Deadlier than Fire: NC firefighters paying out of pocket for crucial health screenings

By Jennifer Emert

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    ASHEVILLE, North Carolina (WLOS) — “If it wasn’t for the testing I was diligent about, I’d be dead today,” said medically retired Asheville Firefighter Ben Brickhouse of how he caught his prostate cancer diagnosis with lab testing during his routine physical. Brickhouse had no symptoms. He’s currently under treatment. Brickhouse’s comments recently touched a nerve for firefighters who have missed out on recent screenings.

Cancer is a leading cause of death among firefighters, and research suggests firefighters are at higher risk of certain types of cancers when compared to the general population, according to the Center for Disease Control’s National Institute for Occupational Safety and Health.

News 13 continues to examine the risks to firefighters in our Deadlier than Fire Investigative Series. A number of fire departments are now going above the routine annual screenings to better protect firefighters’ health. News 13 found some firefighters willing to pay hundreds of dollars, out of pocket, for ultrasounds and scans to give them peace of mind while calling on the state to do more.

“It’s always very high-risk,” explained West Buncombe Fire Chief Dennis Fagnant, watching his crews train at Buncombe County’s Fire and Rescue Training Center in November 2022.

“I need more hose, I need more hose,” called crews surrounded by thick black smoke inside the Residential Burn Training Building on the Woodfin area campus.

“You can’t always predict what’s going to happen, and so that goes back to why we’re out here today,” Chief Fagnant said.

The West Buncombe chief said he sees these opportunities as critical to sharpening a firefighter’s skills.

“If we don’t practice those skills, it diminishes, and then we’re not as prepared as we should be,” he explained.

These skills are critical in a job where timing is everything. Timing can also be vital in discovering — and determining — a firefighter’s cancer risk.

“We’re no different than the general public,” Fagnant said. “The earlier you catch it, the better your results are going to be.”

West Buncombe invested in supplemental cancer insurance for its firefighters.

“This is something that keeps me up at night. You think about, ‘What more can I do to protect our crews?’” Fagnant shared.

The fire department also began a program targeted at tracking Prostate Specific Antigen (PSA) levels since firefighters under 65 are at greater risk for bladder and prostate cancers.

“We can track through time, just simple lab results,” Fagnant said.

It’s tracking that Fagnant knows firsthand has paid off in West Buncombe.

“Caught early, it’s very treatable, and he’s now cancer free,” the chief said of a firefighter within his department, who caught their prostate cancer through the tracking.

In most full-time departments, an annual on-duty occupational physical is standard. Asheville Firefighters’ Association, IAFF Local 332, is also going above the baseline. In December, the association will bring in United Diagnostic Services for several days to conduct ultrasounds and screenings to test for potential cancers. Recently, the group has screened 5,000 firefighters in other IAFF chapters.

“They’ll come in and they’ll scan the organs that are most susceptible to cancer,” said Scott Mullins, Local 332 president and president of the state’s Professional Firefighters and Paramedics of North Carolina. “They’ll also look at our hearts and our necks to see if there’s any blockage in there as well.”

Through mid-November 2022, 45 firefighters signed up and will pay hundreds of dollars, out of the own pockets, for the screenings.

“Some insurance providers do pay for this,” Mullins said. “In our department and a lot of places around North Carolina, at least, firefighters are having to come out of pocket to have this paid for. It will give them good peace of mind that they’re ok. Right now, many of them are concerned about cancer.”

News 13 uncovered that those concerns stem from a pandemic-related consequence that paused some occupational physicals.

News 13 reached out to random fire departments statewide and discovered that in 2020, the city of Raleigh and Black Mountain paused annual firefighter physicals for the year, while the town of Waynesville has been paused for two years. All departments have since resumed the efforts, but the delays were related to health care staffing.

The city of Asheville was impacted this year. The departure of a doctor from AdventHealth, the city’s provider in 2021, left Asheville with a decision. It changed providers to Marathon Health in 2022 and has a hybrid arrangement with AdventHealth still providing labs, stress tests and chest X-rays for preventative cancer detection.

The city of Asheville Fire Department is one of the largest local departments, with a number of firefighters who have received a cancer diagnosis or had their death recognized as a line-of-duty death resulting from occupational cancer.

The city provided News 13 with invoices showing in 2019, prior to the pandemic, the department provided 235 on-duty occupational physicals through AdventHealth that meet The National Fire Protections Association (NFPA) 1582 guidelines. That was out of an eligible 251 firefighters. In the calendar year 2020, NFPA performed 243 physicals for 245 eligible firefighters. In 2018, 218 Asheville firefighters out of an eligible 244 firefighters received physicals.

But data shows 3 of the average 250 existing firefighters got on-duty physicals and screenings through November of 2022. According to city of Asheville Fire Administration, firefighters were told and notified in the Administration’s newsletter, they did have the option to use their private provider for a physical that would be reimbursed.

Fire Departments in the city of Charlotte, Hendersonville, and city of Brevard told News 13 they were able to continue annual firefighter physicals without disruption during the pandemic. The City of Charlotte answered our questions via email, providing the following.

The City of Charlotte and the Charlotte Fire Department are committed to the safety, health, and wellness of our employees. This commitment extends through annual physicals for our firefighters as prescribed in NFPA 1582 for incumbent members. In addition, our clinicians provide survey’s that measure sleep habits and metal health. These annual physicals, which are self-scheduled in the employees’ birth month, are conducted at the Public Safety Occupational Health Clinic (PSOHC). The PSOHC is managed by Reserve Health and the City contracted wellness provider, Marathon Health. Our single location has multiple providers under the direction of a single doctor and includes services such as physical therapy, nutrition, exercise management, and behavioral health services. During the pandemic we were able to continue occupational compliance exams as scheduled. I’m sure there were some appointments that were rescheduled due to an employee being quarantined or isolated, but the pandemic itself did not cause major disruption to our ability to sustain annual physicals.

