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Homeland insecurities
By David Updike
February 13, 2005 - ON FEB. 27, nearly 300 citizens of Montserrat, who have been living legally and working here since 1997 under Temporary Protected Status, will become illegal in this country, subject to immediate deportation. Temporary Protected Status was granted in 1997 because of volcanic activity on the island, eruptions that killed people, burned and buried entire towns, showered the inhabitants with poisonous gases and ash that cause the lung disease silicosis, and rendered two thirds of the island uninhabitable.
Of its 12,000 inhabitants, 8,000 have left, and those who have remained have relocated to the north of the island. Two hundred ninety-two found refuge in the United States, and have built their lives here for the last seven years -- working, going to school, raising families.
Why did Tom Ridge, outgoing director of Homeland Security, rescind Temporary Protected Status for Montserratians? Not, as one might imagine, because the volcano had stabilized, but rather, in an Orwellian twist of logic, for the exact opposite reason: The volcano remains active, with no end in sight to its eruptions and its emissions of noxious fumes and ash, and therefore ''temporary" protected status no longer applies. Two bills in Congress, to grant this small number of people permanent residence, are stalled in the House and the Senate, unlikely to be heard before Feb. 27.
In countless other ways, the Bush administration, Homeland Security, and the US Immigration and Naturalization Service have been found to persecute immigrants, visitors, and students who pose no threat to the security of this country.
Among these is my niece, who arrived here the summer of 2002 with an F-1 visa to attend Iona College in New Rochelle, N.Y. She did so for two years, achieving a grade point average of 3.5. Although she had a partial scholarship, a substantial tuition and housing bill remained, which her mother, an administrator with DHL in Nairobi, managed, with difficulty, to pay. In the summer of 2004, when she was obliged by the laws of the INS to return home and renew her visa, she had a zero balance at her college -- a claim that precious few Americans can make.
Yet, when she dutifully reported to the American embassy in Nairobi to renew her visa, she was told that her mother did not have sufficient funds in her bank account to cover the remaining cost of her education. But she had a job, it was pointed out, and had kept up with all of her payments, and did not owe the college any money. None of this mattered, and she was turned away.
When the fall semester began, she had no choice but to remain in Kenya, and over the next several months her mother accrued the necessary funds in her account. But when Yvonne went to the embassy to plead her case, she was again turned away and told that she had to make an appointment. In the meantime, the deadline for her return to Iona came and went. Desperate now, as well as exasperated and irate, her mother decided to enroll her in Kenyatta University in Nairobi. But what of the $22,000 she already spent attending, with the full intent to graduate, Iona College? What of the two-year investment and scholarship that Iona College had already made in Yvonne? And what, exactly, had she done wrong? Nothing: She has paid all her bills and is a model student of the kind that has been enriching the coffers of the university and the culture of this country for decades.
Judge Jack used statistics to blast silicosis cases
By EDDIE CURRAN
Staff Reporter
July 31, 2005 - A national medical expert who testified in a 10,000-plaintiff silicosis lawsuit in Texas described the main diagnosing doctors as "not being intellectually and scientifically honest" in their findings, according to a June 30 court order in the case.
In that order, U.S. District Judge Janis Graham Jack concluded, among other things, that evidence presented in her court supported only two of the 10,000 claims.
The medical criteria used by the screening companies and the doctors they hired to read X-rays for signs of the disease were polluted by financial incentives and conflicts of interest and led to a "phantom epidemic," Jack wrote.
Silicosis is the occupational lung disease caused by breathing silica, which is the primary component of sand. Exposure to silica is most common in jobs that involve sandblasting, mining, quarrying and rock drilling.
The screening companies involved in this case generally use clerical staff to take employment histories from potential plaintiffs. A breathing test is usually given and an X-ray taken. Though Jack criticized the entire process, she focused her examination on the B-readers -- doctors who become licensed to detect occupational lung diseases by reading X-rays.
