You’re Sick? It’s All In Your Head

From day one, they knew something was wrong. Every morning it looked like someone had sprinkled black pepper on everyone’s desks – only the “black stuff” was greasy. Some cleaned it up with a wet rag; others used Kleenex.

Then, a couple of women started throwing up, usually in their wastebaskets, because the nausea came on so abruptly they couldn’t make it to the bathroom.

No one could ignore the incessant coughing that echoed throughout the office. Sometimes it got so bad that the coughers could no longer speak. Many found they had trouble breathing; they’d step outside often – not for smoke breaks, but to get fresh air.

Stinging eyes were common. So was the “foggy head” feeling that seemed to get worse as the day progressed. There was the putrid smell – some said it reminded them of rotten horseradish – and the horrible headaches.

Someone brought in an air filter from Sharper Image, and within two hours, it was filled. Someone else brought in a mold kit from Home Depot, and the gunk that grew in it looked ominous. People constantly called in sick – one count showed that 82 of the 150 workers were out ill.

People started quitting because they were too sick to work or too afraid the sickness that hit them at work would become permanent. They had families to think of, children to care for. Some of their fears came true; some will never be able to work again.

“I’ve never seen so many sick people in one place at one time,” one employee said, “and I used to work in a hospital.”

The company at first acknowledged the problem, tried to find an answer, even kept a spreadsheet to track the illnesses, but eventually decided it wasn’t at fault.

None of this happened in an illegal sweatshop or some industrial plant. All of this happened in a most unlikely spot to the most unlikely of people: in a four-story, tony office building in north Phoenix to registered nurses working for one of America’s major health care providers.

“We’re nurses with decades of service. We have some credibility. We’re trained to know what a healthy environment is. And they wouldn’t even listen to us,” says Anita Rowan, who was one of the first employees to quit after becoming ill at her workplace. “If they won’t listen to us, who will they listen to?”

Nine nurses eventually pooled their resources and hired Phoenix attorney George Pena to file suit, asserting their employer did not provide the safe and clean environment required under Arizona law, which says employees shall be “free from recognized hazards that are causing or likely to cause death or serious physical harm.”

They hoped to get their medical bills paid and collect compensation for their inability to hold the kind of job they had when they were healthy.

Environmental cases have a reputation of being tough to win – consider how long it took courts to recognize that cigarettes cause cancer – and this one would have been no easier had it actually gone to court. There’s always that pesky “cause and effect” problem – is this environment really the cause of that illness? Both the company and the building management were poised to fight the suit, claiming there was nothing wrong with the building or the air quality and they were not liable for the illnesses these nurses have contracted.

The suit has been dropped, the nurses’ attorney explains, because it was “too tough and too expensive.” Nobody had the quarter-million dollars it would have cost to mount a case.

In the end, it seems, it would all have been futile anyway. As you’ll see, the nation’s lax environmental laws do not provide much protection for people working in a suspected “sick building.”

So this isn’t an uplifting Erin Brockovich-type story, like the 2000 movie that won an Academy Award for Julia Roberts as the diligent legal assistant who uncovered a utility company’s mass pollution and eventually won millions for the families who’d become ill at the hands of the company. No, this isn’t a story about how nine brave caregivers fought for their right to work in a healthy environment and won.

But it is a story that will stun anyone who thought federal and state laws about clean environments meant something.

In 2003, Phoenix landed a plum of an employer: a six-year-old company out of Boston called Health Dialog Services Corporation, which provides “health coaching” over the phone to insurance customers. It was on its way to becoming one of the fastest growing private companies in Massachusetts. It already had offices in Portland and San Antonio and had earned $136 million in revenues by 2005.

Health Dialog rented a large third-floor suite from Transwestern Corp. at 9630 N. 25th Ave. in Phoenix. Most of the space was devoted to 116 open cubicles, where the registered nurses called customers nationwide, dispensing medical advice and helping to manage their illnesses – a service designed to reduce medical costs and recovery time. The top Phoenix brass, meanwhile, had enclosed offices along one wall.

