For Oregon firefighters, cancer is occupational hazard
A crew left Forest Grove Fire & Rescue in full gear to respond to a two-alarm apartment blaze sometime after midnight. A pair of firefighters remained at the station to guard Capt. Rick Ilg's urn.
In the morning, hundreds of Oregon firefighters and others paid their respects to Capt. Ilg at Hillsboro Stadium.
Ilg wasn't on active duty with Forest Grove Fire & Rescue when he died in September, at age 49. He didn't die while responding to an emergency call, either. But he is considered to have died in the line of duty all the same.
Ilg died of complications from brain cancer — considered, under Oregon law, to be a line-of-duty death because of the higher-than-average rates of carcinogen exposure that firefighters face over the course of their careers.
For a week leading up to the Nov. 5 service, firefighters took turns guarding Ilg's urn around the clock — serving with him, if only symbolically, one last time. One longtime volunteer firefighter stood with Ilg's urn for eight straight hours. Another pulled out his phone so they could "watch a movie together."
During the penultimate shift, a friend from back in Ilg's paramedic days was ready to stay until midnight. But that night, Forest Grove Fire Marshal David Nemeyer and interim Chief Patrick Wineman clocked in early.
Ilg was highly respected within Forest Grove Fire & Rescue, where he started work in 2006. He previously worked for Metro West Ambulance as a paramedic.
At his memorial service, friends shared diet root beer and cinnamon bears and remembered Ilg for ducking college to go bartend in Hawaii. Like the rest, he got into the profession because he liked helping people.
Ilg was decorated with the Medal of Valor for his work on a technical rescue in the Oregon Coast Range in 2014. He was later promoted to lieutenant, then to captain.
He continued to serve even after being diagnosed with brain cancer in 2018, although he officially retired this year, not long before he succumbed to the illness.
According to data from the International Association of Fire Fighters, cancer caused two-thirds of line-of-duty deaths in firefighters from 2002 to 2019.
Responding to fires isn't just dangerous for firefighters because of the intense heat and shooting flames, as Wineman explained.
"If you ever get under a roof, they have truss components where all the two-by-fours meet. It creates a web, and it used to be bolted or nailed. Well, they stopped doing that. They started using glue and formaldehyde, which makes things really strong in normal conditions, but when it gets really hot in a fire, all that glue and all that formaldehyde — on top of all the other crap that's in a fire — starts cooking off, and our crews are crawling around breathing it," Wineman said, resting his hand next to the urn. It was already after 1 a.m., with the memorial service just hours away.
"And it's terrible," he added, "because it turns into this."
In memory of Ilg, affectionately known to coworkers as "Ricky," and all the other firefighters who have battled cancer, Oregon firefighters are working to save their own.
In Salem, they're pushing to expand state protections to cover healthcare costs of occupational cancer. At the stations, they're updating gear and procedures to limit exposure to carcinogens. All the while, they are trying to change what is quite literally a toxic culture.
"Growing up, I saw my dad's remorse for a number of friends and coworkers who died of cancer," said Cameron Homan, a 31-year-old, third-generation firefighter in his fifth year with Portland Fire & Rescue. "For me in becoming a firefighter, that was always in the back of my mind — there is a very high likelihood me and folks I know will die of these illnesses."
Under Oregon state law, brain, colon, stomach, testicular cancer, prostate, rectal and breast cancer, multiple myeloma, non-Hodgkin's lymphoma, and leukemia, as well as cancer of the throat or mouth, are all presumed occupational for firefighters since July 1, 2009. That means claims for healthcare costs are sent to Oregon's workers compensation division, and compared to other workplace injuries and diseases, the burden of proof for causation of those diagnoses shifts from the firefighter to the insurance company.
Holly Ilg, Rick's widow, said the insurance company, the State Accident Insurance Fund, accepted Rick's claim. But it wasn't an automatic process.
"We had this two-hour long interview with a physician asking if there was something on the job that could have contributed to this. 'Were you exposed to smoke?' Rick kept saying he always followed protocol," said Holly Ilg, a nurse who met her late husband while he was working for Metro West Ambulance. "We were accepted, which was good, because we would be broke easily if this didn't go through."
