Florida lags behind 34 states in firefighter cancer law

Anthony LaBruzzo never set his boots inside the door of his wife's Paseo town home, but he's there.

He's there in the photos on a ledge near the stairs, and in another alcove where a well-worn fire helmet with gold Sharpie marks all over it sits.

He's in the tattoo daughter Jess, 20, has on her back, a nod to a present of a giant stuffed elephant bought on a 14th birthday trip to Disney World.

He's everywhere in the well-appointed home, but he isn't there anymore, not really.

"He fought it. He was working out, going to the gym and then going for chemo. To be honest, I thought he was going to beat it," said Cher LaBruzzo, Anthony's wife. "But eventually he had a lung removed and after that, we could slowly see him ... yeah."

LaBruzzo, who Cher LaBruzzo said would pick chicken and broccoli for dinner over a bowl of ice cream, never smoked and annoyed his fellow firefighters with 5 a.m. weight lifting, was 50 when he died of a cancer that spread from his lungs to his throat.

The fire service was his life, and it's also what Cher LaBruzzo thinks caused his death.

"Every cancer facility, they said the same thing: Are you a smoker?" she said. "But when he said, 'Well, I'm a firefighter, the doctors all went 'Ahh.' "

In 34 U.S. states, there's a law presuming that if a firefighter gets cancer, it was likely caused by the job. Each state's law varies in what exactly that means and what cancers it covers, but in general that can provide protections such as use of workers' compensation for cancer claims, preventative health care requirements and safety from termination while out on disability leave.

Florida has laws that presume firefighters' heart and lung diseases are caused by their profession, and one that provides some coverage for communicable diseases, but none that assumes their job requirements can cause cancer.

Now, firefighters and their unions across the state are trying to revive an effort to add Florida to the list of states that considers cancer job-related rather than a coincidence.

However, they'll face major hurdles with two questions: What Florida-specific data backs up the phenomenon, and how to pay for it if a law is passed.

"I'm not skeptical about the actual situation where there is a direct correlation between the job firefighters do and cancer. What I am skeptical about is how we would be able to balance making the accommodations for those firefighters and whose responsibility to take care of that extra cost it should be," said state Rep. Heather Fitzenhagen, R-Fort Myers.

Firefighters with cancer

It takes a lot to make Bill Damewood cry, until you mention Danielle DiBenedetto.

"I was stage 3, which means it spread to a lymph node," Damewood, 46, a 15-year firefighter with the city of Fort Myers, said of his colon cancer. He just returned to full duty, after a year of chemotherapy and light duty, on Sunday. "But Danielle was stage 4. She's had a lot of problems."

In February 2013, Damewood's annual medical test, required by the department, showed something abnormal.

"And then I went in for a colonoscopy March 19, saw the surgeon on the 21st and had surgery on the 31st. Within two weeks I was in the hospital with a foot of colon out."

In the time since, Damewood has learned that his grandfather also had colon cancer, but a genetic test at Florida Cancer Specialists showed the two weren't connected, he said.

"With genetic testing showing there was no mutation ... there's better indication it came from work," said Damewood.

DiBenedetto, 49, isn't scheduled for genetic testing for another couple weeks but has no family history of the stage 4 colon cancer she was diagnosed with a little over a year ago, she said.

She has been out of work for about a year from South Trail Fire District, where she's been a firefighter for 18 years.

In December 2013, DiBenedetto went into the hospital for food poisoning, then again for a colon blockage in January. That resulted in removing her colon, where doctors found the cancer. It spread to her lymph nodes — 20 of which were also removed — and her liver.

She'll get a new chemotherapy port soon, then start another, stronger round of the therapy, then "who knows," she said. Her disability leave will be up in a few months, but she isn't sure she will be able to return to work.

Southwest Florida fire department heads say DiBenedetto and Damewood definitely aren't the only firefighters with cancer: There are "well over 30" in Lee County, which has around 600 fire service members, said Bayshore Fire District Chief Larry Nesbit, who serves as head of the Lee County Fire Chiefs' Association.

And for the most part, studies on the connection between firefighting back up what Southwest Florida firefighters say is becoming more and more obvious: that fighting fires could easily mean fighting cancer at some point.