For older registered nurses, it was the job of a lifetime. “We sat on the phone and helped people with their medical needs, but we weren’t on our feet eight hours a day and there were no bedpans,” says Linda Sullivan, who worked as a health coach for two years. “It was nirvana.”

But the excitement of the new job immediately was tempered by what they found in their office. “From day one, there was black stuff in our hair, and it looked like someone took a pepper shaker to our desks and computers,” says Lynda McLaughlin, who began working at Health Dialog in June 2003. “But it was greasy, and you had to be careful how you cleaned it off so it wouldn’t smear everything.”

When McLaughlin worked weekends, she noticed vents were often cleaned “and I’d see all this crap blowing in on us,” she says. By April 2004, she ended up in the hospital with a portocath – a “port” implanted in her chest that let doctors easily administer antibiotics and antifungal medicine, which her doctors said she would need for the rest of her life.

“It turned out to be some sort of fungus,” she reports, adding that the doctor told her it “could be due to a chemical exposure.” She’s quick to note she has never smoked, nor did her parents.

By then, a similar illness had become a common complaint at the Phoenix Health Dialog office. The workday was organized into eight- and 10-hour shifts, with 30 minutes for lunch. Most brought their lunches and ate in the lunchroom, so they were spending their entire shifts inside the building. “But we started taking breaks to go outside for fresh air,” Anita Rowan recalls. “Sometimes that was the only way we could make it through a whole shift.”

But that created problems, too. Linda Sullivan remembers that when she told her supervisor she had to go out for air, the supervisor told her to “shut up,” and that any insinuation of dirty air in the office was “a figment of your imagination.” Word quickly spread to be careful what you said, because management was touchy. That stopped some employees, but others continued to raise their voices about what was happening. The nurses are convinced that their supervisors were spared from the symptoms for two reasons: They worked in those enclosed offices, which didn’t have air vents, and most supervisors didn’t work on weekends, when the vents were cleaned.

Internal e-mails unearthed as the nurses prepared for their lawsuit show the company was alerted to the problem early on. On September 25, 2003, just a few months after the company moved into the building, a health coach e-mailed acting director Deon Logan, saying, “I’m cleaning black stuff off my desk about three times a day. It appears to be getting worse. The building needs to clean the vents.…”

Logan replied, “I know it’s bad… we’re hoping they will be cleaned this weekend….”

Or consider the April 2005 memo to the staff detailing all the things that had been done to fix the dirty air. All the air handlers had been changed, all insulation replaced, all ductwork washed and vacuumed. Diffusers that regulate air pressure had been changed, and some roof units had been replaced. The report said city inspectors found these changes to be sufficient, leading them to determine that “the building far exceeds EPA standards for clean air,” and so the problems were over.

But problems persisted, and on July 29, 2005, Health Dialog temporarily closed its Phoenix office: “We had a disaster with fumes here and had to send folks home and close the office until noon,” read one e-mail from a company official. Acting director Logan would later refer to this as the “Day of the Fumes.”

One health coach, who prefers to remain anonymous, reported in legal documents that she first got sick in December 2005 and had such trouble breathing that a co-worker rushed her to John C. Lincoln Hospital. They tested her for a stroke, and she says her results came back negative. But a CT scan found two nodules on her adrenal glands, and she was given an inhaler to help her breathe. She started seeing specialists and also went to a naturopathic doctor.

Internal e-mails and notes prepared for the lawsuit show that air quality was a priority to Health Dialog. In February 2006, the building’s management, Transwestern, had the vents cleaned in the office while a nursing crew worked the phones. All of those working that day complained about the grit and dust and gunk that blew into their office during the cleaning.

Four days later, the e-mails showed a high level of concern. At 11:50 a.m., Boston manager Susan Macri e-mailed the Phoenix office an “air quality update,” noting she had been receiving regular reports “on the air quality in the center since the duct cleaning was done over the weekend and it doesn’t sound good.”

