Noxious gas has sickened VA workers at DC facility for two years
By ALEX HORTON | The Washington Post | Published: October 12, 2017
WASHINGTON — Staff and patients at a District of Columbia medical facility for homeless military veterans have endured noxious gas exposure for nearly two years as top hospital administrators, though aware of the problem, have failed to remedy it, according to interviews with staff and documents obtained by The Washington Post.
At least eight clinical workers at the Department of Veterans Affairs Community Resource and Referral Center have tested positive for elevated levels of carbon monoxide, a March internal email said, describing a potentially dangerous condition that restricts oxygen circulation. As many as 30 employees, desperate to avoid further exposure, have sought reassignment or permission to work remotely.
One doctor resigned in protest after VA leaders were unable to produce solutions, clinic staffers said.
"Many of my colleagues, including myself, have experienced some type of illness while working in the CRRC," one staffer wrote in an August email responding to a VA health official who appeared to play down symptoms of concerned workers. The most recent incident was Oct. 4, staffers said.
The Post reviewed dozens of emails and records, and conducted numerous interviews with clinical workers and others familiar with the problem. What emerged is an unsettling glimpse of VA's struggle to mitigate a potentially significant health hazard, and raises questions about the agency's ability to fulfill the promises it has made to improve accountability. The troubled agency was identified early on by President Donald Trump as being in dire need of sweeping reform.
VA spokesman Curt Cashour said the hospital's leadership "took aggressive steps to look into the problem" once complaints began to circulate. Tests conducted by VA health officials and the local fire department and gas company, among others, "discovered no leaks, hazardous fumes or health risks," he said, adding that officials continue to monitor the situation.
But those who work at the facility say those tests may not have been performed quickly enough, before the gas dissipated, or if the contractors brought in to conduct them knew which gases to evaluate.
On a given day, the facility is staffed with about 40 employees who serve dozens of patients, all homeless and at-risk veterans who seek care at the clinic. The incidents — numbering in the dozens since winter 2015 — have occurred intermittently and without warning.
Though it remains unclear what's causing the issue, the clinic's staff members have speculated that it could be anything from vehicle exhaust entering the building's heating system intake valves to sewer gas surfacing through sinks and drains. They've reported a range of symptoms, including intense headaches, rashes, stinging eyes, nausea and others — all of which are consistent with sewer gas exposure, as defined by the Centers for Disease Control and Prevention.
Administrators have not only allowed the problem to fester, they have also ordered clinicians back into the building, staffers say.
"I felt devalued. It was like our health wasn't important and our concerns weren't heard," one staffer told The Post, saying morale cratered among those tasked with what they call a rewarding yet grueling effort to help homeless veterans find housing along with primary and mental health care. Those familiar with the facility's troubles spoke on the condition of anonymity, citing their fear of reprisal.
The Community Resource and Referral Center is part of the Washington DC VA Medical Center, the sprawling federal agency's self-proclaimed "flagship" facility. Its acting director, Lawrence Connell, has known about the problems there since June, according to emails exchanged among staff. At least two incidents have occurred since then - with 19 verified in all since late 2015, according to partial records obtained by The Post and data provided by the D.C.fire department.
Local firefighters responded to four such calls between February and November 2016. The last time was Nov. 30. One day later, a clinic safety official notified staff that, in the future, they should refrain from pulling a fire alarm if they encounter "noxious fumes" and to alert Washington Gas instead.
A spokesman for the utility company said no gas leak was found.
Connell "has been briefed regularly on these complaints and has been personally involved in the comprehensive, multi-pronged response involving respected investigators from both inside and outside VA," said Cashour, VA's spokesman. He was a senior adviser to VA Secretary David Shulkin before becoming the medical center's acting director this past summer. Connell accepted the job after his predecessor, Brian Hawkins, was removed after an internal investigation found patients receiving treatment at the facility had been endangered by "the highest levels of chaos" created by managerial ineptitude, a VA inspector general's report concluded.
One months-long email chain exchanged among several clinicians reveals a problem so persistent that it had become banal. "Just wanted everyone to know the gas smell is back," a staffer wrote Feb. 21. Another chimed in nine minutes later: "We smell something also in our area." Two hours later a third staffer wrote, "Haven't smelled it in a couple hours but I do have a bad headache."
Two days later, on Feb. 23, a mental health clinician said she briefed then-director Hawkins on the issue, saying unspecified repairs were made.
Hawkins could not be reached for comment.
On March 30, the emails resumed, when the gas smell returned, and again on May 17, when a social worker reported smelling vehicle exhaust.
Nine days later, after another incident, one staff member wrote, "I can only say this is frightening."
Hawkins was gone by then, but the problem was inherited by his successor.
"I raised the issue with Mr. Connell and the staff . . . this morning again," a senior staffer told colleagues on June 10, a day after yet another incident.
It is unclear how many clinic staffers and veterans have been exposed to the gas or what, if any, permanent afflictions they may carry. Staffers say their symptoms seem to improve when they are away from the clinic. The documents don't indicate anyone's current medical status, including the eight who tested positive for carbon monoxide.
One staffer said the patients are thought to be less at risk because they come for appointments and then leave, though they may not make the connection between potential symptoms and their visit to the clinic.
Staff members, however, can inhale the gas for hours on end.
VA safety officials and senior leaders, discussing the issue internally, say they've tried to resolve the problem. They point to numerous air tests for carbon monoxide, carbon dioxide and other gases as indication of their effort.
Two outdoor pipes were adjusted after some speculated that vehicle exhaust was to blame. Access to a dumpster was blocked. Building contractors even dumped water into drains to flush any sewer gas. An environmental liaison for the building's owner, Lincoln Property Company, acknowledged in December that sewer gas was a contributing factor that had been resolved.
A senior VA official visited Oct. 4, when the most recent gas exposure occurred, but it is unclear whether he experienced the problem firsthand.
Staffers at the clinic point to Todd Williams, one of two acting assistant directors of the main VA hospital who report to Connell, alleging that he too has played down the problem.
On Aug. 12, he said in an email that relocating dumpsters and blocking off two parking spots near an intake pipe would "further mitigate risk associated" with vehicle exhaust circulating in the building. "Given these efforts," he wrote, "do we have a timeline for relocation of providers back to CRRC?"
Cashour declined to address questions about Williams' role in resolving the issue.
Williams does not work at the clinic. Leadership on site has been more sympathetic, staffers say. For instance, a nursing manager advised staff to seek doctor's notes if they feared contact with the gas would adversely impact their health, emails show.
Staffers asked for health officials to conduct an epidemiological analysis of symptoms and exposure rates over time.
VA said they completed assessments and found no link between the clinic and health concerns.