Feedback from fire sector stakeholders

The summaries below highlight the information and comments provided to me regarding the treatment of firefighter cancer claims by the WSIB. Meetings ^{footnote 10[10]} were conducted with each stakeholder except with the City of Toronto, which provided me written comments.

Occupational Disease Policy and Research Branch, WSIB

Staff from the WSIB's Occupational Disease Policy and Research Branch provided me with information on the current process for adjudication of firefighter cancer claims.

The WSIB does not have legislation that provides a presumption for occupational cancers among firefighters. Instead, firefighter cancer claims are adjudicated on a case-by-case basis with the exception of brain cancer and lymphoid leukemia. These two cancers are addressed by policy which outlines the evidence required to establish that a work exposure made a significant contribution to the development of the cancer.

Under policy, a firefighter who develops brain cancer and has been employed as a full-time urban firefighter for 20 years or develops lymphoid leukemia and has been employed as a full-time urban firefighter for 30 years will be considered highly persuasive evidence that the firefighter has developed the cancer as a result of his/her occupation as a firefighter.

Since May 2000, the WSIB has worked extensively with the OPFFA to address issues in adjudicating occupational disease claims and develop prevention initiatives in the firefighting profession.

As of May 2006, the WSIB has allowed 121 claims for a variety of cancers such as brain cancer, bladder cancer, colorectal cancer, kidney cancer, nasal cancer, leukemia and non-Hodgkin's lymphoma. There are also 53 pending claims.

WSIB reports that the allowance rates for these types of firefighter cancer claims are higher than other occupational groups. Since 1999, 85% of firefighter brain cancer claims have been allowed in comparison to the average allowance rate for all occupational groups of 49%. In addition, 83% of firefighter non-Hodgkin's lymphoma claims have been allowed in comparison to the average allowance rate of 26%.

I was also provided with information on the work of the WSIB's Occupational Disease Advisory Panel (ODAP) which made recommendations for the principles to be used in occupational disease adjudication and the standards for the use of scientific evidence in the scheduling of diseases, policy-development and adjudicative support materials for case-by-case adjudication.

The WSIB's Protocol document entitled "Taking ODAP into the Future" describes how the WSIB will operationalize the principles, concepts and recommendations outlined in the ODAP report.

The Protocol outlines the difference between an Occupational Disease Policy and placing an occupational disease in Schedule 3 or Schedule 4 of the WSIA regulation.

The WSIB continues to review scientific literature on a possible link between certain cancers and firefighting. Scientists are also retained to conduct scientific reviews on the issue. The most recent literature review for the WSIB was conducted by Dr. Xuguang Tao on a report entitled, Literature Review and Meta-Analysis on Colorectal Cancer Risk and Firefighting (October 2005).

Although a conclusive scientific link could not be determined between colorectal cancer and firefighting, Dr. Tao's review resulted in the WSIB developing an "adjudicative support information" document for adjudicators. This information has resulted in 8 colorectal firefighter cancer claims to be allowed.

Office of the Fire Marshal (OFM)

Fire Marshal Bernie Moyle and his executive assistant, Tony Pacheco attended on behalf of the OFM. The OFM supports the firefighter associations' call for presumptive legislation. However, the Fire Marshal was quick to add that prevention and education are also key components for the health and safety protection of firefighters.

The Fire Marshal believes that prevention guidelines on the wearing of SCBAs, routine medical screening and an emphasis on a healthy lifestyle are key components in preventing occupational disease. Prevention guidelines should be developed and implemented without delay.

He believes that volunteer firefighters and OFM fire investigators should also be covered by presumptive legislation based on his view that they face similar risks to full-time firefighters.

The OFM is willing to help with the education and prevention components and believes that the Ontario Fire College can play a key role by incorporating these components into its curriculum for new recruits and veteran firefighters.

Ontario Association of Fire Chiefs (OAFC)

Barry Malmsten, Executive Director of the OAFC and Deputy Fire Chief Cynthia Ross Tustin of Bradford West Gwillimbury Fire & Emergency Services and a member of the Board of Directors for the OAFC attended on behalf of the OAFC.

The OAFC supports the call for presumptive legislation to cover both full-time and volunteer firefighters. They believe that Ontario should provide coverage comparable to that existing in the five Canadian provinces and 37 American states which have enacted presumptive legislation.

SCBAs have improved protections for firefighters from inhaling chemicals. However, toxic chemicals remain a risk when SCBAs are not used or are fitted improperly to a firefighter's face or when chemicals seep through wet bunker gear. OAFC advocates the wearing of SCBAs even after a fire has been extinguished during overhaul procedures.

There are 487 fire departments in the province of Ontario made up of 10,400 full-time firefighters, 18,600 volunteer firefighters and 200 part-time firefighters.

