Steve Lewis became a seething malcontent after a visit to the doctor who presides over the Hanford Nuclear Reservation.
Lewis, an electrician, had been exposed to a blast of ammonia vapor from Hanford's underground "tank farms." Down on these farms during the Cold War, as federal workers churned out plutonium for the U.S. nuclear arsenal, they buried the largest haul of high-level nuclear waste in the Western Hemisphere. Lewis is part of another generation of Hanford workers that for more than a decade has been mopping up the festering mess.
His vapor exposure, which occurred in January 2002, flushed his face red and burned his lungs. Four months later, he had headaches and nosebleeds and was gagging on phlegm. He went to see Larry Smick, Hanford's acting medical director, who diagnosed Lewis's complaint as a preexisting condition: "Allergic disease likely making him more sensitive to irritant vapors at work," according to the doctor's handwritten notes.
Lewis was incredulous. He had never had allergies. He said he tried repeatedly during the exam to get the doctor to talk about chemical exposure out at the tank farms, but Smick would only talk allergies.
"Quite honestly, that is when my bubble popped," said Lewis, 51. "I could live with injury because these things do happen. I was not an angry employee up until they started trying to convince me that I hadn't been injured."
The diagnosis that infuriated the electrician is part of a years-long pattern of questionable medical and management practices at Hanford -- first disclosed last fall by a nonprofit watchdog group called the Government Accountability Project -- that is now triggering investigations by federal and Washington state officials.
Energy Secretary Spencer Abraham, whose department oversees the cleanup here, announced Tuesday that he has ordered an investigation of the Hanford Environmental Health Foundation, the private nonprofit clinic where Smick is the ranking doctor.
Department investigators, who descended on the clinic last week, are looking at allegations of fraud, supervisory misconduct and falsification of medical records at the clinic, which the Department of Energy has funded for 38 years.
Yet the scope of management practices that have endangered Hanford workers goes far beyond the clinic -- to the federal government itself and the private contractor it pays to clean up the tank farms, according to interviews with workers, union officials and outside experts in occupational health, as well as internal e-mails and memorandums and a continuing investigation by the Government Accountability Project.
These critics describe a Hanford culture -- dominated by profit-minded contractors and meekly supervised by federal bureaucrats -- where there are powerful financial incentives to cover up worker complaints, falsify reports of work-loss injuries and subordinate safety to production bonuses.
Contractors "have an incentive to minimize the number of workdays lost" to employee injuries, Alan Hopko, an Energy Department official who oversees contracting at Hanford, wrote in a 2002 e-mail. "On the other hand, if [contractors] can do the work faster and cheaper because of fewer workdays lost, they can possibly earn additional fee."
Tim Takaro, a physician who teaches at the University of Washington and treats tank farm workers, says there is "absolutely unequivocal pressure to reduce the number of time-loss injuries at Hanford. Workers are pressured not to complain. For some contractors and some supervisors, there is a cultural pressure not to report injuries."
The Energy Department says that safety is its top priority at Hanford and that it would fire any contractor who endangered workers. Smick and other health officials now facing investigation say they are doing everything they can to protect workers.
The go-fast cleanup
When vapors sickened Lewis two years ago, the Bush administration was just beginning what it calls Hanford's "accelerated cleanup."
There are 177 waste tanks at Hanford, and more than a third of them have been leaking radioactive and cancer-causing toxins into groundwater for decades. The administration's goal is to keep these agents out of the Columbia River, while getting the federal government out of the cleanup business in Hanford as soon as possible. It wants to finish the job in three decades, rather than a previously projected seven. That could amount to a significant financial savings: The federal government now spends $2 billion a year at Hanford.
To that end, the Energy Department has begun offering bonuses of as much as $2 million to the principal contractor on the tank farms, a Colorado-based engineering and construction firm called CH2M Hill, for each waste tank it can empty by the completion of its four-year contract in 2006.
This has quickened the pace of cleanup -- CH2M Hill says it is on track to get its bonuses -- but union critics and some independent health experts say speed has come with a human price.
There has been an increase in the number of vapor injuries on the tank farms, with more than 90 workers at CH2M Hill seeking medical care for tank farm exposures in the past two years, according to data gathered by the Government Accountability Project.
