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An HSE ad warning of the dangers of chemicals which appeared recently in the farming press. Photo HSE |
The
Health and Safety Executive (HSE), the main UK
authority for pesticide incidents, publishes
annual figures which show the level of incident
reporting has been relatively static in recent
years. In 1993/94, 196 incidents were
investigated (226 in 1992/93), and allegations of
ill-health occurred in 83 (84) of these. HSE
inspectors issued 455 (542) enforcement notices.
However, HSE accepts that under-reporting is a
problem. In one survey of 123 pesticide users,
only 2 of 31 users who had been in bodily contact
with pesticides through leakage, spillage or
other means, had reported this to their local
hospital or GP (1). The Pesticide Exposed Group
of Sufferers (PEGS), based on its experience,
believes that under-reporting is endemic.
PEGS was
formed in 1988 by Enfys Chapman after she was
severely affected by exposure to pesticides. The
group held a successful public meeting in Exeter
in 1990, and since then has held others all round
the UK. Meetings are advertised locally on radio,
in the press, and by word of mouth, and typically
attract a large audience. The aim is to share
information about exposure problems and relevant
medical, legal or practical information. PEGS
encourages incident reporting, believing this
will achieve a wider understanding of the extent
of pesticide exposure and its impact on health.
Since meetings began four years ago, PEGS has
acquired a register of 5,000 people who have
contacted the group for advice after exposure.
The
majority of reported incidents involve the
general public, for example in the latest HSE
figures, only two farmers or self-employed people
and 21 employees were involved, compared to 109
members of the general public. Sheep dipping
incidents provided a notable exception (see p. 7)
Agriculture is one of the most dangerous
industries in the UK with a wide range of health
problems. A major reason for under-reporting of
an on-farm incident is the conflicting
responsibilities of the HSE. An incident report
would trigger a visit from the HSE. However, once
visiting, the HSE is required by law to carry out
a full farm inspection, and this in turn could
require the farmer to institute safety measures
which are unrelated to the incident reported.
This can be a costly procedure, and discourages
farmers and farm-workers (for fear of losing
their job) from reporting. Some farmers are
therefore calling for an independent organisation
to monitor their health (2).
Groups
exposed to pesticides fall roughly into three
types. There are the workers in the pesticide
industry-smallest in number but potentially at
greatest risk from acute exposure. There are
those who use pesticides as part of their
job-farm workers, forestry and horticultural,
local authority and other users, who are perhaps
at most risk of chronic exposure. Added to this
are workers in fruit and vegetable packing
plants, and similar occupations, exposed to
residues on produce. Another group exposed in
such a 'secondary' way are, those-usually
women-who wash work clothes. Thirdly, the general
public is at risk through a number of sources:
timber and pest control treatment in dwellings,
agricultural spray drift in rural areas
(particularly, but not only, from aerial
spraying), weed control in urban areas and sports
grounds, and through residues in food, water and
incidental exposure.
Obligations on users
All those who use pesticides have duties under
the Food and Environmental Protection Act (FEPA)
1985. The 1988 Control of Substances Hazardous to
Health (COSHH) Regulations of the Health and
Safety at Work Act 1974, require employers to
carry out a risk assessment before allowing employees to be exposed
to pesticides, and to give greater priority to
reducing exposure through technical and
engineering controls than through personal
protective clothing. Under COSHH, employers and
the self employed must also identify risks to
health and the measures necessary to prevent or
adequately control exposure to pesticides before
use. Most pesticide operators are now required to
hold a Certificate of Competence. A survey
carried out in 1992 indicated that all Forestry
Commission and local authority employees held a
certificate, whereas the figure for those working
as contractors in farming and agriculture was
less than 50%(3). In agriculture, pesticides
should be used according to the Code of Practice
for the Safe Use of Pesticides on Farms and
Holdings (the Green Code)(4). This recommends
ideal spraying conditions, safest wind speed,
separation zones to avoid drift into adjacent
properties, and duties to warn. Off-site drift is
a major problem, and according to Grey Bungay of HSE, "We have developed an improved sampling
strategy for inspectors to use when responding to
drift complaints, which should ensure high
quality evidence for enforcement action."
