COVER STORY

Transforming the Truth:

A Sick Lineman Gets the HMO Runaround

By BETTY BRINK

For the first ten years of his adult working life, Frank Dutcher lived the American Dream: a job he loved; a home he could afford in the small town where he grew up; a happy marriage; three bright, good-looking kids; dominoes on Saturday night and church on Sunday. It wasn't altogether a Norman Rockwell canvas of small-town America -- this is blue-collar Azle, Texas, just 15 miles west of Fort Worth, after all -- but it was close.

Three years ago, the dream turned into an all-too-real American nightmare as the 32-year-old former Texas Utilities Electric senior lineman became critically ill, was forced to quit work, went bankrupt, and found himself and his wife embroiled in what clinical psychologist Dr. Steven Green has described as "a battle with insurance companies -- in a morass of medical contradiction."

Frank Dutcher's personal angst is made worse by the fact that TU Electric failed to protect him, he believes, from exposure to polychlorinated byphenyls [PCBs] -- known to be hazardous to humans for over half a century -- and that a network of doctors and their HMOs, driven by their own corporate bottom lines, failed to give him timely and proper diagnoses and care.

About the only thing agreed on by the HMO specialists who work for TU's insurance companies, Arlington-based Harris HMO and Aetna, is that Dutcher's symptoms -- liver damage, nausea, blackouts, headaches, seizures -- are not caused from exposure to PCBs, banned from production in the U.S. in 1976 but still found in aging electrical transformers all over the country. The toxic compounds in a solvent called Safe Clean, used by Dutcher almost daily to wipe down electrical wires, are not to blame either, they say. Green, in an April psychological evaluation of Dutcher (which found him perfectly sane) notes, however, that a recent toxicological report from a doctor outside the TU HMO network, show "several elevated toxins" in Dutchers blood.

The HMO docs failure to consider PCBs as a probable cause of Dutcher's problems -- and their failure to order the correct diagnostic tests early in the process -- startled Keller Thormahlen, division head of the Texas Department of Health's Toxic Substance Control office, who said, "It's a known occupational hazard, especially for utility workers." The EPA lists PCBs as probable carcinogens that can also cause nausea, abdominal pain, reproductive problems, severe skin diseases, and liver damage.

"Liver dysfunction is in all the literature as a symptom of PCB exposure," Thormahlen said. "Considering the number of years Mr. Dutcher's been with the utility, it's reasonable to assume that he was exposed ... I've seen his [liver] tests, and they fit the classic pattern in PCB exposure." He warned them, however, that PCBs are a "hot topic" and they should be prepared for problems.

Dutcher began taking down transformers for TU in 1986. "We seldom knew which had PCBs and which didn't," he said. He and his crew were never issued hazardous materials suits, he said -- an accusation denied by TU -- and would often get soaked in the oils, which is what happened shortly before he became too ill to work. After changing out a leaking transformer during a May 1995 storm emergency, Dutcher had to wear the same clothes for 12 hours before he got home. TU admits the transformer leaked PCB oils, but says the levels were well below EPA danger thresholds. Nonetheless, Dutcher, who was already suffering from occasional dizziness and nausea, got progressively sicker following the incident. He had to quit work in October of 1995.

Today, the former 210-pound Azle high school football player whose pictures show a man with a ruddy complexion, square jaw, and wide dimpled grin, is moon-faced with puffy eyes that show no sparkle. His hands are swollen and his speech is slow, sometimes slurred. Lifting his 5-foot, 11-inch, 248-pound body from the chair is a chore. He walks with a shuffle.

Deanna Dutcher at 34 is a slender, strikingly attractive woman with porcelain-clear skin and deep-set gray eyes. Her shoulder-length brown hair is pulled back with a clip. As she talks, her eyes, unlike her husbands, take on a look of determination. "I've become the housewife from hell. I'm not going to give up 'til we find out what's wrong with Frank, and who's responsible."

In 1993, when Dutcher's early symptoms began, Richard Hubner, an Azle family practitioner on the Harris HMO plan was the first to find elevations in Dutcher's liver enzymes. For reasons still unexplained Hubner failed to tell him. He prescribed an anti-depressant. But by 1995, Hubner found that Dutcher's liver enzymes were getting worse; he was sent to Dr. Shahid Aziz at Fort Worth's Osteopathic Hospital, for a liver biopsy. Aziz refused to do the test when he discovered they were Harris HMO patients. He told them that they had "bad insurance," and that Harris won't pay for the tests. "I can't help you.'"

