Barb Wilkie's EHN Website
Last updated 2008

I knew that the NEJM article of Jan 2000 on hysteria would haunt us,
but I did not expect Tim Jones to continue his obfuscation of truth after
we "refuted him." -- Nancy McFadden

By Nancy McFadden of BURNT (Bring Urban Recycling to Nashville Today)


Bring Urban Recycling to Nashville Tday is a 501c(3) non-profit organization working on environmental health issues and toxics reduction in middle Tennessee. We are a proud member of Community Shares, a fund for change. Address: PO BOX 128555, NASHVILLE, TN 37212

A recently-published article in the New England Journal of Medicine (1-13-2000) entitled, "Mass Psychogenic Illness Attributed to Toxic Exposure at a High School," refers to a recent incident in McMinnville Tennessee. This NEJM article was researched by Tennessee Department of Health Employees (TDH) with other agencies assisting. The NEJM lists the chief author as Dr. Timothy F. Jones, M.D., along with seven other authors.

I, Nancy G. McFadden, know there is more to this story than what NEJM published. Last year, I had spoken to Mr. Thomas Hatfield, chief of maintenance for Metro Nashville Public Schools, about McMinnville's sick high school. His report, a publicly available record, is included here. From reading the entire NEJM article, it appears that salient points reported by Mr. Hatfield were overlooked by the writers.

Only the abstract of this article is available at the website http://www.nejm.org (Home Page) http://content.nejm.org/cgi/content/short/342/2/96 [Abstract]. Therefore, concerned readers may want to get a hard copy of the entire article.

[NOTE: $12 via fax, $10 via mail; you'll get article and editorial; pay by credit card; use computer form, available from Abstract page; or call 1.800.THE.NEJM; as of 1/25/00 only two people have requested this article ... I was the second one. -- barb]

METRO NASHVILLE PUBLIC SCHOOLS:

Mr. Thomas Hatfield has done much of the legwork to develop Nashville's IPM (integrated pest management) based pest control program, which uses no organophosphates and no sprays, and is based on barriers, sanitation, traps, and baits. This is a systemwide policy, which was devised by Dr. Bill Wise, superintendent of schools, and his staff. Similar policies extend to janitorial services, maintenance, and repair, all designed to promote healthy schools and good indoor air quality (IAQ) for students and teachers. Nashville's Schools were the first to adopt low risk IPM in Tennessee, with little guidance from state government at the onset. BURNT introduced IPM to the Nashville Schools and has provided in-service training for the implementation of IPM in Nashville, starting in 1993.

MCMINNVILLE, TENNESSEE:

On November 17, 1998, Metro Nashville Public Schools sent a three person inspection crew, led by Thomas Hatfield, to Warren County High School in McMinnville, at the request of the Warren County School System. This service was provided as a courtesy in an effort to be a good neighbor, since Nashville has no obligations to Warren County. The following day Mr. Hatfield wrote a report in a letter, dated November 18, 1998. This was over one year before the NEJM article regarding McMinnville was published.

Mr. Hatfield's letter is included here, having been obtained from Mr. Craig Owensby, Public Relations Director of Nashville Public Schools, under Tennessee's Open Records Law. The author of this report, on behalf of BURNT, takes responsibility for its dissemination.

Following is the letter from Thomas Hatfield to Mr. Pedro Paz, superintendent of Warren County Schools: The original will be posted on several websites; eg: EHN http://www.ehnca.org under several sections, including General Links, page N / NEJM (http://ehnca.org/www/ehnlinx/n.htm#New);
"The Word IS Out!" (http://ehnca.org/www/ehnhompg/takheart.htm#Word);
as well as cross referenced under "Stuff Happens!" -- http://ehnca.org/www/ehnhompg/stufhaps.htm;
and it is also the website of Cyndi Norman's Immune at
http://www.immuneweb.org

"METROPOLITAN PUBLIC SCHOOLS"
2601 Bransford Avenue
Nashville, TENN. 37204

November 18, 1998

TO: Mr. Pedro Paz, Superintendent
Warren County Board of Education

FROM: Thomas W. Hatfield, Supervisor
Department of Plant Maintenance
(initialed by Thomas W. Hatfield)

RE: Warren County High School - Air Quality Investigation

As a professional courtesy, I visited the campus of Warren County High School on Tuesday, November 17, 1998. The purpose of my visit (along with 2 members of my staff) was to assist in the attempts to perform an Indoor Air Quality investigation at the High School facility. Numerous agencies were present (Tennessee Department of Health, Department of Agriculture, Emergency Management Services, Fire Marshall Lawrence, etc.) to help identify a potential contaminant within the structure. A synergy of individuals (physicians, board members, private contractors, etc.) also visited the building throughout the day. I am certain there were others that I have failed to identify - but nonetheless, I was impressed with the caliber of expertise from all agencies (and individuals) involved.

INVESTIGATION

My initial investigation began with interviews of several staff members (relevant to symptoms) and a general walk-through of the school. We can often identify a source (contaminant) based on the symptoms being suffered.

Numerous smoke tests were performed to check the credibility of the plumbing profile (sewer lines). The building envelope appeared tight and other than a floor drain or two being dry, the smoking procedure helped to eliminate the possibility of a broken line under the floor or in a wall. Your staff had identified a number of dry traps in several floor drains a few days earlier. The drains were filled with water and as a preventive measure, mineral oil was installed in the traps in the Vocational/Commercial kitchen area.

