A unionized medical worker in Sudbury is ringing the alarm bell after discovering that a routine medical procedure might be toxic for the people who care for chemotherapy patients in local long-term care homes.
Tara Fennell, a personal support worker, is now assigned as a special project researcher for Local 598 Unifor / Sudbury Mine Mill and Smelter Worker's Union.
It was while caring for a patient in February that Fennell learned that she might have been exposed to the unusual situation involving a patient receiving a particular form of chemotherapy that renders the person "cytotoxic".
Cytotoxic chemotherapy medications are hazardous to handle and they remain hazardous even after being administered. Special precautions are supposed to be taken by health-care workers when providing care to a cytotoxic patient as even the person’s bodily waste products can be toxic.
Fennell first encountered the situation in Sudbury after seeing a sign posted on a resident's door indicating that chemotherapy medication was being used.
"But there was nothing else provided. There was no education. The staff had no idea. I had approached a couple of people and asked what it was about … and they weren't sure, just that the residents were taking chemotherapy meds.”
Fennell said she decided to research cytotoxins on her own.
"So I researched it at home and discovered that there was a slew of precautions and policies and procedures that came with it. And none of those were in place," Fennell alleges.
"I came to find that not only was I never educated within my workplace as to what this hazardous medication can do, but was exposed unknowingly," she said.
She said the personal support staff were also exposed to the toxic urine and feces from patients being treated.
Fennell said the Ontario Ministry of Labour, Training and Skills Development (MLTSD) was informed of the situation.
"So the Ministry of Labour was brought in. And because of the limited legislation in regards to this, their hands were tied with what was actionable,” Fennell said. “So they informed the facility that they would have to put out an education piece and policies. And they would have to create policies and procedures in regards to all of this as well. But there again, there's limited legislation, so their hands were kind of tied with this. So well, it's still a work in progress," Fennell added.
Sudbury.com asked the ministry to provide information on specifically what orders and directives it has put out to the Sudbury area nursing homes with respect to educating workers about cytotoxic patients. The ministry said it would begin working on the request and that it would likely take until May 30 before any information could be released.
In the meantime, Fennell said the union has begun educating its members who are working, or have previously worked, in homes where chemotherapy is provided. She said it is now vital to educate workers because the effects of being exposed can take many forms.
When asked if it is known if anyone has fallen sick because of exposure to cytotoxins, Fennell said it was too early to tell.
"Well, this has just come out," Fennell said. "And there's a whole host of issues that can happen through the exposure, like headaches, dermatitis, hair loss, sores in your nose and mouth, and that's just things that you could really physically see."
In those cases, Fennell said with people not knowing they were exposed to cytotoxins, they would have no idea if headaches or skin rashes by a simple allergy or from the cytotoxins.
She added that there is a latency period of five to 15 years for other ailments that have been defined such as fertility and reproductive issues.
Fennell said the union is urging members to go on record in case there is some sickness or ailment that is discovered in the future.
Eric Boulay, the president of Local 598, said he can see parallels with the notorious McIntyre Project, where hardrock miners in Timmins and Elliot Lake were deliberately exposed to aluminum dust in the belief that it would help prevent lung disease.
"The McIntyre project and also the Neelon Casting (lawsuit) that was just recently done by USW (United Steelworkers) are very similar type projects, as you have a substance and we're in basically that step of the process right now, we identified the hazard. And now we need to prove that it's causing these issues with our members and document the exposures and file the claims," said Boulay.
Fennell said there are six homes currently involved in the investigation and education process in Sudbury — citing legal reasons, the union said it would not reveal which facilities were involved in the investigation.
She said reaction from management has been mixed.
"Some of the facilities are very receptive to what we're asking. Some of them aren't. Some of them are doing the bare minimum," Fennell said.
The key issue at this point is that there does not seem to be any specific legislation relating to the specifics of administering the medication and following through with managing the personal waste of patients.
"Chemotherapy meds and cytotoxic medication is becoming more commonplace out of hospital now with oral treatments and whatnot. So it's just going to become a growing issue. So it has to be addressed. And we're reacting to it now. But realistically, this should have happened years ago and they should have been prepared," Fennell said.
Len Gillis covers health care and mining for Sudbury.com.