The Energy Department says it has studied the increased number of vapor injuries but cannot figure out why they occurred. "We have not been able to attribute it conclusively to anything," said Roy Scheppens, manager of the tank farm cleanup for the department. "People can become sensitive all of a sudden to vapor."
CH2M Hill officials say the company is doing all it can to protect its workers. And senior Bush administration officials reject any causal link between the accelerated cleanup and the increasing number of workers being hurt by vapors. "We are very confident that accelerated cleanup and safety go hand in hand," said Jesse H. Roberson, the Energy Department's assistant secretary for environmental management.
Going to the doctor
Larry Smick has issued orders saying that he should personally examine all tank farm workers who claim to be injured on the job, according to e-mails the doctor has sent to his staff.
After Smick saw Lewis on April 8, 2002, the clinic's medical record showed that the electrician said the reason for his visit was "not work-related."
"That is a blatant lie," Lewis said. "I was in there to emphasize to the doctor that I was having symptoms that were work-related."
In an interview, Smick said he could not explain why Lewis's medical records listed his visit as not work-related.
Asked about the allergy diagnosis, Smick said: "It makes medical sense to me. . . . I couldn't, in all honesty, link the ongoing symptoms to an exposure." (Lewis later saw doctors in Seattle and Spokane, Wash., whose diagnoses supported his claim that he was injured by vapor exposure on the job.) The official reason for any worker's injury is a matter of considerable financial importance to private contractors at Hanford. CH2M Hill, for example, has a $1.4 billion federal contract.
Energy Department officials can refuse to pay as much as 10 percent of the money if the rate of "recordable" workplace injuries rises above 2.9 cases per 200,000 hours of work in a six-month period. Medical diagnoses help decide whether a worker's complaint is recordable.
Smick said in the interview that CH2M Hill and other contractors at Hanford often pressure him to reduce the number of work-related injuries, an accusation that CH2M Hill denied. "The company will call me up and say, 'Why did you make this work-related?' They are mad at me," he said.
The doctor said, though, that he and his staff never let this pressure interfere with the practice of responsible medicine. "We want to do everything we can to alleviate the concern and anxiety of workers," he said, adding that if a worker needs care, "recordability issues can go to hell."
But e-mails that Smick has sent in recent years to his medical staff show that he often tried to meet contractors' concerns.
The doctor warned his clinic staff members that they would "create a monster out there for the contractors and their recordability issues" if diagnoses for workers exposed to vapors were written up as anything other than a "normal exam."
The warning, in an e-mail dated June 28, 2001, came after several workers were exposed to smoke and tank farm vapors. They had been brought to the clinic, where nurses and physician assistants apparently angered Smick by writing diagnoses such as "exposure to unknown smell" or "exposure to burning ballast."
After telling his staff that the correct diagnoses should all have been "normal exam," Smick asked his secretary in the e-mail to "bring me all the charts today that had to do with exposure yesterday and I will make the necessary administrative changes by writing addendum. To the providers -- do I have your permission to make the changes to your charging or would you prefer to do it yourself?"
'Just do it!'
On many occasions in recent years, Smick instructed clerks at the clinic to alter patient records to show that a worker's injury was not related to work, according to interviews with two clerks who worked for Smick and who have since left their jobs.
One of them, Nancy Morse, said she often made changes to patient records on direct orders from Smick.
"Dr. Smick would call me after the patient had been seen and was ready to walk out the door," Morse said. "He would order me to change it [the record of visit] to non-occupational. I would say, 'Why?' He would say, 'Just do it!' "
Asked about this, Smick initially denied ordering those kinds of changes. Later in the interview, he said that "years ago" he may have given such orders when "you wanted to make sure that the report that went back to the company reflected the truth."
Medical records are supposed to be written up at the same time the patient is seen. Changing records with intent to misrepresent a patient's condition could be grounds for suspension of a medical license and possible criminal charges, according to Washington state authorities.
For at least two years federal investigators have been trying to find out if the statistics on workplace injuries at the tank farms have been falsified, according to an internal Energy Department document.
Lee T. Ashjian, president of the Hanford Environmental Health Foundation, said in a statement e-mailed to The Washington Post that the clinic "categorically rejects any implication that its worker-oriented medical approach has been compromised."