Aziz's refusal to treat Frank started the Dutchers on a medical odyssey that would take them through the offices of 14 HMO doctors and through a maze of conflicting medical opinions, denials of tests, and outright lies. Medical reports and letters have circulated among the doctors and the insurance companies with false statements, such as the claim that the Dutchers were "in litigation with their company" -- a sure way to scare doctors off. In fact, the Dutchers have never filed a lawsuit against TU.

Aziz began the litany of false reports with a letter stating that Dutcher told him he "had no history of exposure to chemicals," when the lineman had filled out a health history for Aziz and clearly marked "Hazardous Chemicals" in the box for workplace exposures.

And as the Dutchers' kitchen table piled higher and higher with evidence about the symptoms of PCB exposure in humans, doctors became more adamant that PCBs were not the problem.

Instead, Harris and Aetna doctors have branded Dutcher as "obese," denied him medical procedures, and sent him to psychiatrists. PCB levels weren't even run until over a year after he became too sick to work. Through it all, the Dutchers say, they got little help from TU as they tried to fight the company's HMOs, first Harris for denying Frank an early liver biopsy and later Aetna for failing to allow him a critical liver functions test. When Deanna complained to TU, "We were ignored," she said. Neither company would approve their requests for second opinions. They had to pay for them on their own.

Workman's compensation was denied by TU's insurance company, MetLife, after a December 1996 report from Dr. Robert L. Bertrand, assistant professor at the University of Illinois College of Medicine--who had never seen Dutcher but only reviewed his by then hefty file--ruled that Dutcher wasn't too sick to work. At that time he was having blackout spells, dizziness and seizures and a Fort Worth neurologist, Dr. Susan Blue, had recommended that he stay off the poles.

Bertrand noted the phantom lawsuit. "There is mention in the record," he wrote, "that Mr. Dutcher is involved in litigation against his employer related to exposure to polychloral biphenols, and this may be playing a significant role in his ... reluctance to return to work."

"We don't know how that got into Mr. Dutcher's files," Joan Hunter, TU's media relations head, said, admitting that the Dutchers have never sued the company. "But we can't take it out," she said with a straight face, "it's part of the medical record."

Of all the doctors involved in this medical and HMO shell game, Dr. William Lee, 56, a Harris HMO-approved specialist, appeared qualified to have some answers. Head of Southwestern's Clinical Center for Liver Diseases in Dallas, Lee is a cum laude 1963 graduate of Amherst College, who has held medical faculty positions from New York to London.

Frank was sent to Lee in June of 1996 by Dr. Ernst Dorcsh, after the Houston specialist, whom the Dutchers paid on their own, found severe health problems that the HMOs had overlooked: an enlarged heart, pulmonary disease, calcifications in the thoracic aorta and large fatty deposits in the liver. "Strange problems," he told the Dutchers, "for a 30-year-old man."

On June 7, 1996, the Dutchers, armed with a tape recorder, met Lee and told him that they believed PCBs might be the cause of Frank's problems. He immediately discouraged such a notion. They would have "a hard time proving it's PCBs," he said, declining to test Frank at the time saying he would have to "do more research." He added, "Yes, PCBs cause fatty liver but so does being overweight ... how are you going to prove how much is from PCB and how much from overweight?"

A Fort Worth pathologist who reviewed Frank's liver tests, told the couple that "for this much liver damage to be done, Frank would have to be morbidly obese, at four or five hundred pounds." The pathologist believed that the damage was from "some sort of toxins."

It was August before Lee saw them again. Again, Deanna had her tape recorder. At that time, Lee told them, "I can't make any connections to PCBs to the liver. ... I've done a search and there's no reports in the medical literature of this."

Lee wrote to Lawrence Huber, one of Dutcher's doctors, that his problem was most likely due to his "obesity" not PCBs. "There is little evidence of any specific clinical syndrome associated with PCB toxicity," he wrote, adding, "We are concerned that he is placing too much emphasis on the possibility of toxin exposures...."