Still, the employers and their insurance companies can fight the presumed cause of disease or death.
"Testicular cancer is listed as one of the presumptive cancers under the law. Even though it was listed, I was denied coverage by workers comp — even though it was pretty black and white," said Steve Fisher, who recently retired from Tualatin Valley Fire & Rescue.
Fisher is now director of the Oregon State Firefighter Cancer Support Network.
"Even though my claim was eventually accepted, and Rick's was accepted, the fight we went through, it makes you say 'why did we go through all that?" Fisher asked rhetorically. "I could have just made a claim with my insurance company and called it good."
Attorney Nelson Hall has been representing firefighters in Oregon for over 35 years. He said the presumptive law has helped, but state insurance companies still fight claims of those cancers.
Documents from the state workers compensation board show, sometimes in unnerving detail, how firefighters' claims have been challenged and even denied at times.
In March, documents show, a widow testified in a virtual hearing before the board that her late husband often returned from his shifts during 25 years as a firefighter smelling like smoke. His former battalion chief testified face masks weren't always required in the 1990s. But when he contracted tonsil cancer, his claim was denied. His former employer, the city of Salem, and its insurance company successfully argued that the cancer was caused by tobacco use and other medical conditions, rather than from firefighting.
In another case, a 52-year-old submitted a claim after he was diagnosed with prostate cancer, which is presumptive at 55 and younger in state law. According to court records, the firefighter said when he started working as a firefighter in 1994, turnouts were only washed "about once per year" and were often hung next to beds at the station. He added he didn't use air packs when he started, and after fighting fires, he often coughed up black soot. Without an exhaust system in the truck bay, he told the board firefighters would simply paint over walls darkened by diesel fumes.
The employer brought in an expert from Oregon Health & Science University, Dr. Tomasz Beer, who testified studies "do not provide evidence that casually links firefighting to prostate cancer". The judge sided with the employer, Marion County Fire District, finding that firefighting did not contribute to his prostate cancer. (Beer declined to be interviewed for this story).
Both of those cases are still undergoing appeals.
Now, though, firefighters have one of their own answering the call inside the Oregon Legislature.
Rep. Dacia Grayber, a Democrat who represents Tigard and Southwest Portland, is a firefighter with Tualatin Valley Fire & Rescue. So is her husband, Matt Laas.
In March 2019, at a routine annual physical exam, Laas complained of a lump in his throat. The doctor noticed that Laas had mentioned a lump at his last exam, too.
Laas was diagnosed with throat cancer, undergoing surgery the following month. Fortunately, doctors were able to stop it from spreading to his trachea.
"Right off the bat when that diagnosis hit you, I thought of so many of those fires I overhauled over the course of my career when I wasn't wearing proper protection — because nobody was. We didn't realize how bad it was," Laas recalled. "I'm a broken record preaching that to our young firefighters now. I'm an absolute stickler for getting people's skin clean."
Even after the invasive surgery, Laas had to endure 30 radiation treatments to ensure his cancer was gone. He was finally back to full duty by Christmas Day that year.
Grayber says after that experience, she's "determined" to advocate for safer working conditions. She also plans to introduce legislation to expand the types of cancer deemed presumptively occupational to include female reproductive cancers and bladder cancer, which is presumptive in Washington but not Oregon. Prostate cancer is presumptive in Washington starting at age 50.
"Last year, I had a bill to increase all cancers that are presumed for firefighters, but that got killed real quick," Grayber said. "Really powerful business and insurance industry lobby groups killed the bill."
Fire and rescue departments are covered by the either private companies, the State Accident Insurance Fund, which covers Forest Grove Fire & Rescue, or the Special Districts Association, which covers around 300 fire districts.
"It is a labor-verse-management issue. Occupational injuries are not traditionally presumed, and any time you're flipping the burden of proof and requiring an employer to prove a negative, that's always something that is going to get people's attention," said Hasina Wittenberg, a lobbyist for the special districts association. "When we first introduced the presumptions, there was definitely no science or study about cancer and women and firefighting. Things evolve. I'm waiting to see what data Rep. Grayber has to support adding additional cancers."