(5) Prompt notification and quick sampling is
essential, as pesticides can degrade or be washed
away within seven days. However, sampling is
expensive, and no extra resources have been made
available.
Enforcement
Responsibility for administering and enforcing
the legislation is split between two government
agencies: HSE and MAFF. Most problems are dealt
with by statute law and through the HSE and its
enforcement officers, the HSE Agricultural
Inspectorate. However, there are only a small
number of inspectors and prosecutions are
extremely rare. Fines levied on offenders are
often low and do not act as a disincentive. In
addition to statute law, health and safety at
work and injury by pesticides in the wider
community also falls under common law. According
to the British Medical Association's study of
pesticides and health, there are inherent
weaknesses in the UK regulatory system for
pesticides(6):
Nevertheless, over the last four years there have been improvements in the responses to pesticide exposure. In 1992 HSE carried out a major internal review of its manner of dealing with complaints and, according to Frank Hyland, of the HSE, "has spent considerable time improving the way its staff respond to pesticide complaints". This has borne fruit, and PEGS also believes HSE and relevant government departments (Health, Agriculture) are becoming more responsive. "You can get things done more quickly now" said Enfys Chapman, "You get on to the right people, and they accept the information you give them is correct.(7)
Seeking redress
HSE recently produced a guide on incident
reporting structures (see PN24 p.20)(8) -helpful
because of the different bodies involved,
depending on the nature of the incident.
Incidents involving people or the
land-environment are reported to the HSE: but
others may be reported to the National Rivers
Authority, agriculture departments, or the
Veterinary Medicines Directorate. The HSE passes
relevant papers through its system to the
Pesticides Incidents Appraisal Panel (PIAP) to
investigate.
An
injured party could seek redress through the
civil courts in a claim for damages against a
pesticide manufacturer or user. In practice, this
does not happen often: the procedure is slow and
expensive. (See boxes 1 and 2).
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Box
1 I was poisoned by pesticides and solvents when timber treatment from the house next door invaded my old terraced house, without warning, one winter weekend. The active ingredients of this toxic and potentially explosive mixture were mainly lindane and pentachlorophenol, and the solvent 'carrier' was over 85% industrial white spirit. The relevant Code of Practice, Remedial Timber Treatment in Buildings and Guidance Note GS 46 covers just such situations and the hazards to be expected and guarded against-but they are not mandatory. The Approved Code of Practice: The Safe Use of Non-Agricultural Pesticides, does not seem to have any reference to these official HSE guidelines within it. They are supposed to be read in conjunction with the Approved Code-and followed. Why, then, were they not combined in one comprehensive set of legal requirements concerning the use of pesticides and wood preservatives? After ventilating the house, I closed doors and windows, not realising that my nose had 'shut down' under the onslaught-and it was continuing. Next day my carer found me very ill and the house uninhabitable and called the doctor, who ordered evacuation until the house was apparently clear, six weeks on. HSE said later that had she found me dead, tests would have been done, but since I was still alive it took seven weeks of persistent effort to get an investigation started, by which time most of the evidence I needed had, literally, evaporated. As the private individual has no power, knowledge or equipment to collect the kind of evidence the courts currently require, he or she is further unfairly disadvantaged. The immediate respiratory problems (plus nausea, aches and tremor) were followed by symptoms indicating involvement of the lymphatic and neuromuscular systems, liver, kidneys and bladder, and damaged vocal cords. As the National Poisons Unit warned, I was left extremely sensitised. This aftermath has completely disrupted my life and added financial hardship to shock, distress and ill-health, since the National Health Service has little to offer and the patient has therefore to seek private medical treatment. As a handicapped pensioner of small means, whose savings have gone, I would have no hope of any compensation if my union had not taken up the case. If successful, any award is likely to be modest, taking no account of long-term or permanent ill-effects and care needs. This incident was preventable, but the system did not 'protect the public and the environment', nor deal adequately with the consequences. Now, with new neighbours, further chemical treatment is mooted for next door, and, should this option be chosen, HSE's response is to suggest evacuation for 48 hours, followed by decontamination of house and contents (but not offering advice on how or at whose expense). My doctor rules this out as posing unacceptable risks to health, particularly following sensitisation. What possible excuse is there for another chemical invasion now the party wall is known to be permeable? Toxic substances must be confined to the property being treated or, if impossible, a safe non-toxic alternative form of treatment must be used which will not invade other premises nor harm their occupants. |
Nevertheless,
civil actions have had some limited success.
