A Statewide Hot Line Answers the Call on Toxic Hazards

It was a typical afternoon for pharmacists answering the Toxic-Info hot line at San Francisco General Hospital--a woman had been sprayed in the face when a tenant in her apartment house went bonkers with a fire extinguisher, a restaurant employee had become dizzy after her boss poured an unidentified chemical down the drain, a small boy had eaten a flower petal, a child had drunk from a glass of water left out when a flea “fogger” was set off.

The statewide hot line--1-800-233-3360--was established two years ago by the UC San Francisco School of Pharmacy as a service of the San Francisco Bay Area Regional Poison Control Center.

12,000 Calls a Year

It had its baptism by fire during last summer’s watermelon poisoning scare and now handles 12,000 calls each year, most of these from private citizens worried about health hazards of toxic wastes and spills and job-site hazards as well as those of commonly used household chemicals.

Toxics are being widely perceived as a potentially major health problem, and apparently with good reason. Frank J. Mycroft, an environmental toxicologist who is director of Toxic-Info, points out that there are 65,000 organic compounds used to a significant extent in industry and “of those, perhaps 3,000 are commercially important. Of those, about 700 have standards set for the workplace.”

Further, Mycroft points out, of 7 million known chemical compounds, “perhaps several hundred have been tested for carcinogenicity. What we’re describing is an immense ignorance of chemicals and what they can do.”

Although the San Francisco-based hot line was conceived primarily as a service for health professionals and for agencies, “first responders” such as police and fire departments that deal with accidents involving hazardous wastes, the bulk of the callers are concerned individuals and their most frequently voiced concerns are about home flea bombs and the possible effects of paint fumes on fetuses.

The nuclear plant accident at Chernobyl had a “very significant” impact on Toxic-Info, according to Dr. Charles E. Becker, UCSF professor of medicine, head of the division of occupational medicine / toxicology at San Francisco General and medical director of the regional poison center that serves a Northern California population of 6 million.

“This morning,” Becker said during a recent interview in his hospital office, “I was called by one of my former students who has a brain tumor.” As a registered nurse, she had been repeatedly exposed to radiation on the job and she wondered if that might have been the cause.

Making such a determination “is always very hard,” Becker said, and a case such as the above presents a double dilemma to the victim. “People are most frustrated when it’s an involuntary risk,” he said, “and when the medical community itself is not certain how to deal with it.”

For example, he said, “We don’t have good environmental measures” when it comes to hazard-waste dump sites. “All that people have are smells. It’s frustrating. (As medical professionals) we depend very much on being able to have a dose of something. So people smell things, but we haven’t been able to determine exactly what they’re smelling. We’re left with smells and symptoms and a health professional saying, ‘I don’t think . . . . ‘ “

He added, “That’s why Chernobyl is so interesting. If the Russians would give us all the information, then we could get to the dose.”

Some of the calls that come into the Toxic-Info hot line are tragic. Pharmacists recall the case of a toddler who drank a fatal dose of paraquat, a herbicide, from a Coke bottle, and the man who died when a Berkeley family, bringing home its new baby, turned on a faulty heater for the first time and the father died of carbon monoxide poisoning.

Other calls may seem ridiculous, but pharmacists on hot-line duty work on the theory that, if someone is concerned enough to call, the problem is real to them. The job is both rewarding and stressful, explained Olga Woo, a pharmacist who has been on the poison center staff for five years. On this particular day, Woo was sharing with a visitor the little black book of memorable calls, a guaranteed stress-reliever.

Entries included the caller who wanted to know if she could be fatally poisoned by contact with garlic on a finger cut, the one who asked whether bubble gum stuck in the air vent of a car could give off toxic fumes, the one who wondered if there was something wrong with his soup because his coffee mug shattered when he poured the soup into it.

Toothpaste Addiction

Then there was the mother worried that her toddler had developed an addiction to eating Crest toothpaste, the woman who regularly ate contraceptive cream to prevent exposure to AIDS, the doctor whose patient had drunk an intravenous solution when the doctor was out of the room. The doctor pointed out that his patient was an attorney.

Mycroft’s most memorable client arrived in person one morning at San Francisco General, toting a wine glass in which floated a mouse belly-up. The bearer explained that he kept a glass of wine at his bedside each night, in case he awakened and needed a little nip. That morning, he woke to find the dead mouse in the wine remaining, and he was scared. Mycroft convinced him that the mouse had probably drowned.