She said she was sending an official to Phoenix “to resolve this for once and for all.” By 4:53 p.m., Macri said she was closing the office early so the management team “can begin to troubleshoot the problems we are experiencing.” She reassured everyone that they would “absolutely be compensated for your full schedule,” and noted offices in other cities would cover for Phoenix.

For the nurses who had been suffering for months, this development seemed like a good omen – finally someone was addressing their concerns. Further encouragement came as the company began compiling a spreadsheet of employees’ medical concerns and work absences. Titled Air Quality Concerns, the spreadsheet tracked seven symptoms: headaches, tightness of the throat, respiratory problems, nausea, vomiting, vertigo and eye irritation.

In response to this, Transwestern ordered air quality tests, and then Health Dialog commissioned tests on its own. While everyone waited for the results – confident they would show how dirty the air was – more e-mails were flying back and forth about what had by now become a real crisis.

The office’s Phoenix director, Jill Goodspeed, said management would meet to come up with a plan if the test results came back positive for contaminants. Many hoped that would mean moving out of the building entirely. If the test results were negative, however, the center would reopen on Monday morning at 5 a.m.

Mid-management “community leader” Cathy Samson voiced her concern about those plans in an e-mail to her superiors in both Phoenix and Boston: “If the tests come back negative, that sounds great on paper, but it does not fix the problem,” she wrote. “Negative test results do not resolve the potentially serious symptoms of dizziness, nausea, vomiting, as well as the respiratory problems.”

She warned that people would continue to call in sick and would eventually leave the company rather than work in an unhealthy environment. She used herself as an example. “I LOVE my job at Health Dialog – it is the best job I have ever had – but having said all this, I cannot return to work with the kind of strong symptoms I was experiencing, knowing that the air quality is still the same (despite negative test results). Health is very important when you have four young children to raise, as I do.”

Samson went out of her way to praise her bosses, showing she had faith in them: “I know that you are wonderful leaders and that you will do what you think is best.”

Health Dialog officials gave their employees the results of the air test in a PowerPoint presentation. Both their test and the ones done by the management company came back “within air quality standards.” The bottom line, they told their employees, is that there was nothing wrong with the air in the office. The nurses working in those cubicles were shocked. Some demanded to see the official air quality reports, fearing there was a “cover-up,” but the company denied those requests. Some of the nurses called the Occupational Safety and Health Administration, believing the federal agency would be free of bias in checking the air.

Darin Perkins, who heads the state Industrial Commission office that enforces federal OSHA regulations in Arizona, later conducted more tests. To everyone’s amazement, he found nothing in the air.

His official findings note the history of complaints: “Employees are experiencing adverse health effects due to the quality of the indoor air. Symptoms being experienced are headaches, chest pain, lassitude, burning of the eyes and throat.” He also noted that air quality tests were performed by two different companies in February 2006, and he cited other actions Health Dialog had taken: “Closing of the coaching center, having an indoor air quality inspection performed, sending any employees who reported symptoms to Concentra [an occupational medicine company where the nurses were examined by doctors] and communicating and holding informative meetings regarding the indoor air quality findings and concerns.”

In the end, he reported: “These conditions do not represent any apparent violations of the OSHA standard.”

The nurses were incredulous. By then, more than half the women working in that office had experienced some type of illness. Some were sick every time they came to work but continued showing up because they needed the job. They couldn’t understand how anyone could test that air and say it met the “free from hazards” standards demanded of Arizona employers by a state law titled “Employer’s Duty.”

That was the same question PHOENIX magazine posed to Perkins, and his answer was shocking. “When we go in and folks have symptoms like this, what we do is a very basic air quality measurement. But we have no standards at all on indoor air quality. If we find mold, we can alert the employer and that’s pretty much all we can do, because we have no standards whatsoever on mold or chemicals. The range of what is and is not acceptable on indoor air quality is so broad it’s impossible to come up with a limit. What affects me might not affect you.”

