Fighting Fires and Cancer: The doctors’ and cities’ opinions
PHOENIX — KTAR News 92.3 FM interviewed four Valley firefighters who say they contracted cancer on the job. Their claims for workers’ compensation have been denied.
In the second part of this investigative piece, we talk to medical professionals who specialize in this area, who work to protect the firefighters both in the doctor’s office and against the system denying their claims. The cities defend their decisions and say they are following the law.
Read and watch the firefighters’ stories from Monday here.
Doctors turned advocates
Some Valley medical professionals have turned into advocates for some firefighters battling cancer.
Kepra Jack, co-owner and chief operations officer of Heartfit for Duty, has been in the first responder and public safety health field for more than 15 years. She works with 22 different fire agencies in the state of Arizona.
“Unfortunately, we found and diagnosed seven cases of cancer last year,” Jack told KTAR News. “We see these really young healthy guys come in and they don’t have anything. Then five, seven, 12, 15 years in, they have testicular cancer, colorectal cancer or thyroid cancer.”
Heartfit for Duty is a Mesa-based medical practice focused on functional medicine with an extension dedicated to fire department physicals, pre-employment candidate testing and annual exams.
Jack travels the country to educate firefighters about relevant health risks specific to their jobs. She identifies key partners in the healthcare community to help develop early detection programs that focus on cancer and the risk of heart problems.
“We have got to put a lot of detail into early identification and helping any way with coverage,” Jack said. “Because I’m fortunate enough to attend enough symposiums across the nation, I have a lot of interactions with researchers.”
She said she believes the cancers firefighters are getting are caused by the nature of their jobs.
Jack played an intricate role in the passage of the presumptive cancer law through the Arizona Legislature.
HB 2161 broadened state law to allow more than a dozen additional cancers to be considered a presumed occupational disease. Prior to 2017, Arizona’s cancer presumption statute covered only seven types of cancer, including brain, bladder or colon cancer. The expanded law now includes prostate, skin and lung cancers, among others.
Jack provided lawmakers research that linked cancer to firefighters’ jobs.
When she hears a firefighter is denied workers’ compensation after contracting occupational cancer, she feels frustrated.
“Laws don’t get passed by themselves, they get passed by showing proof, and that’s what we did,” Jack said. “We did it very well. We added a lot of cancers and the way we were able to do that is to prove they came from the job.”
Last Halloween, Jack diagnosed Casa Grande firefighter Peter Benzing during his yearly exam at Heartfit for Duty. He has an aggressive form of prostate cancer.
Shortly after learning he had cancer, Benzing filed a claim for workers’ compensation through his employer, the city.
“When I filed my workers’ comp claim, I started making phone calls and educating myself on the process,” Benzing said, “I talked to other firefighters who had been through it themselves. They helped me get a better idea of what I was in store for. They prepared me for the denials.”
Goodyear firefighter Gilbert Aguirre was diagnosed with cancer in 2015 during his yearly physical. He has chronic myeloid leukemia. He has no family history of cancer and believes he contracted the disease from the job.
He admits he knew his cancer would be difficult on himself and his family, but what he didn’t expect was that he would have another fight to battle: workers’ compensation.
“Starting treatment for my cancer was hard enough, but then comes workman’s comp. I filled out my claim with the few lines I was given to describe my illness,” he said. “In a matter of a week or two, I was told I was denied.”
Both Aguirre and Benzing told KTAR News their medical histories were reviewed by an independent medical examiner named Dr. Jason Salganick, a Scottsdale-based oncologist who specializes in gastrointestinal malignancies, lung cancer and myeloma.
Aguirre told KTAR News Salganick never physically examined him.
“I never saw him and he never interviewed me,” Aguirre said. “Supposedly, he just went over my paperwork and my medical history that I already had from doctors.”
Aguirre added that the judge from his appeals court case sided with Salganick.
In Benzing’s case, Salganick was part of a panel that looked over his medical history.
The firefighters describe their medical exams as if they were put on trial.
“It seems that the burden of proof is on the firefighter with the cancer and that we’re guilty, and we are having to prove our innocence. That’s the real frustration,” Benzing said.
“I live in the firefighter medical world,” Jack said. “I know the correlation exists because I look for it.”
“My message to the (independent medical examiner) is ‘Do your homework,'” she said.
Dr. Vershalee Shukla is a radiation oncology specialist in Scottsdale and has been practicing for 16 years. Her practice, Vincere Cancer, started a partnership with the city of Phoenix at the beginning of the year.
She now offers free cancer screenings to first responders across the Valley.
“Before I started this, I didn’t realize how at high risk these guys are,” Shukla said. “Until I did this and read about the World Trade Center, I didn’t know how high a risk it was.”