Solicitors Leigh Day and Co. have specialised in
such cases, and have seen more actions brought,
with increasing success in out of court
settlements-about 150 over the last four years.
"When I began taking up cases of pesticide
exposure", remarked Alan Care at a recent
PEGS meeting in Oxford, "few other firms of
solicitors would touch these cases, but this has
now changed radically."
However,
a recent court action did not succeed. Gaskill v.
Rentokil involved treatment for woodworm with lindane: the plaintiff alleged that chemical
treatment in 1969 and 1971 was responsible for
his developing aplastic anaemia (AA). Judge Otton
agreed with the expert medical witness for the
plaintiff that a link is possible, but also
agreed with conclusions of a MAFF
investigation(9) that some people have an
idiosyncratic response to lindane. The Judge
found that the time lapse in this instance (two
years) between exposure and the onset of AA was
longer than the expected six month period. He
also ruled that, at the time of the incident,
there was no duty on the defendants to warn that
lindane was injurious to health, although
regulations are now tighter(10).
"It
will remain difficult to achieve successful
prosecutions because of the nature of the problem
and the difficulty of showing causation."
said Alan Care(11). Leigh Day & Co argues
strongly for a no-fault compensation scheme,
pointing out that once a claimant has shown a prima
facie case, the burden of proof should lie on
the defendants to show that a chemical is safe
(see PN 23 p.15). Many trade unions, health and
consumer groups support this position, and have
argued for such a scheme(12)
Doctors must play role
While the improvements in
the reporting structure and greater recognition
of problems are welcome, there is a long way to
go to achieve significant change. Victims still
face an uphill struggle, particularly in some
agricultural regions, and many doctors are
unaware of the links between pesticides and
ill-health. It is essential to contact a doctor
immediately in case of exposure, and it is
particularly important to have blood tested
quickly. Yet many doctors are not sympathetic.
Sadly, this seems particularly common in farming
regions, such as Lincolnshire, where a number of
participants from this region at the PEGS meeting
in Oxford reported uncooperative attitudes from
their GP and a local hospital. One household of
11 (four adults, seven children) who were all
affected by spray drift met with constant blank
walls, and eventually paid for their own blood
tests, which were later lost by the hospital.
In
another instance, Margaret Smith (not her real
name), who has been exposed many times during her
working life and is very aware of pesticide
problems, recently spent three days in hospital
after exposure during the course of her work in a
glasshouse. She was using Twinspan (active
ingredients chlor-pyrifos and disulfoton-both organo-phosphates
[OPs]), which is clearly
labelled 'Dangerous if inhaled'. The active
ingredient was in a coated pellet which was
placed on the soil and 'watered in', releasing
fumes dangerous to those in confined spaces. The
farmer was growing on contract, and was required
to use this product, in spite of its danger to
the workforce. Her doctor refused to believe her
problem was pesticide-related, and would not
authorise a blood test(13).