Perkins says he didn’t know how Arizona could demand employers provide a working environment for employees that is “free from hazards” while having absolutely no standards to recognize those hazards. He acknowledges that standards are needed but says he’s not sure how they would be established, considering different people’s reactions to pollutants. So, although their employer had a legal obligation to provide a safe working environment, there was nothing to back up that demand if people got sick at work.

The nurses never understood – even as they later tried to sue – that there were no federal or state standards to protect them.

And apparently, Health Dialog never understood – and still doesn’t – that there were no standards, either.

Health Dialog, to this day, stands by the results of its air quality tests. When PHOENIX magazine asked the company in January what had happened in its Phoenix office, it responded in an e-mail, saying, “Our office air quality was tested by two separate environmental quality firms…. Both found that the air quality in our offices was within acceptable ranges according to Occupational Safety and Health Administration (OSHA) standards.”

This belief would both cost them dearly and allow them to legally wash their hands of the whole affair.

In late February 2006, armed with two reports stating there was nothing wrong with the air, Health Dialog returned to its regular work schedule and expected its employees to show up.

But that wasn’t good enough for Cathy Samson. “I only have symptoms when I come in to work,” she wrote to her bosses on March 1. “When I am at home the symptoms subside. That tells me clearly that there is a problem in the work environment. The sensitive folks with allergies, asthma, etc., are actually a godsend for us, as it has alerted us all that there is a problem.”

Meanwhile, community leader Semira Semino-Asaro researched “sick building syndrome,” reporting in an intra-office memo on March 2 that it “is a real and often debilitating phenomenon,” quoting from to the OSHA Website. She noted the common symptoms of the syndrome were very similar to what she and other Health Dialog employees were suffering. “The main feature of this syndrome is that workers feel better when they leave the building,” she noted, adding this observation: “The irony of a Health Coach sitting in a cubicle with questionable air blowing on him or her while talking to a member about their health is not lost on any of us.”

A few days later, some of the company’s top brass – president Dr. David Wennberg and chief operating officer Patrick Flynn among them – came to Phoenix and took some of the community leaders to dinner. In an e-mail dated March 8, 2006, Samson wrote, “We want to thank you so much for dinner and the opportunity to share our concerns and perspectives with you concerning the air quality situation in Phoenix. We are impressed to have such a wonderful and supporting leadership team!”

She noted that she and her fellow community leaders were on the “frontline” of what was happening in the office and added, “right now, five out of the eight community leaders are experiencing significant symptoms. I am no longer able to even work at the center, as I am strongly affected every time I am in the building. The other four CLs are doggedly working on and simply using medications to control their systems. I find this particularly disturbing.”

Samson suggested the company relocate its office. “I know this is a huge expense and undertaking, but I believe there is a significant health risk here based on the symtomology [sic] and the fact that there is definitely something in the air as a chemical smell has been noted on several occasions.”

On March 14, Samson e-mailed company officials again with another update. She reported that she had to come into the office for some paperwork and that “within 15-20 minutes of being in the center I was having major symptoms – coughing, runny nose, thick throat, eye irritation, bronchial chest tightness, dull chest pain, headache, mental fog, mild nausea and almost threw up in the elevator on the way out.”

She reported she went immediately to Concentra, and after three hours of tests, the diagnosis was “toxic effect of unspecified gas, fume or vapor” and “upper respiratory inflammation due to fumes and vapor.” She said her doctor told her it was “easier to test the air quality than try to do tests to detect a toxic chemical or vapor in a human being,” and suggested more tests be done.