As for her professional and medical opinion regarding Salganick, she doesn’t believe he fully understands what’s going on.
“He’s not an expert. He doesn’t understand the risks that these people face,” Shukla said. “It’s like the perfect storm for cancer.”
Shukla argues Salganick’s approach is misguided. She believes the cancers these firefighters are contracting is not caused by one fire call. “It’s multiple fires, its multiple exposures, and the toxicity is accumulative.”
In court documents obtained by KTAR News, Salganick estimates he has examined roughly 20-30 firefighters. He added, he has yet to find one case where he can link a firefighter’s cancer to the job.
KTAR News reached out to Salganick for an interview on several occasions. The requests were never answered.
KTAR News legal analyst Monica Lindstrom offered her perspective on the issue. She explained once a workers’ compensation claim is made, the insurance company (or the employer, if self-insured) gets the chance to prove the injury did not come from the job.
“In any type of litigation, attorneys can always find an expert to confirm their client’s position,” said Lindstrom. “In this case, the insurance company has had a doctor confirm its position more often than not.”
Meanwhile, Shulka has now taken on the role as an advocate for firefighters. She has served as an expert witness for firefighters when they go to court to appeal their denials.
“Another thing that is really interesting is that I’ll have one fire truck call me and three people on that fire truck have gotten cancer,” Shukla said. “Well I know that’s not normal, so I know they were exposed to something so bad.”
Vincere Cancer Center opens its doors to screen roughly 30 first responders every Friday.
“Because we don’t know what toxins are out there and we don’t necessarily know how to protect them, the best thing to do is cancer screenings early and be very aggressive with it,” Shukla said. “I go over their risk factors and their exposures records and I recommend testing.”
When KTAR News went to Vincere to interview Shukla, it was a free cancer screening day for first responders. The waiting room was full of firefighters.
Phoenix firefighter Jordan Redfield, 32, explained why he was there.
“We are more likely to get cancer than other people who work in other occupations,” Redfield said. “I’m trying to be proactive; I think it’s something newer that we are trying to get ahead of.”
Redfield said it hits home knowing coworkers, family and friends of his have gotten cancer while on the job.
“I don’t think it was something that was talked about or looked at before,” Redfield said. “You owe it to your friends, family and the people who employ you to stay ahead of it and be proactive and be healthy for a long career.”
Shukla said she believes there is an overwhelming sense of fear in the fire service when it comes to cancer.
“One firefighter will call from their fire station to make an appointment and then they hand the phone to the next firefighter and so forth, and right there I will get a flood of appointments for screenings,” Shukla added. “It’s happening all over the Valley and they’re scared.”
Awareness and prevention are two key factors these medical professionals hope to bring to light within the fire service. With more education and data supporting the correlation of cancer and firefighters’ jobs, these medical professionals hope to not only better prevent cancer, but also make it more accessible to get their health care coverage accepted.
The cities’ response
When firefighters are diagnosed with cancer, their union leaders and advocates are some of the first people they get in touch with to help them through the process of submitting a workers’ compensation claim.
“We thought things would be a little bit different when the law was passed in 2017 that changed the language for presumptive cancers for firefighters,” said Brian Moore, vice president of member benefits with United Phoenix Firefighters.
After filing a claim, the firefighter is then seen by an independent medical examiner who offers the cities a recommendation on if the firefighter’s cancer is job-related or not.
Firefighters believe this is often where the denial of their claims originates.
Goodyear firefighters Austin Peck and Gilbert Aguirre have both been denied workers’ compensation claims by their city’s insurance company, CopperPoint Insurance Companies.
Peck shared his cancer battle story with KTAR News four weeks before he died from complications of sinonasal undifferentiated carcinoma.
He believed Salganick was not thorough enough to reach his conclusion that he did not have occupational cancer.
“I saw him for about five minutes,” Peck said. “He didn’t even touch me, and in his report, he openly said, ‘I’ve never heard of this cancer, and I have no idea how he got it, or how to treat it.’”
Peck presented one of his own doctor’s medical findings that concluded his cancer was from carcinogens and exposures in the fire department.
“It was like they didn’t even look at the report,” he said.
He questioned whether the insurance company works with Salganick with the intent to deny their claims.
Both firefighters believe their cancer was caused from the job and that’s why they should be covered under the occupational cancer law passed in 2017.
KTAR News requested in-person interviews with the cities. Instead, they provided these statements:
The city of Goodyear is aware of, embraces and fully complies with its obligations under House Bill 2161.
The city is fully insured for workers’ compensation claims (vs. self-insured), and contracts with a third party, CopperPoint Insurance Companies. CopperPoint evaluates, manages and adjudicates claims and represents the city in the claims appeals process that could potentially go before the Industrial Commission of Arizona or the AZ Court of Appeals. The appeals process provides a system of checks and balances to ensure claim decisions are processed with accuracy. The city’s contract with CopperPoint requires them to follow all laws and regulations, which also includes HB2161 for all claims received after its passage in 2017.