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Box
2 In May 1988, the cellar under my living room was treated for woodworm and (wrongly) suspected damp. This resulted in a four year nightmare which cost me over £26,000 and left me highly sensitised to a wide range of chemicals, including PCP, lindane, TBTO*, white spirit and alkyldimethyl benzyl ammonium chloride (benzalkonim chloride). After receiving little help from the local environmental health department and my GP, the HSE investigated and (45 days after the incident) tested for PCP, lindane and white spirit. TBTO was said not to be testable and benzalkonim chloride not considered necessary to test. The HSE failed to report the case to their own Pesticide Incidents Appraisal Panel (PIAP). The HSE found the contractors at fault and my health at risk. They considered the incident to be very serious, but took no action. I reported the incident to PIAP, which investigated and confirmed my exposure after five years: they published it in their annual report in year six. The cellar is now sealed off. All the timbers and living room floor have been replaced. The carpets have been replaced twice. Furnishings have been re-upholstered, replaced, re-covered and dry cleaned repeatedly. The walls of the living room, hall, kitchen, stripped, lined and replastered. We do not have an adequate system for dealing with the victims of pesticide incidents. The first firm of solicitors dealing with the complaint made significant errors, and only when I changed solicitors after four years did I find a firm which effectively pursued the case. I discovered my claim ceased to exist because the treatment company had stopped trading. My other strongest help has come mainly from voluntary sources. * Use of liquid TBTO for on-site timber treatment was revoked in 1990 because of health concerns. |
Margaret
points out that guidance on OPs indicates people
should not work with products containing these
substances if advised by their doctors that it
will endanger their health. However, her own GP
illustrates the problem that many doctors are not
aware, or would not consider giving this advice.
"Even if they do, how do workers know if
they are working with an organophosphate? It is
not marked on the label," she says.
Immediate
blood testing for pesticide exposure is essential
and victims should go straight to a doctor. Some
GPs are now more aware of the urgency, and are
drawing on the National Health Service
facilities. In 1991, the Chief Medical Officer of
Health wrote to 'All Doctors in England', with a
subsequent follow up letter, asking them to
report incidents where exposure to pesticides and
veterinary medicines "has resulted in
possible adverse effects on human health"
(14). A 'Green Card' surveillance scheme was
proposed to whereby GPs would report on
incidents, and a pilot was established in the
West Midlands and Trent regions. An expanded
scheme would propose a single co-ordinated system
to monitor pesticide poisoning, working in
conjunction with COSHH and the Reporting of
Injuries Diseases and Dangerous Occurrences
Regulations (RIDDOR) of 1986, which require
mandatory reporting of death or major injury at
work. As part of this study, the West Midlands
Poisons Unit (WMPU) was commissioned by the HSE
to monitor the frequency and severity of acute
pesticide poisoning, and reported to HSE in
September 1993. However the Trust [now PAN UK] understands
that the HSE has not yet responded and it appears
unlikely that the WMPU will be able to provide a
public report within the next 18 months(15).
Conclusions
Far
too little is known about pesticide exposure in
the UK, and while the authorities have made
definite advances in recent years, further
changes are essential. There are particular
difficulties facing exposed individuals and
communities in farming areas, where livelihoods
are so dependent on agriculture. There are
reports of farmers carrying on spraying against
regulations, for example when wind speed is too
high or children are playing nearby. Farm workers
who are exposed and report incidents to the
Health and Safety Executive can find themselves
out of a job. On the other hand, some farmers are
acutely aware of the problem and have themselves
been exposed: they are sympathetic, but there is
little they can do without stronger government
support for a change in current agricultural
practice. As a first step:
References:
1. Weyman, A. and R. Feeney, Attitudes to safe working practices, Pesticides News, No. 17, September 1992.
2. Wheatley, Joanna, 'Time for no-ties health watchdog', British Farmer, May 1994.
3. Weyman, A. op cit.
4. HMSO, 1990.
5. Bungay, G., pers. comm, August 1994.
6. British Medical Association, Pesticides, Chemicals and Health, Edward Arnold and BMA, London, 1992.
7. PEGS meeting, Oxford, 4 August 1994.
8. Pesticides and Veterinary Medicines- Reporting Incidents: Guidance for the general public, HSE Books, PO Box 1999 Sudbury, Suffolk, CO10 6FS, Fax 0787 313995.
9. MAFF, Pesticides Safety Division, Evaluation of Fully Approved or Provisionally approved Pesticide Products, Evaluation on Gamma-HCH (lindane), February 1992.
