Thomas Edward Young, a brake mechanic who worked at the Baltimore city garage, never realized the asbestos he cleaned out of worn brake pads for 31 years was killing him. When he discovered he was suffering from mesothelioma, a rare cancer peculiar to asbestos exposure, he filed a claim for medical and disability costs before the Maryland Occupational Disease Board.
But the three-member state board, which rules on disability claims of workers with work-related diseases, took so long on the case that Young died without ever testifying. And when the case was finally heard, the board member presiding was a doctor whose clinic held a private contract with Young's employer, which was fighting the case.
Young's experience with the Occupational Disease Board was hardly an isolated one. An examination of the part-time agency found examples in the past two years of apparent conflict of interest, massive delays and procedures that end up frustrating the compensation claims of ill Maryland workers.
Operating in relative obscurity out of a single room on the sixth floor of a Baltimore office building, the three doctors on the board decide matters of overwhelming financial significance for the 550 Maryland workers who file claims each year, workers who are attempting to show their jobs made them sick.
From an electronics worker claiming his malignant tumor was caused by his X-ray exposure to a health club instructor seeking payment for tennis elbow, the panel weighs testimony from employers, workers, insurance company doctors and others and decides whether disability payments are justified.
And yet for years within the small circle of lawyers, legislators and bureaucrats familiar with its operations, there have been questions about the board's impartiality and efficiency.
"The perception of the board has a cloud over it," says Harvey Epstein, the Maryland commissioner of labor. "The public's perception of the process, if weakened in any way, is harmful."
The industry ties of two of the three board members -- Dr. James Frenkil, the chairman, and Dr. J. Howard Franz -- are well known among lawyers who appear before it.
Frenkil, who has been chairman since 1953, is the founder and director of the Central Medical Center, which he describes as the eastern seaboard's largest industrial clinic. It serves employers and insurance companies from four Baltimore locations. For the last two years, the center has held a $313,103 contract with the city of Baltimore -- James Young's employer -- to provide health services for city workers. Franz has been a longtime consultant for Bethlehem Steel and Allied Chemical.
In an interview, Frenkil said he "always" disqualifies himself from hearing cases involving his clinic's customers, but he says he reviews such cases his colleagues hear and signs the final orders. And both he and Franz say their industry ties are unavoidable because Maryland law requires two of the three board members to have five years experience in treating occupational disease. Also, the pay of the part-time board is too low to be a doctor's total income, they add.
Under Maryland law, one doctor can hear a case, but at least two must sign the decision. Even in cases where a doctor has disqualified himself, the board's practice is to have all three sign the final order.
According to the board's records, in addition to the Young case, Frenkil took testimony or settled cases during the last two years involving General Electric, Roper Eastern, Lesney AMT Corp., American Instrument, James J. Lacey Company and the Bruning Paint Company. These companies were either then or later clients of his clinic, according to a list of clinic customers provided by a doctor who worked at the clinic.
Franz, 64, a Bel Air radiologist, has been a paid consultant to Bethlehem Steel, the state's largest private employer, for over 20 years. During the last two years, 28 Bethlehem Steel workers appeared before the board. Although Franz reviews Bethlehem Steel cases, he has not taken testimony directly.
Franz also is a longtime consultant to Allied Chemical, a spokesman for the large Baltimore employer confirmed. Franz said in an interview that he did medical consulting until recently for National Can, Continental Can, Armco Steel and "maybe 40 to 50" other firms.
Franz has held the expert X-ray reader slot on the board since 1973. "We all read the cases and review them," Franz said, adding that he sees no conflict because most doctors with the needed experience in reading X-rays work for industry.
The board's third member, Dr. John Schaefer, 68, is a retired family practioner with no ties to industry. Frenkil, as chairman of the part-time board, is paid $10,650. His colleagues receive $10,050.
The assumption that doctors with no industry ties cannot be found for the board angers a former Bethlehem Steel worker whose claim was denied in an order signed by the entire panel last Dec. 10.
Analysis of X-rays was critical to his case, but as he did with other cases involving Bethlehem Steel workers, Franz, the radiological expert, disqualified himself from the hearing, where most analysis occurs.
"I think they give me a dirty deal," said Elmer Eldon Yokum, 53, whose slim finances forced him to move to rural West Virginia after 22 years as a welder, stockman and laborer at the giant steel plant. He said heart disease and "welder's lung" left him unable to work. "They should get some doctor from a hospital that has nothing to do with Bethlehem Steel. He ain't going to do nothing that costs Bethlehem Steel money."