Unlike presumptive legislation in other Canadian provinces which outline minimum years of service, the OAFC believes that years of service is not necessarily a relevant factor as not all forms of cancer develop cumulatively. Exposure to toxic chemicals at one fire could be enough to cause cancer.

The OAFC concurs with the Fire Marshal's view that presumptive legislation is one part of a strategy and is not the final solution. Rigorous prevention plans are needed to encourage wellness and require protective preventative measures and early and thorough medical screening. They contend prevention is cheaper than a cure.

The OAFC discussed the SCBA poster that it has helped develop with other stakeholders under the WSIB's Firefighter Marketing Committee. Finally, the OAFC advocates that firefighters fill out exposure reports upon returning from a fire scene. Deputy Fire Chief Ross Tustin provided us with sample exposure forms used by the Barrie and Bradford West Gwillimbury fire departments.

Ontario Professional Fire Fighters Association (OPFFA)

President Fred LeBlanc headed the OPFFA's delegation of Brian George, Executive Vice President, Paul Atkinson and Colin Grieve from the Occupational Disease Committee and Jeff Braun-Jackson, Researcher.

The OPFFA contends that presumptive legislation should be enacted in Ontario given that firefighters are not able to refuse unsafe work conditions and are required to enter environments with over 70 million different chemical combinations to perform their work. They submit that medical and scientific evidence shows that full-time, urban firefighters are two to three times more likely to die from cancer as is the general population.

Although the OPFFA has worked with the WSIB to shorten the time frames for adjudicating firefighter cancer claims, they report some files have taken 2 to 3 years to complete with the majority being denied. As of February 2006, 463 firefighter cancer claims have been submitted with 130 approved, 304 denied and 29 pending.

Enacting presumptive legislation will grant firefighters, who die of cancer, proper recognition of their dedication and ultimate sacrifice. Five Canadian provinces have presumptive legislation. The OPFFA believes that Ontario firefighters should be treated the same with presumptive legislation that follows the ODAP significant contribution factor test recommendation. For those who are not compensated, they contend survivors must endure financial, emotional and physical burdens. Written victim testimonials were provided and Paul Atkinson talked about the struggles that the Shaw family have had in dealing with the death of Hamilton fire captain Bob Shaw.

Along with presumptive legislation, the OPFFA is seeking an amendment to the WSIB's Gastro-Intestinal Cancer and Asbestos Exposure policy to recognize firefighters. Many older buildings entered by firefighters contain asbestos fibres which can become disturbed by the fire. Although firefighters may wear SCBAs at the fire scene, airborne fibres can collect on bunker gear and be inhaled by the firefighter when undressing or cleaning the bunker gear at the fire station.

The OPFFA recognizes that prevention is a crucial piece in protecting firefighters and its responsibility to educate firefighters. It has helped initiate educating firefighters on the importance of wearing SCBAs not only while fighting fires but also when performing overhaul activities.

Paul Atkinson and Colin Grieve sit on the WSIB's Firefighter Marketing Committee which is developing a SCBA poster. The OPFFA advocates that bringing all fire sector stakeholders together benefits everyone concerned. Issues that the OPFFA supports include keeping detailed exposure logs, the monitoring of fire scenes through surveillance programs and securing individual SCBA face pieces for all firefighters. Other areas that need to be explored include health and wellness programs and medical screening for early detection of cancer. OPFFA advocates that resources need to be deployed at the front end rather than the back. Prevention will save money as the average cancer claim in Ontario costs approximately $500,000.

OPFFA reports that seven Ontario municipal councils across the province have passed resolutions urging the provincial government to pass presumptive legislation for firefighters.

Fire Fighters Association of Ontario (FFAO)

Incoming president, John Scheeringa, and Health and Safety Representative, Darren Storey, presented on behalf of the largest volunteer firefighter association in Ontario representing some 3,500 volunteer and part-time firefighters.

The FFAO is advocating for equal treatment with full-time firefighters on the adjudication of firefighter cancer claims by the WSIB. They contend that volunteer and part-time firefighters face the same risks of suffering from cancers due to their work as firefighters. Many rural communities are home to industries that contain chemicals, plastics, recyclable materials, pesticides and fertilizers. Many of the larger more complex hazardous material incidents that occur in Ontario are located on the rail lines and roads of rural communities where volunteer firefighters are the first responders.

The FFAO also believes that improvements should be made to the rural firefighting services' prevention programs such as proper SCBA fit testing and the documentation of exposures to chemicals by firefighters. Mr. Storey highlighted the WSIB Firefighter Marketing Committee's safety poster initiative as a good step but commented that more education needs to be provided to volunteer fire services about the risks of cancers. Along with new equipment, the FFAO advocates that additional information needs to be provided to firefighters, fire chiefs and smaller municipalities on occupational diseases, the WSIB process and prevention.