In addition, our policy is to respect our employees’ privacy and the requirements of HIPPA by not discussing medical information, which includes confirmation of medical conditions.
The city takes the health and safety of its employees very seriously and is committed to helping all of its employees when they face any sort of medical challenge.
CopperPoint Insurance Companies
CopperPoint cannot speak to individual claims, but as to fire fighter claims in general, CopperPoint assesses the facts and circumstances of each claim to determine whether an injury or illness is work-related. CopperPoint has accepted fire fighter cancer claims that are work-related and continues to pay medical and indemnity benefits on those claims.
The City of Casa Grande is a member of the Arizona Municipal Risk Retention Pool – Workers Comp Fund. Potential claims are managed directly through the Pool.
It is our practice not to discuss individual worker comp claims for privacy and security reasons.
KTAR News attempted to get in touch with Arizona Municipal Risk Retention Pool – Workers’ Comp Fund, but they declined to comment.
KTAR News scheduled an interview with the city of Glendale regarding their process of handling workers’ compensation and the denial of Capt. Kevin Thompson’s claim. The city canceled the interview the evening before its planned date.
Thompson was diagnosed with multiple myeloma in April. He’s been a firefighter for more than two decades.
He filed for workers’ compensation May 24 and was denied June 25.
In a press release last week, Mayor Jerry Weiers announced the city reversed the denial of Thompson’s claim.
Weiers said the city’s attorneys previously believed an independent third-party administrator’s decision to deny claims couldn’t be overturned.
— Mayor Jerry Weiers (@MayorWeiers) September 5, 2019
Thompson said cancer is becoming “an epidemic” among firefighters, and it’s expensive to treat.
“I think cities look at the dollar signs associated with treating firefighters with cancer and the potential for a lot of us coming down with it, and the dollar amount scares them,” he said.
When a claim is filed by a firefighter, there is a review process done by the carrier or carrier’s third party. A decision is then made to either accept or deny the claim. If the claim is denied the firefighter may appeal the decision, where it will come before the Commission’s Administrative Law Judge Division.
KTAR News asked the Arizona Industrial Commission, who has the power to approve a claim, for comment. They provided this statement:
After reviewing a claim, a self-insured entity may accept or deny the claim in accordance with Arizona statute. If a claim is denied the claimant may appeal the decision to the Industrial Commission of Arizona’s Administrative Law Judge Division. It should be noted, a claim may be accepted at any time during the process by the carrier or self-insured entity.
Lindstrom explained that when it comes to insurance companies, they are in the business of making and keeping money, and they do not focus on charity.
“If an employer has workers’ compensation insurance through a third party, the employer does not make the decision, the insurance company does,” she said. “As such, at times there may not be much an employer can do.”
The city of Phoenix case study
The city of Phoenix is self-insured and has the power to accept a workers’ compensation claim at any time, regardless of an independent medical examiner’s findings.
In 2018, Phoenix adopted a new culture of approving these claims that were previously denied.
Phoenix City Councilwoman Laura Pastor told KTAR News how this was changed.
“Brian Beck’s case showed up in front of me, and I thought, ‘This should not be denied,’” Pastor said. “Our office jumped in to find out why and how he was being denied.”
Phoenix firefighter Brian Beck passed away in May after a long battle with melanoma. His family told KTAR News his case for workers’ compensation checked off every box the legislation asks for when approving the claim. Yet the city first denied his claim.
Beck’s sister, Melissa Del Pra, told KTAR News, “The claim was denied without much significant reason, and that was kind of expected with others in a similar process.”
After a year of denial and a long fight with cancer, Beck was eventually approved for compensation just before his death. His approval was credited to his family, who wrote to Phoenix City Council members and other state leaders calling for action and attention to his case.
“I started advocating for these cases with Brian Beck to demonstrate here it is … Why is he being denied?” Pastor said. “Brian Beck’s family was very active in this piece.”
Beck’s family created a Facebook page that encouraged people to write to the city officials advocating for Beck’s claim to be approved. Within a week after the page was created, the claim was approved.
Shortly after the reversal, the Phoenix City Council went into a closed session and voted to overturn 15 previously denied claims for firefighters who were battling occupational cancer.
The city is now focused on preventative measures for their firefighters.
“What does it cost at the front end versus in the back end?” Pastor said.
“We were able to calculate that out, and I was able to use that information to demonstrate what we are paying for a firefighter after they are diagnosed to ask, ‘Why we are not screening for cancer?’”
The Fighting Fires and Cancer series will continue through Wednesday.