She got even more direct a few days later in a very strongly worded e-mail to officials in Boston: “NEGATIVE AIR QUALITY TEST RESULTS DO NOT MEAN ANYTHING WHEN STRONG COLLECTIVE SYMPTOMS ARE STARING US IN THE FACE,” she wrote, using the all-caps format – the e-mail equivalent of screaming. Again, she stressed that the center had to move, noting that top officials had said they’d do that if it were necessary. “We have a pregnant woman in our midst, as well as coaches who have compromised immune systems,” Samson explained. “We have coaches that are not looking too good at all, [one woman] looked like death warmed up when she left yesterday. [Three others] have been in bad shape. I spoke with a few of the coaches who looked gray as they were having symptoms, they looked terrible but were struggling on because they wanted to pay their bills.”

Samson e-mailed again on March 28, obviously distressed by what she’d learned at her doctor’s office that day. “I went to Concentra for my follow-up visit, and the doctor said to me that he couldn’t assign me any more time off work (despite the fact that I continue to be highly sensitive to whatever is floating around in the air) ‘because [the company’s human resource officer in the Phoenix office] had called to tell them that the air quality problems had been fixed and therefore they were not to assign any more time off for Health Dialog employees.’”

Her doctor told her all he could do was refer her to an allergist, and she says in the e-mail that she shot back, “Since when do allergy symptoms include nausea, lightheadedness and vomiting??? And do 50 people in the building all have the same allergy which coincidentally only appears when they are in the building???”

She said her doctor agreed that the symptoms seemed more like a toxic exposure, but he was under instructions not to grant her more time off.

This point, as much as anything, still infuriates the nurses who later tried to fight back. They say it violates every ethics rule of medicine to have a company dictate a medical diagnosis. In an internal e-mail, Health Dialog later denied that their human resources officer had called the doctor.

The day after Samson wrote that e-mail, top officials from Boston were e-mailing plans for a breakfast meeting to discuss the problems with all employees experiencing symptoms – and made it clear that they realized the air in the office was making some of their employees sick. They chose to meet away from the office at a local Sheraton to accommodate the coaching center employees who were affected.

On March 31, Health Dialog announced it was abandoning the building that had caused so much illness. In an e-mail to PHOENIX magazine for this story, Myra Green, senior vice president and general counsel for Health Dialog, explained: “After carefully considering our employees’ concerns, Health Dialog made the decision to move our coaching center to temporary space on West Dunlap Avenue in Phoenix, beginning April 17th, 2006. We moved to a new permanent location in Scottsdale in March 2007. These moves were very costly for us because we were required to adapt and equip each of the locations for our health coaching services. In addition, we were unable to terminate our lease for the space at North 25th Avenue and continued to pay rent through the end of the lease in June 2008, because the acceptable air quality testing showed no cause for vacating.”

Green stresses this point: “Health Dialog takes the health and well-being of its employees very seriously, and the events around our office locations in Phoenix were difficult for us all.”

It seemed as if the company had finally taken serious action to address their employees’ concerns and the nurses were at last winning their hard-fought battle to incite change.

But what happened next shocked the nurses back into a state of defeat and hopelessness.

As the people who quit tried to collect workers’ compensation, Health Dialog’s insurance company denied the claims, declaring the illnesses being cited were not work-related. In a June 23, 2006, letter to Linda Sullivan, the Hartford Insurance Group stated this: “Based on our investigation it is our position that your condition is non-industrial related. Although an incident may have occurred [the February 11 vent-cleaning fiasco], no known injury or disease would manifest itself from this episode. Therefore, your workers’ compensation claim is being denied.”

That same letter went out again and again; women involved in the lawsuit said 40 to 60 coworkers were denied workers’ comp. And some of them now ask, when that many people have the same symptoms from the same workplace, how can this not be related to the environment in some way?

There’s a poignant scene in Erin Brockovich in which she first confronts a lawyer from the utility company that’s making dozens of families sick, and she lays out all the illnesses the families are experiencing.

The young attorney, slouching back in his chair, dismisses her list. “A million things could have caused those problems,” he says. “Poor diet, bad genes, irresponsible lifestyle….”