At her desk in the cramped office that houses both the poison control center and the Toxic-Info hot line, Ilene Brewer, a doctorate-level pharmacist, punched a caller’s information on a product consumed into the Poisindex, a database containing information on 750,000 products--ingredients, antidotes, degree of danger. In this instance, she was able to give the caller reassurance. The next minute, she was assuring a woman bitten by her pet lizard that the lizard’s bite is not toxic.

The staff estimates that 10% of the calls to the toxics hot line come from Los Angeles County. (Los Angeles, however, has its own Poison Information Center, operated by the County Medical Assn., 484-5151; it refers toxic spills calls to the toxics center at Northridge Hospital.)

It is a sometimes fuzzy line that distinguishes toxics calls from poison calls. Brewer attempts a definition: “If there’s a patient who’s symptomatic, that’s a poisoning. If a call comes in on the Toxic Info line and it’s something to do with aspirin, that’s a poisoning.”

‘An Information Line’

Olga Woo added, “Poisoning is considered an emergency situation. The toxics line is really an information line. Information can wait. But people misuse the line because it’s an 800 number.”

A typical, legitimate toxics call, Woo said, would be, “I was cleaning my basement and I found all these chemicals. What shall I do?” (In such a case, she said, the hot line might refer the call either to Waste Alert in Sacramento, 1-800-25-TOXIC or to the San Francisco office of the U.S. Consumer Products Safety Commission.)

It is not appropriate, she pointed out, to expect the Toxic-Info hot line to answer questions about adverse effects of prescription drugs. “We don’t know (people’s) medical history,” she explained, “and sometimes they’re calling us for a second opinion, fuel for their fire.”

She added, “We try to be cautious” because of possible medical and legal implications and because “some callers have an ulterior motive. It may be to get a doctor to say they should induce an abortion. A lot of the calls from consumers are because they’re angry. The buck has been passed, so finally they get to us. Some of those callers are seeking legal action. We try not to take sides.”

For the last two months, Woo said, the toxics line has been averaging 100-150 calls a day, which she attributes partially to “some of the recalls, cyanide tampering, things like that.”

The calls from consumers, she said, follow a pattern: “Generally, their questions are, ‘How toxic is it?’ ‘What symptoms can I expect?’ ‘Is it a carcinogen?’ ‘Will it have long-term effects?’ ”

The lion’s share of Toxic-Info’s $120,000 budget is supplied by the state Department of Health Services; Toxic-Info director Frank Mycroft, who has a Ph.D. in environmental toxicology from UC Berkeley, was formerly on the department staff. The budget covers the hot line as well as two publications--Hazard Review, which goes to county health departments, agricultural commissioners and other public agencies, and Newswire, which is sent to the public on request. Both give detailed information on hazardous materials and how to handle exposure.

Mycroft observed that, though pesticide calls account for 25% of the hot line’s volume because “people know pesticides kill bugs,” in truth “pesticides make up perhaps 1% of the chemicals of concern.” Among other hazardous materials, he mentions asbestos, lead and PCBs (polychlorinated biphenyls). PCBs, until banned in 1981, were widely used in a range of products from ironing board covers to varnishes to safety glass.

The PCBs have been shown to cause birth defects and cancer in animals, as well as neurological damage, and are what Mycroft terms “a legitimate concern,” but he assures callers who may have been exposed (such as in a recent transformer explosion in San Francisco) that many years of exposure would be required for human cancer to develop. He recognizes, however, that it is not very reassuring to those who have been exposed, and may have suffered eye irritation, “when the people in the moonsuits come in the next day to do the cleanup.”

In fact, Mycroft said, the San Francisco spill sparked 300 calls to the hot line. He says, “People need to have a number where they can call and speak to a person about their concerns.”

‘I Smell Something’

Many hot-line calls are from people reporting only, “I smell something. . . .” One recent call involved a neighborhood dispute. Mycroft recalled, “Some guy had dumped two pounds of dog repellent on his neighbor’s front lawn. The whole neighborhood reeked.”

Last winter there was an episode in a Northern California county in which a propane supply had been contaminated with a chemical residue in a tanker. When consumers lighted their propane, it formed a potentially hazardous hydrofluoric acid. “For weeks,” Mycroft said, “people were complaining of eye irritation, respiratory tract irritation. One greenhouse complained that all its plants had died.”

24-Hour, 7-day Operation

The Toxic-Info hot line is a 24-hour, seven-day operation, with its on-duty pharmacists working three 12-hour shifts a week; at any time there are two people handling the telephone calls.

There are few plights that they haven’t heard. Mycroft remembers the man who poured chlordane, a volatile liquid insecticide, into his swimming pool, misreading the label. “He turned his pool into a hazardous waste,” Mycroft said. Fortunately, the foul smell alerted the family before anyone dived in.

