteran of the
fire department, sat, ate, and slept outside the mayor's office in
Philadelphia City Hall for 14 days in December to try to persuade the
to implement contract provisions granting coverage for Hepatitis C Virus-related
leave.Through binding arbitration, the firefighters' union had won increased
health benefits and reimbursement for sick leave for firefighters and
paramedics infected with hepatitis C.
But Mayor John Street appealed the arbitrators' ruling in court. Common
Pleas Court Judge Allan Tereshko then ruled the arbitration panel did
have the authority to order use of a $3 million fund for sick leave
reimbursement. So fire fighters have little recourse once they use up
sick leave and vacation days.
Kohler has used up her leave and is now out on 12 weeks of family
leave. By the end of February, she expects she will have used it up,
and will be out of a job. She found out in January 2000 that she had Hepatitis C Virus,but she thinks she has been infected since the early 1990's. She was
misdiagnosed with rheumatoid arthritis in 1993 and said doctors did not
test her for Hepatitis C Virus until she asked for the test a year ago.
The paramedic went on 6 months of interferon alfa-2b and ribavirin
but she relapsed. She is determined to try treatment again, saying,
"Absolutely. I want to save my liver."
Kohler is convinced she and her colleagues became infected on the job.
"There's no way to know where any of us exactly got it. We're exposed to
blood and body fluids every day on our job," she said. "Asking us to
pinpoint where we got the disease is like putting your hand in a beehive
saying, 'Which bee stung you first?' It's impossible to do." She said
personnel are generally healthy and have no other risk factors for Hepatitis C Virus
besides their jobs.
Working as a paramedic is inherently risky, Kohler said. "The
have to protect ourselves are nowhere close to adequate, and there's no
they could ever be adequate unless we put ourselves in full encapsulated
suits and treat people without touching them in any way. And that's just
going to happen."
Kohler advises everyone to get tested for Hepatitis C Virus, and especially
firefighters, paramedics, and people in other high-risk jobs. She said the sooner they
aretested, the sooner they can be treated if necessary. "There's no risk in
being tested," she said. Education and more widespread information are
keys to detecting the disease and treating it early. "Go on the
Everything's there for you, just like I had to learn it. I'm not an
I'm just a victim of this disease," she said.
Another victim of the disease is Philadelphia firefighter Norm Stabinski,
who sat in at City Hall with Kohler. A 22-year veteran of the
found out he had Hepatitis C Virus in November 1998 after he went to donate blood for
friend undergoing heart surgery. The Red Cross sent him a letter telling
he was Hepatitis C Virus-positive.
Stabinski handed the letter to his wife, a nurse practitioner. "She read
that letter, and she looked at me like I was gonna die. She had that
look in her eyes, and it scared the living hell out of me," he said. A
biopsy confirmed the diagnosis, and his doctor estimated he had the
for at least 15 years. Stabinski began researching the disease and
concluded, "I'm going to have to fight a battle here that's going to
lot out of my life." He decided to begin treatment quickly "before I go
either liver failure or liver cancer," he said.
Stabinski went on an aggressive regimen of 5 million units of interferon
alfa-2b daily plus ribavirin. "I'm an aggressive person," he said.
I can do, I'm going to do now to give me a quality of life later on."
Stabinski eventually failed his initial treatment as well as a later
He said he is willing to undergo further treatment and is not waiting
the arrival of the new pegylated interferons. "I don't want to die," he
said. " I want a quality of life. I don't want this disease hanging on
I'm willing to do whatever I gotta do." He intends to depend on a loving
wife and good friends to help him. "That's how I get through it. And
wonderful doctors," he said.
Stabinski's advice is, "Ask your doctor for a hepatitis C test. Demand
If the test is positive, he is in favor of repeated treatment, if
despite possible unpleasant side effects. "Keep trying it. Keep your
up. Do what the doctor tells you to do. It's not pretty, but it's worth
Like Kohler, Stabinski is convinced he acquired Hepatitis C Virus on the job as a
firefighter. "It's a no-brainer. I've done thousands and thousands of
runs -- hundreds of babies I've delivered, car accidents, stabbings,
shootings, fire victims," he said. "We work in blood, we work in mucus,
work in all kinds of conditions -- dirty conditions, unlighted
fire conditions, covered with blood from head to toe. And you're going
tell me it's not work-related? How?"
Besides battling the virus, Stabinski has had to fight bureaucracy all
way, contending with City Hall, workmen's compensation boards, and
arbitration boards. "A peon fighting power -- it takes a lot out of
Of the 61 workmen's compensation cases that firefighters and paramedics
brought in Philadelphia for Hepatitis C Virus, only one has been granted -- after the
firefighter had died. Benefits were accorded to his widow.
While Mayor Street continues to oppose sick leave for Hepatitis C Virus, the majority
City Council members sided with the firefighters and opposed his appeal
the arbitrators' ruling. On December 7, the council voted 11-4 to hire a
lawyer and enter the appeal on the side of the firefighters. The
firefighters eventually failed in their attempt to have the arbitrators'
ruling upheld relating to sick leave for hepatitis C, but the judge did
order the city to implement and pay for confidential Hepatitis C Virus testing for
Philadelphia is in the forefront of the Hepatitis C Virus issue, according to George
Burke, spokesman for the IAFF. He said the union does not have a good
estimate of the extent of the problem in other cities, or even in
Philadelphia. Neither does the CDC, according to the union.
In a review of reports of the situation in five cities (Morbidity and
Mortality Weekly Report, July 28, 2000), the CDC noted that occupational
exposure is not a significant risk factor for transmitting Hepatitis C Virus.
In response to the CDC report, IAFF General President Harold
wrote to Department of Health and Human Services Secretary Donna Shalala
point out several flaws in the methods used to gather and interpret the
from the five cities. For example, it was possible that many
who had been diagnosed earlier may have declined later voluntary tests,
resulting in an underestimate of the rate of infection based on those
In addition, Hepatitis C Virus-positive personnel may have left the fire service
of the rigorous demands of the job -- again resulting in an
the infection rate.
The union would like to see baseline Hepatitis C Virus testing of all fire personnel,
well as a presumption that Hepatitis C Virus is occupationally related. The IAFF's
says unlike medical personnel working in health care settings,
and paramedics work in uncontrolled conditions, dealing with "burning
buildings, temperatures of thousands of degrees, [and] uncooperative
victims" - settings that put them at greater risk for coming into
with Hepatitis C Virus-tainted blood.