• Sick Building Syndrome: A House on Haunted Hill or Chicken Little Goes to Washington?
• Typical Sick Building Problems
• Court Rulings Involving SBS
• Selected Bibliography

At this time of year many houses and buildings take on ghostly appearances and their residents attest to the premises being haunted. For occupants of an increasing number of buildings, however, the "haunting" is thought to last beyond All Hallows' Eve. For while the treats the children bring home on October 31 may make us sick for a day or two if we partake too liberally, "sick buildings" are said to plague a number of people throughout the year. The U.S. government has reported that sick buildings--whose etiology is unknown but is believed to be in some way connected to the quality of air in an enclosed area--cause an estimated loss of $61 billion a year in employee absenteeism, medical costs, reduced productivity, and lower earnings. Regarding the medical costs of long-term exposure to a "sick building," in which the incidence of health effects have at times been reported to be as high as 80% of the occupants, the American Medical Association claims that the annual health care bill alone for sick building-related illnesses has climbed to over $15 billion.

Though the phrase "Sick Building Syndrome" (SBS) is a phrase of the 90s, this nomenclature is actually best thought of as the latest attempt to describe a problem that has befallen man for ages--that of illnesses believed to be caused by the air. In the 18th Century, Benjamin Franklin, in a letter to the Court Physician to the Emperor in Vienna, wrote what could be a description of many modern buildings when he noted that he looked upon "fresh air as a friend . . . and am persuaded that no common air from without is so unwholesome as the air within a close[d] room that has been often breathed and not changed." As another example, Malaria quite literally means "bad air," and before entomology became a science, it was believed that exposure to bad air was the culprit that killed thousands rather than being the result of the bite of the anopheline mosquito. In fact, perhaps the first documented case of what has come to be known of as sick building syndrome occurred in Columbus, Ohio in 1863 when a number of Capitol building employees there suffered from a strange condition that was called "statehouse malaria."

Though the irony of suffering from the bad effects of air in a building which would have, like all political buildings, a high level of "hot air" at best or "bad air" at worst, is lost on very few, the ill effects many office workers report from being in a sick building for an extended period of time is not seen to be funny. Symptoms range from the common complaints of excessive sleepiness, nausea, dizziness, eye irritation, poor concentration, headaches and fatigue to the mortally serious such as brain damage and death.

As well as causing lost productivity and distress among those who claim ill effects from being in a building with poor indoor air quality, the prevalence of "sick buildings" takes up employer time in dealing with the complaints, and perhaps as lasting as the purported health effects, can give a building a bad and lasting reputation. And the problem seems to be escalating. According to World Health Organization (WHO) estimates, nearly thirty percent of all new and remodeled buildings worldwide may be afflicted with indoor air quality problems that may lead to "sick building syndrome" and associated health effects for the buildings' occupants and litigation for the nations' courtrooms.

Table I

In 1983, the World Health Organization (WHO) defined Sick Building Syndrome as "an excess of work related irritations of the skin and mucous membranes and other symptoms, including headache, fatigue, and difficulty concentrating, reported by workers in office buildings." Further, WHO described the physiological symptoms to include the following:

(1) irritation of the eyes, nose, and throat; (2) dry mucous membranes and skin; (3) erythema (dermatitis erythematosa, redness of the skin, inflammation); (4) mental fatigue and headache; (5) respiratory infections and cough; (6) hoarseness of voice and wheezing; (7) hypersensitivity reactions; (8) nausea and dizziness.

WHO's estimates, however, would seem to draw on more than its own working definition of SBS, as explained in Table I. In the real world, both this fairly narrow operative definition and the specific symptoms have expanded considerably in only a few years. Instead, SBS often has come to be a catch-all phrase to describe acute health and comfort effects which appear to be linked to time spent in the building, but no specific illness or cause can be identified. Consequently, both the operative causation of sick building syndrome and the effects SBS is used to explain have ballooned. The illnesses people have are said to be caused by building design, construction, ventilation, energy conservation measures, and maintenance, and the symptoms these flaws cause are frequently a constellation of acute, nonspecific symptoms that affect multiple occupants (see Table II). They do not fit any specific clinical syndrome and are typically not associated with any single source or specific air contaminant.

Table II

TYPICAL SICK BUILDING PROBLEMS

Inadequate ventilation:occurs when heating, ventilating, and air conditioning (HVAC) systems do not effectively distribute air to people in the building.

Chemical contaminants from indoor sources:the predominating source of indoor air pollution. Adhesives, carpeting, upholstery, manufactured wood products, copy machines, pesticides, and cleaning agents emit volatile organic compounds (VOCs). If coupled with poor ventilation, can create poor air quality which is believed by adherents of SBS to either create health problems or exascerbate pre-existing ones.

Chemical contaminants from outdoor sources:more indirect than indoor contaminants. Pollutants such as motor vehicle exhausts can be conveyed indoors through air intake vents, doors, and windows.

Biological contaminants: Bacteria, molds, pollen, and viruses: These contaminants may breed in stagnant water that accumulates in duct work, humidifiers, and the like, or where water has collected on ceiling tiles, carpeting, or insulation. Insects or bird droppings, too, can be a source of biological contaminants. Physical symptoms related to biological contamination include cough, chest tightness, fever, chills, muscle aches, and allergic responses such as mucous membrane irritation and upper respiratory congestion.

These four elements may act in combination, and may supplement other complaints such as inadequate temperature, humidity, or lighting.