The Energy Department last month awarded the health care contract for Hanford to a new company, saying the new contractor, which will take over in three months, will be cheaper.
Back on the tank farm
After his exposure to toxic vapors and his visit to Smick, Steve Lewis became a nettlesome advocate for worker safety. He began to speak out during a time when CH2M Hill, his employer, was rushing to meet deadlines imposed by the Bush administration's accelerated cleanup.
On the tank farm, about 500 workers pumped waste out of leaky single-shell tanks and into double-shell tanks. For the first time in decades, large volumes of some of the world's most toxic and radioactive chemicals were being stirred up. The agitation caused the tank farms -- and the aging system of buried pipelines and valves that enable tank-to-tank transfers of waste -- to vent more vapor than they have in decades, workers and company managers said.
As workers smelled more odors coming out of the tank farms in the past two years, Lewis reported more complaints to his bosses, according to a whistle-blower lawsuit he filed last year. He complained that CH2M Hill was waiting to take readings until after dangerous gases had dissipated. He demanded that the company provide him and other workers with hooded breathing apparatus to protect them from vapors.
Lewis's complaints resulted in company-sponsored "harassment, ridicule, taunting and a hostile working environment," his lawsuit said. Last fall, CH2M Hill settled the lawsuit with Lewis and two other electricians for an undisclosed sum.
Two other tank farm workers who had often complained about safety were abruptly fired last fall.
Hanford police escorted Steve and Virginia Wallace -- he is an instrument technician, and she is a nuclear chemical operator -- off federal property Oct. 6. The couple said the contractor humiliated them in front of fellow workers, not least because it mobilized 16 security vehicles to escort them off federal property. They were fired, the company told them, for timecard irregularities.
Before their dismissal, though, the Wallaces had made a point of telling CH2M Hill how to improve safety practices on the tank farms.
The couple had taken safety classes at Hanford. They are certified instructors in respirator use and handling hazardous material. What they saw out at the tank farms did not square with their training, they said.
Twice last summer, Virginia demanded that her cleanup crew stop work until safety complaints could be addressed. Steve stood up in a public meeting in Richland last year and contradicted a claim by one of the meeting's speakers, Edward Aromi, president of CH2M Hill, about cleanup progress on the tank farms.
The day the Wallaces were fired, they called their local union chief, Randy Knowles. He happened to be in Washington, meeting with officials from the Energy Department and the Defense Nuclear Facilities Safety Board, a federal oversight agency.
"It was bad timing on the company's part and good timing for us," said Knowles, who raised the firings with the federal officials.
Three days later, CH2M Hill rehired the Wallaces. A courier delivered two letters to the couple at their home. Aromi, the president of CH2M Hill, wrote that he was hiring them back because he is "fully committed to creating and maintaining a work place that does not tolerate retaliation or even an appearance of retaliation against those who raise legitimate safety issues."
The contractor has undertaken measures to reduce worker risks. More hooded respirators are available and tank farm workers can wear them whenever they choose. Stacks that vent vapor from some tanks have been raised above face level. More areas of known vapor risk have been fenced off.
Workers and some union officials say that these are steps in the right direction, but that more needs to be done. That, too, was the finding of an expert panel that CH2M Hill commissioned to evaluate vapor risks. Four outside experts recommended in a report last October that the company should require that all tank farm workers wear hooded respirators on the job -- until workers, unions and outside critics can agree with the company on health risks caused by tank vapors.
CH2M Hill, however, killed the report. In its place, the company asked the four experts to each write separate opinions because they "don't all agree on everything," CH2M Hill Vice President Joel A. Eacker said. But in interviews three of the four authors said they all had been in agreement and two of them said they believe the report was killed because the company did not like it.
For its part, CH2M Hill said it continues to listen to all outside criticism and tries to learn from it. "We are ingraining safety into the way we do business," Eacker said.
Out at the tank farms in recent weeks, Steve Lewis said that safety has become more important. But he still finds "tremendous peer pressure" for workers not to wear respirators.
"I bet you in the next two years, we will have 50 more incidents," said Lewis, who is looking for a new job. "If people don't have protection, they are being set up for a lifetime of sickness and maybe even cancer."