Delay in cancer information tarnishes state Health Department's imageby Lorna Benson, Minnesota Public Radio
When the news broke that the Minnesota Department of Health withheld data on rare lung cancer deaths among taconite miners for a year, it generated almost universal outrage. Commissioner Dianne Mandernach apologized for the delay and acknowledged the decision was a mistake.
But this is not the first time the Health Department has sat on information about a possible health risk. Public health experts say this latest episode is a sign that the Department of Health's once golden national reputation is in need of repair.
St. Paul, Minn. — When the report about the delayed data first surfaced, the Health Department explained that its researchers needed time to design new studies looking at the relationship between mining and diseases like mesothelioma, a rare form of lung cancer associated with asbestos exposure.
Without that plan in place for more studies, Mandernach says, the public might have been overly concerned about the findings. But that reasoning does not satisfy Sen John Marty, DFL-Roseville.
"This is not the first time this has happened," Marty said. "It happened six months ago in the case of the poisons in the well waters in Cottage Grove. This isn't the first mistake."
Marty is referring to the chemical PFBA that was discovered recently in east metro drinking water. In April, a Minnesota Public Radio investigation found that Health Department officials were told that the former 3M chemical had been detected in high levels beneath a former dump site in Washington County. That was in early 2005. But the agency didn't begin testing nearby drinking water for the chemical for more than a year. And residents didn't receive the results of those tests until January 2007.
Health Department officials said the delay was caused by the agency's need to develop its own test for PFBA.
Marty says he could understand that reasoning, if there was no other lab in the country that could have tested for the chemical.
"That's not what was the case here. There were people who knew how to measure this," he said.
Labs in several other states had the technology. In an interview in late March, Health Commissioner Mandernach said she was not aware of the process that was going on to develop the test or the timeline. But she defended her agency's approach to the situation.
"We acted very appropriately and expeditiously, and it is still a developing science, and we don't have definitive answers even at this point," she said. "And so two years from now ... I think you will always be able to look back and say, 'Did we? Could we?' Those are questions that are always asked, and we go with the information that we have at the time."
Marty disagrees. He thinks it's clear that most Minnesotans would want to know as soon as possible if a chemical was in their drinking water, or if they worked with a substance that might cause lung cancer.
"What kind of mindset goes into saying, 'We in government know better than you, so we're not going to tell you'? We've got to figure out what's behind that mindset. Is there a political motivation for this, and what is it, because we've got to root that out."
Marty says he has no evidence that there is a political reason behind the Health Department's decision to withhold the data. But he says at the very least there appears to be a troubling pattern.
Marty says there have been several similar cases in other state agencies, where it appears that commissioners and political appointees overruled government scientists or forced them out of their jobs when they didn't agree with their findings.
Marty points to the recent firing of a Minnesota Pollution Control Agency scientist. The researcher alleged in a federal whistleblower lawsuit that his dismissal was related to his work on the pesticide atrazine, which he studied while employed at the Department of Agriculture.
That scientist is the second MPCA researcher to leave the agency against his will in the past year. In 2006, the lead scientist studying 3M chemicals said she was fired for pushing for more research. The MPCA denies the claims of both scientists.
Marty says he plans to explore whether politics is influencing environmental health research at a legislative hearing next week. But some observers believe that won't solve anything.
"Rather than look to that sort of political, polarizing sort of reason for some of these things, maybe we ought to look to the funding of public health infrastructure in the state of Minnesota," said John Finnegan, dean of the School of Public Health at the University of Minnesota.
"You know where the state of Minnesota has been over the last five years. It's been in a situation where no tax is a good tax," said Finnegan. "And we are just not making the investment that we need to make in the state's future, and that includes public health infrastructure."
Finnegan thinks the Health Department was right to take the time to verify its mesothelioma data from the miners. But he says the agency should have been able to do that in about three or four months. He says the fact that it took much longer backs up his suspicion that the agency doesn't have enough staff to do its job.
"There is no question, the Minnesota Department of Health has been recognized as one of the finest state departments of health nationally," Finnegan said. "Just excellent in so many different ways. And I think the sense certainly from my public health colleagues is that it is slipping."
Jan Malcolm, who was commissioner of health in the Ventura administration, said during her tenure, her department's budget was less than 5 percent of the entire health and human services budget.
"That's been a concern for some time, that we really have not kept pace at any level -- at the federal level, the state level or the local level -- in investing in the kind of resources that are needed to maintain those important functions that protect the health of the public," according to Malcolm.
Since the Ventura administration, Minnesota has entered the age of pandemic flu preparedness, perfluorinated chemicals in drinking water and the first reports of mesothelioma in Minnesota miners.
Malcolm says the agency needed more funding when she ran the department, and it needs even more money now.
"It sounds like just making government bigger for the sake of making government bigger. But I think when it comes to the public health infrastructure, I think these are things that really matter to the public, whether we have adequate information and the capacity to act on it quickly to protect the public," Malcolm said.
Publicly, the Health Department isn't blaming its delay in reporting the lung cancer deaths on a lack of funding. However, when asked whether the agency needs more funding to do its job, some department insiders have acknowledged that more funding would help.
The damage of the commissioner's decision to delay the release of the mesothelioma data isn't fully known.
Peter Sandman, an expert on how to communicate risk information, says if miners didn't take precautions that they would have taken, or if lawmakers didn't make policy changes that they would have made, then it was a very harmful decision.
"If this finding changes everything, then it's unforgivable to have sat on it for a year," said Sandman. "If this finding is just another brick in the already pretty solid wall about the risks of taconite, it's still stupid to sit on it for a year, but it's not unforgivable."
Sandman says it could take some time to regain the public trust after an episode like this. He says that timeline will be influenced by how the agency reacts to future events.
"This is a teachable moment for the Health Department," according to Sandman. "And there's good reason to hope that they'll take it to heart, and put in place policies that make it easier to release information and harder to withhold information. But that doesn't happen automatically."
Sandman says if he were counseling Mandernach, he would tell her that it was good to apologize for the decision. But he says she should have added that she would work to restore the department's good reputation.
- All Things Considered, 06/22/2007, 5:15 p.m.