In her order, the Corpus Christi, Texas-based judge used statistics and testimony by national health care experts to bolster her criticisms of the doctors who worked for screening companies -- a group that included two Mobile radiologists (George Martindale and Allen Oaks) and another (James Ballard), who has practiced in Mobile but is based in Birmingham.
For example, she focused on the numbers of silicosis plaintiffs who previously had filed lawsuits claiming asbestosis. That more widespread and dangerous occupational lung disease is detected by the same methods as silicosis.
In late 2000, N&M Inc. -- a Pascagoula-based screening company led by Heath Mason of Grand Bay -- was directed by the law firm of Campbell, Campbell, Harrison, Davis & Dove to change its focus from asbestosis testing to silicosis testing. Mason was told to start with the "existing inventory" of thousands of Campbell Cherry clients previously found by N&M to be suffering from asbestosis.
Jack cited testimony by national health experts that it is exceedingly rare for practicing doctors to encounter patients suffering from both silico sis and asbestosis. She noted that 5,174 of the plaintiffs in her court had been diagnosed with asbestosis before they became silicosis plaintiffs.
"The magnitude of this feat becomes evident when one considers that many pulmonologists, pathologists and B-readers go their entire careers without encountering a single patient with both silicosis and asbestosis," Jack wrote
"Stated differently, a golfer is more likely to hit a hole-in-one than an occupational medicine specialist is to find a single case of both silicosis and asbestosis. N&M parked a van in some parking lots and found over 4,000 such cases."
Ballard, who read X-rays for plaintiffs tested by Mobile-based Respiratory Testing Services, was asked during his testimony to explain his two readings of the chest X-ray of plaintiff Angelean Ball. The first time he read her X-ray, Respiratory Testing asked him to look for signs of asbestosis, and the second time, for silicosis.
On the first reading, Ballard found evidence of signs of disease in the area of the lungs where asbestos is most likely to cause damage. He also noted "extensive pleural thickening," which is a primary sign of asbestosis. On his second reading, Ballard noted damage to the areas of the lung harm ed by exposure to silica, and "found no pleural thickening at all," wrote Jack.
"When presented with this compete reversal, Dr. Ballard posited that 'the films could be mixed up,' meaning that he in reality was not reading from the same film," wrote Jack. "He further stated that 'it would be difficult for (him) to stand by the diagnosis for either one right now.'"
Jack also attacked the uniformity of the findings in the 10,000 diagnoses. The X-ray readings for the vast majority of the plaintiffs were 1/1, a reading that reflects the absolute minimal detectable level of the disease. Most of the other diagnoses reflected the second-lowest possible level of disease.
Those readings not only suggested that the levels of illness in the plaintiffs were quite low, but that the statistically expected variations in disease levels in the group simply didn't exist. For example, a group of 10,000 people with silicosis would be expected to include substantial numbers of people with advanced cases of the disease.
To make her point, the judge cited Oaks' diagnoses. Of the 447 plaintiffs whose X-rays were read by the Mobile radiologist, 408 had the minimum level of the disease, and the remaining 39 had the second-least-minimal finding possible.
Oaks, who was hired by N&M, "made these remarkably uniform findings despite the fact that he examined X-rays from a fairly even distribution of people between 50 and 80 years of age," Jack wrote.
Oaks is a former head of the radiology department at Providence Hospital who read X-rays for N&M part time, and "didn't know the implications," of his work for the company, he said in a May interview.
"I've never been asked to do anything improper by any of the testing companies, the lawyers or anyone, and I wouldn't do it if I was. This whole thing is overly embarrassing to me," Oaks said.
In her ruling, Jack cited testimony from the February hearings by Dr. John Parker, a former top official at the National Institute of Occupational Safety and Health. Parker called the consistency in the levels of illness "stunning," and "defying all statistical logic of what happens to the lung when it's exposed to silicosis."
He testified that the "lack of variability suggests to me that (X-ray) readers are not being intellectually and scientifically honest in their classifications."
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