Industrial hazards are a major public concern and one of the “big problems” identified by Mycroft is overbuying and then dumping of these chemicals. The city of San Francisco has mandated that all industries using chemicals provide the city with an inventory of these substances and how to handle them in case of fire or other disaster. When this is completed, he said, “All the poison center will have to do is type in the address, the name of the company” and get a computer readout for instant action.

Right-to-Know Bill

He hopes to see establishment of a statewide computer data bank and views passage in July of a community right-to-know bill authored by Assemblywoman Maxine Waters (D-Los Angeles) as a big step. The bill, which came about as a direct result of the poison gas disaster that took 2,000 lives in Bhopol, India, in 1984, requires that businesses provide an inventory of substances to local governments, that businesses implement emergency plans including worker training and that local governments have an area plan in the event of a major disaster. Plans are to be submitted by year’s end.

However, Dr. Kent R. Olson, for the past three years director of the San Francisco Bay Area Regional Poison Control Center, points out that industrial workers are not the only ones at risk. “Everyone is exposed to chemicals,” he says. “We all are. I think the average citizen should be more concerned about the things they use around the house. People are concerned about global issues of pollution” but tend to ignore the threat within their own walls which, he says, is far greater.”

For example, Olson said, widespread spraying of malathion to eliminate a fruit fly infestation was a legitimate concern but “in terms of the dose that ended up on one’s yard, well, your neighbor may have sprayed five to 10 times as much when he did his trees.” (Pesticides, he said, represent the most significant exposure to a hazardous element in California.)

For those concerned about the health hazards of home flea bombs, Olson has some reassurance: “The order of toxicity is fairly low. We haven’t had any incidents of poisoning.” There was a hot-line call recently from a woman who had set up nine bombs in one room and was complaining of a headache.

Olson smiled as he mentioned “people complaining loudly about exposure to chemicals while smoking a pack of cigarettes a day.” Becker mentioned a truck driver who had been exposed briefly to PCB--”He was so upset he was smoking 2 1/2 packs of cigarettes a day.”

Hazardous Jobs

For the record, jobs Olson says he would not want, because of the inherent environmental hazards, include roofer (asphalt carcinogens), worker in a small art and print shop (toxic materials) , shipyard welder (volatile lead) and fireman (smoke inhalation).

In his recently published book, “Cancer Prevention: Strategies in the Workplace,” Becker writes that, although cancer kills about 430,000 people in the United States annually, scientists have focused on behavioral factors and “have been slow to appreciate the risk of previous occupational exposures to cancer.”

Until the mechanism of cancer production is fully understood, Becker notes, it will be impossible to estimate “safe” levels of human exposure to about 86 chemical compounds now used in occupational settings and identified as carcinogenic in animals. To point up the scope of the problem, he notes that there are more than 6 million chemicals in the computerized registry of the American Chemical Society, and about 500 new chemicals being proposed each year for toxicological evaluation. Typically, there is a long latency period before carcinogenic effects surface.

Becker, in an interview, distinguished between a toxicity and a hazard, defining toxicity as “the inherent property of a material,” such as radiation or asbestos, where the hazardous dose is known, and a hazard as “the toxicity related to its use. As it sits in the wall (this material) doesn’t do anything . . . unless you open that wall. It only becomes a hazard when it gets into the water, gets into the air.”

The Toxic-Info staff works closely with hospital emergency rooms, where personnel are concerned both about patient decontamination and contamination of the hospital environment by these patients. An example was a woman who had fallen into a mudhole containing asbestos. Emergency room personnel were advised to protect everyone involved by keeping the mud dry while removing it from the patient.

Frequently, Toxic-Info refers calls to the agency of expertise, such as the U.S. Consumer Product Safety Commission, or, in the case of occupationally related incidents, Cal / OSHA, which regulates exposure to hazardous substances.

The California toxics hot line is the first such state-subsidized service in the United States. There is also Chemtrec in Washington, D.C., an information service funded by the chemicals industry. Mycroft, who has thought about expansion to a national hot line, has serious reservations about industry policing itself: “Industry also has liability concerns. If it’s a disaster and you make it a bigger disaster, you can end up paying for it. We have an independence here that I value very much.”

The highly trained Toxic-Info staff, who routinely become involved in patient follow-up, also have a heart. No one snickered, it should be noted, when a distraught cat lover called one recent day to ask if nearby spraying of pesticides might have caused the normally docile household cat to attack its owner. Not likely, they suggested--very politely.