But there was literature, lots of it. Lee himself even had "evidence" in the medical literature that he had authored. In their search at the Southwestern Library, the Dutchers found 89 documents on PCB exposure-related health problems. Two were from textbooks referenced by Lee in a 1994 article on drug-induced liver damage that he wrote for the Medical Center's Department of Internal Medicine. Not only did he reference other researchers who were studying PCB-related liver problems, he wrote in his own paper that "certain halogenated hydrocarbons" (which also describe PCBs) are "toxic mechanisms for liver damage."

Still, on August 1, Lee wrote again to Huber that there "is little if any evidence that liver disease ... correlates with exposure to PCBs."

Lee ordered a blood test for PCB levels, which came back "none detected." Later, a fat biopsy showed "lower than background" levels, which added to Thormahlen's skepticism. "There is no way someone occupationally exposed to PCB has an undetectable body burden when the earth's entire population has detectable levels."

Dr. Lee would not comment on this story "because [the case] is litigation-related," Reyes Abila, Southwestern spokesman said. There is no litigation, Abila was told. "Dr. Lee still prefers not to comment."

Dr. Eugene Strauss, professor of medicine and chief of digestive diseases at the State University of New York saw Dutcher in the fall of 1997, again at the couple's own expense, and told them that Frank's liver damage is acquired. One cause, he said, may be chemicals. He warned them that a future liver transplant is a possibility.

This spring, an independent peer review, requested by the Dutchers of all the Harris HMO doctors who have been involved in this mess, found that Frank should have had three additional liver studies after the "persistent elevated liver enzymes" were diagnosed, and that two of Dutcher's EEGs were "substandard." The group of Boston doctors concluded, nonetheless, that "these are minor matters." In a hearing before a Harris Complaint Appeal Panel on June 24, Dr. Bob Sorokolit, Harris' physician representative, told the Dutchers that the lack of earlier diagnosis and testing wouldn't have changed [Frank's] health outcome anyway, "because there's no treatment for a person damaged by these chemicals." Case closed.

And on July 8, the Texas Department of Insurance, which investigated the Dutcher's claims of HMO abuse, also closed the case without finding fault with either Harris or Aetna, based in large part on both HMOs' investigations of themselves.

State Representative Lon Burnam, D-Fort Worth, who sits on the House Insurance Committee, is outraged. "The treatment of the Dutchers is another example of why this country needs single payer health care. Even though the Texas Legislature passed seven progressive health bills last session, this case just proves that state agencies, like the Texas Department of Insurance, are still in bed with the companies they regulate."

One of those bills allows consumers or their families to sue HMOs for actual damages as well as emotional pain and suffering, if the insurance company denies health care that later proves to have been a necessity. Aetna is already fighting the Texas bill in court, claiming that the 1974 federal Employee Retirement Insurance Security Act (ERISA) -- that allows patients to recover only the benefit denied with no damages even if that denial has resulted in death -- pre-empts state law.

To protect the recently passed Texas legislation, said Tom Hall, a Fort Worth lawyer and Democratic candidate for the U.S. House, the House could insert one sentence in the managed care reform bill that says "'remedies at the state level will not be pre-empted.' Then if an HMO beats you out of your benefits, you or your family can talk to it in the only language it understands: Money."

Drs. William Rea and Theodore Simon of the Environmental Health Center in Dallas, both Gulf War Syndrome disease researchers, are now treating Dutcher. They've found elevated levels of dichlorobenzenes, one of the toxic chemicals in Safe Clean, in the former lineman's blood tests. Testing for PCB levels is in progress. TU has promised the Dutchers that its out-of-network provider, Prudential -- which is supposed to pay 60 percent of medical costs for those who choose not to use the HMOs -- will pay Rea. (Frank still qualifies for TU insurance because he's drawing long-term disability from the company, an amount less than one third of his former $60,000 salary.) To date, Prudential has paid nothing.

And the couple who have yet to file a lawsuit just hired Austin attorney Henry Novak. His first letter of intent to sue was posted to Dr. William Lee.

Betty Brink is a Fort Worth freelance writer. A version of this originally appeared in Fort Worth Weekly.