North Carolina’s pilot firefighter cancer benefits program started in January of 2022. In 10 months, through the end of October/beginning of November $1,350,000 was paid in lump sum and medical reimbursements to 54 North Carolina firefighters with cancer in 2022. As many as 94 claims have been reported to the North Carolina Department of Insurance and the Office of the State Fire Marshall. Thirty of the claims have been denied, because the claim falls outside guidelines for the program. News 13 questioned should the state put more into early detection efforts, paying for preventative screenings.

“I would like to see the state of North Carolina paying for this in the future, many other state’s are doing that. Massachusetts is a perfect example; every professional firefighter is getting a scan up there,” said Mullins.

News 13 reached out to the Department of Fire Services in Massachusetts. Public Information Officer Jake Wark provided the following information:

DFS offers a robust cancer awareness, prevention, and early detection program through the Massachusetts Firefighting Academy. It’s available to all Massachusetts firefighters – career, call, volunteer, or retired. We’re able to offer these services because our Governor, his Administration, and our state Legislature have been very receptive to our concerns and supportive of our efforts, and because we have some great partners on the clinical side. Here are some of the state’s partner efforts:

The “Taking Action Against Cancer in the Fire Service” training from the Firefighter Cancer Support Network (FCSN). We offer this training to all new Academy recruits and as in-service training both online and in person at local fire departments. FSCN provides a “train the trainer” course that helps our Academy instructors to teach firefighters what they can do to prevent cancer and why early detection is so important. Free skin cancer screening for all firefighters. We have teamed up with several dermatologic organizations to offer free skin screenings through a program that the American Academy of Dermatology set up decades ago called SPOT Skin Cancer (previously SPOTMe). This is a program where local dermatologists volunteer their time to conduct a screening – so it is completely dependent on volunteers and is totally free to the firefighter. The dermatologist that spurred this program in Massachusetts, Dr. Christine Kannler, is working to make this program national and several states are piloting it now. Free chest CT scans. This is funded through an earmark in the state budget and it was chosen because insurance typically would not cover these scans for firefighters. There are some eligibility criteria, including participation in the “Taking Action Against Cancer in the Fire Service” training. Firefighters who do not meet these criteria can pay our rate out of pocket, however. Free PSA blood tests. This is also a test that insurance frequently does cover, but only later in the patient’s life than we offer it. There are some eligibility criteria for this test as well, and it’s also funded by a budget earmark. In addition to direct clinical screening, we also help fund fire departments’ purchases of new turnout gear, washer-extractor units, and other equipment. This helps reduce exposure to carcinogens as a preventative measure. According to Wark,

We make these tests and services available because firefighters have a demonstrable need for more and earlier cancer screening that their insurers are not meeting. Firefighters are exposed to products of combustion that are more toxic and carcinogenic than ever before. They are at much greater risk of developing cancer earlier and detecting it later than the public they protect, but this is not reflected by most insurance plans – if they have insurance at all, which many call and volunteer firefighters do not. We are working on expanding these options in the future to include mobile CT Scans, mammograms, and ultrasounds. Finally, I should also point out that state law here requires these services to be put out to bid, meaning that we couldn’t simply bring in a vendor of our choosing.

North Carolina’s pilot program has one more year.

West Buncombe’s Chief said protecting a firefighter’s health within budgets isn’t an easy balancing act.

“Other things we’re looking at, is different specific cancer type blood tests, so we’ll look at genes to see if one or someone may be at more risk than others. That way, we can focus on treatment and preventative treatment,” said Chief Dennis Fagnant.

Making the path forward toward better health and fewer risks is not always clear.

“It’s difficult. It’s not, ‘I wish there was a roadmap,’ and so I think the best way to approach it is, you’ve got to be looking out for your crews, what’s best for them, and, sometimes, that’s costly, but when you look at what these firefighters are doing, I’m going to do everything I can to protect them,” said Fagnant.

On a sad but related note, Asheville Fire Captain and Safety Officer Jeff Lyons passed away Nov. 16, 2022, from cancer related to his job. News 13 featured Lyons and his cancer battle in October.

Lyons was diagnosed just three months prior to his death. Firefighters stressed the need for more early detection efforts in a story just prior to his diagnosis.

Lyons’ death is the fifth active or retired Asheville firefighter death since February 2018.

Between 2020 and 2022, a number of North Carolina fire departments have made safety changes aimed at cutting cancer risks.

The North Carolina Association of Fire Chiefs conducted cancer surveys in 2020 and again in 2022.

The 2022 survey reveals some strides made. In 2022, 51% of the 15% of responding departments provided firefighters with a second set of turn out gear compared to 38.5% in 2020. That prevents firefighters from putting on gear with carcinogens, allowing them to grab the clean set for the next call, while one set is cleaned. In 2022, 62% of responding departments also said they provided a second hood to protect sensitive areas in the neck.

In 2020, according to survey results, 64% of responding departments required annual physicals, and that number dropped to 62% of departments in 2022’s survey.

In 2022, 17% of respondents said they had moved to a clean cab concept, which means potential contaminants from the crew area are limited. Many departments have adopted this concept and now exclude all tools and SCBA from the cab. That’s compared to 36% that were evaluating it in 2020 and just 8% that had implemented the clean cab concept.

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