By the time the crew from Forest Grove Fire & Rescue returned from the apartment fire on Nov. 5, hours before Ilg's funeral service, they had already stripped out of their turnouts and sealed them in bags. Before bed, they did laundry and showered.
That wasn't always standard practice.
Laas and others who joined the ranks in the 1990s say the culture has changed. They recall being trained by Vietnam veterans who used to chain-smoke and hang off the side of trucks with soot on their faces.
"There was a sense of pride when you left a fire, and after you looked like you went through hell. The blacker your gear, that was a badge of courage that showed you weren't afraid," Grayber recalled. "I remember thinking that was really stupid. And then in the early 2000s, we just started seeing our colleagues die of cancer, and we knew why."
But change takes time.
"In terms of shifting protocols and the mindset, it really is in the last two to three years I think I've seen progress in knowing that when your gear is covered in soot and ash, that's not cool anymore," Grayber said.
Laas remarked, "For those entering the fire service now, their frame of reference is a world apart from where it was when I was their age. You won't see an effect in change in cancer rates for another 30 years, but in this generation, I'm hopeful we will see a massive reduction."
According to the Center for Disease Control, firefighters have a 14 percent higher risk of dying from cancer than the general U.S. population. The same studies found firefighters are more than twice as likely to be diagnosed with both testicular cancer and mesothelioma, more than 1.5 times as likely to be diagnosed with both multiple myeloma and non-Hodgkin's lymphoma and 1.31 times as likely to develop brain cancer.
In 2018, Portland Fire & Rescue joined Tualatin Valley and Forest Grove in allowing staff to attend yearly physical exams, which include a wide range of tests including skin, blood and lung tests, while on the clock.
Ryan Norton, a physician at Oregon Health & Sciences University and medical director for Portland Fire & Rescue, said the policy change is leading to increased screenings for Portland firefighters.
"The agreement to allow firefighters to come in on the job has led to us seeing far more Portland firefighters in our lab," Norton said. "If we don't have this contact point, we're missing an opportunity to identify an early cancer. We don't have great screening tests for some of these cancers, but through some physical exams and conversations we can try to identify early warning signs — but that appointment needs to happen. So, we're really happy to see the numbers go up."
While building codes and manufacturing practices are beyond firefighters' control, leaders say in-house changes are making the job safer.
At firehouses, departments are capturing the diesel exhaust let off by ambulances and firetrucks. In fires under their helmets, crews are wearing hoods that block toxic particles.
While "overhauling" or combing through the aftermath of a fire, crews used to take off their gear and wear paper masks or none at all. Now they're leaving their turnouts or suits and breathing apparatuses on. When they leave a fire, they take off the turnouts and seal them in bags to be washed. At large departments, each firefighter now has an extra turnout set at home, so they don't wear a suit caked in carcinogens on the next call.
All these reforms hit firehouses in the last decade.
"It is completely different from when I came in. So much has changed with the collective bargaining agreements," said John Derr, who works as Portland Fire & Rescue's safety chief, a position focused on firefighter and paramedic workplace safety.
Derr added, "New people coming in across the industry are so much more protected against cancer than I was. We want people to have a 25- to 30-year career serving the public and beat that in their retirement, like previous generations have not."
That transformation is not all happening everywhere at once, though. It's subject to different funding sources, governing bodies and collective bargaining agreements.
For example, Banks, which has three staff firefighters and about 75 volunteers, does not have two turnouts for everyone. Forest Grove has two turnouts, which cost about $4,000, for staff but not volunteers.
In the Scappoose Fire District, which has 22 staff and 18 volunteers, Chief Jeff Pricher said the department does not have the tools to capture diesel exhaust in its truck bay in its current building. The district is exploring bond and grant options for a more modern facility.
As he climbed the ranks, Ilg led the push for Forest Grove Fire & Rescue to buy two sets of turnouts and new self-contained breathing apparatus. After brain surgery in December 2018, he returned to work.
"Rick was stubborn as hell. He wasn't going to be told no, and he never cut corners," Holly Ilg said. "It's a family and a brotherhood, and Rick didn't want that to just be talk — to show up when it really matters, but not in the day-to-day. He didn't want to just be a phrase. He wanted to really dig in and be that brotherhood that they promote."
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