"Raymond, Larry" <Larry.Raymond@carolinashealthcare.org> 
11/02/2005 05:51 PM	To
Margaret Sheppard/DC/USEPA/US@EPA
cc

bcc

Subject
RE: Costs of treating 1-BP impairment
	
	
	History:	
This message has been replied to and forwarded.


Nice to hear from you, Margaret. I fear that our small sample and
follow-up on only 2 of our initial four workers are substantial
limitations, but I'll plunge ahead anyway. Our Case 2 was re-exposed
twice at the first employer and then at another employer about 20 miles
away from the first one. She was hospitalized three times at what I
estimate as $20,000 each time (special CT and MRI imaging, spinal fluid
examination, consultations by brain, kidney and other specialists)
followed by rehabilitation for another $2,000, twice. She then underwent
vocational rehabilitation, which prepared her to attend community
college, after which she will be a Medical Office Assistant. She wants
to become certified as a Phlebotomist, and could later attend Nursing
School. Since her claims for medical expenses and lost wages was
initially denied, she had to retain legal counsel, and was awarded a
financial settlement, but I do not have those details. Happily, the
child who was conceived during her initial 1-BP illness was born healthy
and is now in First Grade, apparently doing fine. She had a spontaneous
miscarriage about 2 years later, and has not been pregnant since. Time
away from work likely added up to a year or more.

Case 1 left the furniture business, and was able to obtain a sedentary
job at which I believe she is still working. She, too, was hospitalized
twice and had expenses similar to those above.

Cases 3 and 4 were lost to our follow-up, soon after their (single)
hospitaliztion and referral from the Piedmont Triad area to our
Charlotte medical center. Neuropsychological evaluations of Case 3 added
another $2,000 to the cost of his care. I do not have information on the
rehabilitation costs which these two patients may have generated. 

The treatment of 1-BP intoxication is pretty simple, once the diagnosis
is suspected. Brisk intravenous salt-and-water ("normal saline") therapy
and a strong diuretic (furosemide/Lasix)  helps the kidney eliminate the
bromide ions. However, the attempts to do this treatment by oral
hydration didn't work in the patients we later observed, because they
could not tolerate the volumes of saline needed to wash out the 1-BP.
Hence, the hospitalizations. 

Lingering pain and abnormal sensations (dysesthesias) may require the
use of special medicines which to control neurologic symptoms, and the
expense of these (e.g., gabapentin) could run to $200/month (my
estimate, I haven't check with Pharmacies)and might be indefinite. The
most grievous symptom (ataxia, unsteadiness of gait) has no treatment,
and runs the risk of falling with possible fractures or head injuries,
but neither of these occurred in our 4 patients.  

As you may recall from the Orlando workshop, Margaret, permanent
neurological impairments were the result of 1-BP intoxication. As Case 2
recently put the matter, "It is a drastic, life-changing event and it
makes a person value the things we all take for granted in life."

I wish I were smart enough to dissect out which symptoms were due to
arsenic rather than to 1-BP in our patients, but cannot do so. As you
know, the source of the arsenic was never determined by NIOSH or anyone
else, and arsenic was only measured in one of the Ichihara/Miller
worker-patients, who had a borderline-elevated level. I hope this is
helpful to you. I'd have called, but am hoping you're not still at your
desk at this hour, considering how the DC-area traffic can be. Cheers,
Larry


-----Original Message-----
From: Sheppard.Margaret@epamail.epa.gov
[mailto:Sheppard.Margaret@epamail.epa.gov] 
Sent: Wednesday, November 02, 2005 3:16 PM
To: Raymond, Larry
Subject: Costs of treating 1-BP impairment


Larry,
I am doing some research on the costs of treating health problems due to
overexposure to 1-bromopropane.  This will allow me to describe and
monetize the benefits to public health through regulation.

What are the types of treatment that might be carried out on someone
overexposed to 1-BP?  Approximately how much do these different
treatments cost?  Also, how many days of work might someone miss, or how
would their ability to work be affected by overexposure?

I appreciate whatever help you and others can give me in answering these
questions. Margaret Sheppard USEPA/Stratospheric Protection Division
SNAP Program Tel. 202-343-9163 Fax 202-343-2338
email: sheppard.margaret@epa.gov