In the case of the Health Dialog nurses, the “million things” cited by the company included Phoenix’s notoriously dirty air. One memo to employees lays the air problems in the office totally at the feet of the nation’s fifth largest city: “For those of you new to Arizona, the rain this year broke a 10-year drought. Spring and pollen come early here, as do the viruses. The respiratory illnesses that went through the staff had various causative factors, some related to pre-existing conditions in the staff and others related to allergy triggers. The respiratory illnesses we had here mirrored the rise in respiratory illnesses in the general Phoenix metropolitan area.”

Several of the nurses who spoke with PHOENIX magazine call this nonsense, pointing out that they went outside to breathe that “dirty” Phoenix air because it was the only relief they could find from the awful air inside the office.

Anita Rowan is still in disbelief.

“We are a group of RNs who have been lied to and told our health issues were in our heads,” she tells PHOENIX magazine. “After years of helping others, they have turned their backs on us.”

Rowan was one of nine former Health Dialog nurses who sued the company for their medical bills and their long-term disabilities, which she listed off much like Erin Brockovich did in the movie: bowel cancer, liver cancer, renal failure, chronic lung problems, stroke, loss of voice, need for dialysis, extreme fatigue, irregular heartbeat. And, she says with fear, “We don’t know what else will happen in the long term.” They say two of their co-workers have since died of cancer, and they worry about how much their work environment contributed to their deaths.

Like many of those nurses, Rowan says her symptoms – she was one of the women who threw up in her wastebasket – disappeared when she was away from the office. At least, that’s how it happened at first. Eventually, she says, even her time off wasn’t enough to recoup; now the symptoms just don’t go away.

She started working at Health Dialog in August 2004, and it didn’t take long for her symptoms to manifest. She saw her doctors for the next 19 months, complaining of tightness in the chest, burning eyes, sore throat, nausea, foggy feelings, numerous sinus infections, difficulty breathing, heaviness in her legs. She even had a stroke in 2005 and she says her doctors were “baffled” by what was making her sick.

Early on she suggested an air quality problem – her ex-husband was an air-quality technician – and says she was labeled a “troublemaker” by management. In 2005, she says she used up all her vacation and personal days to deal with her illnesses. “I found it strange that I would be better on my days off and then get sick again when I went to work,” she says.

Rowan got her Registered Nurse certificate in 1970, later did post-graduate work in psychiatry and, in 2000, earned her bachelor’s degree in nursing. She worked in psych wards and ran her own counseling business before joining Health Dialog. She resigned on March 7, 2006.

“I couldn’t breathe, I was having chest pains, I laid on the grass outside, my legs were so heavy, and I thought, ‘This place is too sick for me,’” she says. She has had more than a half-dozen jobs since then but admits she has difficulty keeping a job because of her ongoing health problems.

“I have difficulty with concentration and in finding the right words. I can’t communicate like I used to,” she says. She remembers when she was an outgoing, energetic woman and says she’s not like that anymore. “I isolate myself and don’t want to see anyone. I have no patience. My whole personality has changed. I really haven’t felt well since I left Health Dialog.” But, she laments, she needs a paycheck, so she continues looking for work.

What’s worse, she says, is not knowing exactly what got her sick or what the total consequences will be. “I’m fearful. I don’t know what’s ahead. I don’t seem to have any immune system,” she says.

Linda Sullivan will never work again. She started working at Health Dialog in July 2004 and says she was thrilled. “I was a healthy woman when I went to work for them,” she says.

These days, when she leaves her home, she must take a portable oxygen tank. She says she’ll never forget the awful gaseous smell that permeated the office the day she finally walked out on March 25, 2006. “We got gassed,” she says.

Sullivan is 58 now, single and living on Social Security and Medicare. She suffers from kidney failure and requires daily dialysis. Ironically, she used to be a dialysis nurse. If her doctors didn’t give her free drug samples, she says she doesn’t know what she’d do. She has no idea how she’ll ever pay the quarter-million-dollar hospital bill.