10. Mr. Justice Otton, Judgment (unrevised), Gaskill v. Rentokill, 29 March1994.
11. Care, A. and Day, M.,
The Twists and Turns of Litigation, July 1994, unpublished paper and pers. comm., August 1994.
12. European Consumers Pesticide Charter, PAN Europe Newsletter, June 1990.
13. Pers. comm., 5 September 1994.
14. Acheson, Sir Donald, Chief Medical Officer of Health, ref. PL/CMO(91)5, 4 April 1991. See PN 12, July 1991.
15. Pers. comm. WMPU, 5 September 1994.
| Resources HSE leaflet listing reporting authorities and HSE area offices, from PO Box 1999, Sudbury, Suffolk, CO10 6FS. Tel 0787 881165, Fax 0787 313995. PEGS gives advice to pesticide-exposed sufferers. A poster on pesticide exposure for doctors and hospitals is in preparation. 4 Lloyds House, Regent Terrace, Cambridge, CB2 1AA, Tel. 0223 64707. The Pesticides Trust [now PAN UK] can provide information on active ingredients, and a form to help log incidents. Poison Information Centres for emergency treatment of poison are located in hospitals in: Belfast, Birmingham, Cardiff, Dublin, Edinburgh, Leeds, London, Newcastle (full details through local health authority). These should be consulted where there is doubt about the degree of risk or appropriate management. South West EPA, Heathfield Farmhouse, Callington Cornwall, PL17 7HP. Workers Health International Newsletter (WHIN) and the Hazards Bulletin provide regular coverage of related issues (see p. 23 for full details). There are Hazard advice centres in a number of cities: addresses available through the Hazards Bulletin. |
The concern surrounding organophosphorus (OP) pesticides continues. In Third World countries, OPs are a significant cause of ill-health. A major use here has been as a sheep dip and, as reported recently (Pesticides News 18, 21, 22), the related health problems (see box 3) have caused considerable controversy.
Safety for farmers-confusion
Recommended changes
in practice in a revised HSE guidance on sheep
dipping at last reflect the concerns voiced over
the years by those adversely affected by OP
dips(1).
Unfortunately, the Veterinary
Medicines Directorate (VMD) which licenses OP
dips is more sanguine and, in its annual
report(2), sees no evidence to support a ban. The
VMD ascribes the ill-effects to incorrect dipping
practices and inadequate use of protective
clothing.
Farmers are now required to
hold a certificate of competence before they can
buy OP dips. While some 3,000 applications have
been made for the certificates, there are over
95,000 sheep farmers. At a meeting of MAFF's
Consumer Panel(3) MAFF's Parliamentary Secretary
Nicholas Soames MP was asked if the certificate
of competence meant that compensation would be
paid to those who suffered health problems
through using OP dips. He replied that any
question of compensation must remain a matter
between the individuals concerned and the
pharmaceutical companies. The Farmers Union of
Wales (FUW), through its spokesman John Menon,
who himself dips sheep, has called for an
investigation in variation in user susceptibility
combined with a simple test for measurement of
cholinesterase in workers.
A call for a return to
compulsory dipping for sheep scab-for which OP
dips are currently the main form of prevention-by
FUW was turned down by the Welsh Secretary John
Redwood MP(4), saying it would be premature to
return to statutory controls "without giving
the industry the chance to put its house in
order". The government sees no reason for
involvement.