The FFAO is committed to promoting a health and safety message through its quarterly magazine, web site and conferences.

Association of Municipalities of Ontario (AMO)

A delegation from AMO headed by Brian Rosborough, Scott Vokey and external legal counsel Michelle Smele, discussed the experience of municipalities with the WSIB adjudication process ^{footnote 11[11]}.

Cliff Jeffery, Fire Chief of Quinte West Fire Department, Liz Demers, Human Resources Coordinator of Brant County, Robert Menagh, Human Resources Manager with the City of Cornwall and Stephen Smith, Director of Human Resources with the City of Peterborough all commented that the current case-by-case adjudication process used by WSIB adjudicators for firefighter cancer claims is working effectively. Examples were provided on each representative's experience in dealing with firefighter occupational disease claims at the WSIB. All the representatives believe the system is working and claims are being treated properly.

All agreed that firefighters should be entitled to WSIB benefits if their cancer is caused by work as a firefighter. They are concerned that presumptive legislation is not consistent with the ODAP's protocol on occupational diseases. The scientific evidence does not establish an objective link between various cancers and firefighting. AMO believes that claims for firefighters ought to be adjudicated and determined in the same fashion as all other claims for occupational diseases.

Fire Chief Jeffery emphasized the need for protection and prevention of both full-time and volunteer firefighters and how firefighters are better protected today with superior equipment and the use of SCBA equipment.

Mr. Menagh, who prior to his position in Cornwall was employed in Hamilton, provided information on Hamilton's response to the Plastimet fire including the development of a program to monitor the health of firefighters involved in fighting the fire including the volunteer screening for cancers.

Mr. Smith talked about the importance of training and prevention within the Peterborough Fire Service. Each department has a Training and Prevention Officer.

Since municipalities are Schedule II employers under the WSIA, municipalities are self-insured. Representatives were concerned that any presumptions made with respect to occupational diseases and their link to the workplace could have a significant financial impact on individual municipalities.

City of Toronto

The City of Toronto provided written comments via a letter from Ms. Brigitte Hohn, Executive Director of Human Resources.

The City of Toronto shares the concerns raised by AMO including that there is insufficient evidence of a link between certain cancers and firefighting to warrant a change from case-by-case adjudication. It is concerned about the financial burden that may occur if presumptive legislation is enacted. To date, approved workers' compensation claims for firefighter cancers have resulted in more than $5,000,000 in costs for the City.

The City of Toronto considers it unacceptable that occupational disease should be the outcome of work in any occupation. It believes that prevention and the consistent use of protective equipment is crucial and that the WSIB's Prevention Services Branch be involved in WSIB initiatives arising from my review to outline appropriate actions to prevent future firefighter cancers.

To limit the adjudication time of claims, the City believes that the WSIB should continue to review scientific and medical studies on an ongoing basis. In addition, the City suggests that better information should be provided in WSIB adjudication decisions on what scientific literature has been relied upon.

Under presumptive legislation, the City is concerned that firefighter cancer cases will be inappropriately identified as linked to occupational exposure and cites a Cancer Care Ontario projection that new cancer cases by the year 2020 in Ontario will increase by two-thirds in the general population.

Finally, the City of Toronto asks that the WSIB consider the projected cost impacts of enacting presumptive legislation. Any need for legislative reform must include consideration of new disease funding strategies that enable full and fair compensation for firefighters who develop disease but remain sensitive to the fact that such diseases will likely not be solely work related.

Research Advisory Council (RAC)

Dr. Jean-Yves Savoie, Chair of the Research Advisory Council was joined by Committee members Moira McIntyre, Vice President of Strategic Communications, Policy and Research for the WSIB, Alice Peter, Director of the WSIB's Occupational Disease Policy and Research Branch and by Louise Logan, President of Logan & Associates Incorporated.

Dr. Savoie explained the mandate of RAC is to advise the WSIB's Board of Directors on research initiatives including the allocation of research grants. The Council consists of representatives from the employer and worker community, members from the research community, the Ontario Health and Safety Associations and the WSIB.

Dr. Savoie and Ms. Logan discussed the complexities, long time frames and expense for researching occupational diseases.

As consultant to the Research Advisory Council Strategic Committee, Ms. Logan highlighted the development of a blue print to address occupational disease research on a national level and a think tank related to occupational cancer capacity. She also outlined her experience with presumptive legislation as former Director General of Policy at the Workers' Compensation Board of British Columbia.

Ms. Peter advised that the WSIB has commissioned a review and update of the 2004 Cancer Care Ontario report to the Workers' Compensation Board of British Columbia. The review will focus on recently published literature and proportional mortality studies on the link between firefighting and fourteen types of cancers. The final report is expected in the winter of 2006.