Page 2 - Air Quality Investigation

Your staff identified an unknown grease trap (approximately 1000 gallons) on the exterior of the Commercial Kitchen. This grease trap had been neglected since the school opened 4 1/2 - 5 years ago. Floor drains, plumbing exhaust ventilation(s), the grease trap and sanitary sewer all appear to be tied into the same line. A four (4") inch PVC exhaust ventilation line was identified on the roof (above the Commercial Kitchen area). This line serves as the main manifold for grease trap/sewer exhaust of fumes and odors. A 90 degree elbow had been installed to disallow the re-infiltration of fumes back into the building. This design served little, if any purpose. A fresh air intake of the air handler sit only a few feet away from the exhaust manifold.

REMEDIAL RESPONSES

Staff removed the 90 degree elbow from the exhaust manifold and extended the 12 - 15 feet above the roof line extended vertically 6-8 feet above fresh air intake.)

The grease trap was pumped, thus eliminating a tremendous source of odor/fumes. Another grease trap was also pumped that services the school kitchen/cafeteria area. It is doubtful that the latter grease trap was a contributing source as your staff had routinely treated it with enzymes.

FOLLOW-UP RECOMMENDATIONS

Following is a list of things that I recommend staff to follow-up on:

1) Change all filters in roof-top air handlers.
2) Change all filters in mechanical room(s) air handlers.
3) Prime all floor drains within facility weekly.
4) Remove/relocate paint, paint thinner, etc. located in mop room of Commercial Kitchen.
5) Monitor conditions of grease traps. Periodically, treat with enzymes. Pump every 6 months.
6) Install studor cap vents on ventilation lines (sewer) on roof.
7) Check washing machine drain (Commercial Kitchen) for trap.

Page 3 - Air Quality Investigation

The investigation of Indoor Air Quality complaints is a complex and non-perfected science. Based on past experiences within school settings, there is little doubt that the neglected grease trap, dry floor drains, location of exhaust vent near the fresh air intake could all be contributors to the poor air quality. Relative humidity, wind direction and velocity, temperature, negative and positive air pressures all play a role in the escalation of pre-existing conditions of a structure. The numerous symptoms displayed by occupants of a building, and the fact that most individuals symptoms are alleviated once introduced to fresh air, lead me to believe that the exposure was most likely sewer gases.

At your convenience, please call me to discuss the use of ozone generators within the structure. I believe I saw several within the building.

I would be remiss in my efforts if I failed to mention Mr. Caldwell and the Maintenance Staff at Warren County. Their help and willingness to respond was greatly appreciated. Their help was unconditional.

Perhaps we have identified the source and I am certain that the mitigation of the identified problems will improve the environmental climate of the school. Thank you for letting us share our limited knowledge and vast experiences with you. I hope that we have helped. Do not hesitate to call me if you have questions or if I can be of further help. Good luck and I wish all the Warren County community a GREAT THANKSGIVING!

cc: Mr. Donnie Caldwell, Warren County Maintenance
Mr. Archie Collins, Department of Agriculture
Mr. David Roberts, Department of Health

BURNT is disseminating this report because of our concern that the NEJM authors may have omitted actual indoor air problems that explain some of the illnesses. Such omissions may prevent future indoor air problems from be taken seriously.

For example, nowhere in the NEJM article is there any mention of "ozone generators" mentioned in the Hatfield letter as running at the high school. Ozone generators are recognized as a danger to lung health by the EPA at its website -- http://www.epa.gov/iedweb00/pubs/ozonegen.html. [Also see EHN's resource links on ozone generators at http://ehnca.org/www/ehnlinx/o.htm#Ozone.] The American Lung Association opposes their use in occupied spaces. [See: http://www.alaw.org/problems.html].Could the "ozone generators" be a cause of some of the illnesses in McMinnville?

What about the air intake on the roof? If it was taking in sewer gases, as stated in the report, could that have made some occupants of Warren County HS sick, even temporarily? This is not acknowledged anywhere in the NEJM report.

Could the NEJM authors have done a disservice to the people of McMinnville in their omissions of these and possibly other relevant facts? Perhaps interested journalists will take this report and use it as a springboard for investigative journalism on McMinnville's sick school.

Journalists may call Mr. Craig Owensby, Nashville Schools Public Relations Director, at 615-259-8404 for verification of the letter. Nancy G. McFadden can be reached by email at nmcfadden@mindspring.com or phone 615-386-9520, (use email if possible).

In addition to this article, an editorial in the same issue of NEJM (January 13, 2000) by Dr. Simon Wessely of London, England, discusses the McMinnville incident, entitled, "Responding to Mass Psychogenic Illness." For those unfamiliar with Wessely, in previous articles he has alleged that exercise and cognitive behavior therapy alone will cure cfids (chronic fatigue immune dysfunction syndrome). He ignores other forms of treatment for immune dysfunction and related ailments which has labeled him persona non grata for many with cfids. He has published similar articles in the past on "hysterical syndromes." (Wessely's NEJM editorial is available on-line at http://www.nejm.org/content/2000/0342/0002/0129.asp.) We have no knowledge regarding whether Dr. Wessely studied original source documents or relied solely on the published article in writing his editorial for the NEJM.

Bring Urban Recycling to Nashville Today is a 501c(3) non-profit organization working on environmental health issues and toxics reduction in middle Tennessee. We are a proud member of Community Shares, a fund for change.
Address: PO BOX 128555, NASHVILLE, TN 37212