But finding experienced Maryland doctors free of private ties is difficult.
Dr. William Pillsbury, past president of the 85-member Maryland Occupational Medical Association, said about 25 members are not linked to any industry, but noted some consult for unions or government units.
Those who nominate the doctors for the governor's approval -- the deans of Maryland's two medical schools and the director of the state medical society -- say they knew of some of their nominees' industry work, but assume the doctors always disqualify themselves.
One Baltimore attorney complains one doctor has failed to do this, even when asked.
Following a 1980 city firefighter's case in which the board refused his request to stop Dr. Frenkil from participating, Baltimore attorney Jerome Michaelson wrote an angry letter of complaint to Charles Krysiac, chairman of the Workmen's Compensation Commission.
Although the commission nominally monitors the medical board, sets its budget, provides it office space and can hear appeals from the board's decisions, Krysiac says he has no control over the board.
"It's their problem," Krysiac says. "It's between the board and the governor."
The problem of industry ties has not escaped Bethlehem Steel workers, six of whom filed a $16 million lawsuit Aug. 21 against their employer and three company doctors, including Franz. In court papers, the retired bricklayers claim the doctors never told them their regular, yearly X-rays showed their exposure to asbestos was scarring their lungs.
Further, they claim Franz, as a board member, should have reported any cases of worker disease he discovered through the workers' X-rays to state health officials. A long ignored 1951 state law requires all Maryland doctors to report occupational disease cases to the state, and the workers argue in their suit that Dr. Franz, as a board member, had an extra obligation to do so.
Franz, and Bethlehem Steel spokesman Ted Baldwin, said they had no comment on the charges in the lawsuit.
While a doctor's private ties may be unknown to most workers appearing before the board, all are acutely aware of the board's delays.
The part-time board meets only 2 1/2 hours a week, and has a backlog of 520 cases, all at least a year old. Only two of the doctors are scheduled to hear cases each Tuesday afternoon. The third doctor tends to paperwork.
"We really put in 18 to 20 hours a week, studying cases at home," said Frenkil, who notes the board's occasional out-of-city hearings are all-day sessions.
Although an average of 12 cases are set for hearing each week, an examination of last year's records shows that only four cases, or two cases per doctor, are heard weekly because of a series of continuances.
The board blames the lawyers for workers as well as their employers for the delay, but rarely refuses their requests. The disease claims are handled so leisurely, in fact, that continuance after continuance is granted to attorneys over the telephone by the board secretary.
Despite a 1978 legislative report that urged the doctors to work harder, and an unsuccessful bill introduced at the last session of the General Assembly to force more meetings, the board has not changed its procedures.
For the hundreds of often incapacitated and out-of-work men and women it was set up to help, the result has been frustration.
"It's just ridiculous," Sylvia Luby, a 70-year-old widower who has been waiting over four years for the board to hear the case of her husband, a former shipbuilder who died of asbestos-related cancer in 1976. She lives on $375 a month in Social Security in a one-bedroom apartment in a stucco home in North Baltimore. Plagued by a painful foot condition, she has delayed the needed operation because of lack of money. "All I keep getting is letters postponing it. This has been a tremendous hardship on me."
Workers' lawyers say the delay sometimes forces Marylanders to accept lower payments out of desperation. Employers and insurance companies say the delays affect them, too, adding extra legal expenses.
But it's clear the board's procedures favor those fighting the disease claims.
The dockets are arranged for the convenience of the insurance companies and employers, with various cases against them set for the same day. Although this method encourages the firm's attorneys to show up, it also often means delay for all. If the attorney needs a continuance for one, all the cases on the docket are continued.
For some, the wait is as agonizing as the illness.
Thomas Webster, a Baltimore policeman for 25 years before two heart attacks forced him to retire at age 52, has been waiting three years for word. His wife, Mary, describes how he left a family vacation to travel by bus for a scheduled hearing last year, only to be told it was postponed once again. "The real loss is seeing him get so upset," she said softly. "It just tore me up, coming from him, but he told me, 'I guess they're just waiting for me to die.' "
But the board doctors say they're upset at moving so slowly, too. Chairman Frenkil recently asked Gov. Harry Hughes for two more members and a $10,000 per member salary increase, but received only a polite sympathy letter from Lt. Gov. Sam Bogley.
"The legislature forgets about us," said Frenkil, "although nobody else does." CAPTION: Picture, The Central Medical Center holds a $313,103 contract with the city of Baltimore