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Box
3 I can truthfully call myself a survivor, having been reduced to a screaming lump after inhalation of propetamphos whilst helping my husband to put seventy lambs through our dip in 1992. Dipping isn't a one man job, the whole family plus willing friends become involved. They have to inhale while helping. I've never handled dip concentrate in my life, and neither have my two sons, my brother, or our friend. Only my husband has. There were six of us in total and that we didn't all finish up in one communal grave is remarkable. With the help of a very caring doctor blood samples were sent to the National Poisons Unit at Guys Hospital. I shortly received a greatly concerned phone call from Guys wondering how we were all still standing. Our cholinesterase levels were drastically low. When a whole family collapses, one would expect some action. We were visited by the HSE, who couldn't find fault with our dipping procedures, and by the occupational health doctor who confirmed what we already knew-we were suffering from OP poisoning. Nothing else happened. Our family has had only one common symptom-they call it anxiety. I call it sheer terror. The feeling of anxiety starts in the pit of the stomach, rises until you feel the whole of your inside is trembling with fear and you want to be physically sick. Eventually the trembling subsides and something like normality returns. But I am not sure I know what normal is any more. When one person in a household starts to behave oddly, it is generally noted by the rest of the family. When the whole family does, it becomes the norm. We have all been suicidal. Any physical weakness is emphasised after sensitisation. My husband is prone to blood pressure and stomach ulcers. One of my sons has always had bad colds: we came close to burying him with pneumonia. Since exposure I have suffered numerous little heart attacks, a sharp pain that puts me on the floor followed by palpitations and sweating. These have gradually decreased over the past eighteen months. I on one occasion since I have blacked out entirely. I also experienced hallucinations. We had used diazinon (classified by the WHO as 'moderately hazardous', class II) up to and including 1991. In 1992 we changed to propetamphos (WHO Ib, 'highly hazardous'). I was determined to find out more. Every enquiry I made met with a blank response. I then obtained the health and safety data sheets for these two dips. They read like a horror story. I found it easier to get information from the US, and learned that all OPs were toxic through inhalation. This confirmed our experience! I found that propetamphos had not been evaluated, yet we were, and some still are, using it. What other OP dips were on the market? I found chlorfenvinphos (WHO Ia 'extremely toxic') and carbophenothion (WHO Ib), with studies indicating foetal toxicity and malformations in rats. The VMD said it had not been in use for ten years, but the Hazards Centre said it was only withdrawn as sheep dip in 1989, and as a crop spray in 1993. Why was this stuff was ever licensed in the first place? One person damaged would have been one too many. But we are looking at thousands, with many more to come. |
OP dips and the
environment-confusion
The National Rivers Authority
(NRA) has called for a ban on soakaways as a result of its
recent report on the extent of pollution by OP chemicals used in
sheep dips-particularly chlorfenvinphos, propetamphos and
diazinon in soil and water(5). A new edition of MAFF's Code of
Practice will discourage the use of soakaways, but there will be
no legal ban. In the meantime, two cases of contamination of UK
water sources by sheep dip are being examined by the European
Commission which may rule on the practice.
OP Link to BSE?
There is growing support from the
scientific and lay community for the work of Mark Purdy, an
organic farmer, who documented a correlation between the use of
OPs on warble fly in cattle and the emergence of Bovine
Spongiform Encephalopathy (BSE, or Mad Cow Disease). Purdy has
noted that BSE symptoms of nervousness, apprehension and
uncoordinated movement parallel those of chronic OP poisoning.
He suggests an indirect link through a chain of chemical
exposure. Recent press coverage(6) led to a wave of letters with
fresh cases of the health impact of OPs. There are calls for
government action to restrict OPs, and to mount urgent research.
There has been no response from the government at the time of
going to press, and the next issue of Pesticides News will
investigate further. (PB)
References
1. HSE, Sheep Dipping, 1994, HSE Books, Suffolk.
2. Veterinary Medicines Directorate, Annual Report and Accounts 1993-94, HMSO, London. 60 pp.
3. Minutes of the 18th Meeting of the Consumer Panel, MAFF, London, 27/4/94.
4. Farmers Weekly, Calls for return of compulsory scab dip for sheep are rejected as premature, 15/7/1994.
5. National Rivers Authority, The Disposal of Sheep Dip Waste: Effects on water quality, HMSO, London.
6. Woffinden, B, The seeds of madness, The Guardian Weekend, 13/8/94 and letters 18/8/94.
[This article first appeared in Pesticides News No. 25, September 1994, pages 4-7]