“This is incomprehensible to me,” she says. “It’s beyond tragic. What really kills me is how corporate America can do this and not be held accountable for all the damage they’ve done.”

Sullivan was one of the nine who wanted to sue Health Dialog but remembers roadblocks all over the place. The suit would have cost too much; it would have been hard to prove; they’d face powerful law firms with far more resources than the sole-proprietor lawyer handling their case; and they could expect a hostile jury if they ever went to trial because, as a right-to-work state, Arizona has a reputation of siding with corporations, not employees.

Still, Sullivan pitched in for the $2,500 retainer needed to hire their attorney, George Pena. He filed suit on February 29, 2008.

Lynda McLaughlin was part of the suit, too. She had a stroke while at Health Dialog and, though she once sang professionally,    can now barely speak. She’s 55 and says she’s plagued with fatigue and panic attacks.

“I’m so wiped out,” she says. Her memory problems are so bad she’s taking medicine typically used to treat Alzheimer’s Disease.

Cathy Samson never joined the lawsuit and, apparently, saw her problems diminish after the office was moved. She still works with Health Dialog.

Semira Semino-Asaro didn’t join the suit, either. The nurses lost contact with her but believe she left the company and moved back East.

Phoenix attorney George Pena says he agreed to take the case on a contingency fee, earning nothing unless there was an award of damages. But Pena says he’s a sole practitioner, an attorney working on his own, and he didn’t have the resources to pay for the investigations and expert witnesses that would be necessary to convince a court that negligence – either by the building management or Health Dialog or both – caused these illnesses. He estimates those fees could well run into six figures. None of the women had that kind of money, and they could only get their hands on it if a couple of them mortgaged their homes.

“I have a pretty soft heart,” Pena tells PHOENIX magazine. “These are nurses who have spent their careers helping other people. They’re selfless professionals.”

Pena discouraged them from contemplating serious financial hardships because he saw this case as unwinnable. “Nothing really comes out and says, yes, there are compounds making people sick,” he says. He notes the air tests found some contaminants but nothing beyond common cleaners. “There had to be something wrong for all of them to be ill,” Pena says, but what that was couldn’t be determined.

Meanwhile, he knew both Health Dialog and Transwestern would come out swinging, and they did, claiming no liability and announcing they intended to seek both a dismissal of the case and repayment of their attorney fees and expenses in defending the matter. That presented potentially another financial liability if the nurses lost.

Transwestern hired the Phoenix law firm of Renaud Cook & Drury. Attorney David McDowell of that firm told PHOENIX magazine, “Transwestern and Health Dialog did have air testing done, and the testing showed it was within OSHA and state air quality standards.”

Those non-existing standards, in fact, are a typical defense in these kinds of cases and often scare off lawsuits.

PHOENIX magazine twice asked McDowell what had happened to the third-floor office space since Health Dialog moved out. There was no response to our query, but a site visit to the building in February showed that the floor was vacant.

Health Dialog hired Jones, Skelton & Hochuli. They intended to argue that the nurses couldn’t sue because their health concerns were covered under the workers’ compensation law, even though in a stunning Catch-22, workers’ comp had been denied to those who applied for it.

When PHOENIX magazine contacted Health Dialog at its Boston headquarters, it led to this response from senior vice president Myra Green: “A few former employees did file a lawsuit concerning this issue, but as the facts have emerged, they have voluntarily chosen to seek a dismissal. We believe there never was any merit in these legal claims. Health Dialog regrets any distress that these events may have caused our employees. We believe we responded quickly and in good faith to address this difficult situation.”

So, in the end, the nurses allowed the case to be dismissed, Pena returned the unused portion of the retainer, and everything ended in a whimper. Rowan remembers the day the lawsuit was called off.

“My heart went right through to the bottom of my feet,” she says. “It was the saddest decision I’ll ever have to make, and it will resonate with me for the rest of my life.”