As she joined hundreds of her fellow firefighters in paying respects to Capt. Rick Ilg on Nov. 5, Dacia Grayber felt "shattered," she later said on Twitter.
Grayber was elected last year to represent Tigard and Southwest Portland in the Oregon House. But long before that, she was a firefighter, the wife of a firefighter — and the wife of a cancer survivor.
Grayber and her husband, Matt Laas, both work as firefighters for Tualatin Valley Fire & Rescue.
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.
As Laas was going through his ordeal, so was Ilg.
A decorated and highly respected fire captain with Forest Grove Fire & Rescue — he received the Medal of Valor for his work on a technical rescue in the Oregon Coast Range in 2014 — Ilg was diagnosed with brain cancer in 2018. He underwent surgery that December and then returned to work.
Laas' surgery was successful in removing the cancer, and it hasn't recurred. Ilg was not as fortunate. He continued to work even as his condition worsened, finally retiring this past summer. He died in September at age 49.
Ilg is considered to have died in the line of duty. That's because his cancer is considered, under Oregon law, to be what's called "presumed occupational." In other words, when a firefighter in Oregon is diagnosed with certain types of cancer and he files a workers compensation claim for coverage, the burden of proof is on the state to prove he didn't develop cancer because he was exposed to carcinogens on the job.
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.
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 interim Forest Grove Fire Chief Patrick 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, standing watch beside Ilg's urn hours before his memorial service.
"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."
Claims and challenges
While the law gives Oregon's firefighters some peace of mind, employers and their insurance companies can fight the presumed cause of disease or death when a firefighter submits a workers compensation claim.
"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 insurance providers 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 they worked without face masks 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 under state law when diagnosed prior to age 55. According to court records, the firefighter said when he started working as a firefighter in 1994, turnouts were only washed once per year and were 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 state 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 Smith's prostate cancer. (Beer declined to be interviewed for this story.)
Both of those cases are still undergoing appeals.
Grayber plans to introduce legislation to expand the types of cancer deemed presumptively occupational. Bladder cancer, for example, is covered in Washington but not Oregon.
"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."
Forest Grove Fire & Rescue dispatched a crew to an apartment fire hours before Ilg's funeral service on Nov. 5. By the time they returned to the station, 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.
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 fire trucks. 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 turnout or suit and breathing apparatuses on. When they leave a fire, firefighters 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."
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."
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