1. Mold Litigation Perspectives Presented by: Ben Kollmeyer, MPH, CIH Forensic Analytical Consulting Services CIHC – December 5, 2006 Forensic Analytical

2. Overview The Case of the Phantom Mold Common Issues PCR: A Better Mousetrap?

3. The Case of the Phantom Mold: Carpet Microvacuum Results in a Litigated Manner

4. Background Teacher alleges various injuries caused by environmental conditions at a school. Suit against school dismissed (worker’s compensation as exclusive remedy). Focus shifts to school builders and suppliers. Focus shifts to mold and mycotoxins.

5. Environmental Setting School set in an arid climate. Rooms arranged around a central quad with exterior entrances. Teacher predominately spent time in two classrooms, 4 & 7. Predominately 7. Room 4: slab on grade, sticks & bricks. Room 7: modular at grade w/ crawlspace. Focus of claims is on room 7.

8. Environmental Data Visual observation by three different environmental consultants. Air sampling by one consultant. Microvacuum sampling by two consultants within 6 months of each other. Tapelift and swab samples by two consultants.

9. Visual Findings Summary Room 7 –Standing water and biological growth in sub- grade crawlspace. –Evidence of exterior surface moisture and intrusion into entry. –No elevated moisture in carpet. –No visible mold. Room 4 –Mold at sink separator. –Mold behind baseboard.

10. Room 7

18. Room 4

24. Swab and Tapelift Samples Confirm visual observations. Others do not reveal elevated levels. General agreement among consultants.

25. Air Sampling Summary 2 locations in each room. Viable and non-viable samples. Variety of rooms other than 7 & 4. 4 outdoor control controls. Results do not show elevations in 4 or 7. –Generally lower than outdoors. –No different than other rooms. General agreement among consultants.

26. Microvacuum Results Consultant #1 –cfu/100cm2 –8 samples from room 7. –6 samples from room 4. Consultant #2 –cfu/g –3 samples from room 7. –3 samples from room 4.

27. Carpet Dust Studies Chao, et al (Harvard Study) –Mycopathologia 154:93-106, 2001 Randomly selected office buildings. Most strongly correlated w/ age of carpet: –Yeast –Coelomycetes –Aureobasidium –Non-sporulating

28. Carpet Dust Studies Chew, et al –Allergy 58:13-20, 2003 Randomly selected homes. Most common: –Non-sporulating, Penicillium, Yeast More prevalent in dust than air: –Yeast, Eurotium, A. versicolor

29. Carpet Dust Studies Horner, et al. –Applied & Environmental Microbiology 70:6394-6400, 2004 Non-problem homes. Most common: –Cladosporium –Yeast –Penicillium

30. Carpet Dust Studies Hicks, et al. –JOEH 2:481-492, 2005 Non-problem homes. Most common, high traffic: –Cladosporium, Yeast, Penicillium, Aureobasidium Most common, low traffic: –Cladosporium, Penicillium, Yeast

37. The Positions Plaintiff focused on the presence of elevated levels of yeast with moisture under the building as the cause. Defense found results to be typical of carpets and foot traffic patterns. Focused on moist grass outside of classrooms and lack of differences in sampling results between the two types of construction.

38. The Outcome It settled before trial (of course). Both sides equally unhappy (supposedly).

39. Interpretation of Mvac Results Quantitative….less valuable –Extremely variable. Highly dependent upon how sample is collected. –Commonly used numerical values (i.e., 100K cfu/g) not very reliable. –Focus on comparative samples.

40. Interpretation of Mvac Results Qualitative….more valuable –Compare to genera/species commonly found in non-problem buildings. –Compare to known growth reservoirs. Visual….most valuable –If there is mold exposure, show me the mold.

41. Common Issues

42. Mold is Gold? Investigative Approach: Specificity of Repair Recommendations: –“Remove ?? inches beyond affected materials.” –Methods…containment, PPE, etc. –DT protocols. X CONSTRUCTION MOLD SAMPLING

43. Common Issues Linkages to Causal Factors Linkages to Health Effects Reasonable Degree of Scientific Certainty SOURCE PATHWAY EXPOSURE HEALTH EFFECTS 100% = “YES” “MAYBE” 0% = “NO”

44. Common Issues What Does the Future Hold? –“Damp Indoor Spaces & Health” fungal spores? materials? mycotoxins? mVOCs? bacteria? dust mites? allergens?moisture? sick people with lawyers?

45. PCR: A Better Mousetrap?

46. Mold Sampling Methods Total airborne spores – “nonviable” Viable airborne spores – “culturable” Airborne mold spore equivalents – genetic material – PCR method

47. Nonviable Spore Counting Limited ID at genus level only –Genera groupings become surrogates for individual species. –May be comparing apples to oranges…missing differences between species. Short sampling times. Fast TAT (hours to days). Relatively inexpensive.

48. Viable Culturing Can provide identification to the species level, but is frequently too expensive and time consuming. Viable mold spores only, misses non- viable spores. Furthermore, “viable” may not be “culturable”. Short sampling time. Long turn-around time. Can be quite expensive to get species. “Viable” may not be “culturable” Long TAT

49. PCR Analysis 24-hour speciation of viable and non-viable spores. Instrument-based method with less subjectivity and more conducive to quality assurance procedures. Sampling time constraints lifted, allowing for longer duration samples (e.g., 8-hour). Must target a species or panel for analysis. Optical microscopy and molecular genetics differ taxonomically.

50. Spore TrapsCultures PCR Mold Analysis Methods

51. Putting PCR to Use Characterize Sources –Non-viable assessment to ID key genera. –Collect a representative dust/bulk sample. Non-viable methods to begin focusing panel. PCR analysis of source sample to see what responds. Selection of “indicator” species. Targeted analysis of long-term air samples.

52. Lessons from the Past: PCM Surrogate Method (PCM): counts relatively large airborne fibers instead of airborne asbestos fibers, which are often too short and/or too thin ever to be counted by PCM Surrogate Standard (PCM): Clearance at levels below 0.01 f/cc by PCM. Nearly assured not to have actually assessed airborne asbestos

53. Lessons from the Past: TEM “The TEM method gives the most complete information on airborne asbestos: it can distinguish asbestos from other fibers and also is able to detect very thin fibers. However, it is expensive and time-consuming. TEM is not readily available.” – The EPA Purple Book, 1985

54. PCR: Looking Ahead Back to IH Basics 8-hour TWA sampling reproducibility personal air sampling Changing the “No TLV for Mold” Paradigm personal air sampling occupational exposures epidemiology and linkage to health outcomes movement away from I/O comparisons Better Defined Standard of Practice separating the IH from the overnight mold expert

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