Hazardous duty

The International Agency for Research on Cancer, part of the World Health Organization, recognizes hundreds of known carcinogens.

"And the majority of toxins they've identified are present in just about every fire. So based on that firefighters have known exposure to known carcinogens," said Jim Brinkley, director of occupational health and safety for the International Association of Fire Fighters.

Chemicals that include carcinogens are absorbed into the body in a few ways, including inhalation, ingestion and through the skin, said Lusine Yaghjyan, assistant epidemiology professor at University of Florida's College of Public Health and Health Professions.

And when something synthetic burns, the chemicals in it — such as asbestos, benzene and petroleum — can "absolutely get into the smoke," Yaghjyan said.

The most obvious way firefighters get carcinogens in their bodies is through smoke, but more and more researchers believe absorption through the skin is also a problem.

"Since they are actively perspiring, it all creates the condition for absorption," she said.

A 2006 University of Cincinnati study found higher incident rates in firefighters of testicular cancer, multiple myeloma, non-Hodgkin lymphoma and prostate cancer, plus possible increases in several others.

It also found a lower onset age than in the general population.

"Thirty-two percent of my department was diagnosed with some form of cancer between 2008 and 2010. That is not to say all those cancers were caused by the job, but show me a family unit where one-third of the members were diagnosed and I'm going to be very surprised," said Keith Tyson, a retired Miami-Dade County firefighter and cancer survivor who now works as the Florida director of the national Firefighter Cancer Support Network.

And an ongoing study by the National institute for Occupational Safety and Health at the Centers for Disease Control and Prevention of 30,000 firefighters has, in its first stages, found a similar connection.

There is some contrary evidence: A 2009 study commissioned by the National League of Cities looked at many other studies and concluded the evidence of a connection was tenuous at best.

A representative of the league did not return messages seeking comment on the study.

But Yaghjyan disagrees.

"Based on the evidence that's out there I wouldn't say we don't have anything to make a judgment. We do have some results that seem to be consistent from study to study."

In Michigan, convincing legislators of the connection was the first hurdle, said Mark Docherty, president of the Michigan Professional Fire Fighters Union.

Michigan signed its firefighter cancer presumption into law Jan. 14.

But it was two other fights — getting data and overcoming arguments of a high cost — that led to the 20-year battle for the law, Docherty said.

This won't be the first time Florida firefighters have fought for a presumptive law, but the story appears to be the same this time around.

"People kept saying we need Florida-specific data," said Vicki Sheppard, a retired Palm Beach County chief who worked with the union to push bills into the Legislature in 2003, 2004, 2007 and 2008. The bills all died in committee.

Flash-forward to 2015, and "it's no different. The biggest hurdle we're going to have is the data. Because we're the last people to speak of what's wrong with us. But it's already been vetted in other states. Why do we have to reinvent the wheel in Florida?" said J.P. Duncan, president of the Southwest Florida Professional Fire Fighters and Paramedics.

Florida firefighters pushing for a bill are likely to hit another snag too, Docherty and others said: The question of how to pay for the increased workers' compensation claims.

But Brinkley said in working to estimate how much a law would cost New Hampshire, the IAFF found that less than 1 out of every 100 firefighters was likely to file a claim.

In Michigan, an early cost estimate by the insurer that handles the state's workers' compensation program was $108 million for the First Responder Fund, which fire departments would draw from to pay workers' compensation claims for cancer.

But as the state works on its budget, that estimate is down to around $15 million, which Docherty still believes is high.

"We've got 5,000 firefighters (in Michigan), and 3,000 have been on the job long enough to be eligible ... I think we would be fine with about $5 million," he said.

It's likely that if a bill makes it as far as the Legislature, that same conversation would be had.

Fitzenhagen, the Fort Myers legislator, said she didn't sponsor a cancer presumption bill for the legislative session that starts March 3 but has talked with supporters about it, "if we can find the right language and parameters."

"I think there is evidence to demonstrate there is a higher likelihood for firefighters and first responders to contract cancer ... But there's always a question of how we're going to be able to meet our budgetary constraints," she said.