In the classic case of sick building syndrome, SBS sufferers report relief of their symptoms once they cut off their exposure to the building. Regarding the "diagnosis" of a sick building, a rule of thumb has been that when at least 20 per cent of building occupants "complain of the same medical symptoms from an unknown cause for at least two weeks," a building can be suspected of being "sick." As this concern with the symptoms of the occupants would imply, "Sick Building Syndrome" is a misnomer inasmuch as the syndrome can only be diagnosed by assessing the health of the building occupants, not by an examination of the building itself, although a recent study of SBS in Medical Trial Technique Quarterlysuggested that the building itself, in a sick building case, should be considered "dysfunctional."

At the same time, others have cautioned against granting too much credence to these "trick or treat" claims which have spooked the building industry. Ronald E. Gots, head of the International Center for Toxicology and Medicine, questions the method at which the WHO estimates were derived, noting that the claim that 800,000 to 1,200,000 buildings in the United States have been "diagnosed" as sick is frequently repeated by indoor-air specialists and government officials, but has not, as of yet, been scientifically confirmed. He observes that "when there are plenty of problem-solvers around, a problem will be found. . . . [and] if all you have is a hammer, everything looks like a nail." Consequently, Gots finds that the increasing attention to sick building syndrome in recent years is due more to "misperception and exaggeration" than to an actual rise in buildings and environments which create health problems for their occupants. He points out that the sometimes nebulous symptoms to which SBS claimants refer, such as headaches, fatigue, and difficulty in concentrating, could be just as easily caused by any number of things, including allergies, stress, and job dissatisfaction.

Gots urges restraint in the assignment of sick building syndrome to individuals complaining of any of all of the above listed "symptoms." Other cautionary voices, noting the methodological flaws and unscientific grounding the syndrome still faces, have urged potential plaintiffs to remember the constraints of using still unproven scientific methodologies in the courtroom in making their claims for SBS, established in 1993's Supreme Court ruling Daubert vs Merrill Dow Pharmaceuticals3 S.Ct. 2786 (see Table III for summaries of recent litigation involving SBS). As readers of the April 1998 MTI Review(Vol. 3, no. 1) will recall, that case specified the role of "gatekeeper" judges were to play in the exclusion of contested scientific findings that had not yet found widespread approval within the scientific community. However, interestingly enough, courts themselves have not been immune from the anxiety over SBS. In 1987, the Polk County Courthouse, in Barstow, Florida, constructed at a cost of $37 million, had to be razed and built again at an additional cost of $26 million in order to "cure" the building of its "sickness" which had necessitated the relocation of over 600 occupants of the courthouse due to their claims of sick-building symptoms. In March of this year Boston municipal court chief Justice William J. Tierney complained that a new high-rise which was to house the Suffolk County Courthouse posed credible health risks to courthouse employees. Tierney wrote in a letter to the Massachusetts governor that municipal court employees "uncovered considerable evidence which indicates that the high-rise courthouse . . . may be hazardous to our health," even though no clear-cut causes to reported symptoms had as yet been "diagnosed." This case illustrates the long-term effects of sick building syndrome inasmuch as the "ghost" of a previous "spooking" seems to be "haunting" a present one. For, as reporter Sacha Pfeiffer of the Boston Globe reported on March 17, the concerns and misgivings about moving into the building in 1999 apparently stem from a disastrous 1993 waterproofing project at the site, in which hundreds of employees were reportedly made ill, including several who continue to complain of poor health.

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Table III Court Rulings Involving SBS Cases

Call v Prudential, No. SWC80813 (Los Angeles County Super. Ct., Oct. 1990)--resulted in settlement at trial in which plaintiffs claimed that the combination of faulty building materials and an inadequate ventilation system caused their symptoms.

Bloomquist v Wapello County, 500 N.W. 2d 1 (Iowa 1993)--reversed a trial judge's assessment that plaintiffs' evidence in an SBS case was "unproved medical speculation" without adopting a standard of epidemiological evidence in toxic tort cases.

Weekly v The Industrial Commission, 615 N.E. 2d 59 (App. III, 1993)--affirmed an earlier finding that a plaintiff's claim of sick-building syndrome, which stated that chemical exposure during her employer's remodeling project had given her blistering lips, a swollen tongue, nausea, dizziness, disorientation, and a permanent hypersensitivity to chemicals and odors everywhere, including her own home, had psychological roots only and that there was no identifiable immunologic or other physiological conditions.

Bahura v S.E.W. Investors, No. 19594-90 (Super. Ct., D.C., Dec. 23, 1993)--as reported in MTI Review(Volume 2, number 1), awarded $950,000 to five employees of the Environmental Protection Agency who complained that their various illnesses had been caused by sick-building syndrome after being exposed to numerous chemicals that were used during building renovation in an environment which had inadequate ventilation. Subsequent motion for further damages (D.C. Super. Ct. Civil Action No. 90-CA-10594, November 29, 1995) was denied on grounds that the symptoms were intermittent and unpredictable and injuries were not serious and verifiable.

Clausen v Standard Insurance Co., 1997 U.S. Dist. Lexis 5873 (D. Colo., April 29, 1997)--reversed an insurance company's denial of long-term disability benefits to an employer claiming total disability as a result of sick-building syndrome.

Consequently, the issue of sick building syndrome has become as unsettled as the quality of the air adherents to SBS believe to be at the heart of the problem. As scientists continue their quest to understand what it is about some buildings that makes some of the occupants sick, one can realistically expect the search for indoors that can be thought of as Franklin's "best friend" to be haunted by the anxiety over "dysfunctional" buildings well past the coming and going of All Hallows' Eve.

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